215 results on '"Jason H. Rogers"'
Search Results
2. vICE-Guided T-TEER in a Patient Without TEE Windows
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Gagan D. Singh, Edris Aman, Tai Pham, Jason H. Rogers, Kwame Atsina, and Thomas W.R. Smith
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Cardiac Catheterization ,Treatment Outcome ,Atrial Fibrillation ,Humans ,Cardiology and Cardiovascular Medicine ,Echocardiography, Transesophageal - Published
- 2022
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Catalog
3. Mortality Associated with Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: MFIRE Registry
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Neal Duggal, Milo Engoren, Scott M Chadderdon, Evelio Rodriguez, M. Andrew Morse, Mani A Vannan, Pradeep Yadav, Michael Morcos, Flora Li, Mark Reisman, Enrique Garcia-Sayan, Deepa Raghunathan, Nishtha Sodhi, Paul Sorajja, lily chen, Jason H Rogers, Marcella Calfon Press, Christopher Kovach, Edward A Gill, Firas Zahr, Stanley Chetcuti, Yuan Yuan, Graciela Mentz, D. Scott Lim, and Gorav Ailawadi more...
- Abstract
BACKGROUND The association, if any, between the effective regurgitant orifice (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients undergoing mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip™ system. The objective is to determine the association between EROA/LVEDV and 1-year mortality among patients undergoing m-TEER with MitraClip™. METHODS In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. RESULTS We studied 525 patients with secondary MR who underwent m-TEER in 11 centers. Most patients were male (63%) and were NYHA class III (61%) or IV (21%). MR was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely with median=0.19 mm2/mL, interquartile range [0.12,0.28] mm2/mL, and 187 (36%) patients had values more...
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- 2023
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4. Randomized Trials Are Needed for Transcatheter Mitral Valve Replacement
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Vinod H. Thourani, Vinay Badhwar, Gorav Ailawadi, Bassem M. Chehab, David A. Heimansohn, Jennifer A Cowger, Mayra Guerrero, Rahul Sharma, Paul Sorajja, and Jason H. Rogers
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Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,medicine.medical_specialty ,Mitral regurgitation ,Standard of care ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Mitral Valve Insufficiency ,medicine.disease ,law.invention ,Stenosis ,Treatment Outcome ,Randomized controlled trial ,law ,Humans ,Mitral Valve ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Reimbursement ,Resource utilization ,Randomized Controlled Trials as Topic - Abstract
Transcatheter mitral valve replacement (TMVR) is a new therapy for treating symptomatic mitral regurgitation (MR) and stenosis. The proposed benefit of TMVR is the predictable, complete elimination of MR, which is less certain with transcatheter repair technologies such as TEER (transcatheter edge-to-edge repair). The potential benefit of MR elimination with TMVR needs to be rigorously evaluated against its risks which include relative procedural invasiveness, need for anticoagulation, and chronic structural valve deterioration. Randomized controlled trials (RCTs) are a powerful method for evaluating the safety and effectiveness of TMVR against current standard of care transcatheter therapies, such as TEER. RCTs not only help with the assessment of benefits and risks, but also with policies for determining operator or institutional requirements, resource utilization, and reimbursement. In this paper, the authors provide recommendations and considerations for designing pivotal RCTs for first-in-class TMVR devices. more...
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- 2021
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5. Iatrogenic Atrial Septal Defect Closure Through the Steerable Guide Catheter: Description of Technique and Single-Center Experience
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Hannah M, Bernstein, Benjamin, Stripe, Lily, Chen, Edris, Aman, Thomas W R, Smith, Jason H, Rogers, and Gagan D, Singh
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Cardiac Catheterization ,Catheters ,Treatment Outcome ,Iatrogenic Disease ,Humans ,Heart Septal Defects, Atrial ,Retrospective Studies - Abstract
To introduce a novel method of direct iatrogenic atrial septal defect (iASD) closure through the MitraClip steerable guide catheter (SGC).MitraClip implantation requires transseptal puncture and the creation of an iASD. There are relatively rare instances, such as hemodynamically significant shunting or concerns for embolus, where iASD must be closed during index procedure. In these instances, it may be beneficial to not give up access to left atrium.We retrospectively reviewed all iASD closures during MitraClip implantation at our institution from 2015 to 2020. Cases where an ASD occluder was deployed directly through SGC were included.Eleven patients had immediate iASD closure through the SGC. Indications for using this method included concern for paradoxical embolus, large defect size and/or significant shunting. Closure device sizes ranged from 8 to 22 mm. Mean time from removal of clip delivery system to occlusion of iASD was 14.6 minutes. There were no procedural complications related to iASD closure using this method.Closure of iASD intra-procedurally directly through transseptal guide sheath via the method described was safe and allowed for continuous left atrium access. more...
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- 2022
6. Contemporary Review in Interventional Cardiology: Mitral Annuloplasty in Secondary Mitral Regurgitation
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Steven F. Bolling, Jonathan Yap, and Jason H. Rogers
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medicine.medical_specialty ,Mitral regurgitation ,Interventional cardiology ,business.industry ,valvular heart disease ,Mitral ring ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Functional mitral regurgitation ,Mitral Annuloplasty - Abstract
Secondary mitral regurgitation (SMR, also known as functional mitral regurgitation or FMR) is one of the most prevalent types of valvular heart disease and occurs when the left ventricle dilates, c... more...
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- 2021
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7. Volumetric Intracardiac Echocardiogram-Guided MitraClip in Patients Intolerant to Transesophageal Echocardiogram: Results From a Multicenter Registry
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Tai H. Pham, Jade Tso, Carlos E. Sanchez, Steven J. Yakubov, Edris A. Aman, Thomas W.R. Smith, Jason H. Rogers, and Gagan D. Singh
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- 2023
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8. Transcatheter Mitral Annuloplasty
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Jason H. Rogers and Steven F. Bolling
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medicine.medical_specialty ,biology ,business.industry ,Millipede ,Medicine ,business ,biology.organism_classification ,Mitral Annuloplasty ,Surgery - Published
- 2021
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9. 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure
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Brian Whisenant, Neil J. Weissman, Ian J. Sarembock, Gregg W. Stone, Vivek Rajagopal, JoAnn Lindenfeld, Samir R. Kapadia, Saibal Kar, Paul A. Grayburn, Jacob M. Mishell, Coapt Investigators, Michael J. Mack, David J. Cohen, William T. Abraham, Michael Rinaldi, D. Scott Lim, Andreas Brieke, Jason H. Rogers, and Steven O. Marx more...
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Male ,medicine.medical_specialty ,Cardiotonic Agents ,Percutaneous ,030204 cardiovascular system & hematology ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Heart Failure ,Mitral regurgitation ,business.industry ,MitraClip ,Hazard ratio ,Mitral Valve Insufficiency ,medicine.disease ,Confidence interval ,Hospitalization ,Heart failure ,Quality of Life ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) resulted in fewer heart failure hospitalizations (HFHs) and lower mortality at 24 months in patients with heart failure (HF) with mitral regurgitation (MR) secondary to left ventricular dysfunction compared with guideline-directed medical therapy (GDMT) alone.This study determined if these benefits persisted to 36 months and if control subjects who were allowed to cross over at 24 months derived similar benefit.This study randomized 614 patients with HF with moderate-to-severe or severe secondary MR, who remained symptomatic despite maximally tolerated GDMT, to TMVr plus GDMT versus GDMT alone. The primary effectiveness endpoint was all HFHs through 24-month follow-up. Patients have now been followed for 36 months.The annualized rates of HFHs per patient-year were 35.5% with TMVr and 68.8% with GDMT alone (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.37 to 0.63; p 0.001; number needed to treat (NNT) = 3.0; 95% CI: 2.4 to 4.0). Mortality occurred in 42.8% of the device group versus 55.5% of control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001; NNT = 7.9; 95% CI: 4.6 to 26.1). Patients who underwent TMVr also had sustained 3-year improvements in MR severity, quality-of-life measures, and functional capacity. Among 58 patients assigned to GDMT alone who crossed over and were treated with TMVr, the subsequent composite rate of mortality or HFH was reduced compared with those who continued on GDMT alone (adjusted HR: 0.43; 95% CI: 0.24 to 0.78; p = 0.006).Among patients with HF and moderate-to-severe or severe secondary MR who remained symptomatic despite GDMT, TMVr was safe, provided a durable reduction in MR, reduced the rate of HFH, and improved survival, quality of life, and functional capacity compared with GDMT alone through 36 months. Surviving patients who crossed over to device treatment had a prognosis comparable to those originally assigned to transcatheter therapy. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation [COAPT]; NCT01626079). more...
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- 2021
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10. Cohesin Gene Haploinsufficiency Does Not Prevent Development of Inv(16) Acute Myeloid Leukemia
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Shannon E. Conneely, Jason H. Rogers, Rogelio Aguilar, Kristen J Kurtz, Paul P. Liu, Margaret A. Goodell, Debananda Pati, and Rachel E. Rau
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
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11. An Allosteric Shift in CD11c Affinity Activates a Proatherogenic State in Arrested Intermediate Monocytes
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Jason H. Rogers, Gagan D. Singh, Mable K Orser, Stephanie R. Soderberg, Huaizhu Wu, Scott I. Simon, Keith A. Bailey, Mack B. Reynolds, Alfredo A Hernandez, Greg A. Foster, Anthony G. Passerini, and Andrea Fernandez more...
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Male ,Chemokine ,Cell Culture Techniques ,Coronary Artery Disease ,Integrin alpha4beta1 ,Cardiovascular ,Monocytes ,0302 clinical medicine ,Lab-On-A-Chip Devices ,2.1 Biological and endogenous factors ,Immunology and Allergy ,Aetiology ,Non-ST Elevated Myocardial Infarction ,Aorta ,biology ,Chemistry ,Microfluidic Analytical Techniques ,Middle Aged ,Coronary Vessels ,Recombinant Proteins ,Heart Disease ,medicine.anatomical_structure ,Female ,Adult ,medicine.medical_specialty ,Endothelium ,CD14 ,Innate Immunity and Inflammation ,Immunology ,Vascular Cell Adhesion Molecule-1 ,CD11c ,CD18 ,CD16 ,Cell Line ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Allosteric Regulation ,Clinical Research ,Vascular ,Internal medicine ,medicine ,Humans ,Heart Disease - Coronary Heart Disease ,Aged ,Integrin binding ,Monocyte ,Cell Membrane ,Transendothelial and Transepithelial Migration ,Endothelial Cells ,Atherosclerosis ,CD11c Antigen ,Endocrinology ,Case-Control Studies ,biology.protein ,Endothelium, Vascular ,030215 immunology - Abstract
Intermediate monocytes (iMo; CD14+CD16+) increase in number in the circulation of patients with unstable coronary artery disease (CAD), and their recruitment to inflamed arteries is implicated in events leading to mortality following MI. Monocyte recruitment to inflamed coronary arteries is initiated by high affinity β2-integrin (CD11c/CD18) that activates β1-integrin (VLA-4) to bind endothelial VCAM-1. How integrin binding under shear stress mechanosignals a functional shift in iMo toward an inflammatory phenotype associated with CAD progression is unknown. Whole blood samples from patients treated for symptomatic CAD including non-ST elevation MI, along with healthy age-matched subjects, were collected to assess chemokine and integrin receptor levels on monocytes. Recruitment on inflamed human aortic endothelium or rVCAM-1 under fluid shear stress was assessed using a microfluidic-based artery on a chip (A-Chip). Membrane upregulation of high affinity CD11c correlated with concomitant activation of VLA-4 within focal adhesive contacts was required for arrest and diapedesis across inflamed arterial endothelium to a greater extent in non-ST elevation MI compared with stable CAD patients. The subsequent conversion of CD11c from a high to low affinity state under fluid shear activated phospho-Syk– and ADAM17-mediated proteolytic cleavage of CD16. This marked the conversion of iMo to an inflammatory phenotype associated with nuclear translocation of NF-κB and production of IL-1β+. We conclude that CD11c functions as a mechanoregulator that activates an inflammatory state preferentially in a majority of iMo from cardiac patients but not healthy patients. more...
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- 2020
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12. Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique
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Gagan D. Singh, Sarah Chen, Dali Fan, Jonathan Yap, Thomas W. Smith, Edris Aman, Benjamin Stripe, and Jason H. Rogers
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Demographics ,Left atrium ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,CLIPS ,Retrospective Studies ,computer.programming_language ,Heart Valve Prosthesis Implantation ,medicine.diagnostic_test ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,General Medicine ,Treatment Outcome ,medicine.anatomical_structure ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,Parallax ,business ,Nuclear medicine ,computer - Abstract
BACKGROUND During MitraClip implantation sub-valvular correction of trajectory and/or alignment may increase adverse clip or leaflet events. With systematic adjunctive use of fluoroscopy ("Parallax technique"), we aimed to assess parameters that minimize the need for corrective measures and help increase procedural efficiency. METHODS We retrospectively analyzed 30 patients without (Fl-) and 39 patients utilizing adjunctive fluoroscopy (Fl+) during MitraClip implantation. After establishing trajectory and supra-valvular alignment, the Parallax technique was utilized. Trajectory and alignment are maintained during advancement. RESULTS All patients had 3 or 4+ MR. There were no differences in baseline demographics. The average number of clips (Fl- vs Fl+) was 1.72 ± 0.8 vs 1.59 ± 0.5, p = .57. For the first clip, the need for sub-valvular alignment (80% vs. 36%, p = .0001), eversion with retraction back to left atrium (23% vs. 10%, p = .001) and the number of grasps (2.3 ± 1.2 vs 1.4 ± 0.9) was reduced. The time from transseptal puncture to first clip deployment (71 ± 21 vs 44 ± 16 min, p = .01) was reduced. Procedural success was achieved in all but one patient in the Fl- group (p = ns). There were no differences noted for in-hospital or 30-day outcomes. CONCLUSIONS Systematic use of a simple and easy to implement "Parallax technique" was associated with reduced need for sub-valvular manipulation and was associated with improved procedural times. Further larger scale studies are needed to assess the applicability of the technique. more...
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- 2020
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13. Intracardiac echocardiographic‐guided right‐sided cardiac biopsy: Case series and literature review
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Stephen L. Wall, Lily Chen, Jason H. Rogers, and Joseph L. Pearman
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Cardiac Catheterization ,medicine.medical_specialty ,Intracardiac echocardiography ,Biopsy ,Heart Ventricles ,030204 cardiovascular system & hematology ,Targeted biopsy ,Intracardiac injection ,Free wall ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cardiac biopsy ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiac Tumors ,medicine.diagnostic_test ,business.industry ,General Medicine ,Treatment Outcome ,Echocardiography ,Radiology ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Bioptome - Abstract
Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE-directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5-Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE-guided EMB in the literature-noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE-guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right-sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy. more...
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- 2020
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14. Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature
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Tai H Pham, Matthew S Glassy, Gagan D Singh, and Jason H Rogers
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General Medicine - Published
- 2022
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15. A clinical impact study of dermatologists’ use of the 23- or 35-gene expression profile tests to guide surgical excision and enhance management plan confidence
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Aaron S Farberg, Kelli L Ahmed, Briana B Rackley, Jennifer J Siegel, Brooke H Russell, Jason H Rogers, Sarah J Kurley, and Matthew S Goldberg
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Dermatology - Abstract
Purpose: To understand how dermatologists utilize the results from ancillary diagnostic gene expression profile (dGEP) testing with the 23- or 35-GEP tests to determine optimal patient management strategies. Study: Dermatologists who regularly treat patients with difficult-to-diagnose melanocytic lesions who had previously initiated dGEP testing at least 3 times were eligible to complete the questionnaire in this Institutional Review Board-approved study. There were 24 randomized vignettes presented covering a spectrum of cases with diagnostic/clinical uncertainty such as atypical melanocytic proliferation, dysplastic nevus with regression, deep penetrating melanocytic neoplasm, and atypical intraepidermal melanocytic proliferation. Respondents were provided with a clinical impression and diagnosis in the context of a narrative pathology report with/without a re-excision recommendation; cases were also described without (baseline) and with a dGEP test result (likely benign or likely malignant). Anonymous responses concerning the patient management plan including excision and follow-up recommendations and confidence were captured. Statistical significance was calculated by nonparametric Wilcoxon signed-rank test with continuity correction. Results: In total, 32 dermatologists (84% in a private practice setting) completed the survey, with 50% indicating additional dermatopathology specialization. Approximately 44% of respondents indicated they performed 10-50 biopsies of melanocytic lesions per month, and 31%, greater than 100 per month. When dGEP results were provided, there was an overall increase in management plan confidence, regardless of which dGEP result was provided (benign dGEP 26.2%, malignant dGEP 24.7%). Also, when dGEP results were provided, changes in surgical excision recommendations were statistically significant in 75% of scenarios tested (p < 0.02). Clinical impact was assessed by quantifying the directional shift in treatment in relation to the dGEP result. With regard to excision recommendations across vignettes, benign dGEP results prompted 29.7% of clinicians to decrease their margins or forgo excision altogether. Malignant dGEP results prompted 63.5% of clinicians to increase their surgical excision recommendations. Appropriate alterations in patient follow-up frequency were observed, with 18.8% of clinicians reducing and 43.2% increasing follow-up frequency for patients receiving benign or malignant dGEP results, respectively. Conclusion: The addition of dGEP testing to diagnostic scenarios with confounding clinical features and uncertainty in optimal management prompted important changes in recommendations regarding the need for excision, appropriate margins, and follow-up-frequency. Overall, dGEP tests help to guide clinical decision-making for dermatologists in a variety of otherwise diagnostically ambiguous or clinicopathologically discordant scenarios. more...
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- 2022
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16. Watchman FLX
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Jacqueline Saw, Gagan D. Singh, and Jason H. Rogers
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Closure (topology) ,medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2020
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17. First-in-Human Transfemoral Transseptal Mitral Valve Chordal Repair
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Michael J. Reardon, Jason H. Rogers, Steven F. Bolling, Thomas W. Smith, Scott Lim, Adrian Ebner, and Walter D. Boyd
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medicine.medical_specialty ,Mitral regurgitation ,business.industry ,First in human ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,Mitral valve ,cardiovascular system ,Cardiology ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Mitral valve chordal repair has been a cornerstone technique for surgical mitral valve correction of degenerative mitral regurgitation (MR). More than one-half of all isolated mitral valve operations performed in the United States are for patients with leaflet prolapse and/or elongated or ruptured more...
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- 2020
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18. Retrieval of a MitraClip from the left atrium using a two‐snare technique: Case report and review of the literature
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Benjamin Stripe, Gagan D. Singh, Thomas W. Smith, and Jason H. Rogers
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Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Left atrium ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Foreign-Body Migration ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Heart Atria ,030212 general & internal medicine ,Embolization ,Device Removal ,Reduction (orthopedic surgery) ,Aged ,Heart Valve Prosthesis Implantation ,business.industry ,MitraClip ,valvular heart disease ,Mitral Valve Insufficiency ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
MitraClip is used for reduction of mitral insufficiency in patients who are not good surgical candidates, but with expanding indications, the use of MitraClip and the number of complications will increase. Here is presented a case of a single leaflet device attachment that worsened the patient's mitral insufficiency, as well as the technique for stabilizing the valve followed by retrieval of the device. A special focus is placed on removing the using a two-snare technique to avoid the need for a surgical cutdown and repair. more...
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- 2019
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19. Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes
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Gagan D. Singh, Dali Fan, Jason H. Rogers, Neil Beri, Thomas W. Smith, and Walter D. Boyd
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,Septal Occluder Device ,medicine.medical_treatment ,Iatrogenic Disease ,Population ,030204 cardiovascular system & hematology ,Single Center ,Cardiac Catheters ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Mitral valve ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,education ,Intraparenchymal hemorrhage ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Atrial Septum ,business.industry ,MitraClip ,Mitral valve replacement ,General Medicine ,medicine.disease ,Pulmonary hypertension ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Injuries ,Heart Valve Prosthesis ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Review indications and outcomes for transcatheter iatrogenic atrial septal defect (iASD) closure in patients undergoing MitraClip or transseptal (TS) mitral valve-in-valve/ring (ViV/ViR) procedures. Background Mitral valve transcatheter interventions require large-diameter TS sheaths that can result in iASDs that necessitate post-procedure transcatheter closure. Although the presence of iASD has been well-described, indications for closure and outcomes after TS mitral valve interventions have not been reported. Methods Patients undergoing MitraClip repair and ViV or ViR transcatheter mitral valve replacement (TMVR) from February 14, 2014, to January 16, 2018, were studied retrospectively in this single center study. Results Seventeen patients had iASD closure: 11 MitraClip and 6 TMVR (5 ViV, 1 ViR). Indications for iASD closure included large iASD (n = 7), large left-to-right shunt (n = 9), pulmonary hypertension (n = 8), large right-to-left shunt (n = 1), severe RV dysfunction (n = 2), thin/aneurysmal septum (n = 2), and mobile material on pacemaker leads (n = 2). Closures were performed without complications using Amplatzer septal occluders. At 30 days, 94% of subjects (n = 16) were alive with one patient deceased from unknown causes. There were no myocardial infarctions or strokes. At 12 months, follow-up was available for 14 of 17 patients, and 71% of patients (10/14) were alive. One patient died due to cardiac causes, two from noncardiac causes and one for unknown reasons. There was one myocardial infarction, one intraparenchymal hemorrhage, and no ischemic strokes. Conclusions The most common reasons for iASD closure after TS MV procedures are: large ASD unlikely to spontaneously close, large left-to-right shunt, and pulmonary hypertension. Patients who required iASD closure had low 30-day mortality but higher one-year mortality potentially reflecting a population with substantial comorbidities. more...
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- 2019
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20. Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: COAPT Trial
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Saibal Kar, Neil J. Weissman, Michael J. Mack, Suzanne V. Arnold, David J. Cohen, D. Scott Lim, Brian Whisenant, Gregg W. Stone, Federico M. Asch, William T. Abraham, Jacob M. Mishell, Jason H. Rogers, Maurice Enriquez-Sarano, JoAnn Lindenfeld, and Paul A. Grayburn more...
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medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,MEDLINE ,Severity of Illness Index ,Quality of life ,Physiology (medical) ,Internal medicine ,Outcome Assessment, Health Care ,Medicine ,Humans ,Public Health Surveillance ,Functional mitral regurgitation ,Randomized Controlled Trials as Topic ,Heart Failure ,Mitral regurgitation ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,medicine.disease ,Prognosis ,Heart failure ,Heart Valve Prosthesis ,Cardiology ,Quality of Life ,Percutaneous therapy ,Cardiology and Cardiovascular Medicine ,business ,Cardiovascular outcomes - Abstract
Background: In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone. Methods: Outcomes in COAPT between 30 days and 2 years were examined on the basis of the severity of residual MR at 30 days. Results: TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [ P P P interaction =0.92). The improvement in Kansas City Cardiomyopathy Questionnaire score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR ≤2+ but deteriorated in those with 30-day MR 3+/4+ (–0.3±1.7 versus –9.4±4.6 [ P =0.0008]) consistently in both groups ( P interaction =0.95). Conclusions: In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or heart failure hospitalizations and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01626079. more...
- Published
- 2021
21. Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure
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Zixuan Zhang, Bahira Shahim, JoAnn Lindenfeld, Björn Redfors, Samir R. Kapadia, Ian J. Sarembock, Gregg W. Stone, William T. Abraham, Vivek Rajagopal, Ioanna Kosmidou, Michael Rinaldi, Jason H. Rogers, Prakriti Gaba, Andreas Brieke, and Michael J. Mack more...
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Heart Failure ,Heart Valve Prosthesis Implantation ,Male ,medicine.medical_specialty ,Mitral regurgitation ,Cardiac Catheterization ,Randomization ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,medicine.disease ,Treatment Outcome ,Quality of life ,Heart failure ,Internal medicine ,medicine ,Clinical endpoint ,Cardiology ,Quality of Life ,Humans ,Cumulative incidence ,Transcatheter mitral valve repair ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study sought to assess the sex-specific outcomes in patients with heart failure (HF) with 3+ and 4+ secondary mitral regurgitation (SMR) treated with transcatheter mitral valve repair (TMVr) plus guideline-directed medical therapy (GDMT) versus GDMT alone in the COAPT trial. Background The impact of sex in patients with HF and severe SMR treated with TMVr with the MitraClip compared with GDMT alone is unknown. Methods Patients were randomized 1:1 to TMVr versus GDMT alone. Two-year outcomes were examined according to sex. Results Among 614 patients, 221 (36.0%) were women. Women were younger than men and had fewer comorbidities, but reduced quality of life and functional capacity at baseline. In a joint frailty model accounting for the competing risk of death, the 2-year cumulative incidence of the primary endpoint of all HF hospitalizations (HFH) was higher in men compared with women treated with GDMT alone. However, the relative reduction in HFHs with TMVr was greater in men (HR: 0.43; 95% CI: 0.34-0.54) than women (HR: 0.78; 95% CI: 0.57-1.05) (Pinteraction = 0.002). A significant interaction between TMVr versus GDMT alone treatment and time was present for all HFHs in women (HR: 0.57; 95% CI: 0.39-0.84, and HR: 1.39; 95% CI: 0.83-2.33 between 0-1 year and 1-2 years after randomization, respectively, Pinteraction = 0.007) but not in men (HR: 0.48; 95% CI: 0.36-0.64, and HR: 0.33; 95% CI: 0.21-0.51; Pinteraction = 0.16). Female sex was independently associated with a lower adjusted risk of death at 2 years (HR: 0.64; 95% CI: 0.46-0.90; P = 0.011). TMVr consistently reduced 2-year mortality compared with GDMT alone, irrespective of sex (Pinteraction = 0.99). Conclusions In the COAPT trial, TMVr with the MitraClip resulted in improved clinical outcomes compared with GDMT alone, irrespective of sex. However, the impact of TMVr in reducing HFH was less pronounced in women compared with men beyond the first year after treatment. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Tria] [COAPT]; NCT01626079 ) more...
- Published
- 2021
22. Transseptal chordal replacement: early experience
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Jason H. Rogers and Steven F. Bolling
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Surgical repair ,Mitral regurgitation ,Beating heart ,medicine.medical_specialty ,Keynote Lecture Series ,business.industry ,Clinical study design ,Resection ,Surgery ,medicine.anatomical_structure ,Chordal graph ,Native valve ,Mitral valve ,Materials Chemistry ,medicine ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Chordal replacement is a fundamental technique used in the surgical repair of primary mitral regurgitation, and can be an effective means of preserving the native valve without leaflet resection. Surgical chordal replacement can be challenging since it is performed on an open, non-beating heart, and choosing the correct chord length to restore the zone of coaptation requires both intuition and skill. Developing transcatheter, transfemoral, and transseptal approaches to mitral valve chordal replacement presents the opportunity for safer and potentially earlier treatment of patients with primary mitral regurgitation. In particular, transcatheter methods will allow adjustment of chordal length and position real-time on a beating heart under echocardiographic guidance. In this manuscript, we review the current transcatheter transseptal technologies in development and discuss the various issues related to device design, efficacy, durability, and clinical trial design. more...
- Published
- 2021
23. MitraClip Implantation Guided by Volumetric Intracardiac Echocardiography: Technique and Feasibility in Patients Intolerant to Transesophageal Echocardiography
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Jason H. Rogers, Gagan D. Singh, Edris Aman, Jonathan Yap, and Thomas W. Smith
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medicine.medical_specialty ,Intracardiac echocardiography ,030204 cardiovascular system & hematology ,Intracardiac injection ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,General Medicine ,Surgical Instruments ,Treatment Outcome ,Feasibility Studies ,Mitral Valve ,Functional status ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Echocardiography, Transesophageal - Abstract
Transesophageal echo (TEE) guidance is essential for successful MitraClip implantation. In patients intolerant to TEE, options are limited. Three patients, with contraindications to TEE, underwent MitraClip implantation using volumetric intracardiac echo (vICE). All patients had severe symptomatic degenerative mitral regurgitation (MR) and had successful implantation of at least one clip with reduction of MR to ≤2+ maintained at 30d follow-up. All patients had improvement in functional status without any adverse clinical, clip, or vICE related events. We discuss in detail the technical considerations and limitations to performing the MitraClip procedure with vICE guidance. more...
- Published
- 2021
24. Targeting signaling pathways vulnerabilities for the treatment of IKZF1-deleted ph-negative B lymphoblastic leukemia
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Rohit Gupta, Jason H. Rogers, Xin Long, Rogelio Aguilar, Geraldo Medrano, Jaime Reyes, Michele Redell, Margaret A. Goodell, and Rachel E. Rau
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Cancer Research ,Oncology - Abstract
7033 Background: Approximately 20% of children diagnosed with B lymphoblastic leukemia (B-ALL) will suffer a relapse, and most adults with B-ALL have a poor prognosis. Genome-wide association studies of B-ALL patients have identified frequent deletions of the gene IKZF1, encoding the master regulator of lymphoid development, IKAROS. These deletions are associated with therapy resistance, increased risk of relapse, and inferior survival. Currently, how loss of IKAROS function contributes to therapy resistance and increased risk of relapse is not fully understood. We used CRISPR-Cas9 genome editing to develop human B-ALL cell lines with various IKZF1 deletions that genetically and phenotypically recapitulate those occurring in patients. Using these isogenic cell lines, we have previously shown IKZF1 deletion results in cell-intrinsic chemoresistance and increased activation of the JAK/STAT signaling pathway (Rogers, Gupta et al. 2021). Methods: Given JAK/STAT is often dysregulated in poor-prognosis leukemia, we investigated the potential mechanisms of aberrant JAK/STAT activation and the therapeutic potential of targeting JAK/STAT in our engineered cell lines. We treated our cells with SH-4-54 (STAT3/5 inhibitor) or tofacitinib (JAK1 inhibitor) alone and in combination with dexamethasone. To elucidate how loss of IKAROS mediates an increase in JAK-STAT activity, we also performed RNAseq of known pathway regulators, comparing IKZF1 wild-type with IKZF1 knockout. Results: The JAK/STAT negative regulator Suppressor of Cytokine Signaling 2 (SOCS2) was significantly downregulated with IKZF1 deletion, validated by RTqPCR and immunoblotting. We further analyzed publicly-available RNAseq data from > 650 pediatric B-ALL samples, finding that SOCS2 expression is significantly lower in patients with low IKZF1expression (likely corresponding to IKZF1 deletion) compared to those with high IKZF1 expression. When we treated our engineered cell lines with tofacitinib or SH-4-54, IKZF1 wild-type cells were sensitive to each compound, suggesting JAK/STAT signaling plays a vital role in cell survival. In contrast, the IKZF1-deleted cells were relatively resistant to JAK/STAT inhibitors alone. However, in combination with dexamethasone, treatment of cells with sub-IC50 levels of SH-4-54 or tofacitinib resulted in re-sensitization to glucocorticoid-induced apoptosis. Conclusions: Our findings support that IKZF1 deletion leads to a targetable upregulation of the JAK/STAT pathway that, when inhibited, results in relative re-sensitization to dexamethasone. JAK/STAT pathway upregulation in IKZF1 deleted cells may be mediated by decreased expression of SOCS2. These results provide initial promise for targeting these vulnerabilities for the treatment of this poor-prognosis disease. more...
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- 2022
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25. 4-Dimensional Intracardiac Echocardiography in Transcatheter Mitral Valve Repair With the Mitraclip System
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Carlos E. Sanchez, Steven J. Yakubov, Gagan Singh, Jason H. Rogers, Nathan H. Kander, and Gilbert H.L. Tang
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Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,Treatment Outcome ,Predictive Value of Tests ,Echocardiography, Three-Dimensional ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,Radiology, Nuclear Medicine and imaging ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Echocardiography, Transesophageal - Published
- 2020
26. Watchman FLX: Early 'Real World' Experience in Search for the Perfect Closure
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Gagan D, Singh, Jason H, Rogers, and Jacqueline, Saw
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Treatment Outcome ,Septal Occluder Device ,Atrial Fibrillation ,Humans ,Atrial Appendage - Published
- 2020
27. Modeling IKZF1 lesions in B-ALL reveals distinct chemosensitivity patterns and potential therapeutic vulnerabilities
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Geraldo Medrano, Jaime M. Reyes, Tidie Song, Rachel E. Rau, Carlo D. Cristobal, Margaret A. Goodell, Anna Guzman, Jason H. Rogers, Michael C. Gundry, Rogelio Aguilar, Kristen Kurtz, Lorenzo Brunetti, Shannon E Conneely, Cade Johnson, Sean Barnes, and Rohit Gupta more...
- Subjects
Vincristine ,Lymphoid Neoplasia ,Myeloid ,Daunorubicin ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Cell cycle ,Biology ,Prognosis ,medicine.disease ,Burkitt Lymphoma ,Ikaros Transcription Factor ,Mice ,Leukemia ,medicine.anatomical_structure ,Downregulation and upregulation ,Recurrence ,medicine ,Null cell ,Cancer research ,Animals ,Humans ,medicine.drug ,Lymphoid leukemia - Abstract
IKAROS family zinc finger 1 (IKZF1) alterations represent a diverse group of genetic lesions that are associated with an increased risk of relapse in B-lymphoblastic leukemia (B-ALL). Due to the heterogeneity of concomitant lesions it remains unclear how IKZF1 abnormalities directly affect cell function and therapy resistance and whether their consideration as a prognostic indicator is valuable in improving outcome. We used CRISPR/Cas9 to engineer multiple panels of isogeneic lymphoid leukemia cell lines with a spectrum of IKZF1 lesions in order to measure changes in chemosensitivity, gene expression, cell cycle, and in vivo engraftment dynamics that can be directly linked to loss of IKAROS protein. IKZF1 knockout and heterozygous null cells displayed relative resistance to a number of commonly employed therapies for B-ALL including dexamethasone, vincristine, asparaginase, and daunorubicin. Transcription profiling revealed a stem/myeloid cell-like phenotype and JAK/STAT upregulation after IKAROS loss. We also used a CRISPR homology-directed repair (HDR) strategy to knock-in the dominant-negative IK6 isoform tagged with GFP into the endogenous locus and observed a similar drug resistance profile with the exception of retained sensitivity to dexamethasone. Interestingly, IKZF1 knockout and IK6 knock-in cells both have significantly increased sensitivity to cytarabine, suggesting intensification of nucleoside analog therapy may be specifically effective for IKZF1-deleted B-ALL. Both types of IKZF1 lesions decreased survival time of xenograft mice, with higher numbers of circulating blasts and increased organ infiltration. Given these findings, exact specification of IKZF1 status in patients may be a beneficial addition to risk stratification and could inform therapy.Key pointsEngineered IKZF1 perturbations result in a stem-cell like expression signature, enhanced engraftment in vivo, and multi-drug resistanceLoss of IKAROS may result in new vulnerabilities due to increased sensitivity to cytarabine and upregulation of JAK/STAT and mAb targets more...
- Published
- 2020
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28. A novel clock‐face method for characterizing peridevice leaks after left atrial appendage occlusion
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Jason H. Rogers, Dali Fan, Gagan D. Singh, Matthew S. Glassy, Thomas W. Smith, Sarah Westcott, and William Wung
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Leak ,Time Factors ,Septal Occluder Device ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Left atrial appendage occlusion ,03 medical and health sciences ,Quadrant (abdomen) ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine.artery ,Atrial Fibrillation ,Occlusion ,medicine ,Humans ,Atrial Appendage ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Prosthesis Failure ,Ostium ,Treatment Outcome ,Pulmonary artery ,Female ,Radiology ,Implant ,Anatomic Landmarks ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Objectives To propose a novel method for mapping leak location and frequency to a clock-face representation of the left atrial appendage (LAA) ostium. Background LAA occlusion with the Watchman device (WD) is an established therapy to reduce thromboembolic events in patients with atrial fibrillation (AF) and intolerance to long-term oral anticoagulation. Postimplantation leaks are known sequelae, but leak locations and characteristics are poorly described. Methods We retrospectively reviewed 101 consecutive WD implants from April 2015 to February 2018. Leak locations from 6-week post-implant transesophageal echocardiograms were mapped to a clock-face representation of the LAA ostium: 12:00 as cranial near the limbus, 3:00 as anterior toward the pulmonary artery, 6:00 as caudal near the mitral annulus, and 9:00 as posterior. Patient demographics, LAA dimensions, and procedural characteristics were also collected. Results Thirty-four patients had ≥1 leak totaling 45 leaks at 6-week follow-up. Baseline patient demographics showed a mean age 77, CHA2 DS2 VASc 4.69, and 64% of patients with permanent AF. No patient had a detectable leak at the time of implant. At 6 weeks, mean leak size was 2.67 ± 0.89 mm with no leak over 5 mm (largest 4.60 mm). Most leaks occurred along the posterior 6:00-12:00 segment (39/45) and the 6:00-9:00 quadrant (16/45). Conclusion Six-week post-WD implant leaks localize to the posterior LAA ostium. This could result from the elliptical LAA orifice, differential LAA tissue composition, or implantation technique. This study provides a novel method for describing the location of post-implant leaks and serves as the basis for further investigations. more...
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- 2020
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29. Transjugular mitral valve repair with the MitraClip: A step-by-step guide
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Sarah Chen, Thomas W. Smith, Jason H. Rogers, Gagan D. Singh, and Jonathan Yap
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Male ,Reoperation ,medicine.medical_specialty ,Cardiac Catheterization ,Catheterization, Central Venous ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Femoral access ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Venous anatomy ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,General Medicine ,Recovery of Function ,Middle Aged ,Surgery ,Treatment Outcome ,Right Internal Jugular ,medicine.vein ,Heart Valve Prosthesis ,Access site ,Mitral Valve ,Jugular Veins ,Cardiology and Cardiovascular Medicine ,business - Abstract
The MitraClip procedure is carried out almost exclusively via the transfemoral approach. However, in some patients transfemoral delivery of MitraClip is not technically feasible (e.g., occluded inferior vena cava or tortuous/obstructive iliofemoral venous anatomy). The technical considerations and challenges of the MitraClip procedure are amplified when an alternate route is considered. We describe a successful case of MitraClip performed via the right internal jugular (IJ) approach in a patient with a flail A3 scallop and previous mitral valve repair. We reviewed prior cases in the literature and discuss step-by-step the pertinent clinical and technical considerations for performing this procedure via the transjugular route. In summary, the right IJ access site provides a reasonable alternative to perform the MitraClip procedure in cases where femoral access is contraindicated or prohibitive. A thorough understanding of the technical considerations is crucial in improving procedural success rates. more...
- Published
- 2020
30. THE EVOLUTION OF TRANSCATHETER EDGE TO EDGE REPAIR WITH MITRACLIP AND ITS OUTCOMES IN SECONDARY MITRAL REGURGITATION
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Paul D. Mahoney, Mathew Price, Michael J. Rinaldi, Jason H. Rogers, Federico M. Asch, Francesco Maisano, and Saibal Kar
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Cardiology and Cardiovascular Medicine - Published
- 2022
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31. Early clinical results with the Tendyne transcatheter mitral valve replacement system
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Gorav Ailawadi, Vinod H. Thourani, Jason H. Rogers, and Jared P. Beller
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Less invasive ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Randomized controlled trial ,law ,Clinical investigation ,Mitral valve ,Perspective ,cardiovascular system ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business - Abstract
Transcatheter mitral valve replacement is an emerging technology for the treatment of mitral valve regurgitation. Numerous devices are in development and in various stages of clinical investigation. The Tendyne system (Tendyne Holdings, LLC, a subsidiary of Abbott Vascular, Roseville, Minnesota) is a fully repositionable and retrievable, transapical transcatheter mitral valve replacement platform. The results of the early feasibility studies in the U.S. are highly encouraging and a pivotal randomized trial is underway. The Tendyne transcatheter mitral valve replacement valve may prove to be a safe, less invasive approach to treatment of mitral valve disease. more...
- Published
- 2018
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32. Early experience with Millipede IRIS transcatheter mitral annuloplasty
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Steven F. Bolling, Walter D. Boyd, Jason H. Rogers, and Thomas W. Smith
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Mitral regurgitation ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Diastole ,Mitral ring ,030204 cardiovascular system & hematology ,Nyha class ,03 medical and health sciences ,0302 clinical medicine ,Mitral annuloplasty ring ,Internal medicine ,Perspective ,cardiovascular system ,medicine ,Cardiology ,Surgery ,cardiovascular diseases ,030212 general & internal medicine ,Ct imaging ,Cardiology and Cardiovascular Medicine ,business ,Mitral Annuloplasty - Abstract
The IRIS mitral annuloplasty ring is a transcatheter, transfemoral and transseptal-delivered complete, semi-rigid annuloplasty ring. The IRIS system mimics surgical annuloplasty by reducing the mitral septal-lateral dimension and improving leaflet coaptation. We report the early experience with the IRIS system in seven patients. These patients had 3–4+ mitral regurgitation (MR) with annular dilation and were symptomatic NYHA II-IV with LV end systolic dimensions ≤65 mm. Patients were excluded for LVEF 70 mmHg. Baseline and 30-day transthoracic echocardiography and CT imaging was performed. In phase 1, 4 patients had surgical IRIS mitral ring implantation. In phase 2, 3 patients had transfemoral, transseptal delivery of the IRIS mitral ring. There was no procedural death, or MI. The mitral SL diameter was reduced from 38.0±4.1 to 25.9±4.9 mm at 30 days (31.8% SL reduction, n=7). MR was reduced from baseline 3–4+ to 0–1+ in all patients at 30 days. There were improvements in NYHA class and there was a decrease in diastolic LV volumes from 182.4±54.3 to 115.3±98.8 mL at 30 days (36.8% reduction). Based on these initial positive findings, ongoing clinical trials are underway to further evaluate the safety and efficacy of the IRIS ring. more...
- Published
- 2018
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33. Initial clinical experience with the FlexPoint Steerable Transseptal Needle in left-sided structural heart procedures
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Jason H. Rogers, Gagan D. Singh, Walter D. Boyd, Benjamin Stripe, Thomas W. Smith, and Dali Fan
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,Transseptal needle ,Heart Diseases ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,Punctures ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Left sided ,Right atrial ,Left atrial appendage occlusion ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Heart procedures ,Atrial Septum ,business.industry ,MitraClip ,Equipment Design ,General Medicine ,Middle Aged ,Surgery ,Stylet ,Treatment Outcome ,medicine.anatomical_structure ,Needles ,Fluoroscopy ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Interatrial septum - Abstract
Objectives The purpose of this study is to describe the initial clinical experience with a steerable transseptal needle (STSN) for left-sided structural heart procedures. Background Targeted transseptal (TS) puncture is required for many structural heart procedures, and the use of a steerable needle has not previously been described. Methods Consecutive patients undergoing structural heart interventions with targeted TS puncture under transesophageal echocardiographic (TEE) and fluoroscopic guidance were studied. The STSN was used in all patients with a standard commercial TS sheath. Deflection of the needle was performed "real time" to achieve localization of the TS puncture site. Results Twenty-seven patients underwent STSN puncture of the interatrial septum. In all cases, the needle could be deflected in vivo to achieve optimal tenting and localization of the puncture site without having to remove or reshape the needle. The needle was deflected to match a wide range of right atrial diameters (width 4.3 ± 0.9 cm and length 6.0 ± 0.9 cm in the 4-chamber view). In two patients with prior mitral valve surgery and a fibrotic septum, assisted crossing was achieved using the piercing stylet in one patient, and Bovie energy in the other. There were no procedural complications, and all patients had successful completion of the intended structural heart procedure. Conclusions The STSN needle can be used to target the intended puncture location on the interatrial septum with real-time adjustable deflection without the need to remove and reshape the needle. In all cases crossing was successful and there were no complications. more...
- Published
- 2018
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34. Clipping the Ring
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Walter D. Boyd, Gagan D. Singh, Thomas W. Smith, and Jason H. Rogers
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medicine.medical_specialty ,Mitral valve repair ,Mitral regurgitation ,business.industry ,medicine.medical_treatment ,MitraClip ,Class iii ,Clipping (medicine) ,030204 cardiovascular system & hematology ,New york heart association ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Mitral annuloplasty ring ,cardiovascular system ,Medicine ,Transcatheter mitral valve repair ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 68-year-old man and observant Jehovah’s Witness was referred for transcatheter mitral valve repair for recurrent severe (4+) symptomatic (New York Heart Association functional class III) mitral regurgitation (MR) after previous surgical mitral valve repair. Two years before, he underwent more...
- Published
- 2018
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35. Transcatheter Annuloplasty for Mitral Regurgitation with an Adjustable Semi-Rigid Complete Ring: Initial Experience with the Millipede IRIS Device
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Walter D. Boyd, Thomas W. Smith, Adrian Ebner, Eberhard Grube, Jason H. Rogers, and Steven F. Bolling
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medicine.medical_specialty ,Ring (mathematics) ,Mitral regurgitation ,business.industry ,Annuloplasty rings ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Transcatheter mitral valve repair ,030212 general & internal medicine ,Iris (anatomy) ,Cardiology and Cardiovascular Medicine ,business ,Mitral Annuloplasty - Abstract
Background: Complete, semi-rigid annuloplasty rings result in more durable reduction of mitral regurgitation (MR) over time than partial or flexible bands. We herein report the initial experience w... more...
- Published
- 2018
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36. Percutaneous Tricuspid Annuloplasty
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Antonio Mangieri, Scott Lim, Azeem Latib, and Jason H. Rogers
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Cardiac Catheterization ,medicine.medical_specialty ,Poor prognosis ,Percutaneous ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Cardiac Valve Annuloplasty ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid annuloplasty ,Internal medicine ,Risk of mortality ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Tricuspid valve ,business.industry ,Suture Techniques ,Tricuspid Valve Insufficiency ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Right-sided heart failure - Abstract
The tricuspid valve was ignored for a long time. The prevalence of severe tricuspid regurgitation is not negligible, however, and is associated with poor prognosis. In cases of primary tricuspid regurgitation, surgical options are limited by a high risk of mortality and morbidity. New percutaneous approaches are becoming available to meet this consistent unmet clinical need. This review presents the current available devices that reproduce both the complete and uncomplete surgical annuloplasty techniques. more...
- Published
- 2018
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37. Novel Intra-Annular Mitral Valve Imaging With Intracardiac Echocardiography for Direct Transcatheter Mitral Annuloplasty
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Jason H. Rogers, Steven F. Bolling, Walter D. Boyd, and Thomas W. Smith
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Male ,Cardiac Catheterization ,Left ventricular dilation ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Intracardiac echocardiography ,medicine.medical_treatment ,Mitral ring ,Prosthesis Design ,Predictive Value of Tests ,Mitral valve annuloplasty ,Internal medicine ,Mitral valve ,medicine ,Humans ,In patient ,cardiovascular diseases ,Mitral Annuloplasty ,Aged ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,Hemodynamics ,Mitral Valve Insufficiency ,Recovery of Function ,Middle Aged ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Feasibility Studies ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Surgical mitral valve annuloplasty has been a cornerstone of surgical mitral valve repair since first described over 50 years ago by Carpentier ([1][1]). In patients without excessive leaflet tethering or left ventricular dilation, mitral ring annuloplasty can effectively correct secondary mitral more...
- Published
- 2019
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38. Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique
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Jason H. Rogers, Gagan D. Singh, Thomas W. Smith, and Nabil A. Shafi
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Adult ,Male ,Cardiac Catheterization ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Adolescent ,health care facilities, manpower, and services ,education ,Computed tomography ,030204 cardiovascular system & hematology ,Balloon ,Cardiac Catheters ,Ventricular Function, Left ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pull-through technique ,health services administration ,Ductus arteriosus ,medicine.artery ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Ductus Arteriosus, Patent ,Aged ,Retrospective Studies ,Adult patients ,medicine.diagnostic_test ,business.industry ,Hemodynamics ,Equipment Design ,General Medicine ,Sizing ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary artery ,Atrial Function, Left ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,High flow - Abstract
Objectives To describe a novel balloon sizing technique used during adult transcatheter patent ductus arteriosus (PDA) closure. In addition, to determine the clinical and procedural outcomes in six patients who underwent PDA balloon sizing with subsequent deployment of a PDA occluder device. Background Transcatheter PDA closure in adults has excellent safety and procedural outcomes. However, PDA sizing in adults can be challenging due to variable defect size, high flow state, or anatomical complexity. We describe a series of six cases where the balloon- pull through technique was successfully performed for PDA sizing prior to transcatheter closure. Methods Consecutive adult patients undergoing adult PDA closure at our institution were studied retrospectively. A partially inflated sizing balloon was pulled through the defect from the aorta into the pulmonary artery and the balloon waist diameter was measured. Procedural success and clinical outcomes were obtained. Results Six adult patients underwent successful balloon pull-through technique for PDA sizing during transcatheter PDA closure, since conventional angiography often gave suboptimal opacification of the defect. All PDAs were treated with closure devices based on balloon PDA sizing with complete closure and no complications. In three patients that underwent preprocedure computed tomography, the balloon size matched the CT derived measurements. Conclusion The balloon pull-through technique for PDA sizing is a safe and accurate sizing modality in adults undergoing transcatheter PDA closure. more...
- Published
- 2017
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39. Tct connect-431 The Impact of Lipomatous Atrial Septal Hypertrophy (LASH) on Left-Sided Structural Heart Interventions
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Jonathan Yap, Andrew Chiou, Lily Chen, Thomas B. Smith, Jason H. Rogers, Edris Aman, and Gagan D. Singh
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medicine.medical_specialty ,business.industry ,Internal medicine ,Septal hypertrophy ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Left sided - Published
- 2020
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40. Transseptal access for left heart structural interventions in the setting of prior atrial septal defect closure
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Thomas W. Smith, Gagan D. Singh, Sarah Chen, Benjamin Stripe, Jonathan Yap, and Jason H. Rogers
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,Punctures ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Heart Septal Defects, Atrial ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Risk Factors ,Atrial Fibrillation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Closure (psychology) ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,MitraClip ,Hemodynamics ,Mitral Valve Insufficiency ,General Medicine ,Atrial septal defect closure ,Recovery of Function ,medicine.disease ,Structural interventions ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Heart Valve Prosthesis ,Patent foramen ovale ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
A transseptal puncture is critical for "left-sided" structural heart interventions. Procedures such as transcatheter edge-to-edge repair (MitraClip) and left atrial appendage (LAA) closure (Watchman) require precise puncture of the interatrial septum (IAS), and the presence of a prior atrial septal defect (ASD) closure device poses a challenge. We aim to present a successfully completed case of MitraClip and Watchman in the presence of ASD closure device in two different patients. A review of the literature will be reported, and pertinent clinical and technical considerations will be discussed in depth to achieve procedural success. In summary, transseptal puncture for left heart structural interventions is feasible in the presence of a prior ASD/patent foramen ovale closure device. A detailed understanding of the anatomical considerations as well as the use of multimodality imaging to evaluate the IAS will aid in improving procedural success rates. more...
- Published
- 2019
41. Watchman Occlusion in Long-Standing Persistent Atrial Fibrillation: Larger Left Atrial Appendages With Greater Residual Leak
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Matthew S, Glassy, William, Wung, Sarah, Westcott, Thomas W R, Smith, Dali, Fan, Jason H, Rogers, and Gagan D, Singh
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Aged, 80 and over ,Male ,Cardiac Catheterization ,Time Factors ,Atrial Remodeling ,Prosthesis Design ,Treatment Outcome ,Predictive Value of Tests ,Risk Factors ,Atrial Fibrillation ,Humans ,Atrial Appendage ,Atrial Function, Left ,Female ,Echocardiography, Transesophageal ,Aged ,Retrospective Studies - Abstract
This study sought to compare patients with and without long-standing persistent atrial fibrillation (LSPAF) undergoing Watchman left atrial appendage (LAA) occlusion.An increased burden of atrial fibrillation is associated with progressive left atrial remodeling and enlargement.Transesophageal echocardiography (TEE) measures of LAA ostial diameter and depth, device compression, and residual leak were evaluated in 101 consecutive Watchman cases. The patients were categorized into LSPAF (n = 48) or non-LSPAF (n = 53) groups and compared.The average LAA ostial diameter for LSPAF versus non-LSPAF by TEE omniplane at 0° was 21.1 ± 4.1 mm versus 18.2 ± 3.6 mm (p = 0.0002); at 45° was 18.7 ± 3.4 mm versus 16.3 ± 3.1 mm (p = 0.0004); at 90° was 19.6 ± 3.8 mm versus 16.2 ± 3.4 mm (p = 0.00001); and at 135° was 21.0 ± 4.1 mm versus 18.0 ± 4.1 mm (p = 0.0005). The average LAA depth for LSPAF versus non-LSPAF by TEE at 0° was 28.1 ± 6.4 mm versus 25.2 ± 4.9 mm (p = 0.02); at 45° was 27.9 ± 5.8 mm versus 25.1 ± 4.3 mm (p = 0.007); at 90° was 27.2 ± 5.2 mm versus 22.8 ± 3.7 mm (p = 0.0001); and at 135° was 25.6 ± 5.4 mm versus 21.5 ± 3.8 mm (p = 0.0001). In successfully treated patients, 77% of the LSPAF group received larger device (27, 30, or 33 mm) implants versus only 46% in the non-LSPAF group (p = 0.003). While both groups had similar rates of moderate (3 to 5 mm) leaks at implant (2% vs. 0%; p = 0.14), 27% of the LSPAF vs. 4% of the non-LSPAF group had moderate leaks (p = 0.04) on 6-week follow-up TEE.Patients with LSPAF have significantly larger LAA sizes, require larger devices, and have more residual leak on follow-up TEE. LSPAF may represent a higher risk group that warrants more stringent long-term follow-up. more...
- Published
- 2019
42. Pearls From a Case of Left Atrial Appendage Closure
- Author
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Jason H. Rogers, Thomas W. Smith, and Gagan D. Singh
- Subjects
Appendage ,medicine.medical_specialty ,business.industry ,Left atrial ,Closure (topology) ,Medicine ,business ,Surgery - Published
- 2019
- Full Text
- View/download PDF
43. Transcatheter Management of Failed Mitral Valve Repair
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Jason H. Rogers, Thomas W. Smith, and Gagan D. Singh
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medicine.medical_specialty ,Mitral valve repair ,business.industry ,medicine.medical_treatment ,medicine ,business ,Surgery - Published
- 2019
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44. Challenges of Transcatheter Therapy for Functional Mitral Regurgitation
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Thomas W. Smith, Jason H. Rogers, and Gagan D. Singh
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medicine.medical_specialty ,business.industry ,Internal medicine ,Transcatheter therapy ,Cardiology ,Medicine ,business ,Functional mitral regurgitation - Published
- 2019
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45. Occluder Therapy for Residual Mitral Regurgitation After Transcatheter Repair
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Jason H. Rogers, Gagan D. Singh, and Thomas W. Smith
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Internal medicine ,medicine ,Cardiology ,Residual ,business - Published
- 2019
- Full Text
- View/download PDF
46. List of Contributors
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Samer Abbas, Shuaib Abdullah, Hasan Ahmad, Gorav Ailawadi, Wail Alkashkari, Osama Alsanjari, Jason H. Anderson, Judah Askew, Luis Asmarats, Ganesh Athappan, Rizwan Attia, Vasilis Babaliaros, Richard Y. Bae, Charles M. Baker, Subhash Banerjee, Vinayak N. Bapat, Colin M. Barker, Itsik Ben-Dor, Stefan Bertog, Phillipe Blanke, Peter Block, Patrick Boehm, Stephen Brecker, Emmanouil S. Brilakis, Marcus Burns, Christian Butter, Allison K. Cabalka, Barry Cabuay, Alex Campbell, John D. Carroll, Anson W. Cheung, Adnan K. Chhatriwalla, Martin Cohen, Mauricio G. Cohen, Frank Corrigan, Cameron Dowling, Tanya Dutta, Mackram Eleid, Robert Saeid Farivar, Ted Feldman, Thomas Flavin, Jessica Forcillo, Jennifer Franke, Sameer Gafoor, Evaldas Girdauskas, Steven L. Goldberg, Mario Gössl, Mayra Guerrero, Alexander Haak, Cameron Hague, Eva Harmel, Ziyad Hijazi, David Hildick-Smith, Ilona Hofmann, Samuel E. Horr, Nay M. Htun, Shaw Hua (Anthony) Kueh, Vladimir Jelnin, Brandon M. Jones, Ravi Joshi, Rami Kahwash, Ankur Kalra, Norihiko Kamioka, Samir R. Kapadia, Ryan K. Kaple, Judit Karacsonyi, Marc R. Katz, John J. Kelly, Samuel Kessel, Ung Kim, Neal S. Kleiman, Thomas Knickelbine, Amar Krishnaswamy, Vibhu Kshettry, Shaw-Hua Kueh, Ivandito Kuntijoro, Shingo Kuwata, Jonathon Leipsic, Stamatios Lerakis, John R. Lesser, Scott M. Lilly, D. Scott Lim, David Lin, Francesco Maisano, Gurdeep Mann, Christopher Meduri, Stephanie Mick, Michael Mooney, Aung Myat, Srihari S. Naidu, Michael Neuss, Fabian Nietlispach, Mickaël Ohana, Ioannis Parastatidis, Tilak K.R. Pasala, Ateet Patel, Paul Pearson, Wesley R. Pedersen, François Philippon, Augusto Pichard, Anil Poulose, Alberto Pozzoli, Matthew J. Price, Vivek Rajagopal, Claire Raphael, Michael J. Reardon, Evelyn Regar, Josep Rodés-Cabau, Jason H. Rogers, Carlos E. Ruiz, Michael Salinger, Muhamed Saric, Lowell Satler, Jacqueline Saw, Lynelle Schneider, Atman P. Shah, Rahul Sharma, Mark Victor Sherrid, Joy S. Shome, Horst Sievert, Gagan D. Singh, Thomas W. Smith, Benjamin Sun, Hussam Suradi, Gilbert H.L. Tang, Maurizio Taramasso, Jay Thakkar, Vinod H. Thourani, Stacey Tonne, Imre Ungi, Laura Vaskelyte, Joseph M. Venturini, Marko Vezmar, Ron Waksman, Zuyue Wang, John Graydon Webb, Dominik M. Wiktor, and Mathew R. Williams more...
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- 2019
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47. Right Sided Trouble: Persistent Shunting after Iatrogenic Atrial Septal Defect Closure with an Amplatzer PFO Occluder Treated Successfully With a Cardioform Septal Occluder
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Carleton Nibley, Jason H. Rogers, Wayland Lim, and Bradley D. Stauber
- Subjects
medicine.medical_specialty ,business.industry ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Atrial fibrillation ,General Medicine ,Atrial septal defect closure ,medicine.disease ,Ablation ,Shunt (medical) ,Shunting ,Internal medicine ,Cardiology ,Medicine ,Septal Occluder ,cardiovascular diseases ,business - Abstract
We describe a patient with severe, symptomatic platypnea-orthodeoxia after an atrial fibrillation ablation leading to an iatrogenic atrial septal defect. The shunt was initially closed with Amplatzer PFO occluder, however with continued symptoms and brisk flow through the device, an alternative solution had to be devised. After removal of the device and placement of a Gore Cardioform septal occluder sealed the defect, alleviating symptoms almost instantaneously. To our knowledge, this is the first such case reported. more...
- Published
- 2019
- Full Text
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48. Transseptal Direct Complete Annuloplasty: Early Experience
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Jason H. Rogers and Steven F. Bolling
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Keynote Lecture Series ,Mitral valve repair ,medicine.medical_specialty ,Mitral regurgitation ,business.industry ,medicine.medical_treatment ,Treatment options ,Surgical risk ,Surgery ,medicine.anatomical_structure ,Mitral valve ,medicine ,Materials Chemistry ,Cardiology and Cardiovascular Medicine ,business - Abstract
Annuloplasty is a fundamental component of surgical mitral valve repair, and is employed in nearly 100% of repair operations for both primary and secondary mitral regurgitation (SMR). Developing transcatheter techniques to replicate surgical annuloplasty has been the focus of significant innovation and development in recent years. Since many patients are not offered surgery due to high perceived surgical risk, transcatheter approaches will provide new treatment options. In this manuscript, we review technologies which allow transseptal and transcatheter mitral valve (MV) annuloplasty. more...
- Published
- 2021
- Full Text
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49. Accuracy and procedural characteristics of standard needle compared with radiofrequency needle transseptal puncture for structural heart interventions
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Dali Fan, Gagan D. Singh, Thomas W. Smith, Jason H. Rogers, Gaurav Sharma, and Reginald I. Low
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,General Medicine ,030204 cardiovascular system & hematology ,Heart septum ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Major complication ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization - Abstract
Objectives Our objectives were to assess for differences between standard and radiofrequency (RF) needle in procedural times, success, and spatial accuracy. Background Targeted transseptal (TS) puncture is essential for structural heart interventions. Spatial accuracy of standard versus RF needle has not been reported. Methods Consecutive patients undergoing structural heart interventions requiring TS puncture were studied retrospectively. A standard needle was alternated with a RF needle. Procedural success and times were recorded. Measurements based on intraprocedural transesophageal echocardiograms of the intended versus final TS crossing site were obtained. Pre-puncture and maximal tenting of the septum were also recorded. Results Twenty-five patients underwent standard needle and 27 RF TS access. All RF needle attempts to cross were successful without an assistance wire. Three standard needle patients required assisted crossing. After failed TS access, two patients had successful RF TS access. TS procedural times significantly favored the RF needle for time from septum to puncture (P = 0.02). Both standard and RF access yielded accurate crossing with no significant differences between the intended and actual crossing site. Maximal tenting was significantly less with the RF needle (P = 0.004). There were no major complications. Conclusions In the hands of an experienced operator, there were no major clinically significant differences between the standard and RF needle approaches. However, procedural unassisted crossing success was higher with the RF needle approach as compared to standard needle. Procedural times and degree of septum tenting favored the RF over standard needle. Accuracy was similar with both approaches. RF was a successful strategy when standard needle failed. There were no major complications with either TS puncture strategy. © 2016 Wiley Periodicals, Inc. more...
- Published
- 2016
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50. Targeted Transseptal Access for MitraClip Percutaneous Mitral Valve Repair
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Jason H. Rogers, Gagan D. Singh, and Thomas W. Smith
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Cardiac Catheterization ,medicine.medical_specialty ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Punctures ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Humans ,Mitral Valve ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair ,Interatrial septum - Abstract
Targeted transseptal puncture remains the most critical initial part of the overall MitraClip procedure. Care and attention must be implemented for patient safety in choosing the optimal puncture site. A consistent and step-by-step methodical approach is recommended. As experienced operators are targeting more complex and nontraditional pathologic conditions, use of adjunctive tools and maneuvers (outlined in this review) are paramount to achieving successful targeted transseptal access and ultimately procedural success. more...
- Published
- 2016
- Full Text
- View/download PDF
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