60 results on '"Jose F. Condado"'
Search Results
2. Will Transcatheter Aortic Valve Replacement (TAVR) be the Primary Therapy for Aortic Stenosis?
- Author
-
Jose F. Condado and Peter C. Block
- Subjects
Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis (AS) or failing surgical bioprosthesis (valve-in-valve, VIV-TAVR). In TAVR, the collapsed transcatheter heart valve (THV) is introduced using the delivery system inserted from the femoral artery (preferred) or other alternative accesses (transapical, transaortic, transcarotid, subclavian/transinnominate or transcaval). The delivery system is then advanced until coaxially aligned with the aortic annulus, where the THV is deployed. This procedure can be associated with complications such as access site injury (vascular complication), paravalvar leak, cerebrovascular events and conduction disturbances. However, the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection, preprocedural planning (i.e. MDCT annular sizing), THV technology (i.e. new generation valves), and procedural techniques (i.e. minimalist TF-TAVR and alternative percutaneous access options), as well as a decrease in complications as TAVR experience grows. Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending, it is likely that TAVR will soon be approved for lower risk patients as well.
- Published
- 2016
- Full Text
- View/download PDF
3. Leaflet Modification Technologies
- Author
-
Jose F. Condado, Adam Greenbaum, Norihiko Kamioka, Toby Rogers, Jaffar M. Khan, Robert J. Lederman, and Vasilis Babaliaros
- Published
- 2022
- Full Text
- View/download PDF
4. The Art of SAPIEN 3 Transcatheter Mitral Valve Replacement in Valve-in-Ring and Valve-in-Mitral-Annular-Calcification Procedures
- Author
-
Patrick Gleason, Anurag Sahu, Isida Byku, Joe X. Xie, Gaetono Paone, Norihiko Kamioka, Jose F. Condado, Adam Greenbaum, Keshav Kohli, Vasilis Babaliaros, Jaffar M. Khan, John Lisko, Toby Rogers, Emily Perdoncin, Robert J. Lederman, and Christopher G Bruce
- Subjects
Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,medicine.medical_specialty ,Mitral annular calcification ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Valve in ring ,humanities ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Internal medicine ,cardiovascular system ,Cardiology ,Humans ,Mitral Valve ,Medicine ,In patient ,cardiovascular diseases ,Heart valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
The SAPIEN 3 is the only transcatheter heart valve commercially available for compassionate transcatheter mitral valve replacement in patients with previous mitral surgical rings and mitral annular calcification (valve in ring [VIR] and valve in mitral annular calcification [VIM]). Reported outcomes have been inconsistent or poor. The review provides an overview of the authors' approach to achieve largely consistent results despite the intrinsic limitations of SAPIEN 3 VIM and VIR. The approach includes bedside modifications of the valve implant, the delivery system, and of the cardiac substrate itself. Until purpose-built devices are readily available, VIR and VIM procedures will require aggressive multidisciplinary cooperation, meticulous planning and execution, and postprocedure management by experienced, high-volume operators.
- Published
- 2021
- Full Text
- View/download PDF
5. Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus
- Author
-
Brian Whisenant, Pradeep Yadav, Gaetano Paone, Paul Mahoney, James M. McCabe, Jaffar M. Khan, John Lisko, Jose F. Condado, Adam Greenbaum, Norihiko Kamioka, Ramzi Khalil, Jasleen Tiwana, Patrick Gleason, Toby Rogers, Neal S. Kleiman, Michael J. Reardon, Sachin S. Goel, Kendra J. Grubb, Krishna Cherukuri, Robert J. Lederman, David Lasorda, Rachel Koch, Vasilis Babaliaros, Brian C. Case, David V. Daniels, Christopher G Bruce, Christian Spies, and Isida Byku
- Subjects
Aortic valve ,Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Ventricular outflow tract obstruction ,Investigational device exemption ,030204 cardiovascular system & hematology ,Prosthesis ,Article ,Ventricular Outflow Obstruction ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,cardiovascular system ,Mitral Valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves. Background LAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain. Methods This is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty. Results Twenty-one patients with a annuloplasty or valve prosthesis–protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30 days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time. Conclusions Tip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.
- Published
- 2021
- Full Text
- View/download PDF
6. Contributors
- Author
-
Oliver G. Abela, George S. Abela, Amer Alaiti, Mazen S. Albaghdadi, Carlos E. Alfonso, Hilary F. Armstrong, Steven R. Bailey, Subhash Banerjee, Ori Belson, Navid Berenji, Gary N. Binyamin, Joao Braghiroli, Emmanouil S. Brilakis, Shmuel Chen, Michael Clifton, Jose F. Condado, Jennifer P. Connell, Michael Dangl, Kathryn Das, Makram R. Ebeid, Gabby Elbaz-Greener, Matthew C. Evans, Alexandre Ferreira, Aloke V. Finn, Nathan Frogge, Offer Galili, Samantha Gaston, Jessica Nathalia González, K. Jane Grande-Allen, Jelani K. Grant, Aashish Gupta, null Adrian Howansky, Dora Y. Huang, Kurt Jacobson, J. Stephen Jenkins, Thomas Johnson, Gregory K. Jones, Elysa Jui, Edo Kaluski, Vasili Katsadouros, Sameer Khandhar, Eitan Konstantino, Maya Konstantino, Alexandra Lansky, John Lasala, Neil Pendril Lewis, Alejandro Eric Macias, Michael Magarakis, Mark Mariathas, Cesar E. Mendoza, Ryan Merritt, Hayley Moore, Masayuki Mori, John Moscona, William B. Moskowitz, Liam Musto, Hoang Nguyen, Odunayo Olorunfemi, Takayuki Onishi, Yuko Onishi, Peter O'Kane, Purven Parikh, Samuel P. Powell, Marloe Prince, Furqan A. Rajput, Sarah Reeves, Prakash Saha, Tomas Antonio Salerno, Yu Sato, Megan Sattler, Sudhakar Sattur, Amit Shah, Nicolas W. Shammas, Venkat Shankarraman, Reema Sheth, Kavya L. Singampalli, Dilpreet Singh, George A. Stouffer, Bradley H. Strauss, Christopher B. Sylvester, Prashanth Thakker, Manoj Thangam, Thomas M. Todoran, Catalin Toma, On Topaz, Nirupama Vellanki, Renu Virmani, Xin Wei, Giora Weisz, Christopher J. White, Scott L. Willis, Iosif Xenogiannis, and Jeffrey P. Yourshaw
- Published
- 2022
- Full Text
- View/download PDF
7. The impact of calcified aortic and mitral valves on clinical presentations and related structural heart interventions
- Author
-
Hoang Nguyen, Navid Berenji, and Jose F. Condado
- Published
- 2022
- Full Text
- View/download PDF
8. Pulmonary Venous Waveforms Predict Rehospitalization and Mortality After Percutaneous Mitral Valve Repair
- Author
-
Vinod H. Thourani, Patrick Gleason, Jose N. Binongo, Frank Corrigan, John Chen, Peter C. Block, Sharon Howell, Vasilis Babaliaros, Norihiko Kamioka, Shawn Reginauld, Jane Wenjing Wei, Patricia Keegan, Jose F. Condado, Stephen D. Clements, John Lisko, Aneel Maini, Lucia Alvarez, and Stamatios Lerakis
- Subjects
Male ,Cardiac Catheterization ,Pulmonary Circulation ,medicine.medical_specialty ,Time Factors ,Hemodynamics ,Patient Readmission ,Risk Assessment ,Atrial Pressure ,Predictive Value of Tests ,Risk Factors ,Cause of Death ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,Proportional hazards model ,business.industry ,MitraClip ,Hazard ratio ,Mitral Valve Insufficiency ,Odds ratio ,Middle Aged ,Echocardiography, Doppler ,Confidence interval ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Mitral Valve ,Atrial Function, Left ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Percutaneous Mitral Valve Repair - Abstract
Objectives In this study, the authors hypothesized that intraprocedural improvement of pulmonary venous (PV) waveforms are predictive of improved outcomes. In this report, they analyzed intraprocedural invasive and echocardiographic changes with respect to rehospitalization and mortality. Background The effects of hemodynamic changes during percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Vascular, Santa Clara, California) are incompletely characterized. Methods The authors retrospectively reviewed records and intraprocedural transesophageal echocardiograms of 115 consecutive patients (age 76 ± 12 years) who underwent PMVR for mitral regurgitation (MR) from May 2013 to January 2017 at Emory University Hospital. They assessed intraprocedural PV waveforms for improvement in morphology, measured change in MR grade by semiquantitative methods, evaluated invasive changes in left atrial pressure (LAP) and V-wave, and compared with 30-day and 1-year rehospitalization and all-cause mortality. Results Ninety-three cases (80%) had PV waveforms before and after clip placement sufficient for analysis, of which 67 (73%) demonstrated intraprocedural improvement in PV morphology and 25 (27%) did not. At 24 months, 57 (85%) of those with PV improvement were living, compared with only 10 (40%) of those without improvement. Proportional hazards models demonstrated a significant survival advantage in those with PV improvement (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.08 to 0.93, p = 0.038). By multivariable analysis, PV improvement predicted reduced 1-year cardiac rehospitalization (odds ratio [OR]: 0.18, p = 0.044). Intraprocedural assessment of MR grade and invasive hemodynamics did not consistently predict mortality and rehospitalization. Conclusions PV waveforms are important markers of procedural success after PMVR. Our data show intraprocedural PV waveforms may predict rehospitalization and mortality after PMVR. A larger, multicenter cohort will be important to clarify this relationship.
- Published
- 2019
- Full Text
- View/download PDF
9. Difference in Aortic Valve Area Measured With Cardiac CT and Transthoracic Echocardiography
- Author
-
Arthur E. Stillman, Sung Min Ko, Yi-An Ko, Jose F. Condado, Stamatios Lerakis, and Vasilis Babaliaros
- Subjects
medicine.medical_specialty ,Aortic valve area ,business.industry ,Internal medicine ,medicine ,Cardiology ,business - Published
- 2019
- Full Text
- View/download PDF
10. Imaging for Predicting, Detecting, and Managing Complications After Transcatheter Aortic Valve Replacement
- Author
-
Stephen D. Clements, Norihiko Kamioka, Frank Corrigan, Sharon Howell, John Chen, John Lisko, Stamatios Lerakis, Patricia Keegan, Jose F. Condado, Vasilis Babaliaros, and Patrick Gleason
- Subjects
Models, Anatomic ,Patient-Specific Modeling ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,030204 cardiovascular system & hematology ,Appropriate use ,Multimodal Imaging ,030218 nuclear medicine & medical imaging ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Cognitive Complications ,Valve replacement ,Predictive Value of Tests ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Paravalvular leak ,business.industry ,Models, Cardiovascular ,Aortic Valve Stenosis ,Magnetic Resonance Imaging ,Cardiac Imaging Techniques ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Printing, Three-Dimensional ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
The management of patients with valvular heart disease is increasingly reliant on multimodal cardiac imaging. In patients with severe aortic stenosis considered for transcatheter aortic valve replacement, careful pre-procedural planning with multimodal imaging is necessary to avoid and prevent complications during the procedure. During or immediately after the procedure, rapid echocardiographic assessment is important to assess the new valve's function and manage major complications. Echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging all share important roles in the post-procedural evaluation of abnormal transcatheter valve function. This review discusses the use of multimodal imaging for predicting, detecting, and managing complications after TAVR.
- Published
- 2019
- Full Text
- View/download PDF
11. Antegrade Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction
- Author
-
Isida Byku, Jose F. Condado, James M. McCabe, Kendra J. Grubb, Patrick Gleason, Robert J. Lederman, Andres Jadue, Adam Greenbaum, Toby Rogers, Jaffar M. Khan, John Lisko, Jasleen K Tiwana, Vasilis Babaliaros, Gaetano Paone, and Norihiko Kamioka
- Subjects
medicine.medical_specialty ,Electrosurgery ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Ventricular outflow tract obstruction ,Ventricular Outflow Obstruction ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,Anterior mitral leaflet ,Mitral valve ,medicine ,Cardiology ,Ventricular outflow tract ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization - Abstract
Background: Intentional laceration of the anterior mitral leaflet (LAMPOON) is an effective adjunct to transcatheter mitral valve replacement that prevents left ventricular outflow tract (LVOT) obstruction. To date, LAMPOON has been performed in over 150 patients using a retrograde approach that can be technically challenging. A modified antegrade transseptal technique may simplify the procedure. Methods: Antegrade LAMPOON was developed and tested in nonsurvival pig experiments. Thereafter, antegrade LAMPOON was performed in patients at prohibitive risk of LVOT obstruction. Clinical, procedural, and angiographic details were abstracted from medical records of their index procedure, and were compared with findings in comparable patients at risk of fixed-LVOT obstruction in the LAMPOON investigational device exemption trial. Results: Eight patients at risk of fixed LVOT obstruction underwent antegrade LAMPOON. Leaflet traversal and laceration were technically successful in all. There were no cases of clinically significant LVOT obstruction (mean LVOT gradient at discharge: 5.4±1.4 mm Hg). One patient suffered a ventricular wire perforation, unrelated to the antegrade LAMPOON technique, and did not survive to discharge. At the time of discharge, no patients had an increase of >10 mm Hg in LVOT gradient compared with baseline. Procedure times (from traversal to transcatheter mitral valve replacement) were shorter, compared with the retrograde technique in the LAMPOON investigational device exemption trial (39±09 versus 65±35 minutes). All patients survived (8/8, 100%) the procedure, and 7/8 (88%) survived to 30 days, similar to subjects in the LAMPOON investigational device exemption trial. Conclusions: Antegrade LAMPOON is an effective, reproducible, and simplified strategy to lacerate the anterior leaflet before transcatheter mitral valve replacement. The authors recommend the technique as the new standard for LAMPOON.
- Published
- 2020
- Full Text
- View/download PDF
12. Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement
- Author
-
James Stewart, Hope Caughron, Kreton Mavromatis, Andy Dong, Chandan Devireddy, Patricia Keegan, Bradley G. Leshnower, Jose F. Condado, Leslie Ogburn, Frank Corrigan, Stamatios Lerakis, Robert A. Guyton, Norihiko Kamioka, Amy Simone, Peter C. Block, Jose N. Binongo, Ateet Patel, Jessica Forcillo, Vinod H. Thourani, John A. Wells, and Vasilis Babaliaros
- Subjects
Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,Time Factors ,Health Status ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,Patient Readmission ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Risk of mortality ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Proportional hazards model ,business.industry ,Hazard ratio ,Age Factors ,Hemodynamics ,Atrial fibrillation ,Aortic Valve Stenosis ,Odds ratio ,Length of Stay ,medicine.disease ,Patient Discharge ,Confidence interval ,Treatment Outcome ,Aortic Valve ,Creatinine ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Objectives This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR). Background Information about predictors and safety of NDD after TAVR is limited. Methods The study reviewed 663 consecutive patients who underwent elective balloon-expandable TAVR (from July 2014 to July 2016) at our institution. We first determined predictors of NDD in patients who underwent minimalist transfemoral TAVR. After excluding cases with complications, we compared 30-day and 1-year outcomes between NDD patients and those with longer hospital stay using Cox regression adjusting for the Predicted Risk of Mortality provided by the Society of Thoracic Surgeons. The primary endpoint was the composite of mortality and readmission at 1 year. Results A total of 150 patients had NDD after TAVR and 210 patients had non-NDD. Mean age and the Society of Thoracic Surgeons Predicted Risk of Mortality were 80.7 ± 8.8 years and 6.6 ± 3.7%, respectively. Predictors of NDD were male sex (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.28 to 3.18), absence of atrial fibrillation (OR: 1.62; 95% CI: 1.02 to 2.57), serum creatinine (OR: 0.71; 95% CI: 0.55 to 0.92), and age (OR: 0.95; 95% CI: 0.93 to 0.98). As expected, 84% of patients with complications had non-NDD. After excluding cases with complications, there was no difference in hazard rates of the 30-day composite outcome between NDD and non-NDD (hazard ratio: 0.62; 95% CI: 0.20 to 1.91), but the hazard of the composite outcome at 1 year was significantly lower in the NDD group (hazard ratio: 0.47; 95% CI: 0.27 to 0.81). This difference in the composite outcome can be explained by the lower hazard of noncardiovascular related readmission in the NDD group. Conclusions Factors predicting NDD include male sex, absence of atrial fibrillation, lower serum creatinine, and younger age. When compared with patients without complications with a longer hospital stay, NDD appears to be safe, achieving similar 30-day and superior 1-year clinical outcomes.
- Published
- 2018
- Full Text
- View/download PDF
13. Assessment of Commonly Used Frailty Markers for High- and Extreme-Risk Patients Undergoing Transcatheter Aortic Valve Replacement
- Author
-
James Stewart, Bradley G. Leshnower, Nnaemeka M. Ndubisi, Vinod H. Thourani, Jose F. Condado, Paul Khairy, Yi-An Ko, Vasilis Babaliaros, Chandan Devireddy, Michael Yuan, Robert A. Guyton, Louis P. Perrault, Jose N. Binongo, John J. Kelly, and Jessica Forcillo
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Activities of daily living ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Logistic regression ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Activities of Daily Living ,medicine ,Risk of mortality ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Stroke ,Serum Albumin ,Aged ,Retrospective Studies ,Aged, 80 and over ,Exercise Tolerance ,Frailty ,Hand Strength ,business.industry ,Patient Selection ,Retrospective cohort study ,Aortic Valve Stenosis ,medicine.disease ,Logistic Models ,Treatment Outcome ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Abstract
Background The effect of frailty on outcomes after transcatheter aortic valve replacement (TAVR) remains incompletely understood. The objective of this study was to evaluate the performance of four commonly used frailty markers as predictors of early and late outcomes among patients undergoing TAVR. Methods A review was performed of 361 high- and extreme-risk patients undergoing TAVR from 2011 to 2015. Four frailty variables were assessed: serum albumin (g/dL), 5-m walk (seconds), grip strength (kg), and Katz index of independence in activities of daily living. Logistic regression was used to examine the association between the frailty indicators and 30-day composite of mortality, stroke, new heart block requiring permanent pacemaker, major or life-threatening bleeding, acute renal failure, major vascular complication, and 30-day readmission rate. Minimum distance to the perfect point (0, 1) was performed to delineate a cutoff point for each frailty indicator, and risk models were compared using receiver-operating characteristics curves. Results The composite of outcomes occurred in 28% of patients. Serum albumin, activities of daily living, and 5-m walk were independent predictors for 30-day composite outcomes, but only albumin was predictive of 30-day mortality. A new frailty model (four frailty indicators, age, and sex) to predict 30-day mortality was created and compared with The Society of Thoracic Surgeons predicted risk of mortality. Better discrimination was found with the new frailty model (area under the curve 0.74 versus 0.58). New individual frailty variable cutoff values were found to predict our composite of events. Conclusions Among high- and extreme-risk patients undergoing TAVR, our new frailty model was more discriminative of 30-day mortality than The Society of Thoracic Surgeons predicted risk of mortality. New cutoff values for frailty indicators were identified and will require further validation.
- Published
- 2017
- Full Text
- View/download PDF
14. Readmission rates after transcatheter aortic valve replacement in high- and extreme-risk patients with severe aortic stenosis
- Author
-
Paul Khairy, Peter C. Block, Yi Lasanajak, Hope Caughron, Robert A. Guyton, Patricia Keegan, Jose F. Condado, Bradley G. Leshnower, Jose N. Binongo, Vinod H. Thourani, Jessica Forcillo, Amy Simone, Vasilis Babaliaros, and Chandan Devireddy
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Anemia ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Patient Readmission ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Risk Factors ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Aortic Valve Stenosis ,medicine.disease ,Confidence interval ,Cardiac surgery ,Acute Disease ,Cohort ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective In high- or extreme-risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30-day and 1-year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1-year mortality. Methods A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University. Results Patients' median age was 83 years, and 46.6% were female. Early all-cause readmission for the cohort was 10.5%, and late readmission was 18.8%. Anemia was related to both early all-cause (hazard ratio [HR], 0.74) and cardiovascular-related readmission (HR, 0.60). A 23-mm valve implanted was associated with early all-cause readmission (HR, 1.73). Length of hospital stay was related to late all-cause (HR, 1.14) and cardiovascular-related readmission (HR, 1.21). Postoperative permanent stroke had an impact on late cardiovascular-related readmission (HR, 3.60; 95% confidence interval, 1.13-11.49). Multivariable analysis identified anemia as being associated with 30-day all-cause readmission, and anemia and postoperative stroke were associated with 30-day cardiovascular-related readmission. Readmissions seemed to be related to 1-year mortality (HR, 2.04; 95% confidence interval, 1.33-3.12). Conclusions We show some baseline comorbidities and procedural complications that are directly associated with early and late readmissions, and anemia and postoperative stroke were associated with an increase in mortality. Moreover, we found that readmission was associated with double the hazard of death within 1 year. Whether treatment of identified risk factors could decrease readmission rates and mortality warrants further investigation.
- Published
- 2017
- Full Text
- View/download PDF
15. Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement: Comparing Transthoracic versus Transesophageal Echocardiographic Guidance
- Author
-
Frank Corrigan, Stamatios Lerakis, Shuang Lin, Vasilis Babaliaros, Sharon Howell, Salim S. Hayek, James MacNamara, Vinod H. Thourani, Patricia Keegan, Jose F. Condado, and Shuai Zheng
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Georgia ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Comorbidity ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,law.invention ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Valve replacement ,Randomized controlled trial ,Risk Factors ,law ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Retrospective Studies ,Cardiac catheterization ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Incidence ,Incidence (epidemiology) ,Aortic Valve Stenosis ,Odds ratio ,Intensive care unit ,Surgery ,Causality ,Survival Rate ,body regions ,Treatment Outcome ,Surgery, Computer-Assisted ,Echocardiography ,Cardiology ,Hybrid operating room ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern.We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared.The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P = .326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P .001) during the procedure. Although not independently associated with PVR at discharge (odds ratio = 1.12; 95% CI, 0.69-1.79), TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups.TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR.
- Published
- 2017
- Full Text
- View/download PDF
16. Anatomical risk models for paravalvular leak and landing zone complications for balloon-expandable transcatheter aortic valve replacement
- Author
-
Jose N. Binongo, Frank Corrigan, Stamatios Lerakis, Kreton Mavromatis, Bradley G. Leshnower, Vinod H. Thourani, Ioannis Parastatidis, Chandan Devireddy, Peter C. Block, Jessica Forcillo, Vasilis Babaliaros, Robert A. Guyton, James Stewart, Ateet Patel, Arthur E. Stillman, and Jose F. Condado
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Area under the curve ,General Medicine ,030204 cardiovascular system & hematology ,Surgery ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Balloon expandable stent ,Valve replacement ,Landing zone ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Paravalvular leak ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed. Methods Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated. Results A total of 316 consecutive TAVR patients were included. Median age was 82.0 years (74.0–87.0) and STS score was 8.3% (5.4–10.9). Factors associated with ≥mild PVL included TAVR with Sapien/Sapien XT vs. Sapien 3 (OR = 2.50, 95% CI = 1.24–5.07), LVOT nontubularity (OR = 1.02, 95% CI = 1.01–1.04), LZ calcification (OR = 1.01, 95% CI = 1.00–1.01), and low cover index (OR = 0.94, 95% CI = 0.91–0.96). Factors associated with LZ complications included LZ calcification (OR = 1.01, 95% CI 1.00–1.01), leaflet asymmetry (OR = 1.01, 95% CI 1.01–1.02), and cover index (OR = 1.09, 95% CI 1.03–1.14). Predictive models for ≥mild PVL (AUC = 0.71, 95% CI = 0.66–0.77), ≥moderate PVL (AUC = 0.75, 95% CI = 0.65–0.84), and LZ complications (AUC = 0.77, 95% CI = 0.67–0.87) were created using procedural details and anatomical data from the MDCT. Clinical variables were not included as they were poorly correlated with the occurrence of PVL and LZ complications. For each outcome, the area under the curve (AUC) of the multivariate model was superior to the model consisting only of individual factors. Conclusions A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR. © 2017 Wiley Periodicals, Inc.
- Published
- 2017
- Full Text
- View/download PDF
17. Long or redundant leaflet complicating transcatheter mitral valve replacement: Case vignettes that advocate for removal or reduction of the anterior mitral leaflet
- Author
-
Gaetano Paone, Dennis W. Kim, Dee Dee Wang, Stamatios Lerakis, Marvin H. Eng, Vinod H. Thourani, Vasilis C. Babaliaros, Adam Greenbaum, Robert J. Lederman, Jose F. Condado, and William O' Neill
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Case vignette ,Ventricular Outflow Obstruction ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Mitral valve ,medicine ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Cardiac catheterization ,business.industry ,Mitral valve replacement ,General Medicine ,Surgery ,medicine.anatomical_structure ,Anterior mitral leaflet ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter mitral valve replacement (TMVR) procedures can be an alternative to surgical valve replacement for high surgical risk patients with bioprosthetic mitral valves, annuloplasty rings, or severe mitral annular calcification (MAC). TMVR can trigger acute left ventricular outflow tract (LVOT) obstruction from permanent displacement of the native anterior mitral leaflet toward the left ventricular septum, more often among patients undergoing valve-in-ring and valve-in-MAC procedures. Although acute LVOT obstruction is well described in the literature, there are important additional complications of TMVR related to the length and/or redundancy of the anterior mitral valve that have been recognized after mitral valve surgery and have not been previously reported in the setting of TMVR. These additional complications include acute mitral regurgitation secondary to prolapsing native leaflet through the TMVR, frozen TMVR leaflet secondary to overhanging native leaflet and late LVOT obstruction in the neo-LVOT secondary to long native leaflet. Preprocedural planning with imaging (echocardiography and computed tomography) and measurement of anterior mitral leaflet length is critical important in understanding the risk for these complications. As transcatheter mitral valve technology proliferates, interactions with the anterior mitral leaflet after TMVR may be more frequent than initially anticipated. We believe that there is no advantage to an intact anterior leaflet and advocate removal or reduction of the leaflet prior to TMVR. © 2017 Wiley Periodicals, Inc.
- Published
- 2017
- Full Text
- View/download PDF
18. Outcomes After Paravalvular Leak Closure
- Author
-
Stamatios Lerakis, Ateet Patel, Jose F. Condado, John A. Wells, Jessica Forcillo, Stephen D. Clements, Andrew J. Ritter, Andy Dong, Norihiko Kamioka, Robert A. Guyton, Vinod H. Thourani, Peter C. Block, Bradley G. Leshnower, Vasilis Babaliaros, and James Stewart
- Subjects
medicine.medical_specialty ,Surgical approach ,business.industry ,medicine.medical_treatment ,Background data ,Retrospective cohort study ,Prom ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Valve replacement ,Medicine ,Endocarditis ,030212 general & internal medicine ,Paravalvular leak ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL). Background Data comparing the treatment of PVL with TI and SI are limited. Methods A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure–related symptoms at 1 year. Results Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p Conclusions In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions.
- Published
- 2017
- Full Text
- View/download PDF
19. Should We Perform Carotid Doppler Screening Before Surgical or Transcatheter Aortic Valve Replacement?
- Author
-
Chandan Devireddy, Kreton Mavromatis, Vinod H. Thourani, Bradley G. Leshnower, Patricia Keegan, Jose F. Condado, James A. Stewart, Robert A. Guyton, Amy Simone, Eric L. Sarin, Lillian L. Tsai, Aneel Maini, Vasilis C. Babaliaros, Yi-An Ko, Peter C. Block, Mohammad H. Rajaei, Michael E. Halkos, Hanna A. Jensen, and Edward P. Chen
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,Humans ,Medicine ,Carotid Stenosis ,030212 general & internal medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ejection fraction ,business.industry ,Ultrasonography, Doppler ,Atrial fibrillation ,Retrospective cohort study ,medicine.disease ,Surgery ,Stenosis ,Logistic Models ,medicine.anatomical_structure ,Regional Blood Flow ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Carotid Artery, Internal ,Artery - Abstract
Background Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear. Methods We retrospectively reviewed patients with artery stenosis who underwent ICAS screening before surgical (SAVR) or transcatheter aortic valve replacement (TAVR) between January 2007 and August 2014. Logistic regression models were used to determine the relation between post-procedure stroke and total (sum of left and right ICAS) and maximal unilateral ICAS. Age, sex, history of atrial fibrillation, cerebrovascular disease and diabetes, left ventricular ejection fraction, and procedure type were considered as covariates. Two-subgroup analyses were performed in patients who underwent TAVR and SAVR, adjusting for procedure specific details. Results A total of 996 patients underwent ICAS screening before TAVR (n = 467) or SAVR (n = 529). The prevalence of at least ≥70% ICAS was 5.2% (n = 52) and incidence of 30-day stroke was 3.4% (n = 34). Eight patients who underwent carotid intervention before valve replacement and 6 patients with poor Doppler images were excluded from the final analysis. We found no statistically significant association between stroke and either the total or maximal unilateral ICAS for all patients ( p = 0.13 and p = 0.39, respectively) or those undergoing TAVR ( p = 0.27 and p = 0.63, respectively) or SAVR ( p = 0.21 and p = 0.36, respectively). Conclusions We found no statistically significant association between ICAS severity procedure-related stroke after aortic valve replacement. This suggests that universal carotid Doppler screening before isolated TAVR or SAVR is unnecessary.
- Published
- 2017
- Full Text
- View/download PDF
20. End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?
- Author
-
Vinod H. Thourani, Patricia Keegan, Amy Simone, Jose F. Condado, Eric L. Sarin, Peter C. Block, Vasilis Babaliaros, Robert A. Guyton, James Stewart, Aneel Maini, Kreton Mavromatis, Bradley G. Leshnower, Chandan Devireddy, Jessica Forcillo, and Stamatios Lerakis
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Aortic valvuloplasty ,Surgery ,End stage renal disease ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,Aortic valve stenosis ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Dialysis - Abstract
Background Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Results Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=
- Published
- 2017
- Full Text
- View/download PDF
21. A single healthcare experience with Impella RP
- Author
-
Nikoloz Shekiladze, Habib Samady, Jeong Hwan Kim, Michael C. McDaniel, Jose F. Condado, Gautam Kumar, Wissam Jaber, Chandan Devireddy, Pratik B. Sandesara, and Vasilis Babaliaros
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Shock, Cardiogenic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,Myocardial infarction ,Survival rate ,Impella ,Retrospective Studies ,business.industry ,Cardiogenic shock ,General Medicine ,medicine.disease ,Pulmonary embolism ,Treatment Outcome ,Ventricular assist device ,Shock (circulatory) ,Cardiology ,Heart-Assist Devices ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care - Abstract
Objectives To understand the predictors of survival and indications for Impella RP in a single healthcare experience. Background The Impella RP can be used to temporarily support patients with right ventricular (RV) dysfunction after left ventricular assist device (LVAD) placement or myocardial infarction (MI). However, recent postmarket approval data have raised concerns of higher than expected mortality with this device. Methods A retrospective chart review and analysis of all patients that underwent Impella RP placement in the Emory Healthcare system between January 2016 and December 2018 were performed. Patients were classified according to the indication. Results A total of 39 patients underwent Impella RP placement. Six patients were post-LVAD, 9 were implanted for massive pulmonary embolism with persistent shock, 8 for postcardiac surgery RV failure (non-LVAD), 11 for RV failure post-MI, and 5 for new or worsening nonischemic cardiomyopathy. The worst survival was noted in MI-related cardiogenic shock group and in patients who presented with cardiac arrest (3/12). All observed deaths were due to persistent refractory shock. There was no device related death. Survival improved during the last year of experience compared to the first 2 years. Conclusion This study supports the selective use of the Impella RP, with a higher than national reported survival rate (49% vs. 28.6%). Indication appears to be an important factor determining survival.
- Published
- 2020
22. Impact of Kidney Disease on Catheter-Based Mitral Valve Interventions
- Author
-
Vasilis Babaliaros, Nikoloz Koshkelashvili, and Jose F. Condado
- Subjects
medicine.medical_specialty ,business.industry ,MitraClip ,Psychological intervention ,Disease ,medicine.disease ,Catheter ,medicine.anatomical_structure ,Mitral valve ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,cardiovascular diseases ,business ,Valve disease ,Kidney disease - Abstract
Mitral valve disease is the most common valve disease in patients with chronic kidney disease (CKD). In these patients, increased dysfunction of the mitral valve apparatus is caused by an altered physiologic state, endothelial repetitive injury, and inflammation.
- Published
- 2020
- Full Text
- View/download PDF
23. Characteristics and Outcomes of Pulmonary Angioplasty With or Without Stenting for Sarcoidosis-Associated Pulmonary Hypertension: Systematic Review and Individual Participant Data Meta-Analysis
- Author
-
Jose F. Condado, Jose Tafur-Soto, William Bracamonte-Baran, Vasilis Babaliaros, Stacy A. Mandras, and Adrian daSilva-deAbreu
- Subjects
Male ,medicine.medical_specialty ,Sarcoidosis ,Hypertension, Pulmonary ,medicine.medical_treatment ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,Internal medicine ,medicine ,Humans ,Multicenter Studies as Topic ,030212 general & internal medicine ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Clinical trial ,Stenosis ,Meta-analysis ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Vascular Stenosis - Abstract
Background: Pulmonary angioplasty has been performed in patients with sarcoidosis-associated pulmonary hypertension (SAPH) but most evidence comes from case reports and small case series. Overall outcomes remain unclear. We conducted an individual participant data (IPD) meta-analysis of baseline, procedural, and outcome data of pulmonary angioplasty in patients with SAPH. Methods: We performed searches and systematically reviewed references from PubMed, Embase, Cochrane, ClinicalTrials.gov, and grey literature. We included IPD of patients who underwent pulmonary angioplasty for SAPH. Those without definitive diagnosis of sarcoidosis or with other causes of pulmonary vascular stenosis or compression were excluded. Results: Of 1293 screened references, 7 were included. IPD was obtained for 17 patients (median age 60 (55-65) years; 82.4% female); most of whom were Scadding stages III or IV and had NYHA FC III or IV. All patients with documented changes in 6-minute-walk distance (6MWD) had a significant improvement that ranged from 12.6 to 102.4% (P < 0.01). There were no deaths during a median follow-up of 6 (3-18) months. Conclusions: Pulmonary angioplasty with or without stenting of focal stenosis or compressions of pulmonary vessels may lead to significant improvement in 6MWD in patients with SAPH. However, this study had a small sample and some methodological limitations, such as analysis mostly of case reports and series. Randomized controlled clinical trials and/or large multicenter registry studies are needed to provide higher evidence in this topic.
- Published
- 2021
- Full Text
- View/download PDF
24. Aortic Regurgitation Generates a Kinematic Obstruction Which Hinders Left Ventricular Filling
- Author
-
Ajit P. Yoganathan, Vrishank Raghav, Ikechukwu Okafor, Gautam Kumar, Prem A. Midha, and Jose F. Condado
- Subjects
Aortic valve ,medicine.medical_specialty ,Swine ,Heart Ventricles ,Aortic Valve Insufficiency ,Biomedical Engineering ,Diastole ,Kinematics ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Ventricular Outflow Obstruction ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Internal medicine ,medicine ,Animals ,Physics ,Jet (fluid) ,Models, Cardiovascular ,Biomechanical Phenomena ,medicine.anatomical_structure ,Particle image velocimetry ,Ventricle ,Cardiology ,Blood Flow Velocity - Abstract
An incompetent aortic valve (AV) results in aortic regurgitation (AR), where retrograde flow of blood into the left ventricle (LV) is observed. In this work, we parametrically characterized the detailed changes in intra-ventricular flow during diastole as a result of AR in a physiological in vitro left-heart simulator (LHS). The loss of energy within the LV as the level of AR increased was also assessed. The validated LHS consisted of an optically-clear, flexible wall LV and a modular AV holder. Two-component, planar, digital particle image velocimetry was used to visualize and quantify intra-ventricular flow. A large coherent vortical structure which engulfed the whole LV was observed under control conditions. In the cases with AR, the regurgitant jet was observed to generate a “kinematic obstruction” between the mitral valve and the LV apex, preventing the trans-mitral jet from generating a coherent vortical structure. The regurgitant jet was also observed to impinge on the inferolateral wall of the LV. Energy dissipation rate (EDR) for no, trace, mild, and moderate AR were found to be 1.15, 2.26, 3.56, and 5.99 W/m3, respectively. This study has, for the first time, performed an in vitro characterization of intra-ventricular flow in the presence of AR. Mechanistically, the formation of a “kinematic obstruction” appears to be the cause of the increased EDR (a metric quantifiable in vivo) during AR. EDR increases non-linearly with AR fraction and could potentially be used as a metric to grade severity of AR and develop clinical interventional timing strategies for patients.
- Published
- 2017
- Full Text
- View/download PDF
25. Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease?
- Author
-
Robert A. Guyton, Hope Caughron, Peter C. Block, James Stewart, Chandan Devireddy, Kreton Mavromatis, Bradley G. Leshnower, Patricia Keegan, Ateet Patel, Jose F. Condado, Moosa Haider, Jessica Forcillo, Eric L. Sarin, Amy Simone, Vinod H. Thourani, Stamatios Lerakis, and Vasilis Babaliaros
- Subjects
COPD ,medicine.medical_specialty ,Multivariate analysis ,Transcatheter aortic ,business.industry ,Sedation ,medicine.medical_treatment ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Severe chronic obstructive pulmonary disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Valve replacement ,Internal medicine ,Cohort ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objectives To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD). Background TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown. Methods We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% ≤50) who underwent minimalist vs. standard TF-TAVR between 2008 and 2015 at our institution. Results Of 88 patients with severe COPD, 46 underwent minimalist and 42 underwent standard TF-TAVR. There were no differences on baseline characteristics, except for more history of coronary artery bypass grafting (45.5% vs. 20.6%, P = 0.03) and less history of cerebrovascular disease (16.7% vs. 45.5%, P = 0.03) in the standard TF-TAVR. Seventeen minimalist TF-TAVR patients (41.0%) were transferred directly to the general medical ward with telemetry monitoring (without ICU stay); all standard TF-TAVR patients went to the ICU. Minimalist TF-TAVR patients had shorter procedure time (97 vs. 129 min, P
- Published
- 2016
- Full Text
- View/download PDF
26. Transcatheter Aortic Valve Replacement in the USA
- Author
-
Hanna A. Jensen, Jose F. Condado, and Vinod H. Thourani
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,medicine.disease ,Surgical risk ,Direct flow ,Surgery ,Clinical trial ,Stenosis ,Valve replacement ,Aortic valve replacement ,medicine ,In patient ,business - Abstract
Transcatheter aortic valve replacement (TAVR) is the preferred treatment for severe aortic stenosis (AS) in patients considered to be extreme-risk surgical risk and is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Currently, the balloon-expandable SAPIEN valve and the self-expanding CoreValve are approved for TAVR in the USA. An additional four TAVR valves (Lotus, Portico, Direct Flow, and JenaValve) are in clinical trials in the USA.
- Published
- 2019
- Full Text
- View/download PDF
27. Radioprotective strategies for interventional echocardiographers during structural heart interventions
- Author
-
Jose F. Condado, Vasilis Babaliaros, Frank Corrigan, Norihiko Kamioka, Vinod H. Thourani, Jose Miguel Iturbe, Stephen D. Clements, Sharon Howell, Michael J. Hall, and Stamatios Lerakis
- Subjects
medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,Heart Diseases ,Psychological intervention ,030204 cardiovascular system & hematology ,Radiation Dosage ,Radiography, Interventional ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Radiation Protection ,Risk Factors ,Internal medicine ,Mitral valve ,Occupational Exposure ,Radiologists ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Paravalvular leak ,Radiation Injuries ,Occupational Health ,Ultrasonography, Interventional ,business.industry ,Radiation dose ,Total body ,General Medicine ,Radiation Exposure ,Occupational Injuries ,Radiation exposure ,medicine.anatomical_structure ,Radiation shielding ,Echocardiography ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC). Background Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE. Methods We monitored 32 structural interventions - 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding. Results Mean doses were higher for the primary IC than the primary IE: IC#1-99, 222, 378; IE#1-48, 52, 416 (body, lens, and hand doses in μSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE-guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE-guided procedures (IC#1 294 vs. IE#1 676 μSv). In a subgroup using radioprotective drapes during TTE-guided TAVR, IC dose was reduced without effect on the IE. Conclusions Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.
- Published
- 2018
28. Transcatheter Mitral Valve-in-Valve Therapy
- Author
-
Brian Kaebnick, Jose F. Condado, and Vasilis Babaliaros
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Transesophageal echocardiogram ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Cardiac computed tomography angiography ,Internal medicine ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Embolization ,Heart Valve Prosthesis Implantation ,medicine.diagnostic_test ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,Treatment Outcome ,medicine.anatomical_structure ,Landing zone ,cardiovascular system ,Access site ,Cardiology ,Mitral Valve ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business - Abstract
Valve-in-valve and valve-in-ring transcatheter mitral valve replacement can be used in for the treatment of inoperable patients with failing mitral surgical bioprosthesis or valve repairs. Preprocedural multi-image evaluation by a heart team must include transthoracic echocardiogram, transesophageal echocardiogram, and cardiac computed tomography angiography (CTA). CTA is used to determine access site (transapical, transseptal, or transatrial), transcatheter valve size, and landing zone. Though complications can occur (ie, valve embolization, bleeding, or vascular complications), this less invasive procedure has a reported success rate of 70% to 100% and is now increasingly used.
- Published
- 2016
- Full Text
- View/download PDF
29. How Can We Help a Patient With a Small Failing Bioprosthesis?
- Author
-
Ajit P. Yoganathan, Jose F. Condado, Prem A. Midha, Domingo E. Uceda, Vrishank Raghav, Sivakkumar Arjunon, Stamatios Lerakis, Vasilis Babaliaros, and Vinod H. Thourani
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,Hemodynamics ,medicine.disease ,Thrombosis ,Surgery ,Pulse duplicator ,medicine.anatomical_structure ,Valve replacement ,medicine ,Embolization ,Heart valve ,business ,Cardiology and Cardiovascular Medicine ,Reduction (orthopedic surgery) - Abstract
Objectives The aim of this study was to investigate the hemodynamic performance of a transcatheter heart valve (THV) deployed at different valve-in-valve positions in an in vitro model using a small surgical bioprosthesis. Background Patients at high surgical risk with failing 19-mm surgical aortic bioprostheses are not candidates for valve-in-valve transcatheter aortic valve replacement, because of risk for high transvalvular pressure gradients (TVPGs) and patient-prosthesis mismatch. Methods A 19-mm stented aortic bioprosthesis was mounted into the aortic chamber of a pulse duplicator, and a 23-mm low-profile balloon-expandable THV was deployed (valve-in-valve) in 4 positions: normal (bottom of the THV stent aligned with the bottom of the surgical bioprosthesis sewing ring) and 3, 6, and 8 mm above the normal position. Under controlled hemodynamic status, the effect of these THV positions on valve performance (mean TVPG, geometric orifice area, and effective orifice area), thrombotic potential (sinus shear stress), and migration risk (pullout force and embolization flow rate) were assessed. Results Compared with normal implantation, a progressive reduction of mean TVPG was observed with each supra-annular THV position (normal: 33.10 mm Hg; 3 mm: 24.69 mm Hg; 6 mm: 19.16 mm Hg; and 8 mm: 12.98 mm Hg; p Conclusions Supra-annular implantation of a THV in a small surgical bioprosthesis reduces mean TVPG but may increase the risk for leaflet thrombosis and valve migration. A 3- to 6-mm supra-annular deployment could be an optimal position in these cases.
- Published
- 2015
- Full Text
- View/download PDF
30. Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access?
- Author
-
Stamatios Lerakis, Robert A. Guyton, Lillian L. Tsai, Kreton Mavromatis, Bradley G. Leshnower, James Stewart, Peter C. Block, Patricia Keegan, Jose F. Condado, Chandan Devireddy, Mohammad H. Rajaei, Amjadullah Q. Syed, Eric L. Sarin, Vasilis Babaliaros, Amy Simone, Ayaz Rahman, Jose N. Binongo, Vinod H. Thourani, Hanna A. Jensen, and Brian Kaebnick
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiology ,law.invention ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Interquartile range ,law ,Risk of mortality ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Thoracic Surgery ,Retrospective cohort study ,Intensive care unit ,Surgery ,Femoral Artery ,medicine.anatomical_structure ,Cardiothoracic surgery ,Female ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Learning Curve - Abstract
Background A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience. Methods We retrospectively reviewed 151 consecutive patients who underwent MA-TAVR with surgeons and interventionists equally as primary operator at Emory University between May 2012 and July 2014. Our institution had performed 300 TAVR procedures before implementation of MA-TAVR. Patient characteristics and early outcomes were compared using Valve Academic Research Consortium 2 definitions among 3 groups: group 1 included the first 50 patients, group 2 included patients 51 to 100, and group 3 included patients 101 to 151. Results Median age for all patients was 84 years and similar among groups. The majority of patients were men (56%) and the median ejection fraction for all patients was 55% (interquartile range, 38.0%-60.0%). The majority of patients were high-risk surgical candidates with a median Society of Thoracic Surgeons Predicted Risk of Mortality of 10.0% and similar among groups. The overall major stroke rate was 3.3%, major vascular complications occurred in 3% of patients, and greater-than-mild paravalvular leak rate was 7%. In-hospital mortality and morbidity were similar among all 3 groups. Conclusions In a high-volume TAVR center, transition to MA-TAVR is feasible with acceptable outcomes and a diminutive procedural learning curve. We advocate for TAVR centers to actively pursue the minimalist technique with equal representation by cardiologists and surgeons.
- Published
- 2015
- Full Text
- View/download PDF
31. Percutaneous tricuspid valve-In-ring replacement for the treatment of recurrent severe tricuspid regurgitation
- Author
-
Jose F. Condado, Robert Leonardi, and Vasilis Babaliaros
- Subjects
medicine.medical_specialty ,Tricuspid valve ,Percutaneous ,business.industry ,General Medicine ,Regurgitation (circulation) ,Surgery ,medicine.anatomical_structure ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Paravalvular leak ,Cardiology and Cardiovascular Medicine ,business - Abstract
Percutaneous tricuspid valve-in-ring replacement can be an alternative to surgery for high-risk patients with symptomatic severe tricuspid regurgitation that recurs after surgical ring repair. Practitioners must pay attention to the specific technical details associated with this procedure that include: using the ring as a fluoroscopic landmark, sizing the valve area with multi-modality imaging, choosing the appropriate device based on the patients anatomy, and dealing with the inevitable paravalvular leak (created by the ring deformation in the absence of valve-specific devices). Our case demonstrates that percutaneous tricuspid valve-in-ring replacement is a feasible treatment that can result in both hemodynamic and symptomatic improvement.
- Published
- 2015
- Full Text
- View/download PDF
32. A complex transcatheter mitral valve replacement and repair for the treatment of refractory severe mitral regurgitation
- Author
-
Peter C. Block, Vasilis Babaliaros, Dennis W. Kim, Jose F. Condado, Vinod H. Thourani, Stamatios Lerakis, Hanna K. Jensen, and Brian Kaebnick
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Cardiac Catheterization ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Valve in ring ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Mitral valve ,Internal medicine ,Mitral valve annuloplasty ,medicine ,Humans ,Valve-in-ring ,Aged ,Cardiac catheterization ,Medicine(all) ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,Valve in valve ,medicine.anatomical_structure ,030228 respiratory system ,lcsh:RC666-701 ,Cardiology ,Valve-in-valve ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Transcatheter mitral valve replacement ,Echocardiography, Transesophageal - Published
- 2016
- Full Text
- View/download PDF
33. The Fluid Mechanics of Transcatheter Heart Valve Leaflet Thrombosis in the Neosinus
- Author
-
Rahul Sharma, Ajit P. Yoganathan, Ikechukwu Okafor, Vrishank Raghav, Tanya Rami, Vinod H. Thourani, Prem A. Midha, Vasilis Babaliaros, Raj Makkar, Hasan Jilaihawi, Jose F. Condado, and Gautam Kumar
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Heart Valve Leaflet ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Heart valve ,Thrombus ,business.industry ,Hemodynamics ,Models, Cardiovascular ,Thrombosis ,medicine.disease ,Heart Valves ,Surgery ,medicine.anatomical_structure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Transcatheter heart valve (THV) thrombosis has been increasingly reported. In these studies, thrombus quantification has been based on a 2-dimensional assessment of a 3-dimensional phenomenon. Methods: Postprocedural, 4-dimensional, volume-rendered CT data of patients with CoreValve, Evolut R, and SAPIEN 3 transcatheter aortic valve replacement enrolled in the RESOLVE study (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Dysfunction With Multimodality Imaging and Its Treatment with Anticoagulation) were included in this analysis. Patients on anticoagulation were excluded. SAPIEN 3 and CoreValve/Evolut R patients with and without hypoattenuated leaflet thickening were included to study differences between groups. Patients were classified as having THV thrombosis if there was any evidence of hypoattenuated leaflet thickening. Anatomic and THV deployment geometries were analyzed, and thrombus volumes were computed through manual 3-dimensional reconstruction. We aimed to identify and evaluate risk factors that contribute to THV thrombosis through the combination of retrospective clinical data analysis and in vitro imaging in the space between the native and THV leaflets (neosinus). Results: SAPIEN 3 valves with leaflet thrombosis were on average 10% further expanded (by diameter) than those without (95.5±5.2% versus 85.4±3.9%; P R 2 =0.7, P Conclusions: Although transcatheter aortic valve replacement thrombosis is a multifactorial process involving foreign materials, patient-specific blood chemistry, and complex flow patterns, our study indicates that deployed THV geometry may have implications on the occurrence of thrombosis. In addition, a supraannular neosinus may reduce thrombosis risk because of reduced flow stasis. Although additional prospective studies are needed to further develop strategies for minimizing thrombus burden, these results may help identify patients at higher thrombosis risk and aid in the development of next-generation devices with reduced thrombosis risk.
- Published
- 2017
34. Unmasking the Effect of Obesity on Aortic Valve Replacement
- Author
-
Kreton Mavromatis and Jose F. Condado
- Subjects
medicine.medical_specialty ,Aortic valve replacement ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Obesity - Published
- 2018
- Full Text
- View/download PDF
35. First-in-Man Study of the Low-Dose Paclitaxel Using the COBRA-P Drug-Eluting Coronary Stent System With a Novel Biodegradable Coating in De Novo Coronary Lesions
- Author
-
Jose A. Condado, Katsuhisa Waseda, Yasuhiro Honda, Carlos Calderas, Junya Ako, Jose F. Condado, Peter J. Fitzgerald, and Daisaku Nakatani
- Subjects
Neointimal hyperplasia ,medicine.medical_specialty ,First-in-man study ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,General Medicine ,medicine.disease ,Surgery ,Lesion ,chemistry.chemical_compound ,Paclitaxel ,chemistry ,Drug-eluting stent ,Coronary stent ,Intravascular ultrasound ,medicine ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Objective The aim of this first-in-man trial was to evaluate vessel response of two doses of the balloon expandable Cobra-P drug-eluting coronary stent (DES). Background The Cobra-P DES system consists of a cobalt chromium alloy with bioabsorbable siloxane sol–gel matrix coating that elutes low dose paclitaxel. Methods A total of 60 lesions (54 patients) were sequentially assigned to extremely low-dose (group A: 3.7 µg/18 mm; n = 30, 1/33 dose of the TAXUS Liberte) or low-dose (group B: 8 µg/18 mm; n = 30) arm. Intravascular ultrasound images were obtained at post-procedure and at 4 months. Results Patient and lesion characteristics were matched between the two groups except for the higher prevalence of men in group B. At 4 months, there were no significant differences in neointimal obstruction (13.5 ± 9.5% vs. 10.9 ± 7.8%, P = 0.276), and maximum cross-sectional narrowing (31.2 ± 14.3% vs. 28.6 ± 16.1%, P = 0.523) between the two groups. Late-acquired incomplete stent apposition occurred in four cases in each arm (P = 1.000). Although the volume of late-acquired incomplete stent apposition did not differ between the two groups (1.0 ± 0.6 mm3 vs. 8.6 ± 10.9 mm3, P = 0.200), maximum late-acquired incomplete stent apposition area was significantly smaller in group A than in group B (1.1 ± 0.3 mm2 vs. 2.5 ± 1.4 mm2, P = 0.029). Conclusions In the first-in-man study of the Cobra-P DES, neointimal hyperplasia at 4 months appears to be similar between extremely low-dose and low-dose groups. Although the incidence of late-acquired incomplete stent apposition was similar, the magnitude of the late-acquired gap between the stent and vessel was greater in the low-dose group compared with the extremely low-dose group. © 2013 Wiley Periodicals, Inc.
- Published
- 2014
- Full Text
- View/download PDF
36. Gender inequalities in transcatheter aortic valve replacement: The jury is still out
- Author
-
Jose F, Condado and Peter C, Block
- Subjects
Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Socioeconomic Factors ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Aortic Valve Stenosis - Published
- 2017
37. Anatomical risk models for paravalvular leak and landing zone complications for balloon-expandable transcatheter aortic valve replacement
- Author
-
Jose F, Condado, Frank E, Corrigan, Stamatios, Lerakis, Ioannis, Parastatidis, Arthur E, Stillman, Jose N, Binongo, James, Stewart, Kreton, Mavromatis, Chandan, Devireddy, Bradley, Leshnower, Robert, Guyton, Jessica, Forcillo, Ateet, Patel, Vinod H, Thourani, Peter C, Block, and Vasilis, Babaliaros
- Subjects
Aged, 80 and over ,Balloon Valvuloplasty ,Male ,Aortic Valve Insufficiency ,Clinical Decision-Making ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,Logistic Models ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Multidetector Computed Tomography ,Multivariate Analysis ,Odds Ratio ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed.Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated.A total of 316 consecutive TAVR patients were included. Median age was 82.0 years (74.0-87.0) and STS score was 8.3% (5.4-10.9). Factors associated with ≥mild PVL included TAVR with Sapien/Sapien XT vs. Sapien 3 (OR = 2.50, 95% CI = 1.24-5.07), LVOT nontubularity (OR = 1.02, 95% CI = 1.01-1.04), LZ calcification (OR = 1.01, 95% CI = 1.00-1.01), and low cover index (OR = 0.94, 95% CI = 0.91-0.96). Factors associated with LZ complications included LZ calcification (OR = 1.01, 95% CI 1.00-1.01), leaflet asymmetry (OR = 1.01, 95% CI 1.01-1.02), and cover index (OR = 1.09, 95% CI 1.03-1.14). Predictive models for ≥mild PVL (AUC = 0.71, 95% CI = 0.66-0.77), ≥moderate PVL (AUC = 0.75, 95% CI = 0.65-0.84), and LZ complications (AUC = 0.77, 95% CI = 0.67-0.87) were created using procedural details and anatomical data from the MDCT. Clinical variables were not included as they were poorly correlated with the occurrence of PVL and LZ complications. For each outcome, the area under the curve (AUC) of the multivariate model was superior to the model consisting only of individual factors.A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR. © 2017 Wiley Periodicals, Inc.
- Published
- 2016
38. Transcatheter Aortic Valve Replacement: Current Technology and Future Directions
- Author
-
Vinod H. Thourani, Amjad Syed, Jose F. Condado, Michael O. Kayatta, Richard C. Gilmore, Bradley G. Leshnower, Eric L. Sarin, Hanna A. Jensen, Vasilis Babaliaros, and Mohammad H. Rajaei
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Population ,Less invasive ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,Intensive care medicine ,education ,Surgical repair ,education.field_of_study ,business.industry ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Surgical risk ,Stenosis ,Treatment Outcome ,Heart Valve Prosthesis ,Cardiology ,Current technology ,Surgery ,business ,Cardiology and Cardiovascular Medicine - Abstract
Transcatheter aortic valve replacement as an alternative to open surgical repair is rapidly becoming more used in high-risk patients with aortic stenosis. Transcatheter aortic valve replacement offers the benefit of being much less invasive than traditional surgical repair and has evolved as a therapeutic option for patients with prohibitive surgical risk or those deemed surgically inoperable. Nevertheless, despite its potential to mitigate risk in this frail population, it comes with its own unique set of complications. Technological advancements in valve structure, function, and delivery have and continue to attempt to minimize these risks. This review aims to summarize current advancements in transcatheter aortic valve replacement technology while also introducing areas of future direction in this exciting new field.
- Published
- 2016
39. Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches
- Author
-
John A, Wells, Jose F, Condado, Norihiko, Kamioka, Andy, Dong, Andrew, Ritter, Stamatios, Lerakis, Stephen, Clements, James, Stewart, Bradley, Leshnower, Robert, Guyton, Jessica, Forcillo, Ateet, Patel, Vinod H, Thourani, Peter C, Block, and Vasilis, Babaliaros
- Subjects
Heart Failure ,Heart Valve Prosthesis Implantation ,Male ,Reoperation ,Academic Medical Centers ,Cardiac Catheterization ,Georgia ,Time Factors ,Middle Aged ,Heart Valves ,Patient Readmission ,Transcatheter Aortic Valve Replacement ,Postoperative Complications ,Treatment Outcome ,Risk Factors ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL).Data comparing the treatment of PVL with TI and SI are limited.A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year.Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p 0.001), a shorter intensive care unit stay (0 vs. 3 days; p 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups.In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions.
- Published
- 2016
40. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can risk stratify patients in transcatheter aortic-valve replacement (TAVR)
- Author
-
Jessica Forcillo, James Stewart, Jose N. Binongo, Christian F. Witzke-Sanz, Parichart Junpaparp, Chandan Devireddy, Kreton Mavromatis, Bradley G. Leshnower, Ateet Patel, Janani Rangaswami, Jose F. Condado, Yi Lasanajak, Peter C. Block, Vinod H. Thourani, David S. Wheeler, Robert A. Guyton, and Vasilis Babaliaros
- Subjects
Blood Platelets ,Male ,medicine.medical_specialty ,Transcatheter aortic ,Neutrophils ,Lymphocyte ,medicine.medical_treatment ,Subgroup analysis ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Leukocyte Count ,0302 clinical medicine ,Postoperative Complications ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Lymphocytes ,Platelet lymphocyte ratio ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Platelet Count ,fungi ,Complete blood count ,Aortic Valve Stenosis ,Prognosis ,Surgical risk ,United States ,Surgery ,body regions ,Survival Rate ,medicine.anatomical_structure ,Baseline characteristics ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) mark systemic inflammation. Patients with high NLR and PLR have worse cardiovascular disease and outcomes. We assessed the role of these ratios in predicting outcomes after transcatheter aortic valve replacement (TAVR). Methods The association between NLR and PLR with baseline characteristics, 30-day outcomes, and 1-year readmission/survival was determined in patients that underwent TAVR between 2007 and 2014 and had baseline complete blood count with differential. A subgroup analysis determined the association between change in NLR and PLR (discharge-baseline) and 1-year outcomes. Results In 520 patients that underwent TAVR, a higher NLR (p=0.01) and PLR (p=0.02) were associated with a higher STS-PROM score, and with increased occurrence of the 30-day early-safety outcome (by VARC-2), even after adjusting for STS-PROM score, valve generation (Sapien vs. Sapien XT), and access (transfemoral vs. non-transfemoral) (NLR: OR 1.29, 95% CI 1.04–1.61; PLR: OR 1.27, 95% CI 1.01–1.60) but not with 1-year readmission or survival. In our subgroup analysis (N=294), change in PLR was not associated with the 1-year outcomes but a high change in NLR was associated with worse 1-year survival/readmission and 1-year survival, even after adjusting for STS-PROM score, valve generation and access (HR 1.22, 95% CI 1.04–1.44 and HR 1.26, 95% CI 0.99–1.6, respectively). Conclusions NLR and PLR correlate with surgical risk. An elevated NLR and PLR were associated with the occurrence of 30-day adverse outcomes, similar to the STS-PROM score. A high variation of NLR from baseline to discharge may help stratify patients that underwent TAVR in addition to traditional risk factors.
- Published
- 2016
41. Balloon Versus Computed Tomography Sizing of the Aortic Annulus for Transcatheter Aortic Valve Replacement and the Impact of Left Ventricular Outflow Tract Calcification and Morphology on Sizing
- Author
-
Jose F, Condado, Stamatios, Lerakis, James, Stewart, Hanna, Jensen, Travis S, Henry, Sung Min, Ko, Arthur, Stillman, Mohammad H, Rajaei, Kreton, Mavromatis, Chandan, Devireddy, Eric, Sarin, Brad, Leshnower, Robert, Guyton, Brian, Kaebnick, Vinod H, Thourani, Peter C, Block, and Vasilis, Babaliaros
- Subjects
Aged, 80 and over ,Male ,Cardiac Catheterization ,Patient Selection ,Calcinosis ,Aortic Valve Stenosis ,Organ Size ,United States ,Ventricular Outflow Obstruction ,Transcatheter Aortic Valve Replacement ,Dimensional Measurement Accuracy ,Echocardiography ,Aortic Valve ,Multidetector Computed Tomography ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
To evaluate the role of balloon annular sizing in transcatheter aortic valve replacement (TAVR).Multidetector cardiac computed tomography (MDCT) is the gold standard for aortic annular sizing in TAVR. Balloon sizing is increasingly used in patients with borderline annular size and severe calcification. A comparison between these two techniques is needed.We retrospectively compared baseline characteristics and 30-day outcomes of patients undergoing balloon-expandable TAVR using annular MDCT or balloon sizing. Paravalvular leak (PVL) rates were compared adjusting for access site, valve generation, size, and valve calcification.A total of 205 patients underwent TAVR with MDCT (n = 110) or balloon sizing (n = 95). Balloon-sized patients were older (83 years vs 81 years; P=.03), had more valve calcification (60.2% vs 30.9%; P.001), and underwent more minimalist TAVR (61.1% vs 40%; P=.03). Although we found no difference between balloon and MDCT sizing in rates of acute renal failure (3.2% vs 0.9%; P=.34), annular rupture (1.1% vs 1.8%; P.99), ≥ mild PVL by angiography (40% vs 35.5%; P=.57), or 30-day transthoracic echocardiography (40.7% vs 29.3%; P=.78), balloon-sized patients had a higher aortic regurgitation index (≥25) of 74.4% vs 54.1% (P=.01). Thirty-day rates of ≥ moderate PVL were 7.0% with balloon and 5.7% with MDCT sizing (P=.34). Balloon sizing recommended a different valve size in 34.0% of patients who underwent both methods (n = 50). A different recommendation occurred more often in patients with moderate/severe annular calcification (50.0% vs 33.3%; P=.01) and non-tubular left ventricular outflow tracts (LVOTs) (70.6% vs 30.3%; P=.01).Balloon sizing can be a complement to MDCT for annular sizing in TAVR, especially in patients with moderate/severe annular calcification, borderline annular size, and non-tubular LVOT.
- Published
- 2016
42. Impact of Preoperative Chronic Kidney Disease in 2,531 High-Risk and Inoperable Patients Undergoing Transcatheter Aortic Valve Replacement in the PARTNER Trial
- Author
-
Martin B. Leon, Rakesh M. Suri, E. Murat Tuzcu, Jessica Forcillo, Scott Lim, Hersh S. Maniar, Vasilis Babaliaros, Michael J. Mack, Hanna A. Jensen, Nirat Beohar, Gorav Ailawadi, Lars G. Svensson, Raj Makkar, Howard C. Herrmann, Samir R. Kapadia, Vinod H. Thourani, Jose F. Condado, Alan Zajarias, Girma Minalu Ayele, Ajay J. Kirtane, Susheel Kodali, Wilson Y. Szeto, Chandan Devireddy, Darshan Doshi, and Rupa Parvataneni
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Critical Illness ,Renal function ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Renal Dialysis ,Internal medicine ,Cause of Death ,Risk of mortality ,medicine ,Humans ,030212 general & internal medicine ,Cause of death ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Ejection fraction ,business.industry ,Hazard ratio ,Aortic Valve Stenosis ,medicine.disease ,Survival Analysis ,Surgery ,Treatment Outcome ,Cardiology ,Kidney Failure, Chronic ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Follow-Up Studies - Abstract
Background Although preoperative renal dysfunction (RD) is associated with increased mortality and morbidity after surgical aortic valve replacement, its impact on clinical outcomes after transcatheter aortic valve replacement (TAVR) is less defined. Methods TAVR patients in the PARTNER (Placement of Aortic Transcatheter Valves) trial with a calculable glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation were included. Patients were divided into three groups: GFR >60 mL/min (none/mild RD), GFR 31 to 60 mL/min (moderate RD), and GFR ≤30 mL/min (severe RD). Operative characteristics and clinical outcomes were analyzed. Cox regression models were used to determine multivariable predictors of 1-year all-cause mortality. Results A total of 2,531 inoperable or high surgical risk patients from the PARTNER trial and continued access registries had a calculable GFR level: 767 (30%) had normal renal function or mild RD, 1,473 (58%) had moderate RD, and 291 (12%) presented with severe RD. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for the cohort was 11.5%, and it was highest in those with severe RD (13.8%). Patients with severe RD were more often women with a higher prevalence of diabetes. Patients with severe RD had the highest incidence of 30-day and 1-year all-cause mortality and rehospitalization. The 30-day rate of death from any cause was 10.7% in the severe RD group versus 6.0% in the moderate and mild RD groups ( p = 0.01). The 1-year rate of death from any cause was 34.4% in the severe RD group versus 21.5% in the moderate RD and 20.8% in the none/mild RD groups (adjusted hazard ratio [HR] 2.24, p p = 0.24 for severe versus moderate). Other significant predictors of 1-year all-cause mortality included lower body mass index, frailty, the transapical approach, a lower ejection fraction, oxygen-dependent chronic obstructive pulmonary disease, liver disease, and male sex. Conclusions Preoperative severe RD is a significant predictor for 1-year mortality in TAVR patients. Careful risk stratification by the heart team is required in patients with severe preprocedural RD.
- Published
- 2016
43. Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model
- Author
-
Ajit P. Yoganathan, Ikechukwu Okafor, Jose F. Condado, Vinod H. Thourani, Prem A. Midha, Vrishank Raghav, Stamatios Lerakis, and Vasilis Babaliaros
- Subjects
Balloon Valvuloplasty ,Models, Anatomic ,medicine.medical_specialty ,0206 medical engineering ,Hemodynamics ,02 engineering and technology ,030204 cardiovascular system & hematology ,Balloon ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Heart valve ,Bioprosthesis ,business.industry ,Models, Cardiovascular ,020601 biomedical engineering ,Valve in valve ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The purpose of this study was to optimize hemodynamic performance of valve-in-valve (VIV) according to transcatheter heart valve (THV) type (balloon vs. self-expandable), size, and deployment positions in an in vitro model.VIV transcatheter aortic valve replacement is increasingly used for the treatment of patients with a failing surgical bioprosthesis. However, there is a paucity in understanding the THV hemodynamic performance in this setting.VIV transcatheter aortic valve replacement was simulated in a physiologic left heart simulator by deploying a 23-mm SAPIEN, 23-mm CoreValve, and 26-mm CoreValve within a 23-mm Edwards PERIMOUNT surgical bioprosthesis. Each THV was deployed into 5 different positions: normal (inflow of THV was juxtaposed with inflow of surgical bioprosthesis), -3 and -6 mm subannular, and +3 and +6 mm supra-annular. At a heart rate of 70 bpm and cardiac output of 5.0 l/min, mean transvalvular pressure gradients (TVPG), regurgitant fraction (RF), effective orifice area, pinwheeling index, and pullout forces were evaluated and compared between THVs.Although all THV deployments resulted in hemodynamics that would have been consistent with Valve Academic Research Consortium-2 procedure success, we found significant differences between THV type, size, and deployment position. For a SAPIEN valve, hemodynamic performance improved with a supra-annular deployment, with the best performance observed at +6 mm. Compared with a normal position, +6 mm resulted in lower TVPG (9.31 ± 0.22 mm Hg vs. 11.66 ± 0.22 mm Hg; p 0.01), RF (0.95 ± 0.60% vs. 1.27 ± 0.66%; p 0.01), and PI (1.23 ± 0.22% vs. 3.46 ± 0.18%; p 0.01), and higher effective orifice area (1.51 ± 0.08 cm(2) vs. 1.35 ± 0.02 cm(2); p 0.01) at the cost of lower pullout forces (5.54 ± 0.20 N vs. 7.09 ± 0.49 N; p 0.01). For both CoreValve sizes, optimal deployment was observed at the normal position. The 26-mm CoreValve, when compared with the 23-mm CoreValve and 23-mm SAPIEN, had a lower TVPG (7.76 ± 0.14 mm Hg vs. 10.27 ± 0.18 mm Hg vs. 9.31 ± 0.22 mm Hg; p 0.01) and higher effective orifice area (1.66 ± 0.05 cm(2) vs. 1.44 ± 0.05 cm(2) vs. 1.51 ± 0.08 cm(2); p 0.01), RF (4.79 ± 0.67% vs. 1.98 ± 0.36% vs. 0.95 ± 1.68%; p 0.01), PI (29.13 ± 0.22% vs. 6.57 ± 0.14% vs. 1.23 ± 0.22%; p 0.01), and pullout forces (10.65 ± 0.66 N vs. 5.35 ± 0.18 N vs. 5.54 ± 0.20 N; p 0.01).The optimal deployment location for VIV in a 23 PERIMOUNT surgical bioprosthesis was at a +6 mm supra-annular position for a 23-mm SAPIEN valve and at the normal position for both the 23-mm and 26-mm CoreValves. The 26-mm CoreValve had lower gradients, but higher RF and PI than the 23-mm CoreValve and the 23-mm SAPIEN. In their optimal positions, all valves resulted in hemodynamics consistent with the definitions of Valve Academic Research Consortium-2 procedural success. Long-term studies are needed to understand the clinical impact of these hemodynamic performance differences in patients who undergo VIV transcatheter aortic valve replacement.
- Published
- 2016
44. Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease?
- Author
-
Jose F, Condado, Moosa N, Haider, Stamatios, Lerakis, Patricia, Keegan, Hope, Caughron, Vinod H, Thourani, Chandan, Devireddy, Bradley, Leshnower, Kreton, Mavromatis, Eric L, Sarin, James, Stewart, Robert, Guyton, Jessica, Forcillo, Ateet, Patel, Amy, Simone, Peter C, Block, and Vasilis, Babaliaros
- Subjects
Aged, 80 and over ,Male ,Cardiac Catheterization ,Georgia ,Time Factors ,Aortic Valve Stenosis ,Kaplan-Meier Estimate ,Severity of Illness Index ,Femoral Artery ,Survival Rate ,Transcatheter Aortic Valve Replacement ,Pulmonary Disease, Chronic Obstructive ,Treatment Outcome ,Humans ,Female ,Echocardiography, Transesophageal ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD).TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown.We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% ≤50) who underwent minimalist vs. standard TF-TAVR between 2008 and 2015 at our institution.Of 88 patients with severe COPD, 46 underwent minimalist and 42 underwent standard TF-TAVR. There were no differences on baseline characteristics, except for more history of coronary artery bypass grafting (45.5% vs. 20.6%, P = 0.03) and less history of cerebrovascular disease (16.7% vs. 45.5%, P = 0.03) in the standard TF-TAVR. Seventeen minimalist TF-TAVR patients (41.0%) were transferred directly to the general medical ward with telemetry monitoring (without ICU stay); all standard TF-TAVR patients went to the ICU. Minimalist TF-TAVR patients had shorter procedure time (97 vs. 129 min, P 0.001), ICU time (21.8 vs. 29.8 hr, P = 0.001) and length of stay (2 vs. 5 days, P = 0.001). There were no differences in procedure complications and 30-day mortality between groups. In our multivariate analysis, minimalist TF-TAVR (HR 0.28, 95%CI 0.08-0.97) and previous coronary revascularization (HR 0.24, 95%CI 0.09-0.65) were associated with increased 1-year survival. In contrast, moderate paravalvular leak (HR 7.73, 95%CI 1.94-30.84) was associated with decreased 1-year survival.In patients with severe COPD, Minimalist TF-TAVR results in less resource utilization and improved 1-year survival compared to standard approach. Our findings should be validated in a larger cohort of patients with severe COPD. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
45. Gender inequalities in transcatheter aortic valve replacement: The jury is still out
- Author
-
Peter C. Block and Jose F. Condado
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,General Medicine ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Jury ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,media_common - Published
- 2017
- Full Text
- View/download PDF
46. Is it really 'paradoxical' or just the ventricle?
- Author
-
Peter C. Block and Jose F. Condado
- Subjects
Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Low gradient ,Heart Valve Prosthesis Implantation ,business.industry ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Ventricle ,Aortic valve stenosis ,Aortic Valve ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with paradoxical low flow low gradient (PLFLG) aortic stenosis (AS) have favorable mid-term outcomes after transcatheter aortic valve replacement (TAVR). These outcomes were comparable to those patients with high gradient AS (HGAS). Clinicians should avoid delaying referral of patients with PLFLG AS for valve replacement for either surgical aortic valve replacement (SAVR) or TAVR. Further studies are need to understand the increased early mortality after TAVR in PLFLG AS compared to HGAS, and to determine whether improvements of TAVR procedural techniques can result in better outcomes.
- Published
- 2016
47. End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?
- Author
-
Jose F, Condado, Aneel, Maini, Bradley, Leshnower, Vinod, Thourani, Jessica, Forcillo, Chandan, Devireddy, Kreton, Mavromatis, Eric L, Sarin, James, Stewart, Robert, Guyton, Amy, Simone, Patricia, Keegan, Stamatios, Lerakis, Peter C, Block, and Vasilis, Babaliaros
- Subjects
Balloon Valvuloplasty ,Heart Valve Prosthesis Implantation ,Male ,Time Factors ,Patient Selection ,Aortic Valve Stenosis ,Kaplan-Meier Estimate ,Middle Aged ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Renal Dialysis ,Risk Factors ,Humans ,Kidney Failure, Chronic ,Female ,Aged ,Proportional Hazards Models ,Retrospective Studies - Abstract
Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies.A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed.Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002-1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595-9.840), but dialysis duration and type, and SAVR versus TAVR were not.Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
48. Does a Higher Society of Thoracic Surgeons Score Predict Outcomes in Transfemoral and Alternative Access Transcatheter Aortic Valve Replacement?
- Author
-
Yi Lasanajak, Jose N. Binongo, Amy Simone, Vinod H. Thourani, James Stewart, Lillian L. Tsai, Patricia Keegan, Vasilis Babaliaros, Jose F. Condado, Eric L. Sarin, Peter C. Block, Mohammad H. Rajaei, Stamatios Lerakis, Jessica Forcillo, Hanna A. Jensen, Chandan Devireddy, Kreton Mavromatis, Bradley G. Leshnower, and Robert A. Guyton
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Femoral artery ,Prom ,030204 cardiovascular system & hematology ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Valve replacement ,Risk Factors ,medicine.artery ,Risk of mortality ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Stroke ,Societies, Medical ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Incidence ,Thoracic Surgery ,Aortic Valve Stenosis ,medicine.disease ,United States ,Surgery ,Femoral Artery ,Survival Rate ,Cardiothoracic surgery ,Aortic Valve ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Follow-Up Studies - Abstract
Background Nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) is often associated with worse outcomes than TF TAVR. We investigated the relationship between increasing Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score and observed mortality and morbidity in TF and non-TF TAVR groups. Methods We reviewed 595 patients undergoing TAVR at Emory Healthcare between 2007 and 2014. Clinical outcomes were reported for 337 TF patients (57%) and 258 non-TF patients (43%). We created 3 STS PROM score subgroups: 15%. A composite outcome of postoperative events was defined as death, stroke, renal failure, vascular complications, or new pacemaker implantation. Results TF patients were older (82.4 ± 8.0 vs 80.8 ± 8.7 years, p = 0.02), whereas the STS PROM was higher in non-TF patients (10.5% ± 5.3% vs 11.7% ± 5.7%, p = 0.01). Observed/expected mortality was less than 1.0 in all groups. The rate of the composite outcome did not differ between STS PROM subgroups in TF ( p = 0.68) or non-TF TAVR ( p = 0.27). One-year mortality was higher for patients with STS PROM >8% in the non-TF group; however, this difference was not observed in TF patients ( p = 0.40). Conclusions As expected, non-TF patients were at a higher risk than TF patients for procedural morbidity and death. Although no differences were observed in 30-day deaths or morbidity in different STS PROM subgroups, those undergoing non-TF TAVR at a higher STS PROM (>8%) had higher 1-year mortality. When applicable, TF TAVR remains the procedure of choice in high- or extreme-risk patients undergoing TAVR.
- Published
- 2015
49. TCT-695 The Incidence of Paravalvular Leak in Transthoracic Echocardiography-guided deployment of Transcatheter Aortic Valve is Comparable to that of Transesophageal Echocardiography-guided Deployment: An Update of the Emory Experience
- Author
-
Salim S. Hayek, James MacNamara, Vinod H. Thourani, Patricia Keegan, Jose F. Condado, Shuang Lin, Vasilis Babaliaros, Stamatios Lerakis, Nikolaos Spilias, and Shuai Zheng
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Software deployment ,Incidence (epidemiology) ,Internal medicine ,medicine ,Cardiology ,Radiology ,Paravalvular leak ,business ,Cardiology and Cardiovascular Medicine - Published
- 2015
- Full Text
- View/download PDF
50. Pulmonary stenting for the treatment of sarcoid induced pulmonary vascular stenosis
- Author
-
Jose F, Condado, Vasilis, Babaliaros, Travis S, Henry, Brian, Kaebnick, Dennis, Kim, and Gerald W, Staton
- Subjects
Adult ,Male ,Cardiac Catheterization ,Time Factors ,Computed Tomography Angiography ,Perfusion Imaging ,Angioplasty ,Arterial Occlusive Diseases ,Constriction, Pathologic ,Phlebography ,Middle Aged ,Pulmonary Artery ,Treatment Outcome ,Sarcoidosis, Pulmonary ,Recurrence ,Retreatment ,Exercise Test ,Humans ,Pulmonary Veno-Occlusive Disease ,Female ,Stents ,Immunosuppressive Agents ,Aged - Abstract
The best treatment of patients with external pulmonary vascular compression due to advanced sarcoidosis is unknown.To report a single-center experience of percutaneous treatment for pulmonary vascular stenosis caused by external compression due to advanced sarcoidosis.We report a case series of 5 patients with biopsy confirmed advanced sarcoidosis, seen at our academic institution with worsening dyspnea despite increase of immunosuppressive therapy. All patients were evaluated by a multidisciplinary team (cardiology, pulmonary and radiology) using a multi-modality approach, including chest-computed tomography angiography, ventilation/perfusion scintigraphy, pulmonary function test, 6-minute walk test and heart catheterization.Three out of five patients underwent pulmonary artery or vein angioplasty and stenting resulting in symptomatic improvement: Patient 1 had persistent symptomatic improvement measured by subjective and objective methods at 30 months; patient 2 required re-intervention due to recurrent pulmonary vein stenosis at 6-months followed by persistent improvement; and patient 3, had a procedure complicated with in-stent thrombosis requiring thrombolysis and anticoagulation with improvement. The remaining two patients were medically treated because underlying thromboembolic disease (patient 4) and diffuse pulmonary vein stenosis not amenable to percutaneous intervention (patient 5).Pulmonary vascular stenosis from external compression can be a rare but unrecognized caused of worsening symptoms in advanced sarcoidosis. Pulmonary vascular angioplasty and stenting can provide clinical benefit in select patients.
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.