702 results on '"Michael J Reardon"'
Search Results
2. Current definitions of hemodynamic structural valve deterioration after bioprosthetic aortic valve replacement lack consistencyCentral MessagePerspective
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Bart J.J. Velders, MD, Michiel D. Vriesendorp, MD, PhD, Federico M. Asch, MD, Michael J. Reardon, MD, Francois Dagenais, MD, Michael G. Moront, MD, Joseph F. Sabik III, MD, Rolf H.H. Groenwold, MD, PhD, and Robert J.M. Klautz, MD, PhD
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bioprosthetic aortic valve replacement ,echocardiography ,hemodynamic structural valve deterioration ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement. Methods: Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up. All patients received the same stented bioprosthesis. Echocardiographic parameters were assessed by an independent core laboratory. Moderate or greater stenotic hemodynamic structural valve deterioration was defined according to Capodanno and colleagues, Dvir and colleagues, and the Valve Academic Research Consortium 3; regurgitation data were not considered in this analysis. Consistency was quantified on the basis of structural valve deterioration classification at subsequent time points. Results: A total of 1118 patients received implants. Patients’ mean age was 70 years, and 75% were male. Hemodynamic structural valve deterioration at any visit was present in 51 patients (4.6%), 32 patients (2.9%), and 34 patients (3.0%) according to Capodanno, Dvir, and Valve Academic Research Consortium 3. A total of 1064 patients (95%) were never labeled with structural valve deterioration by any definition. After the first classification with structural valve deterioration, 59%, 59%, and 65% had no subsequent structural valve deterioration classification according to Capodanno, Dvir, and Valve Academic Research Consortium 3, respectively. Conclusions: The current definitions of hemodynamic structural valve deterioration are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic structural valve deterioration. Although the diagnosis of structural valve deterioration may be categorical, echocardiographic indices lack this degree of precision in the first 5 years after surgical aortic valve replacement. The inconsistency of current structural valve deterioration definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.
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- 2024
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3. Impact of Residual Transmitral Mean Pressure Gradient on Outcomes After Mitral Transcatheter Edge-to-Edge Repair
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Yasser M. Sammour, MD, MSc, Rody G. Bou Chaaya, MD, Taha Hatab, MD, Syed Zaid, MD, Joe Aoun, MD, Priscilla Wessly, MD, Chloe Kharsa, MD, William A. Zoghbi, MD, Sherif Nagueh, MD, Marvin D. Atkins, MD, Michael J. Reardon, MD, Nadeen Faza, MD, Stephen H. Little, MD, Neal S. Kleiman, MD, and Sachin S. Goel, MD
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mean gradient ,MitraClip ,mitral repair ,MVG ,outcomes ,TEER ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: There is conflicting evidence regarding the effect of residual transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Different TMPG cutoffs have been employed in prior studies with varying results. Objectives: The purpose of this study was to examine the association between residual TMPG and M-TEER outcomes. Methods: Consecutive patients undergoing M-TEER at our institution between 2014 and 2022 were included and divided based on quartiles of predischarge TMPG. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazard models. We performed subgroup analyses according to mitral regurgitation (MR) mechanism. The primary outcome was all-cause mortality or heart failure hospitalization. Results: We included 283 patients (age 76.7 ± 10.8 years, 42.8% women, 78.4% Caucasian, and baseline TMPG 2.4 ± 1.3 mm Hg). Higher baseline TMPG was a predictor of increased TMPG after M-TEER (coefficient 0.60 [95% CI: 0.40-0.70]; P
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- 2024
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4. Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?Central MessagePerspective
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Bart J.J. Velders, MD, Michiel D. Vriesendorp, MD, PhD, Federico M. Asch, MD, Francois Dagenais, MD, Rüdiger Lange, MD, Michael J. Reardon, MD, Vivek Rao, MD, Joseph F. Sabik, III, MD, Rolf H.H. Groenwold, MD, PhD, and Robert J.M. Klautz, MD, PhD
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prosthesis–patient mismatch ,postoperative hemodynamic parameters ,echocardiography ,surgical aortic valve replacement ,predictive analytics ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Background: Although various hemodynamic parameters to assess prosthetic performance are available, prosthesis–patient mismatch (PPM) is defined exclusively by effective orifice area (EOA) index thresholds. Adjusting for the Society of Thoracic Surgeons predicted risk of mortality (STS PROM), we aimed to explore the added value of postoperative hemodynamic parameters for the prediction of all-cause mortality at 5 years after aortic valve replacement. Methods: Data were obtained from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a multicenter prospective cohort study examining the performance of the Avalus bioprosthesis. Candidate predictors were assessed at the first follow-up visit; patients who had no echocardiography data, withdrew consent, or died before this visit were excluded. Candidate predictors included peak jet velocity, mean pressure gradient, EOA, predicted and measured EOA index, Doppler velocity index, indexed internal prosthesis orifice area, and categories for PPM. The performance of Cox models was investigated using the c-statistic and net reclassification improvement (NRI), among other tools. Results: A total of 1118 patients received the study valve, of whom 1022 were eligible for the present analysis. In univariable analysis, STS PROM was the sole significant predictor of all-cause mortality (hazard ratio, 1.40; 95% confidence interval, 1.26-1.55). When extending the STS PROM with single hemodynamic parameters, neither the c-statistics nor the NRIs demonstrated added prognostic value compared to a model with STS PROM alone. Similar findings were observed when multiple hemodynamic parameters were added. Conclusions: The STS PROM was found to be the main predictor of patient prognosis. The additional prognostic value of postoperative hemodynamic parameters for the prediction of all-cause mortality was limited.
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- 2024
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5. Myocardial Blood Flow Reserve, Microvascular Coronary Health, and Myocardial Remodeling in Patients With Aortic Stenosis
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Fares Alahdab, Ahmed I. Ahmed, Malek Nayfeh, Yushui Han, Ola Abdelkarim, Moath S. Alfawara, Stephen H. Little, Michael J. Reardon, Nadeen N. Faza, Sachin S. Goel, Mohamad Alkhouli, William Zoghbi, and Mouaz H. Al‐Mallah
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aortic stenosis ,aortic valve replacement ,echocardiography ,global longitudinal strain ,myocardial blood flow ,noninvasive imaging ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Coronary microvascular function and hemodynamics may play a role in coronary circulation and myocardial remodeling in patients with aortic stenosis (AS). We aimed to evaluate the relationship between myocardial blood flow and myocardial function in patients with AS, no AS, and aortic valve sclerosis. Methods and Results We included consecutive patients who had resting transthoracic echocardiography and clinically indicated positron emission tomography myocardial perfusion imaging to capture their left ventricular ejection fraction, global longitudinal strain (GLS), and myocardial flow reserve (MFR). The primary outcome was major adverse cardiovascular event (all‐cause mortality, myocardial infarction, or late revascularization). There were 2778 patients (208 with aortic sclerosis, 39 with prosthetic aortic valve, 2406 with no AS, and 54, 49, and 22 with mild, moderate, and severe AS, respectively). Increasing AS severity was associated with impaired MFR (P
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- 2024
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6. The robustness of the flow-gradient classification of severe aortic stenosisCentral MessagePerspective
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Bart J.J. Velders, MD, Michiel D. Vriesendorp, MD, PhD, Federico M. Asch, MD, Michael G. Moront, MD, Francois Dagenais, MD, Michael J. Reardon, MD, Joseph F. Sabik III, MD, Rolf H.H. Groenwold, MD, PhD, and Robert J.M. Klautz, MD, PhD
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flow-gradient classification ,severe aortic stenosis ,stroke volume ,low flow ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objectives: A flow-gradient classification is used to determine the indication for intervention for patients with severe aortic stenosis (AS) with discordant echocardiographic parameters. We investigated the agreement in flow-gradient classification by stroke volume (SV) measurement at the left ventricular outflow tract (LVOT) and at the left ventricle. Methods: Data were used from a prospective cohort study and patients with severe AS (aortic valve area index ≤0.6 cm2/m2) with preserved ejection fraction (>50%) were selected. SV was determined by an echocardiographic core laboratory at the LVOT and by subtracting the 2-dimensional left ventricle end-systolic from the end-diastolic volume (volumetric). Patients were stratified into 4 groups based on SV index (35 mL/m2) and mean gradient (40 mm Hg). The group composition was compared and the agreement between the SV measurements was investigated using regression, correlation, and limits of agreement. In addition, a systematic LVOT diameter overestimation of 1 mm was simulated to study flow-gradient reclassification. Results: Of 1118 patients, 699 were eligible. The group composition changed considerably as agreement on flow state occurred in only 50% of the measurements. LVOT SV was on average 15.1 mL (95% limits of agreement −24.9:55.1 mL) greater than volumetric SV. When a systematic 1-mm LVOT diameter overestimation was introduced, the low-flow groups halved. Conclusions: There was poor agreement in the flow-gradient classification of severe AS as a result of large differences between LVOT and volumetric SV. Furthermore, this classification was sensitive to small measurement errors. These results stress that parameters beyond the flow-gradient classification should be considered to ensure accurate recommendations for intervention.
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- 2023
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7. Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair
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Rody G. Bou Chaaya, Taha Hatab, Sahar Samimi, Fatima Qamar, Chloe Kharsa, Joe Aoun, Nadeen Faza, Stephen H. Little, Marvin D. Atkins, Michael J. Reardon, Neal S. Kleiman, Sherif F. Nagueh, William A. Zoghbi, Ashrith Guha, Syed Zaid, and Sachin S. Goel
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mitral regurgitation ,mitral transcatheter edge‐to‐edge repair ,pulmonary effective arterial elastance ,pulmonary hypertension ,right ventricular afterload ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge‐to‐edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge‐to‐edge repair. Methods and Results We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge‐to‐edge repair. The end points were all‐cause mortality and a composite of mortality and heart failure hospitalization at 2 years. Using the receiver operating characteristic curve–derived threshold of 0.6 for pulmonary effective arterial elastance ([Ea], pulmonary artery systolic pressure/stroke volume), patients were stratified into 3 profiles based on PH severity (low elastance [HE]: Ea
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- 2024
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8. Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge‐to‐Edge Repair
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Taha Hatab, Sahar Samimi, Rody G. Bou Chaaya, Fatima Qamar, Chloe Kharsa, Priscilla Wessly, Nadeen Faza, Stephen H. Little, Marvin D. Atkins, Michael J. Reardon, Neal S. Kleiman, William A. Zoghbi, Sherif F. Nagueh, Syed Zaid, and Sachin S. Goel
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echocardiographic profile ,transcatheter edge‐to‐edge repair ,transmitral pressure gradient ,tricuspid regurgitation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge‐to‐edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long‐term outcomes after TEER. Methods and Results We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well‐established outcomes‐related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all‐cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two‐year event‐free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2‐year event‐rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71–5.17], P
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- 2024
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9. Understanding Treatment Preferences for Patients with Tricuspid Regurgitation
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Vijay Iyer, Nadeen N. Faza, Michael Pfeiffer, Mark Kozak, Brandon Peterson, Mortiz Wyler von Ballmoos, Sarah Mollenkopf, Melissa Mancilla, Diandra Latibeaudiere-Gardner, and Michael J. Reardon
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Medicine (General) ,R5-920 - Abstract
Background. Tricuspid regurgitation (TR) is a high-prevalence disease associated with poor quality of life and mortality. This quantitative patient preference study aims to identify TR patients’ perspectives on risk-benefit tradeoffs. Methods. A discrete-choice experiment was developed to explore TR treatment risk-benefit tradeoffs. Attributes (levels) tested were treatment (procedure, medical management), reintervention risk (0%, 1%, 5%, 10%), medications over 2 y (none, reduce, same, increase), shortness of breath (none/mild, moderate, severe), and swelling (never, 3× per week, daily). A mixed logit regression model estimated preferences and calculated predicted probabilities. Relative attribute importance was calculated. Subgroup analyses were performed. Results. An online survey was completed by 150 TR patients. Shortness of breath was the most important attribute and accounted for 65.8% of treatment decision making. The average patients’ predicted probability of preferring a “procedure-like” profile over a “medical management-like” profile was 99.7%. This decreased to 78.9% for a level change from severe to moderate in shortness of breath in the “medical management-like” profile. Subgroup analysis confirmed that patients older than 64 y had a stronger preference to avoid severe shortness of breath compared with younger patients ( P
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- 2024
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10. Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms
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Ankur Kalra, MD, Rajiv Das, MB ChB, MD, Mohammad Alkhalil, MD, DPhil, Iryna Dykun, MD, Alessandro Candreva, MD, Omar Jarral, MBBS, PhD, Syed M. Rehman, MBBS, Monil Majmundar, MD, Kunal N. Patel, MD, MPH, Josep Rodes-Cabau, MD, PhD, Michael J. Reardon, MD, and Rishi Puri, MBBS, PhD
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Aortic stenosis ,Bicuspid aortic valve ,Surgical aortic valve replacement ,Transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.
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- 2024
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11. Commentary: The safety and efficacy of balloon-expandable vs. self-expanding trans-catheter aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis
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Michael J. Reardon, Tanvir Bajwa, and Jeffrey J. Popma
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TAVR ,TAVI ,balloon-expandable ,self-expanding ,aortic stenosis ,randomized controlled trial ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2023
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12. Practice Patterns and Outcomes of Transcatheter Aortic Valve Replacement in the United States and Japan: A Report From Joint Data Harmonization Initiative of STS/ACC TVT and J‐TVT
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Tsuyoshi Kaneko, Sreekanth Vemulapalli, Shun Kohsaka, Kazuo Shimamura, Amanda Stebbins, Hiraku Kumamaru, Adam J. Nelson, Andrzej Kosinski, Koichi Maeda, Joseph E. Bavaria, Shigeru Saito, Michael J. Reardon, Toru Kuratani, Jeffrey J. Popma, Taku Inohara, Vinod H. Thourani, John D. Carroll, Hideyuki Shimizu, Morimasa Takayama, Martin B. Leon, Michael J. Mack, and Yoshiki Sawa
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aortic stenosis ,bioprosthetic aortic valve ,TAVR ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The practice pattern and outcome of medical devices following their regulatory approval may differ by country. The aim of this study is to compare postapproval national clinical registry data on transcatheter aortic valve replacement between the United States and Japan on patient characteristics, periprocedural outcomes, and the variability of outcomes as a part of a partnership program (Harmonization‐by‐Doing) between the 2 countries. Methods and Results The patient‐level data were extracted from the US Society of Thoracic Surgeons /American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) and the J‐TVT (Japanese Transcatheter Valvular Therapy) registry, respectively, to analyze transcatheter aortic valve replacement outcomes between 2013 and 2019. Data entry for these registries was mandated by the federal regulators, and the majority of variable definitions were harmonized to allow direct data comparison. A total of 244 722 transcatheter aortic valve replacements from 646 institutions in the United States and 26 673 transcatheter aortic valve replacements from 171 institutions in Japan were analyzed. Median volume per site was 65 (interquartile range, 45–97) in the United States and 28 (interquartile range, 19–41) in Japan. Overall, patients in J‐TVT were older (United States: mean‐age, 80.1±8.7 versus Japan: 84.4±5.2; P
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- 2022
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13. Transcatheter Aortic Valve Replacement With Self‐Expandable Supra‐Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry
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Luis Augusto P. Dallan, John K. Forrest, Michael J. Reardon, Wilson Y. Szeto, Isaac George, Susheel Kodali, Neal S. Kleiman, Steven J. Yakubov, Kendra J. Grubb, Fang Liu, Cristian Baeza, and Guilherme F. Attizzani
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surgical aortic valve replacement ,transcatheter aortic valve replacement in degenerated surgical aortic valve ,transcatheter aortic valve replacement ,valve‐in‐valve ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Transcatheter aortic valve replacement with supra‐annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self‐expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. Methods and Results Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In‐hospital, 30‐day, and 1‐year clinical outcomes were based on the Society of Thoracic Surgeons‐American College of Cardiology‐Transcatheter Valve Therapy registry definitions. Transcatheter aortic valve replacement in degenerated surgical aortic valve was performed in 5897 patients (5061 [85.8%] patients received the Evolut R valve and 836 [14.2%] received the Evolut PRO valve). Thirty‐day transcatheter heart valves hemodynamic performance was excellent in both groups (mean gradient: Evolut PRO: 13.8±7.5 mm Hg; Evolut R: 14.5±8.1 mm Hg), while paravalvular regurgitation was significantly different between valve types (P=0.02). Clinical events were low at 30 days (Evolut PRO: for the all‐cause mortality, 2.8%, any stroke was 1.8%, new pacemaker implantation, 3.0%: Evolut R:all‐cause mortality, 2.5%, any stroke was 2.2%, new pacemaker implantation, 5.3%) and 1 year (Evolut PRO: all‐cause mortality, 9.2%; any stroke, 3.1%; Evolut R: all‐cause mortality, 9.8%; any stroke, 2.9%). Conclusions Transcatheter aortic valve replacement in degenerated surgical aortic valve with self‐expandable supra‐annular transcatheter heart valves is associated with excellent clinical outcomes and valve hemodynamics. Additional reductions in residual paravalvular regurgitation were obtained with the next generation Evolut PRO.
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- 2021
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14. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis
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John K. Forrest, G. Michael Deeb, Steven J. Yakubov, Hemal Gada, Mubashir A. Mumtaz, Basel Ramlawi, Tanvir Bajwa, Paul S. Teirstein, Michael DeFrain, Murali Muppala, Bruce J. Rutkin, Atul Chawla, Bart Jenson, Stanley J. Chetcuti, Robert C. Stoler, Marie-France Poulin, Kamal Khabbaz, Melissa Levack, Kashish Goel, Didier Tchétché, Ka Yan Lam, Pim A.L. Tonino, Saki Ito, Jae K. Oh, Jian Huang, Jeffrey J. Popma, Neal Kleiman, Michael J. Reardon, Paul Sorajja, Timothy Byrne, Merick Kirshner, John Crouch, Joseph Coselli, Guilherme Silva, Robert Hebeler, Robert Stoler, Ashequl Islam, Anthony Rousou, Mark Bladergroen, Peter Fail, Donald Netherland, W.A.L. Tonino, Arnaud Sudre, Pierre Berthoumieu, Houman Khalili, G. Chad Hughes, J Kevin Harrison, Ajanta De, Pei Tsau, Nicolas M. van Mieghem, Robert Larbalestier, Gerald Yong, Shikhar Agarwal, William Martin, Steven Park, Michael Reardon, Siamak Mohammadi, Josep Rodes-Cabau, Jeffrey Sparling, C. Craig Elkins, Brian Ganzel, Ray V. Matthews, Vaughn A. Starnes, Kenji Ando, Bernard Chevalier, Arnaud Farge, William Combs, Rodrigo Bagur, Michael Chu, Gregory Fontana, Visha Dev, Ferdinand Leya, J. Michael Tuchek, Ignacio Inglessis, Arminder Jassar, Nicolo Piazza, Kevin Lacappelle, Daniel Steinberg, Marc Katz, John Wang, Joseph Kozina, Frank Slachman, Robert Merritt, Bart Jensen, Jorge Alvarez, Robert Gooley, Julian Smith, Reda Ibrahim, Raymond Cartier, Joshua Rovin, Tomoyuki Fujita, Bruce Rutkin, Steven Yakubov, Howard Song, Firas Zahr, Shigeru Miyagawa, Vivek Rajagopal, James Kauten, Mubashir Mumtaz, Ravinay Bhindi, Peter Brady, Sanjay Batra, Thomas Davis, Ayman Iskander, David Heimansohn, James Hermiller, Itaru Takamisawa, Thomas Haldis, Seiji Yamazaki, Paul Teirstein, Norio Tada, Shigeru Saito, William Merhi, Stephane Leung, David Muller, Robin Heijmen, George Petrossian, Newell Robinson, Peter Knight, Frederick Ling, Sam Radhakrishnan, Stephen Fremes, Eric Lehr, Sameer Gafoor, Thomas Noel, Antony Walton, Jon Resar, David Adams, Samin Sharma, Scott Lilly, Peter Tadros, George Zorn, Harold Dauerman, Frank Ittleman, Erik Horlick, Chris Feindel, Frederick Welt, Vikas Sharma, Alan Markowitz, John Carroll, David Fullerton, Bartley Griffith, Anuj Gupta, Eduardo de Marchena, Tomas Salerno, Stanley Chetcuti, Ibrahim Sultan, Sanjeevan Pasupati, Neal Kon, David Zhao, and John Forrest
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Cardiology and Cardiovascular Medicine - Published
- 2023
15. Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation
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Maan Malahfji, Valentina Crudo, Yodying Kaolawanich, Duc T. Nguyen, Amr Telmesani, Mujtaba Saeed, Michael J. Reardon, William A. Zoghbi, Venkateshwar Polsani, Michael Elliott, Robert O. Bonow, Edward A. Graviss, Raymond Kim, and Dipan J. Shah
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Cardiology and Cardiovascular Medicine - Published
- 2023
16. Commentary: Does this model reality?Central Message
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Nadeen N. Faza, MD and Michael J. Reardon, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2022
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17. Commentary: Taking to heart the challenge of primary cardiac sarcomaCentral Message
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Vinod Ravi, MD and Michael J. Reardon, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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18. TAVR in 2023: Who Should Not Get It?
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Sukhdeep Bhogal, Toby Rogers, Amer Aladin, Itsik Ben-Dor, Jeffrey E. Cohen, Christian C. Shults, Jason P. Wermers, Gaby Weissman, Lowell F. Satler, Michael J. Reardon, Steven J. Yakubov, and Ron Waksman
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Cardiology and Cardiovascular Medicine - Published
- 2023
19. Explant vs Redo-TAVR After Transcatheter Valve Failure
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Gilbert H.L. Tang, Syed Zaid, Neal S. Kleiman, Sachin S. Goel, Shinichi Fukuhara, Mateo Marin-Cuartas, Philipp Kiefer, Mohamed Abdel-Wahab, Ole De Backer, Lars Søndergaard, Shekhar Saha, Christian Hagl, Moritz Wyler von Ballmoos, Oliver Bhadra, Lenard Conradi, Kendra J. Grubb, Emily Shih, J. Michael DiMaio, Molly Szerlip, Keti Vitanova, Hendrik Ruge, Axel Unbehaun, Jorg Kempfert, Luigi Pirelli, Chad A. Kliger, Nicholas Van Mieghem, Thijmen W. Hokken, Rik Adrichem, Thomas Modine, Silvia Corona, Lin Wang, George Petrossian, Newell Robinson, David Meier, John G. Webb, Anson Cheung, Basel Ramlawi, Howard C. Herrmann, Nimesh D. Desai, Martin Andreas, Markus Mach, Ron Waksman, Christian C. Schults, Hasan Ahmad, Joshua B. Goldberg, Arnar Geirsson, John K. Forrest, Paolo Denti, Igor Belluschi, Walid Ben-Ali, Anita W. Asgar, Maurizio Taramasso, Joshua D. Rovin, Marco Di Eusanio, Andrea Colli, Tsuyoshi Kaneko, Tamim N. Nazif, Martin B. Leon, Vinayak N. Bapat, Michael J. Mack, Michael J. Reardon, and Janarthanan Sathananthan
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Cardiology and Cardiovascular Medicine - Published
- 2023
20. Outcomes of Full and Partial Cardiac Autotransplantation for Complex Left-Sided Heart Tumors
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Qasim Al Abri, Lamees I. El Nihum, Areeba Ali, Duc T. Nguyen, Edward A. Graviss, Thomas E. MacGillivray, and Michael J. Reardon
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- 2023
21. 30-Day Clinical Outcomes of a Self-Expanding Transcatheter Aortic Valve
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Michael J. Reardon, Bassem Chehab, Dave Smith, Antony S. Walton, Stephen G. Worthley, Ganesh Manoharan, Ibrahim Sultan, Gerald Yong, Katherine Harrington, Paul Mahoney, Neal Kleiman, Raj R. Makkar, Gregory Fontana, Augustin DeLago, Ravi K. Ramana, Nicholas Bates, and Lars Søndergaard
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Cardiology and Cardiovascular Medicine - Published
- 2023
22. MitraClip After Failed Surgical Mitral Valve Repair—An International Multicenter Study
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Zouhair Rahhab, David Scott Lim, Stephen H. Little, Maurizio Taramasso, Shingo Kuwata, Matteo Saccocci, Corrado Tamburino, Carmelo Grasso, Christian Frerker, Theresa Wißt, Ross Garberich, Jörg Hausleiter, Daniel Braun, Eleonora Avenatti, Victoria Delgado, Gian Paolo Ussia, Fausto Castriota, Roberto Nerla, Hüseyin Ince, Alper Öner, Rodrigo Estevez‐Loureiro, Azeem Latib, Damiano Regazzoli, Nicolo Piazza, Hind Alosaimi, Peter P. T. de Jaegere, Jeroen Bax, Danny Dvir, Francesco Maisano, Paul Sorajja, Michael J. Reardon, and Nicolas M. Van Mieghem
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MitraClip ,recurrent mitral regurgitation ,surgical mitral valve repair ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Recurrence of mitral regurgitation (MR) after surgical mitral valve repair (SMVR) varies and may require reoperation. Redo mitral valve surgery can be technically challenging and is associated with increased risk of mortality and morbidity. We aimed to assess the feasibility and safety of MitraClip as a treatment strategy after failed SMVR and identify procedure modifications to overcome technical challenges. Methods and Results This international multicenter observational retrospective study collected information for all patients from 16 high‐volume hospitals who were treated with MitraClip after failed SMVR from October 29, 2009, until August 1, 2017. Data were anonymously collected. Technical and device success were recorded per modified Mitral Valve Academic Research Consortium criteria. Overall, 104 consecutive patients were included. Median Society of Thoracic Surgeons score was 4.5% and median age was 73 years. At baseline, the majority of patients (82%) were in New York Heart Association class ≥III and MR was moderate or higher in 86% of patients. The cause of MR pre‐SMVR was degenerative in 50%, functional in 35%, mixed in 8%, and missing/unknown in 8% of patients. The median time between SMVR and MitraClip was 5.3 (1.9–9.7) years. Technical and device success were 90% and 89%, respectively. Additional/modified imaging was applied in 21% of cases. An MR reduction of ≥1 grade was achieved in 94% of patients and residual MR was moderate or less in 90% of patients. In‐hospital all‐cause mortality was 2%, and 86% of patients were in New York Heart Association class ≤II. Conclusions MitraClip is a safe and less invasive treatment option for patients with recurrent MR after failed SMVR. Additional/modified imaging may help overcome technical challenges during leaflet grasping.
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- 2021
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23. Commentary: Cardiac care during the coronavirus disease 2019 pandemic: Competing constraintsCentral Message
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Michael J. Reardon, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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24. Myocardial Scar and Mortality in Chronic Aortic Regurgitation
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Maan Malahfji, Alpana Senapati, Bhupendar Tayal, Duc T. Nguyen, Edward A. Graviss, Sherif F. Nagueh, Michael J. Reardon, Miguel Quinones, William A. Zoghbi, and Dipan J. Shah
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aortic regurgitation ,aortic valve replacement ,cardiac magnetic resonance ,myocardial scar ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Chronic aortic regurgitation (AR) can be associated with myocardial scarring. It is unknown if scarring in AR is linked to poor outcomes and whether aortic valve replacement impacts this association. We investigated the relationship of myocardial scarring to mortality in chronic AR using cardiac magnetic resonance. Methods and Results We enrolled patients with moderate or greater AR between 2009 and 2019 and performed a blinded assessment of left ventricle remodeling, AR severity, and presence and extent of myocardial scarring by late gadolinium enhancement. The primary outcome was all‐cause mortality. We followed 392 patients (median age 62 [interquartile range, 51–71] years), and 78.1% were men, and 25.8% had bicuspid valves. Median aortic valve regurgitant volume was 39 mL (interquartile range, 30–60). Myocardial scar was present in 131 (33.4%) patients. Aortic valve replacement was performed in 165 (49.1%) patients. During follow‐up, up to 10.8 years (median 32.3 months [interquartile range, 9.8–69.5]), 51 patients (13%) died. Presence of myocardial scar (hazard ratio [HR], 3.62; 95% CI, 2.06–6.36; P
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- 2020
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25. Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 5-Year Outcomes of the SURTAVI Randomized Clinical Trial
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Nicolas M, Van Mieghem, G Michael, Deeb, Lars, Søndergaard, Eberhard, Grube, Stephan, Windecker, Hemal, Gada, Mubashir, Mumtaz, Peter S, Olsen, John C, Heiser, William, Merhi, Neal S, Kleiman, Stanley J, Chetcuti, Thomas G, Gleason, Joon Sup, Lee, Wen, Cheng, Raj R, Makkar, Juan, Crestanello, Barry, George, Isaac, George, Susheel, Kodali, Steven J, Yakubov, Patrick W, Serruys, Rüdiger, Lange, Nicolo, Piazza, Mathew R, Williams, Jae K, Oh, David H, Adams, Shuzhen, Li, Michael J, Reardon, and James, Yun
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Male ,Stroke ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Aortic Valve Stenosis ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Importance: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.Objective: To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, setting, and participants: SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.Intervention: Patients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.Main outcomes and measures: The prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.Results: A total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Conclusions and relevance: Among intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.
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- 2023
26. Type A Aortic Dissection with Antegrade Intimointimal Intussusception
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Christine Lannon, Priya Arunachalam, Lamees I. El Nihum, Nina Manian, Amr Telmesani, Qasim Al Abri, and Michael J. Reardon
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General Medicine - Published
- 2023
27. Transcatheter Mitral Valve Replacement with Dedicated Devices
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Joe Aoun, Michael J. Reardon, and Sachin S Goel
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General Medicine - Published
- 2023
28. What’s New with TAVR? An Update on Device Technology
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Syed Zaid, Marvin D. Atkins, Neal S. Kleiman, Michael J. Reardon, and Gilbert H. L. Tang
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General Medicine - Published
- 2023
29. Endovascular Management of the Ascending Aorta: State of the Art
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Aidan D. Atkins, Michael J. Reardon, and Marvin D. Atkins
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General Medicine - Published
- 2023
30. Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability
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Parth V. Desai, Sachin S. Goel, Neal S. Kleiman, and Michael J. Reardon
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General Medicine - Published
- 2023
31. Late Transcatheter Aortic Valve Thrombosis Leading to Cardiogenic Shock
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Qasim Al Abri, Lamees I. El Nihum, Tomoya Hinohara, Su Min Chang, Nadeen N. Faza, Sachin S. Goel, Neal S. Kleiman, Moritz C. Wyler von Ballmoos, Marvin D. Atkins, and Michael J. Reardon
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Cardiology and Cardiovascular Medicine - Published
- 2022
32. Surgical Salvage of Annular Rupture After Transcatheter Aortic Valve Implantation by Conversion Into Annular Enlargement
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Lamees I. El Nihum, Qasim Al Abri, Amr Telmesani, Areeba Ali, Yuncen A. He, Tomoya Hinohara, Manuel Reyes, Mahesh Ramchandani, and Michael J. Reardon
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Cardiology and Cardiovascular Medicine - Published
- 2022
33. Renin‐Angiotensin System Blockade in Aortic Stenosis: Implications Before and After Aortic Valve Replacement
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Sachin S. Goel, Neal S. Kleiman, William A. Zoghbi, Michael J. Reardon, and Samir R. Kapadia
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aortic stenosis ,aortic valve replacement ,renin‐angiotensin system ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aortic stenosis (AS) is a common valvular heart disease in the aging population that is characterized by a variable period of asymptomatic phase before development of symptoms and severe AS. Mortality and morbidity is substantial even after aortic valve replacement, in part related to persistent left ventricular hypertrophy, diastolic dysfunction, and heart failure. Renin‐angiotensin system (RAS) blockade therapy is associated with modulation of adverse left ventricular remodeling, reduction in myocardial hypertrophy, and fibrosis, resulting in clinical improvements in patients with congestive heart failure There are emerging data to suggest benefit of RAS blockade in patients with AS before and after AVR with regard to potentially slower progression of aortic valve calcification, left ventricular mass and survival benefit in favor of RAS blockade group before AVR, and also survival benefit in patients after AVR. We review the available data to understand the role of RAS blockade before AVR and in patients undergoing surgical AVR and transcatheter AVR. There are significant survival advantages of RAS inhibition in patients with AS undergoing surgical AVR or transcatheter AVR. On the basis of existing literature, adequately powered randomized trials are needed to evaluate the role of RAS inhibition in patients with AS.
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- 2020
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34. Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement
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Kashish Goel, Jared M. O’Leary, Colin M. Barker, Melissa Levack, Vivek Rajagopal, Raj R. Makkar, Tanvir Bajwa, Neal Kleiman, Axel Linke, Dean J. Kereiakes, Ron Waksman, Dominic J. Allocco, David G. Rizik, Michael J. Reardon, and Brian R. Lindman
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aortic valve stenosis ,frailty ,gait speed ,outcomes ,physical function ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Gait speed is a reliable measure of physical function and frailty in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Slow gait speed pre‐TAVR predicts worse clinical outcomes post‐TAVR. The consequences of improved versus worsened physical function post‐TAVR are unknown. Methods and Results The REPRISE III (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System–Randomized Clinical Evaluation) trial randomized high/extreme risk patients to receive a mechanically‐expanded or self‐expanding transcatheter heart valve. Of 874 patients who underwent TAVR, 576 with complete data at baseline and 1 year were included in this analysis. Slow gait speed in the 5‐m walk test was defined as
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- 2020
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35. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial
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Christopher U. Meduri, Dean J. Kereiakes, Vivek Rajagopal, Raj R. Makkar, Daniel O'Hair, Axel Linke, Ron Waksman, Vasilis Babliaros, Robert C. Stoler, Gregory J. Mishkel, David G. Rizik, Vijay S. Iyer, John Schindler, Dominic J. Allocco, Ian T. Meredith, Ted E. Feldman, and Michael J. Reardon
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aortic valve stenosis ,pacemaker dependency ,permanent pacemaker ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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- 2019
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36. Lower Blood Pressure After Transcatheter or Surgical Aortic Valve Replacement is Associated with Increased Mortality
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Brian R. Lindman, Kashish Goel, Javier Bermejo, Joshua Beckman, Jared O'Leary, Colin M. Barker, Clayton Kaiser, João L. Cavalcante, Sammy Elmariah, Jian Huang, Graeme L. Hickey, David H. Adams, Jeffrey J. Popma, and Michael J. Reardon
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aortic valve stenosis ,blood pressure ,mortality ,transcatheter aortic valve implantation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Blood pressure (BP) guidelines for patients with aortic stenosis or a history of aortic stenosis treated with aortic valve replacement (AVR) match those in the general population, but this extrapolation may not be warranted. Methods and Results Among patients enrolled in the Medtronic intermediate, high, and extreme risk trials, we included those with a transcatheter AVR (n=1794) or surgical AVR (n=1103) who were alive at 30 days. The associations between early (average of discharge and 30 day post‐AVR) systolic BP (SBP) and diastolic BP (DBP) measurements and clinical outcomes between 30 days and 1 year were evaluated. Among 2897 patients, after adjustment, spline curves demonstrated an association between lower SBP (
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- 2019
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37. Tumors of the Heart and Great Vessels
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Moritz C. Wyler von Ballmoos and Michael J. Reardon
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- 2022
38. Mechanisms of Death in Low-Risk Patients After Transcatheter or Surgical Aortic Valve Replacement
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Basel, Ramlawi, G Michael, Deeb, Steven J, Yakubov, Alan H, Markowitz, G Chad, Hughes, Robert B, Kiaii, Jian, Huang, Neal S, Kleiman, and Michael J, Reardon
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Heart Valve Prosthesis Implantation ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Aortic Valve Stenosis ,General Medicine ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Death in high- and intermediate-risk patients after self-expanding transcatheter (TAVR) and surgical aortic valve replacement (surgery) differed in mechanisms and timing. In both risk groups, 1-year all-cause mortality was lower in TAVR than in surgery patients. The differences in mechanism and timing of death in low-risk patients has not been studied. This report explores the mechanisms of death during 3 time periods; 0 to 30 days (early), 31 to 120 days (recovery), and 121 to 365 days (late).We retrospectively examined the mechanisms and timing of death following TAVR or surgery in the randomized Evolut Low Risk Trial. Patients were enrolled between March 2016 and November 2018 from 86 designated TAVR centers. Mechanisms of death were categorized as due to technical reasons, failure to repair, complications linked to death, failure to recover or other.All-cause mortality at 1 year was 2.2% for TAVR and 2.8% for surgery, p = 0.44. Early deaths included 3 TAVR patients, all due to technical reasons, and 8 surgery patients (1 technical, 5 complications and 2 failed to recover). Recovery period deaths included 6 TAVR patients (4 complications, 1 failed to recover and 1 other), and 1 surgery patient from complications of valve endocarditis. Late period deaths included 6 TAVR patients and 9 surgery patients, primarily due to complications.In this low-risk study cohort, no patient died from failure to repair the valve; reduction in procedural complications in the TAVR and surgery groups remain opportunities for further improvement in outcomes. Clinical Trial Registrations (clinicaltrials.gov): NCT02701283 (Evolut Low Risk).
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- 2022
39. Aortic Dissection During Pregnancy and Puerperium: Contemporary Incidence and Outcomes in the United States
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Yunda Wang, Kanhua Yin, Yesh Datar, Joy Mohnot, Ariana Y. Nodoushani, Yong Zhan, Karl J. Karlson, Niloo M. Edwards, Michael J. Reardon, and Nikola Dobrilovic
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Cardiology and Cardiovascular Medicine - Abstract
Background Aortic dissection (AD) during pregnancy and puerperium is a rare catastrophe with devastating consequences for both parent and fetus. Population‐level incidence trends and outcomes remain relatively undetermined. Methods and Results We queried a US population‐based health care database, the National Inpatient Sample, and identified all patients with a pregnancy‐related AD hospitalization from 2002 to 2017. In total, 472 pregnancy‐related AD hospitalizations (mean age, 30.9±0.6 years) were identified from 68 514 000 pregnancy‐related hospitalizations (0.69 per 100 000 pregnancy‐related hospitalizations), with 107 (22.7%) being type A and 365 (77.3%) being type B. The incidence of AD appeared to increase over the 16‐year study period but was not statistically significant ( P for trend >0.05). Marfan syndrome, primary hypertension, and preeclampsia/eclampsia were found in 21.9%, 14.4%, and 11.5%, respectively. On multivariable logistic regression analysis, Marfan syndrome was associated with the highest risk of developing AD during pregnancy and puerperium (adjusted odds ratio, 3469.36 [95% CI, 1767.84–6831.75]; P Conclusions We quantified population‐level incidence and in‐hospital mortality in the United States and observed an increase in the incidence of pregnancy‐related AD. In contrast, its in‐hospital mortality appears lower than that of non–pregnancy‐related AD.
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- 2023
40. Quality of Life After Fractional Flow Reserve–Guided PCI Compared With Coronary Bypass Surgery
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William F, Fearon, Frederik M, Zimmermann, Victoria Y, Ding, Jo M, Zelis, Zsolt, Piroth, Giedrius, Davidavicius, Samer, Mansour, Rajesh, Kharbanda, Nikolaos, Östlund-Papadogeorgos, Keith G, Oldroyd, Olaf, Wendler, Michael J, Reardon, Y Joseph, Woo, Alan C, Yeung, Nico H J, Pijls, Bernard, De Bruyne, Manisha, Desai, and Mark A, Hlatky
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Canada ,Coronary Artery Disease ,Angina Pectoris ,Fractional Flow Reserve, Myocardial ,Percutaneous Coronary Intervention ,Treatment Outcome ,surgical procedures, operative ,Physiology (medical) ,Quality of Life ,Humans ,cardiovascular diseases ,Coronary Artery Bypass ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Background: Previous studies have shown that quality of life improves after coronary revascularization more so after coronary artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI). This study aimed to evaluate the effect of fractional flow reserve guidance and current generation, zotarolimus drug-eluting stents on quality of life after PCI compared with CABG. Methods: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) is a multicenter, international trial including 1500 patients with 3-vessel coronary artery disease who were randomly assigned to either CABG or fractional flow reserve–guided PCI. Quality of life was measured using the European Quality of Life–5 Dimensions (EQ-5D) questionnaire at baseline and 1 and 12 months. The Canadian Cardiovascular Class angina grade and working status were assessed at the same time points and at 6 months. The primary objective was to compare EQ-5D summary index at 12 months. Secondary end points included angina grade and work status. Results: The EQ-5D summary index at 12 months did not differ between the PCI and CABG groups (difference, 0.001 [95% CI, –0.016 to 0.017]; P =0.946). The trajectory of EQ-5D during the 12 months differed ( P Conclusions: In the FAME 3 trial, quality of life after fractional flow reserve–guided PCI with current generation drug-eluting stents compared with CABG was similar at 1 year. The rate of significant angina was low in both groups and not significantly different. The trajectory of improvement in quality of life was significantly better after PCI, as was working status in those Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02100722.
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- 2022
41. Indication Creep in Transcatheter Aortic Valve Implantation—Data or Desire?
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Sachin S. Goel and Michael J. Reardon
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Cardiology and Cardiovascular Medicine - Abstract
This Viewpoint discusses the expanded use of transcatheter aortic valve implantation in low-risk, younger patients.
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- 2023
42. Intraprocedural Doppler and Invasive Hemodynamic Profiling Predict Clinical Outcomes After Mitral TEER
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Syed Zaid, Priscilla Wessly, Taha Hatab, Safi U Khan, Nadeen Faza, Stephen H Little, Marvin D Atkins, Michael J Reardon, Neal S Kleiman, William A Zoghbi, and Sachin S Goel
- Abstract
BackgroundWhether intraprocedural changes in left atrial pressure and Doppler Echocardiographic parameters are synergistic in predicting outcomes after mitral transcatheter edge-to-edge repair (TEER) is not currently known. We sought to evaluate real-time changes in invasive hemodynamics and non-invasive Doppler to develop intraprocedural profiles and assess their impact on clinical outcomes after TEER for MR.MethodsIntraprocedural changes in hemodynamics and Doppler flow with transesophageal echocardiography were assessed in 181 patients with significant MR (51.9% primary MR) undergoing TEER between 2014 and 2022. Independent predictors of the primary composite endpoint of 1-year mortality and heart failure hospitalization (HFH) were identified using multivariable Cox-regression. With receiver operating characteristic curve-derived thresholds for the predictors of the primary end-point, patients were stratified into hemodynamic profiles based on the number of predictors present, and their impact on outcomes was examined.ResultsMedian follow-up was 21.3 months (IQR:11.3-36.5), with 1-year mortality and HFH rates of 19.3% and 12.7%, respectively. Residual mean left atrial pressure (mLAP) [HR=1.073/mmHg (1.03-1.12)], a lesser degree of MR reduction [HR=0.65/grade (0.45-0.93)], and lesser increment in PV systolic time velocity integral (S-VTI) [HR=0.95/cm (0.91-0.99)] were independent predictors of 1-year mortality/HFH. MR reduction by 15mmHg (43.6%) were the most predictive thresholds. Optimal profile (0 predictors), Mixed (1 predictor) and Poor profile (≥2 predictors) were present in 28.7%, 39.2% and 32.0% of cases respectively. Two-year cumulative event-free survival was 60.1% overall, and higher in patients with optimal profile compared to mixed/poor groups (84.7% vs 55.5% vs 43.3%, P5mmHg [HR=2.32 (1.17-4.61)].ConclusionIntraprocedural hemodynamic profiling integrating changes in invasive hemodynamics and non-invasive doppler provide prognostic information in patients undergoing TEER and may provide real-time intraprocedural guidance to optimize long-term clinical outcomes.
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- 2023
43. Differences in Myocardial Remodeling and Tissue Characteristics in Chronic Isolated Aortic and Mitral Regurgitation
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Maan Malahfji, Danai Kitkungvan, Alpana Senapati, Duc T. Nguyen, Carlos El-Tallawi, Bhupendar Tayal, Dany Debs, Valentina Crudo, Edward A. Graviss, Michael J. Reardon, Miguel Quinones, William A. Zoghbi, and Dipan J. Shah
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Background: The left ventricular hemodynamic load differs between aortic regurgitation (AR) and primary mitral regurgitation (MR). We used cardiac magnetic resonance to compare left ventricular remodeling patterns, systemic forward stroke volume, and tissue characteristics between patients with isolated AR and isolated MR. Methods: We assessed remodeling parameters across the spectrum of regurgitant volume. Left ventricular volumes and mass were compared against normal values for age and sex. We calculated forward stroke volume (planimetered left ventricular stroke volume−regurgitant volume) and derived a cardiac magnetic resonance–based systemic cardiac index. We assessed symptom status according to remodeling patterns. We also evaluated the prevalence of myocardial scarring using late gadolinium enhancement imaging, and the extent of interstitial expansion via extracellular volume fraction. Results: We studied 664 patients (240 AR, 424 primary MR), median age of 60.7 (49.5–69.9) years. AR led to more pronounced increases in ventricular volume and mass compared with MR across the spectrum of regurgitant volume ( P P P P value for trend P =0.24 and 0.42, respectively). Conclusions: Cardiac magnetic resonance identified significant heterogeneity in remodeling patterns and tissue characteristics at matched degrees of AR and MR. Further research is needed to examine if these differences impact reverse remodeling and clinical outcomes after intervention.
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- 2023
44. Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials
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Yousif Ahmad, James P Howard, Ahran D Arnold, Mahesh V Madhavan, Christopher M Cook, Maria Alu, Michael J Mack, Michael J Reardon, Vinod H Thourani, Samir Kapadia, Hans Gustav Hørsted Thyregod, Lars Sondergaard, Troels Højsgaard Jørgensen, William D Toff, Nicolas M Van Mieghem, Raj R Makkar, John K Forrest, Martin B Leon, and Cardiology
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Cardiology and Cardiovascular Medicine - Abstract
AimsAdditional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients.Methods and resultsThe main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI.ConclusionIn lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.
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- 2023
45. Morphometric analysis of calcification and fibrous layer thickness in carotid endarterectomy tissues.
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Richard I. Han, Thomas M. Wheeler, Alan B. Lumsden, Michael J. Reardon, Gerald M. Lawrie, K. Jane Grande-Allen, Joel D. Morrisett, and Gerd Brunner
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- 2016
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46. Cardiac Angiosarcomas
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Andrew J. Bishop, Jing Zheng, Aparna Subramaniam, Amol J. Ghia, Chenyang Wang, Susan L. McGovern, Shreyaskumar Patel, B. Ashleigh Guadagnolo, Devarati Mitra, Ahsan Farooqi, Michael J. Reardon, Betty Kim, Nandita Guha-Thakurta, Jing Li, and Vinod Ravi
- Subjects
Cohort Studies ,Diagnostic Imaging ,Cancer Research ,Oncology ,Brain Neoplasms ,Hemangiosarcoma ,Humans ,Hemorrhage ,Prognosis ,Article ,Retrospective Studies - Abstract
We evaluated a cohort of patients with cardiac angiosarcomas (CA) who developed brain metastases (BM) to define outcomes and intracranial hemorrhage (IH) risk.We reviewed 26 consecutive patients with BM treated between 1988 and 2020 identified from a departmental CA (n=103) database. Causes of death were recorded, and a terminal hemorrhage (TH) was defined as an IH that caused death or prompted a transfer to hospice.The prevalence of BM was 25% (n=26/103). A total of 23 patients (88%) had IH, including 21 (81%) at initial BM diagnosis, of which 18 (86%) required hospitalization. The median platelet count at the time of IH was 235k (interquartile range, 108 to 338k).Nearly all patients died of disease (n=23, 88%) and most patients died from TH (n=13, 57%). TH occurred at BM presentation in 6 (46%) patients, whereas 3 (23%) had TH from known but untreated lesions, 2 (15%) had continued uncontrolled IH during radiation therapy, and 2 (15%) from new BM. Platelet count50k was not associated with TH (P=0.25).Subsequent IH occurred in 9 patients (35%), and importantly, no patients who completed radiation therapy (n=10) for BM died from TH.Patients with CA frequently develop BM, and the risk of IH is high, resulting in an alarming rate of TH despite normal platelet counts. Therefore, early diagnosis and intervention are warranted. We recommend surveillance brain imaging, and importantly, once BM is detected, prompt local therapy is warranted to try and mitigate the risk of TH.
- Published
- 2022
47. Functional Status After Transcatheter and Surgical Aortic Valve Replacement
- Author
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Mark K. Tuttle, Bob Kiaii, Nicolas M. Van Mieghem, Roger J. Laham, G. Michael Deeb, Stephan Windecker, Stanley Chetcuti, Steven J. Yakubov, Atul Chawla, David Hockmuth, Patrick Teefy, Shuzhen Li, and Michael J. Reardon
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
48. 2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients
- Author
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John K. Forrest, G. Michael Deeb, Steven J. Yakubov, Joshua D. Rovin, Mubashir Mumtaz, Hemal Gada, Daniel O’Hair, Tanvir Bajwa, Paul Sorajja, John C. Heiser, William Merhi, Abeel Mangi, Douglas J. Spriggs, Neal S. Kleiman, Stanley J. Chetcuti, Paul S. Teirstein, George L. Zorn, Peter Tadros, Didier Tchétché, Jon R. Resar, Antony Walton, Thomas G. Gleason, Basel Ramlawi, Ayman Iskander, Ronald Caputo, Jae K. Oh, Jian Huang, and Michael J. Reardon
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
49. Large, Hormonally Active Primary Cardiac Paraganglioma: Diagnosis and Management
- Author
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Susan L. Haley, Lamees I. El Nihum, M. Mujeeb Zubair, Michael J. Reardon, Qasim Al Abri, Thomas E. MacGillivray, and Daniel J. Lenihan
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Pulmonary and Respiratory Medicine ,Surgical resection ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Cardiac Paraganglioma ,Coronary ischemia ,Chest pain ,medicine.disease ,Left ventricular mass ,Positron emission tomography ,Heart team ,cardiovascular system ,medicine ,Surgery ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac Tumors - Abstract
We describe a 26-year-old woman presenting with chest pain and evidence of coronary ischemia. Echocardiography revealed a large left ventricular mass initially deemed unresectable at her initial institution. Investigation revealed a dopamine-secreting primary cardiac paraganglioma (PCP) encompassing vital cardiac architecture. This case discusses our heart team approach to complex cardiac masses and illustrates the feasibility of surgical resection in complex cases of hormonally active PCPs.
- Published
- 2022
50. Surgical Sutureless and Sutured Aortic Valve Replacement in Low-risk Patients
- Author
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Jae K. Oh, G. Michael Deeb, G. Chad Hughes, Steven J. Yakubov, Stephen E. Fremes, Michael J. Reardon, Thomas G. Gleason, Stuart J. Head, Thomas Modine, Jian Huang, J. Kevin Harrison, M. Erwin Tan, Ka Yan Lam, and Pim A.L. Tonino
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Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Global Health ,Prosthesis Design ,Risk Assessment ,Severity of Illness Index ,law.invention ,Transcatheter Aortic Valve Replacement ,Postoperative Complications ,Valve replacement ,Aortic valve replacement ,Randomized controlled trial ,Risk Factors ,law ,medicine ,Humans ,Stroke ,Aged ,business.industry ,Incidence ,Suture Techniques ,Aortic Valve Stenosis ,medicine.disease ,Sutureless Surgical Procedures ,Surgery ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Female ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
Randomized clinical trials have shown that transcatheter aortic valve replacement is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial.The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding transcatheter aortic valve replacement or surgery. Use of sutureless or sutured valves was at the surgeons' discretion.Six hundred eighty patients underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The Valve Academic Research Consortium-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P = .93). All-cause mortality between groups was similar at 30 days (0.5% vs 1.5%, P = .28) and 1 year (3.3% vs 2.6%, P = .74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P = .65) and 1 year (2.6% vs 2.2%, P = .76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P.001). Aortic valve-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P = .04). Mean gradients 1 year after sutureless and sutured aortic valve replacement were 9.9 ± 4.2 versus 11.7 ± 4.7 mm Hg (P.001).Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics but with an increased rate of pacemaker implantation and valve-related hospitalizations.
- Published
- 2022
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