Author: "Peter M. Pollak" - Searchworks@Jio Institute Digital Library Search Results

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1. Topological Data Analysis Identified Prognostically-Distinct Phenotypes in Transcatheter Edge-to-Edge Repair Patients

Author: Chieh-Ju Chao, MD, Timothy Barry, MB, BCh, BAO, Amith Seri, MBBS, Ahmed El Shaer, MBBS, Nadia Chavez Ponce, MD, Soham Chakraborty, BS, Sean Smith, MD, Mohamad Alkhouli, MD, Jeremy Thaden, MD, David Fortuin, MD, John P. Sweeney, MD, Mackram Eleid, MD, Charanjit S. Rihal, MD, David R. Holmes, MD, Peter M. Pollak, MD, Abdallah El Sabbagh, MD, Steven J. Lester, MD, Jae K. Oh, MD, Win-Kuang Shen, MD, Imon Banerjee, PhD, and Reza Arsanjani, MD
Subjects: Computer applications to medicine. Medical informatics, R858-859.7
Abstract: Objective: To identify prognostically distinct phenotype clusters in transcatheter edge-to-edge repair (TEER) patients based on topological data analysis (TDA), which was never used to assess the heterogeneous TEER population. Patients and Methods: Patients who underwent TEER (June 2014-September 2020) at Mayo Clinic sites were identified from the institutional database. Thirteen variables were used for TDA. The topological network graph was created using the Python Scikit-TDA Kepler-Mapper package (v. 2.0.1), and clustering was performed at the graph level with Louvain’s modularity method. Kaplan-Meier survival analysis was used to assess the all-cause mortality of each cluster. Result: A total of 389 consecutive patients were included in the final analysis, and 2 major clusters were identified. The mean age was 80.3 ± 8.7 years; 256 (65.8%) were male. Fifty-five (14.5%) patients died during the mean follow-up duration (185 days). Kaplan-Meier analysis showed significant survival differences among the 2 clusters (hazard ratio, 2.70; 95% CI, 1.50-4.87; P=.0005). Cluster 1 (n=227) had moderate or increased residual mitral regurgitation (cluster 0 vs cluster 1: 19.4% vs 41.9%; P
Published: 2023
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2. Iatrogenic left common carotid artery to right internal jugular vein arteriovenous fistula closure

Author: Kyle Steiger, BA, Charles Ritchie, MD, Peter M. Pollak, MD, Sukhwinder J.S. Sandhu, MD, David Miller, MD, and Young Erben, MD
Subjects: Arteriovenous fistula, Iatrogenic, Left common carotid artery, Right internal jugular vein, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: We report a minimally invasive approach to the repair of a 2.8-cm × 6.0-cm left proximal common carotid to right internal jugular vein arteriovenous fistula. A 47-year-old woman with coronavirus disease 2019 pneumonia had received extracorporeal membranous oxygenation and developed a rare, presumably cannulation-related, vascular injury. We used a plug designed and typically used for the endovascular management of a patent ductus arteriosus.
Published: 2022
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3. Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip

Author: Chieh-Ju Chao, Amith Seri, Bishoy Abraham, Juan M. Farina, Evelyn Fennelly, Megan Campany, Milagros Pereyra, Ebram F. Said, Courtney Kenyon, Ayman R. Fath, Sean Smith, Skye Buckner-Petty, Corbin A. Rayfield, David Fortuin, John P. Sweeney, Eric H. Yang, Chadi Ayoub, Mackram F. Eleid, Mohamad Alkhouli, Charanjit S. Rihal, David R. Holmes, Peter M. Pollak, Abdallah El Sabbagh, Jae K. Oh, and Reza Arsanjani
Subjects: mitral valve insufficiency, endovascular procedures, echocardiography, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: Prior studies have reported conflicting results of persistent iatrogenic atrial septal defect (iASD) and its impact following a transcatheter edge-to-edge repair (TEER) procedure. This study aims to evaluate the incidence of iASD and its clinical and hemodynamic impact after a TEER. Methods: Consecutive patients who underwent a TEER procedure from June 2014 to September 2020 at the Mayo Clinic were identified. The presence of iASD was retrospectively identified on post-procedure transthoracic echocardiography (TTE) to group patients into an iASD+ group and an iASD− group for comparison of prognosis and cardiac function. Results: A total of 316 patients were included; the mean age was 79.1 ± 9.1 years, and 67.7% were male. Persistent iASD was diagnosed in 108 (34.2%) patients. There was no difference concerning all-cause mortality, heart failure hospitalization, and stroke/TIA between groups at follow-up (median follow-up of 9 months). Post-procedure TTE demonstrated no differences regarding right ventricle (RV) and left ventricle (LV) dimensions and function, including TAPSE (15.2 ± 4.6 vs. 15.4 ± 5.5 mm, p = 0.875), and LV ejection fraction (51.1 ± 14.0% vs. 51.3 ± 13.9%, p = 0.933). However, patients with iASD had higher RV systolic pressure (48.7 ± 14.4 vs. 45.5 ± 14.5 mmHg, p = 0.042) compared with patients without iASD. Conclusion: Notwithstanding higher RV pressures, patients with persistent iASD had no hemodynamic compromise and an equal prognosis compared with those without a residual atrial defect after a TEER procedure. These findings support the mid-term safety of procedures in which an interatrial defect needs to be created and would argue against the need for interventional closure.
Published: 2022
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4. Characteristics and Outcomes After Transcatheter Aortic Valve Implantation in Immunocompromised Patients

Author: Alexander Ghannam, S. Michael Gharacholou, Colleen T. Ball, Peter M. Pollak, Pragnesh P. Parikh, Carolyn Landolfo, Mays T. Ali, and Kevin Landolfo
Subjects: Heart Valve Prosthesis Implantation, Transcatheter Aortic Valve Replacement, Immunocompromised Host, Treatment Outcome, Risk Factors, Aortic Valve, Neoplasms, Humans, Aortic Valve Stenosis, Cardiology and Cardiovascular Medicine
Abstract: Immunocompromised (IC) patients are at greater risk of adverse outcomes from cardiac surgery, and less invasive options for treating severe aortic stenosis among IC patients are often sought. However, despite greater preference for transcatheter aortic valve implantation (TAVI) in this population, there are limited data on outcomes in IC patients. Between January 2015 and December 2019, we studied patients with severe aortic stenosis who underwent TAVI. We defined IC status by the presence of active malignancy and receipt of oncologic treatment, post-organ transplantation-associated immunosuppression, human immunodeficiency virus, chronic steroid use (5 mg/day), or active autoimmune disorder, and compared characteristics and outcomes of IC patients with those of non-IC patients. Of 173 patients who underwent TAVI, 56 (32%) were IC, 30 (54%) had active malignancy and underwent active treatment, 19 (34%) were IC without malignancy, and 7 (13%) were both IC and had active malignancy. IC patients, compared with non-IC patients, had similar baseline demographics, Society of Thoracic Surgeons risk scores (median 4.3% vs 4.4%), and overall complications (29% vs 26%). There were 37 deaths (16 IC and 21 non-IC) over a median follow-up of 17 months (95% confidence interval [CI] 14 to 20 months), and 1-year survival after TAVI was 84.0% for IC patients and 89.0% for non-IC patients (p = 0.51 by log-rank). After adjusting for Society of Thoracic Surgeons risk scores, IC patients had a nonsignificant trend toward greater risk of death compared with non-IC patients (adjusted hazard ratio 1.48, 95% CI 0.77 to 2.84). IC patients had a significantly smaller risk of cardiac-related death (adjusted hazard ratio 0.21, 95% CI 0.05 to 0.98) but a greater risk of noncardiac-related death (adjusted hazard ratio 4.14, 95% CI 1.71 to 10.0) than non-IC patients. In conclusion, IC patients who underwent TAVI have similar complication rates as non-IC patients, with a nonsignificant trend toward greater mortality, specifically related to noncardiac causes.
Published: 2022
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5. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020
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6. Anatomic Approach to Transseptal Puncture for Structural Heart Interventions

Author: Mackram F. Eleid, Mohamad Alkhouli, Jeremy J. Thaden, Peter M. Pollak, Colleen E. Lane, Paul A. Friedman, Charanjit S. Rihal, Ammar M. Killu, Abdallah El Sabbagh, and Trevor Simard
Subjects: Cardiac Catheterization, medicine.medical_specialty, business.industry, Psychological intervention, Punctures, Surgery, Treatment Outcome, Left atrial, Cardiac interventions, Atrial Fibrillation, Catheter Ablation, Humans, Medicine, Heart Atria, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, business
Abstract: The use of transseptal puncture continues to rise given the increase in left atrial cardiac interventions. The authors review an anatomic approach to transseptal puncture incorporating multimodality imaging both pre- and intraprocedurally with stepwise escalation algorithms to ensure safe and efficacious large-bore transseptal puncture.
Published: 2021
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7. Outcomes of Radial Versus Femoral Access in Patients With Severe Aortic Stenosis Undergoing Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Replacement

Author: Salman, Farhat, Abdallah, El Sabbagh, Mohammed, Al-Hijji, Keniel, Pierre, Nahyr S, Lugo-Fagundo, Yader, Sandoval, Michael S, Gharacholou, Peter M, Pollak, Mandeep, Singh, Mackram F, Eleid, Mohammed, Al-Khouli, David R, Holmes, Mayra, Guerrero, Rajiv, Gulati, Malcolm, Bell, and Charanjit S, Rihal
Subjects: Aged, 80 and over, Male, Stroke, Transcatheter Aortic Valve Replacement, Percutaneous Coronary Intervention, Treatment Outcome, Fluoroscopy, Humans, Female, Aortic Valve Stenosis
Abstract: The safety and feasibility of radial access in patients undergoing percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) has not been studied.This study included consecutive patients who underwent PCI within 30 days before TAVR at Mayo Clinic. Vascular access was left to the discretion of the operator. Baseline demographics, procedural data, PCI outcomes, and subsequent transfemoral TAVR outcomes were extracted from patient charts.A total of 331 patients were included in this study, with 107 patients undergoing PCI via radial access (rPCI), and 224 via femoral access (fPCI). Mean age was 80.6 years and 35.6% were females (35.5% rPCI vs 35.3% fPCI). More patients in the fPCI group had previous coronary artery bypass graft surgery (13.1% rPCI vs 34.4% fPCI; P.001). Fluoroscopy time (13.36 minutes vs 18.86 minutes; P.001) and contrast use (115 mL vs 140 mL; P.01) were lower in the rPCI group than in the fPCI group. Crossover rate from radial to femoral was 6.5%. There were more access-site hematomas in the fPCI group (2.8% rPCI vs 14.3% fPCI; P.001), with no statistically significant rate of other access-related complications. There was no difference in stroke, myocardial infarction, cardiac arrest, or unplanned surgery. There was no difference in bleeding or stroke between both groups during subsequent transfemoral TAVR.Radial access for pre-TAVR PCI is feasible and safe and is associated with a lower rate of access-site hematoma. This study supports the increased use of transradial access for pre-TAVR PCI.
Published: 2022

8. 30‐day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip

Author: William R. Miranda, Abdallah El Sabbagh, Demilade Adedinsewo, Charanjit S. Rihal, Mohamad Alkhouli, Peter M. Pollak, Keniel F. Pierre, Mayra Guerrero, Mohammed Al-Hijji, and Mackram F. Eleid
Subjects: Cardiac Catheterization, medicine.medical_specialty, Demographics, Diastole, 030204 cardiovascular system & hematology, Age and sex, Nyha class, 03 medical and health sciences, Atrial Pressure, 0302 clinical medicine, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Patient Reported Outcome Measures, 030212 general & internal medicine, Aged, 80 and over, business.industry, MitraClip, Mitral Valve Insufficiency, General Medicine, Left atrial pressure, Treatment Outcome, Symptom improvement, Cardiology, Mitral Valve, Female, Functional status, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND Change in left atrial pressure (LAP) has been shown to be associated with symptom improvement post-MitraClip; however, the association between acute procedural changes in transmitral diastolic mean gradient (MG) compared to LAP and symptom improvement is not well established. METHODS 164 consecutive patients undergoing MitraClip at Mayo Clinic between June 2014 and May 2018 were included. Preclip and postclip MG and LAP were recorded. Baseline demographics, clinical, and echocardiographic outcomes, including 30-day New York Heart Association (NYHA) functional status were obtained from patient charts. RESULTS Median age was 81.5 years (IQR: 76.3, 87), 34% were female and 94.5% had NYHA class III and IV functional status at baseline. At baseline, median MG was 4 mmHg (IQR: 3, 5) and LAP was 19 mmHg (IQR: 16, 23.5). Following MitraClip deployment, the median MG was 4 mmHg (IQR: 3, 6) and the median LAP was 17 mmHg (IQR: 14, 21), 69.5% of patients had less than moderate MR. There was no statistically significant association between change in MG and NYHA functional class at 30 days (OR = 0.95, 95% CI: 0.76-1.20). However, a reduction in LAP following MitraClip deployment was significantly associated with improvement in NYHA functional status at 30 days following adjustments for age and sex (aOR 3.36, 95% CI: 1.34-8.65). There was no significant correlation between change in mean LAP and change in MG (p = .98). CONCLUSION Unlike change in left atrial pressure, change in MG post-MitraClip was not associated with patient reported outcomes at 30 days and did not correlate with change in left atrial pressure. Long-term follow up is needed to evaluate the impact of LA pressure on symptoms.
Published: 2021
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9. Resting Cardiac Efficiency Affects Survival Following Transcatheter Aortic Valve Replacement

Author: Floyd David Fortuin, Kevin L. Greason, Panwen Wang, Peter M. Pollak, Hasan Ashraf, Mackram F. Eleid, John P. Sweeney, Nithin R. Venepally, Farouk Mookadam, Sai Harika Pujari, Nirat Beohar, Mohamed Allam, Reza Arsanjani, and Pradyumna Agasthi
Subjects: Male, medicine.medical_specialty, Cardiac output, medicine.medical_treatment, 030204 cardiovascular system & hematology, Doppler echocardiography, Severity of Illness Index, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Aortic valve replacement, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Retrospective Studies, Framingham Risk Score, medicine.diagnostic_test, business.industry, Atrial fibrillation, Aortic Valve Stenosis, General Medicine, medicine.disease, Treatment Outcome, Blood pressure, Aortic Valve, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Cardiac power to left ventricular mass (LVM) ratio, also termed cardiac efficiency (CE), reflects the rate of cardiac work delivered to the potential energy stored in LVM. We sought to assess the association between baseline resting CE and survival post transcatheter aortic valve replacement (TAVR).We retrospectively extracted data of patients who received TAVR in the Mayo Clinic Foundation with follow up data available at 1 year. Cardiac output was measured using Doppler echocardiography at baseline. CE was calculated using the formula, (cardiac output × mean arterial blood pressure)/(451 × LVM × 100) W/100 g. Survival score analysis was performed to identify cut off value for CE to identify the maximum difference in mortality in the study cohort. Patients were subsequently divided into 2 groups CE 0.38 W/100 g and CE ≥ 0.38 W/100 g. Survival was determined using Kaplan-Meier method.We included 954 patients in the final analysis. CE in group1 vs group 2 was 0.31 ± 0.05 W/100 g vs 0.59 ± 0.18 W/100 g. Patients in group1 were more likely to be male, had a higher prevalence of atrial fibrillation, prior myocardial infarction, mitral and tricuspid regurgitation. They also had a higher STS risk score, NYHA functional class, and lower aortic valve area. The remainder of the baseline characteristics was similar in both groups. A lower CE was associated with higher 1-year mortality following TAVR based on multivariate analysis. (Group1: 22.18% vs Group 2: 9.89%, p .0001).In our cohort, a low baseline CE (0.38 W/100 g) conferred higher mortality risk following TAVR.
Published: 2020
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10. Clinical Outcomes following Left Atrial Appendage Occlusion: A Single-Center Experience

Author: K.L. Venkatachalam, Jeffery Winder, Pragnesh Parikh, Demilade Adedinsewo, Susie Sennhauser, Elizabeth R. Lesser, Carolyn Landolfo, Najiyah Salwa, Launia J. White, Peter M. Pollak, and Salman Farhat
Subjects: Male, Gastrointestinal bleeding, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Single Center, Left atrial appendage occlusion, Antithrombotic, medicine, Humans, Atrial Appendage, Pharmacology (medical), Stroke, Aged, Retrospective Studies, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Surgery, Treatment Outcome, Female, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract: Introduction: Percutaneous left atrial appendage closure is an established alternative to anticoagulation therapy for stroke prophylaxis among patients with nonvalvular atrial fibrillation. There are currently no guidelines on the choice of antithrombotic therapy following placement of the Watchman® device, the optimal time to discontinue anticoagulation or the duration of follow-up imaging after device deployment. Our main objective was to evaluate clinical outcomes among these patients. Methods: We conducted a retrospective review of patients who received a Watchman® device at Mayo Clinic sites between January 2010 and December 2018. We constructed Cox-proportional hazard models to evaluate the effect of specific variables on clinical outcomes. Results: 231 patients were identified (33% female), median age was 77 years, CHA2DS2-VASc score was 5 and HASBLED score was 4. We found no difference in clinically significant bleeding based on initial antithrombotic choice. However, patients with prior gastrointestinal bleeding were more likely to have a bleeding event in the first 6 weeks following Watchman® implantation (HR 9.40, 95% CI 2.15–41.09). Device sizes of 24–27 mm were significantly associated with a decreased risk of thromboembolic events (HR 0.15, 95% CI 0.04–0.55) compared to 21-mm devices. Peridevice leak (PDL) sizes appeared to either remain the same or increase on follow-up imaging. Discussion/Conclusions: This observational study showed no statistically significant difference in bleeding risk related to initial antithrombotic choice. Smaller device sizes were associated with thromboembolic events, and longitudinal PDL assessment using transesophageal echocardiography showed these frequently do not decrease in size. Larger studies are needed.
Published: 2020
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11. STEMI Mimics

Author: Peter M. Pollak
Published: 2020
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12. Using a novel echo-marker to identify high mortality risk patients with moderate aortic stenosis

Author: Carolyn M. Larsen, David R. Holmes, Tasneem Z. Naqvi, William K. Freeman, David Fortuin, Steven J. Lester, Reza Arsanjani, Amith Reddy Seri, John P. Sweeney, Abdallah El Sabbagh, Timothy Barry, Mackram F. Eleid, Chieh-Ju Chao, Marlene Girardo, Pradyumma Agasthi, Peter M. Pollak, Jae K. Oh, Kristen A. Sell-Dottin, Yuxiang Wang, Christopher P. Appleton, Anusha Shanbhag, David Majdalany, and Said Alsidawi
Subjects: medicine.medical_specialty, Mean arterial pressure, Ejection fraction, business.industry, Proportional hazards model, medicine.disease, Stenosis, Aortic valve area, High mortality risk, Aortic valve replacement, Mortality data, Internal medicine, Cardiology, Medicine, business
Abstract: BackgroundRecent studies have shown that patients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention instead of periodic surveillance. Identifying patients at higher risk is therefore warranted concerning the possibility of expanding aortic valve replacement indication.ObjectiveWe aim to investigate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis.MethodsAdult patients with moderate aortic stenosis (aortic valve area 1.0-1.5 cm2) at Mayo Clinic sites in 1/2010-12/2020 were identified. Baseline demographics, echocardiography, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff of 80 mmHg for analysis. Kaplan-Meier and Cox regression analyses were used to assess the performance of AugMAP.ResultsA total of 4,563 patients with moderate aortic stenosis were included. The mean age was 73.7±12.5 years and 60.5 % were male. The median follow-up was 2.5 years, and 36.0% of patients died. The mean LVEF was 60.1 ± 11.4%, and the mean AugMAP was 99.1 ± 13.1 mmHg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all p< 0.0001). Multivariate Cox regression showed that AugMAP was independently associated with all-cause mortality after adjusting for age, sex, and LVEF (HR: 0.99 per unit increase, 95%CI: 0.978-0.996, p=0.01).ConclusionAugMAP is a simple and effective echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit more from earlier intervention.Condensed abstractPatients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention. We aim to validate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis. AugMAP can identify patients at higher mortality risk within the first two years after the diagnosis of moderate aortic stenosis, regardless of LVEF. AugMAP was also independently associated with all-cause mortality after adjusting for age, sex, and LVEF. AugMAP is a simple and effective novel echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit from earlier intervention.
Published: 2021
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13. Functional Mitral Regurgitation: Interventions and Outcomes

Author: Andrew W. Murray, Peter M. Pollak, Archer Kilbourne Martin, Harish Ramakrishna, and J. Ross Renew
Subjects: Heart Valve Prosthesis Implantation, medicine.medical_specialty, Mitral regurgitation, business.industry, MitraClip, Myocardial Ischemia, Psychological intervention, Mitral Valve Insufficiency, medicine.disease, Anesthesiology and Pain Medicine, Internal medicine, Heart failure, Myocardial Revascularization, Cardiology, medicine, Humans, Mitral Valve, Cardiology and Cardiovascular Medicine, business, Functional mitral regurgitation
Published: 2019
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14. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

Author: Dawn Kleindorfer, Jose Gutierrez, Debbie Lombardi-Hill, Amytis Towfighi, Hooman Kamel, Peter M. Pollak, Seemant Chaturvedi, Kevin M. Cockroft, Thanh N. Nguyen, Walter N. Kernan, Linda S. Williams, Anjail Sharrief, Steven J. Kittner, James F. Meschia, Enrique C. Leira, Tanya N. Turan, Olive Lennon, Pasquale Santangeli, and Sidney C. Smith
Subjects: Advanced and Specialized Nursing, Secondary prevention, medicine.medical_specialty, business.industry, Clinical Decision-Making, American Heart Association, Guideline, medicine.disease, United States, Stroke, Ischemic Attack, Transient, Practice Guidelines as Topic, Emergency medicine, Humans, Medicine, In patient, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Risk Reduction Behavior
Published: 2021
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15. Closure of abnormal coronary communications: Coronary, fistulae, congenital, and iatrogenic

Author: Donald J. Hagler and Peter M. Pollak
Subjects: medicine.medical_specialty, business.industry, medicine.disease, Thrombosis, Coronary arteries, Catheter, medicine.anatomical_structure, Internal medicine, Vascular Disorder, Occlusion, medicine, Cardiology, Arterial malformations, business, Artery
Abstract: Congenital fistulae covers a wide spectrum of vascular disorder including arteriovenous malformations and venovenous communications. This chapter primarily deals with the diagnosis and management of coronary arterial malformations and specifically fistulae. However the catheter intervention techniques described can also be applied to extra-cardiac malformations as well. We detail both antegrade and retrograde approaches to interventions techniques. We discussed the use of various coils and plugs for occlusion of fistulae. We noted concerns for the long term observation of such fistulae. Some may require anticoagulation and antiplatelet therapy to prevent coronary artery thrombosis due to sluggish flow and clotting in markedly dilated coronary arteries.
Published: 2021
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16. Abstract 12588: Characteristics and Survival After Transcatheter Aortic Valve Replacement in Immunocompromised Patients: A Cohort Study

Author: Pragnesh Parikh, Mays Ali, Shahyar M. Gharacholou, Colleen T. Ball, Kevin Landolfo, Carolyn Landolfo, Alexander Ghannam, and Peter M. Pollak
Subjects: medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, valvular heart disease, medicine.disease, Cardiac surgery, Stenosis, Valve replacement, Physiology (medical), Internal medicine, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract: Background: Immunocompromised (IC) patients are at greater risk from cardiac surgery. Transcatheter aortic valve replacement (TAVR) may be more preferable for treating severe aortic stenosis (AS), though data regarding outcomes of IC patients are limited. Methods: We reviewed TAVR procedures performed at our institution from 1/2015-12/2019.We defined IC as either active malignancy receiving oncologic treatment or post organ transplant on immunosuppression, HIV, chronic steroid use (>5mg/day), or autoimmune disorder. Survival probability was estimated using the Kaplan-Meier (KM) method. Cox regression was used to evaluate the association of IC with survival. Results: Of 173 patients who underwent TAVR, 56 (32%) were IC: 30 (54%) had active malignancy undergoing active treatment, 19 (34%) were IC without malignancy, and 7 (13%) had both. Among the 19 IC patients without malignancy, 4 were post organ transplant, 3 were taking chronic steroids, 2 had autoimmune disorder, 1 had HIV, and 10 had ≥2 combination of the above. IC patients, as compared to non-IC patients, had similar baseline demographics and STS risk score (median 4.3 vs. 4.4), respectively. There were 37 deaths (16 IC and 21 non-IC) over a median follow up of 1.4 years (IQR 1.0-2.0 years). 1-year survival after TAVR was 84.5% for IC patients and 89.0% for non-IC patients (log rank p = 0.51). After adjusting for age and sex, an association between IC and survival was observed but not found to be statistically significant (adjusted HR, 1.55; 95% CI, 0.80-3.00). Conclusions: IC patients undergoing TAVR have similar baseline characteristics as non-IC patients with a trend towards worse survival. Longer term follow-up may help clarify the impact of IC status on survival after TAVR.
Published: 2020
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17. Abstract 13572: The Effects of Baseline Thrombocytopenia on Post-procedural Bleeding and Thrombotic Outcomes of Left Atrial Appendage Closure With Watchman Device

Author: Eric H. Yang, Chia-Chun Chiang, Marlene Girardo, Peter M. Pollak, Mohamad A. Alkhouli, David R. Holmes, Paul A. Friedman, Reza Arsanjani, Chieh-Ju Chao, and Pradyumna Agasthi
Subjects: Appendage, medicine.medical_specialty, Interventional cardiology, business.industry, medicine.medical_treatment, Atrial fibrillation, medicine.disease, Left atrial appendage occlusion, Left atrial, Physiology (medical), Internal medicine, medicine, Cardiology, In patient, Closure (psychology), Cardiology and Cardiovascular Medicine, business
Abstract: Background: Left atrial appendage occlusion (LAAO) devices have successfully provided an alternative therapeutic option in patients with atrial fibrillation and high bleeding risk. However, patients with thrombocytopenia (TP) were underrepresented in the milestone trials, and the optimal strategy of postprocedural antithrombotic therapy in this group of patients remains unclear. Methods: Patients were identified from the National Cardiac Database Registry - LAAO database at all three Mayo Clinic sites in the period from 1/2016-10/2019. Patients were further divided into TP (platelet < 150 x 10^9/L) and control (platelet > 150 x 10^9 /L) groups for clinical outcome analysis. Outcome endpoints include composite of bleeding (GI bleeding, hemorrhagic stroke, and other non-intracranial hemorrhage) and composite thrombotic events (device thrombus, ischemic stroke, TIA and undetermined stroke). Results: A total of 249 consecutive patients were included in the final analysis. The mean age was 76.7 ± 7.2 years, and 169 (67.9%) were male; 242 (97.2%) were white. The mean CHA2DS2-VASc score was 5.3 ±1.5, and the HAS-BLED score was 3.0 ± 1.1. TP at baseline was present in 74 (29.7%) patients. The median follow-up time was 6.8 months. The use of post-procedural antithrombotic regimens was similar between the two groups (Table 1). When comparing the TP group to control, there was no significant difference in composite bleeding events (10.8% vs. 8.0%, P = 0.069) and thrombotic events (2.7% vs. 2.3%, P= 0.170). Conclusions: The presence of baseline TP does not significantly increase post-procedural bleeding risk in atrial fibrillation/atrial flutter patients who underwent an LAAO occlusion procedure with the Watchman device (Boston Scientific). This group of patients can be treated with the same antithrombotic regimen as patients with normal platelet levels. Future studies are still warranted to determine the optimal antithrombotic regimen.
Published: 2020
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18. Utilization of an electronic health record derived elder risk assessment score and outcome in patients undergoing aortic valve replacement

Author: Shahyar M. Gharacholou, A.E.S El Sabbagh, M.S Singh, Paul Y. Takahashi, F.D.C Del-Carpio Munoz, R.C Chaudhry, Patricia A. Pellikka, P.G.B Borgman, C.B Ball, and Peter M. Pollak
Subjects: medicine.medical_specialty, Aortic valve replacement, Electronic health record, business.industry, Emergency medicine, medicine, In patient, Cardiology and Cardiovascular Medicine, Risk assessment, medicine.disease, business, Outcome (game theory)
Abstract: Background Older adults with severe aortic stenosis (AS) are at high risk of mortality unless surgical or transcatheter aortic valve replacement (AVR) is performed. Risk stratification often becomes complicated in frail elders with multi-morbidity, and time constraints limit thorough evaluation of geriatric comorbidities in the outpatient clinic setting. Purpose Utilization of an automated administratively-derived electronic health record (EHR) tool may aid in risk stratification of AS patients undergoing AVR. Methods We reviewed patients with severe AS undergoing AVR at our hospital program and cross-referenced with the Elder Risk Assessment (ERA) score. The ERA score is an administratively abstracted score derived on adults >60 years old followed by general medicine clinic. It contains the following variables: marital status, age, hospitalized days in preceding 2 years, diabetes, coronary disease, heart failure, stroke, pulmonary disease, cancer, and dementia; higher scores indicate greater risk for adverse outcomes. Kaplan-Meier method was used to estimate survival by ERA score tertile. Cox regression was used to test the association of ERA with survival. Results There were 97 patients with severe AS undergoing AVR with ERA scores. Mean age was 80.6 (±6.6) years, 37% were female, average Society of Thoracic Surgery (STS) score was 3.6% (± 2.6), and 7% had transcatheter AVR. Co-morbidities were prevalent and included atrial fibrillation (41%), chronic renal failure (16%), stroke (14%), and diabetes (35%). Over a mean follow-up of 68 months (± 37.9 months), there were 62 deaths. Elevated ERA score was associated with worse long term survival (p=0.016 by log-rank) (Figure 1), with only 49% surviving at 5 years in the highest ERA tertile vs 68% in the lowest ERA tertile. Cox regression demonstrated that the relative risk of death per 6 unit increase in ERA score was 1.54 (95% CI 1.21–1.96, P Conclusions Patients undergoing AVR for severe AS are often co-morbid older adults. An automated EHR derived ERA score was independently associated with survival after accounting for STS score and may streamline and improve risk assessment in these patients. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Mayo Clinic
Published: 2020
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19. Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Author: Rajiv Gulati, Mandeep Singh, R. Scott Wright, Freddy Del-Carpio Munoz, Si M. Pham, Gary E. Lane, Abdallah El Sabbagh, Peter M. Pollak, Arashk Motiei, Timir K. Paul, Patricia A. Pellikka, Gurpreet S. Sandhu, Matthew P. Johnson, Shahyar M. Gharacholou, Bradley Lewis, Gregory W. Barsness, and Dilip P. Pillai
Subjects: Male, medicine.medical_specialty, Time Factors, Bypass grafting, medicine.medical_treatment, 030204 cardiovascular system & hematology, Culprit, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Postoperative Complications, Internal medicine, medicine, Long term outcomes, ST segment, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Aged, Aged, 80 and over, business.industry, Percutaneous coronary intervention, Middle Aged, medicine.disease, Survival Rate, surgical procedures, operative, medicine.anatomical_structure, Treatment Outcome, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Mace, Artery
Abstract: Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.
Published: 2020

20. Abstract WMP119: Short Term Use of Direct Oral Anticoagulants is Not Associated With Decreased Bleeding in High Risk Patients Following Percutaneous Left Atrial Appendage Closure

Author: Peter M. Pollak, K.L. Venkatachalam, Najiyah Salwa, Salman Farhat, Pragnesh Parikh, Demilade Adedinsewo, Jeffrey Winder, and Susie Sennhauser
Subjects: Advanced and Specialized Nursing, Appendage, medicine.medical_specialty, Cardioembolic stroke, High risk patients, Percutaneous, business.industry, Atrial fibrillation, medicine.disease, Surgery, Left atrial, medicine, Neurology (clinical), Closure (psychology), Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Introduction: Percutaneous left atrial appendage closure is well established as an alternative to anticoagulation therapy for stroke prophylaxis among patients with non-valvular atrial fibrillation (NVAF) with relative or absolute contraindications to anticoagulation. Only the Watchman® (BSC) device has FDA approval for this indication. There are no current guidelines on the choice of short term antithrombotic therapy following placement of the Watchman® device. The landmark Watchman® clinical trials utilized warfarin and aspirin in the first 45 days to facilitate endothelialization; however these studies were started prior to direct oral anticoagulants (DOAC) becoming widely available. Our main objective was to compare bleeding outcomes with warfarin vs. DOACs following Watchman® device placement. Methods: We conducted a retrospective chart review of all patients who received a Watchman® device at all three Mayo Clinic sites (MN, FL, AZ) between January 2010 and December 2018 with follow up for outcomes at 45 days or 6 weeks following procedure. We conducted bivariate analysis using t-tests and chi-square tests as appropriate. A logistic regression model was constructed to evaluate the effect of anticoagulant choice on bleeding and thromboembolic outcomes. Clinically significant bleeding was defined as bleeding leading to interruption of anticoagulation regimen or requiring transfusion. Results: 232 patients were identified (33% female), mean age in years, CHADS2VASC score and HASBLED scores were 77, 5 and 4 respectively. Overall, 39% were initiated on non-warfarin therapies and 11% had a significant bleeding episode during follow up. There was no difference in clinically significant bleeding events (11% vs. 12%; OR 0.92, 95% CI: 0.32 – 2.65) with short term DOAC use compared to warfarin. Patients who received a Watchman® due to GI bleeding were more likely to have a bleeding event in the first 6 weeks following Watchman® (OR: 4.08, 95% CI: 1.30 – 12.75). Conclusion: This observational study demonstrates no significant difference in bleeding episodes with DOACs compared to warfarin during the first 6 weeks following Watchman® device placement in patients at high risk for bleeding. Larger prospective studies are needed.
Published: 2020
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21. Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention

Author: Dilip P. Pillai, S. Michael Gharacholou, Gary E. Lane, Charanjit S. Rihal, Malcolm R. Bell, Gurpreet S. Sandhu, Freddy Del-Carpio Munoz, Nkechinyere N. Ijioma, Patricia A. Pellikka, Jorge A. Brenes-Salazar, Mandeep Singh, Peter M. Pollak, Ryan J. Lennon, Rajiv Gulati, and Arashk Motiei
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Culprit, Electrocardiography, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, Hospital Mortality, Prospective Studies, Registries, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Aged, medicine.diagnostic_test, business.industry, Unstable angina, Incidence, Cardiogenic shock, Coronary Stenosis, Percutaneous coronary intervention, medicine.disease, Coronary Vessels, United States, Treatment Outcome, surgical procedures, operative, Echocardiography, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited.Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS.Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P = .009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P = .50 by log-rank).Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.
Published: 2018
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22. Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure

Author: Mackram F. Eleid, Sidakpal S. Panaich, Charanjit S. Rihal, Claire E. Raphael, Donald J. Hagler, Allison K. Cabalka, Elad Maor, Mohamad Alkhouli, Guy S. Reeder, and Peter M. Pollak
Subjects: Male, Cardiac Catheterization, medicine.medical_specialty, Time Factors, Percutaneous, Echocardiography, Three-Dimensional, Hemodynamics, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Hemolysis, 03 medical and health sciences, Atrial Pressure, 0302 clinical medicine, Risk Factors, Internal medicine, Mitral valve, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Paravalvular leak, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Heart Failure, Heart Valve Prosthesis Implantation, Mitral regurgitation, business.industry, Proportional hazards model, Mitral Valve Insufficiency, Recovery of Function, General Medicine, Middle Aged, Echocardiography, Doppler, Color, Surgery, Log-rank test, Treatment Outcome, medicine.anatomical_structure, Blood pressure, Heart Valve Prosthesis, Multivariate Analysis, Cardiology, Mitral Valve, Atrial Function, Left, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract: Background Data on the clinical utility of left atrial (LA) hemodynamic monitoring during percutaneous mitral interventions are limited. Objectives To evaluate the association between intraprocedural LA pressures during percutaneous mitral paravalvular leak (PVL) closure and long term survival. Methods Patients who underwent mitral PVL repair with invasive LA pressure monitoring were divided at baseline to three tertiles based on their mean final LA pressure ( 30% of mean systolic blood pressure). Primary outcome was all-cause mortality. Results 134 patients (mean age 68 ± 12 years) were studied. Over 3 year mean follow-up, 81 (38%) patients died. The cumulative probability of death at 3 years was significantly higher among patients in the highest LA pressure tertile (56 ± 8% vs. 28 ± 5%, log rank P
Published: 2017
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23. COMPARING RADIAL AND FEMORAL APPROACHES IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION PRIOR TO TRANSCATHETER AORTIC VALVE REPLACEMENT

Author: Mandeep Singh, Abdallah El Sabbagh, Rayan Suliman, Mackram F. Eleid, Shahyar M. Gharacholou, Yader Sandoval, Malcolm R. Bell, David R. Holmes, Mohammed Al-Khouli, Salman Farhat, Mohammed Al-Hijji, Mayra Guerrero, Charanjit S. Rihal, Peter M. Pollak, Rajiv Gulati, and Keniel F. Pierre
Subjects: medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, medicine.disease, Stenosis, Valve replacement, Internal medicine, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, business
Published: 2021
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24. LATE THROMBOEMBOLIC OUTCOMES FOLLOWING PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION

Author: Peter M. Pollak, K.L. Venkatachalam, Salman Farhat, Pragnesh Parikh, Demilade Adedinsewo, Susie Sennhauser, Jeffrey Winder, and Najiyah Salwa
Subjects: medicine.medical_specialty, Percutaneous, business.industry, Internal medicine, medicine.medical_treatment, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, Left atrial appendage occlusion
Published: 2020
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25. PATIENT REPORTED OUTCOMES CAN BE PREDICTED BY CHANGE IN LEFT ATRIAL PRESSURE AND NOT CHANGE OF TRANSMITRAL GRADIENT FOLLOWING MITRACLIP

Author: Abdallah El Sabbagh, Susie Sennhauser, Keniel F. Pierre, Pragnesh Parikh, Demilade Adedinsewo, Charanjit S. Rihal, Peter M. Pollak, Mohammed Al-Hijji, Mohamad Alkhouli, and Fnu N. Salwa
Subjects: medicine.medical_specialty, business.industry, MitraClip, Diastole, 030204 cardiovascular system & hematology, 03 medical and health sciences, Left atrial pressure, 0302 clinical medicine, Symptom improvement, Left atrial, Internal medicine, Cardiology, medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Pressure gradient
Abstract: The association between the acute change in mean direct left atrial (LA) pressure and symptom improvement post MitraClip has been shown. Mean transmitral diastolic Doppler pressure gradient is routinely measured before and after MitraClip deployment and is used in assessing procedural success.
Published: 2020
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26. LEFT ATRIAL APPENDAGE SEAL FOLLOWING PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION

Author: Pragnesh Parikh, Peter M. Pollak, Demilade Adedinsewo, Susie Sennhauser, Salwa Najiyah, Salman Farhat, K.L. Venkatachalam, and Jeffrey Winder
Subjects: Appendage, medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Atrial fibrillation, medicine.disease, Left atrial appendage occlusion, Seal (mechanical), Left atrial, Internal medicine, Occlusion, cardiovascular system, medicine, Cardiology, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Percutaneous left atrial appendage (LAA) occlusion is well established as an alternative to anticoagulation therapy for stroke prophylaxis among patients with non-valvular atrial fibrillation (NVAF). Only the Watchman® device has FDA approval for this indication. Based on the design of the initial
Published: 2020
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27. A hybrid technique for treatment of commissural primary mitral regurgitation

Author: Charanjit S. Rihal, Claire E. Raphael, Elad Maor, Joseph F. Malouf, Sidakpal S. Panaich, Mackram F. Eleid, Guy S. Reeder, and Peter M. Pollak
Subjects: Male, medicine.medical_specialty, Cardiac Catheterization, Time Factors, Vascular plug, 030204 cardiovascular system & hematology, Prosthesis Design, Severity of Illness Index, Nyha class, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Mitral regurgitation, business.industry, MitraClip, Hemodynamics, Mitral Valve Insufficiency, General Medicine, Recovery of Function, Commissure, Surgery, Treatment Outcome, Heart Valve Prosthesis, Transcatheter therapy, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. Methods We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip. Results The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30-day follow-up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow-up of 20 months (range 5-50 months) with no reported device dislodgement. Conclusions Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients.
Published: 2018

28. Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience

Author: Guy S. Reeder, Nathaniel W. Taggart, Frank Cetta, Charanjit S. Rihal, Donald J. Hagler, Peter M. Pollak, Joseph T. Poterucha, Alexander C. Egbe, and Allison K. Cabalka
Subjects: congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Blood transfusion, Heart block, business.industry, Cardiogenic shock, medicine.medical_treatment, Infarction, General Medicine, medicine.disease, Surgery, Internal medicine, Device Embolization, Cohort, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Myocardial infarction, Cardiology and Cardiovascular Medicine, Adverse effect, business
Abstract: Objectives To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup. Background There are limited data on mid-term follow-up after transcatheter VSD closure. Methods Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention. Results In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82–5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12–4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years. Conclusions Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up. © 2015 Wiley Periodicals, Inc.
Published: 2015
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29. Percutaneous Mitral Valve Replacement Using a Transvenous, Transseptal Approach

Author: Charanjit S. Rihal, Jeffrey B. Geske, Joseph A. Malouf, Allison K. Cabalka, Rakesh M. Suri, Megan Coylewright, and Peter M. Pollak
Subjects: medicine.medical_specialty, Framingham Risk Score, Percutaneous, business.industry, medicine.medical_treatment, Mitral valve replacement, Cardiac surgery, Surgery, medicine.anatomical_structure, Valve replacement, Internal medicine, Mitral valve, Redo surgery, medicine, Cardiology, Heart valve, business, Cardiology and Cardiovascular Medicine
Abstract: Objectives The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access. Background Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay. Methods We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve. Results From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea. Conclusions We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.
Published: 2015
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30. Percutaneous Stenting of a Left Ventricular Assist Device Outflow Kink

Author: Charanjit S. Rihal, Mohammed Al-Hijji, Abdallah El Sabbagh, Peter M. Pollak, Rajiv Gulati, and Atta Behfar
Subjects: Male, medicine.medical_specialty, Percutaneous, Recurrent gastrointestinal bleeding, medicine.medical_treatment, 030204 cardiovascular system & hematology, Status post, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Aged, Heart Failure, Ischemic cardiomyopathy, Heartmate ii, business.industry, Stent, Surgery, 030228 respiratory system, Ventricular assist device, Cardiology, Stents, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Destination therapy
Abstract: A 70-year old man with end-stage ischemic cardiomyopathy status post HeartMate II (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) implantation as destination therapy presented with recurrent gastrointestinal bleeding. He was seen by gastroenterology and had a work-up that
Published: 2016
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31. The Evolving Face of Myocardial Reperfusion in Acute Coronary Syndromes: A Primer for the Internist

Author: Nandan S. Anavekar, Bernard J. Gersh, Malcolm R. Bell, Peter M. Pollak, and R. Jay Widmer
Subjects: Acute coronary syndrome, medicine.medical_specialty, medicine.medical_treatment, Context (language use), Myocardial Reperfusion, 030204 cardiovascular system & hematology, Revascularization, Risk Assessment, Time-to-Treatment, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Intensive care medicine, Disease burden, Unstable angina, business.industry, Percutaneous coronary intervention, General Medicine, medicine.disease, Practice Guidelines as Topic, business
Abstract: Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes. With an ever-growing body and weight of knowledge in this field, the clinician is tasked with several challenges. First, there are a variety of pathways of care to be considered; second, adjunctive medical therapies are expanding; and third, when coupled with the multiple combinations of adjunctive supportive therapies for revascularization, the variety of potential therapeutic options can be overwhelming and confusing. Herein, we carefully review all the relevant guidelines and the contributing literature, taking a 4-step approach: (1) review the importance of risk stratification before engaging in a particular strategy of care, (2) define the reperfusion strategies available, (3) review the specific agents (antiplatelet and anticoagulant) that support reperfusion strategies, and (4) apply the strategies of care in the context of the clinical presentation.
Published: 2017

32. 4800Left atrial hemodynamics during percutaneous mitral paravalvular leak closure are associated with long term survival

Author: Elad Maor, Sidakpal S. Panaich, Chet Rihal, R. A. Nishimura, Claire E. Raphael, Mohamad A. Alkhouli, Allison K. Cabalka, Guy S. Reeder, Mackram F. Eleid, Peter M. Pollak, and Donald J. Hagler
Subjects: medicine.medical_specialty, Percutaneous, business.industry, Left atrium, Hemodynamics, medicine.anatomical_structure, Internal medicine, Long term survival, medicine, Cardiology, Paravalvular leak, Closure (psychology), Cardiology and Cardiovascular Medicine, business
Published: 2017
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33. Multiparametric CMR Imaging of Infarct Remodeling in a Percutaneous Reperfused Yucatan Mini-pig Model

Author: Samantha Clarke, Michael Salerno, Peter M. Pollak, Mark Yeager, Christopher M. Kramer, David Lopez, and Jonathan A. Pan
Subjects: medicine.medical_specialty, Percutaneous, Swine, Myocardial Infarction, Magnetic Resonance Imaging, Cine, Myocardial Reperfusion Injury, 030204 cardiovascular system & hematology, Models, Biological, Multimodal Imaging, Sensitivity and Specificity, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Internal medicine, Image Interpretation, Computer-Assisted, medicine, Animals, Radiology, Nuclear Medicine and imaging, Computer Simulation, Artery occlusion, Myocardial infarction, cardiovascular diseases, Ventricular remodeling, Spectroscopy, Models, Statistical, Ventricular Remodeling, business.industry, Reproducibility of Results, Pig model, medicine.disease, Infarct size, Image Enhancement, Pathophysiology, Subtraction Technique, Cardiology, cardiovascular system, Molecular Medicine, Swine, Miniature, business, Algorithms
Abstract: To further understanding of the temporal evolution and pathophysiology of adverse ventricular remodeling over the first 60 days following a myocardial infarction (MI) in both the infarcted and remote myocardium, we performed multi-parametric cardiac magnetic resonance (CMR) imaging in a closed-chest chronic Yucatan mini-pig model of reperfused MI. Ten animals underwent 90 min left anterior descending artery occlusion and reperfusion. Three animals served as controls. Multiparametric CMR (1.5T) was performed at baseline, Day 2, Day 30 and in four animals on Day 60 after MI. Left ventricular (LV) volumes and infarct size were measured. T1 and T2 mapping sequences were performed to measure values in the infarct and remote regions. Remote region collagen fractions were compared between infarcted animals and controls. Procedure success was 80%. The model created large infarcts (28 ± 5% of LV mass on Day 2), which led to significant adverse myocardial remodeling that stabilized beyond 30 days. Native T1 values did not reliably differentiate remote and infarct regions acutely. There was no evidence of remote fibrosis as indicated by partition coefficient and collagen fraction analyses. The infarct T2 values remained elevated up to 60 days after MI. Multiparametric CMR in this model showed significant adverse ventricular remodeling 30 days after MI similar to that seen in humans. In addition, this study demonstrated that remote fibrosis is absent and that infarct T2 signal remains chronically elevated in this model. These findings need to be considered when designing preclinical trials using CMR endpoints.
Published: 2017

34. FEASIBILITY OF UPRIGHT TREADMILL EXERCISE CARDIAC MAGNETIC RESONANCE IMAGING IN PULMONARY ARTERIAL HYPERTENSION

Author: Brian P. Shapiro, Patricia Mergo, Peter M. Pollak, Charles D. Burger, and Jordan Ray
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Cardiac magnetic resonance imaging, business.industry, Internal medicine, medicine, Cardiology, Treadmill exercise, Cardiology and Cardiovascular Medicine, business
Published: 2019
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35. DOES RESTING CARDIAC POWER EFFICIENCY AFFECT SURVIVAL POST TRANSCATHETER AORTIC VALVE REPLACEMENT?

Author: Mackram F. Eleid, Panwen Wang, Nithin R. Venepally, Peter M. Pollak, John P. Sweeney, Floyd David Fortuin, Farouk Mookadam, Justin Z. Lee, Reza Arsanjani, and Pradyumna Agasthi
Subjects: Left ventricular mass, Cardiac efficiency, medicine.medical_specialty, Transcatheter aortic, Valve replacement, business.industry, medicine.medical_treatment, Internal medicine, cardiovascular system, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Cardiac Power to left ventricular mass (LVM) ratio, also termed cardiac efficiency (CE), reflects the rate of cardiac work delivered with respect to the potential energy stored in LVM. We sought to assess the association between baseline resting CE and survival post transcatheter aortic valve
Published: 2019
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36. CHARACTERISTICS AND LONG TERM OUTCOMES OF PATIENTS WITH PRIOR CORONARY ARTERY BYPASS GRAFTING UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST-ELEVATION MYOCARDIAL INFARCTION

Author: S. Michael Gharacholou, Arashk Motiei, Gurpreet S. Sandhu, Matthew P. Johnson, Sina Rahimpour, Patricia A. Pellikka, Bradley Lewis, Gregory W. Barsness, Rajiv Gulati, Gary E. Lane, Freddy Del-Carpio Munoz, Si M. Pham, Dilip Pillai, Charanjit S. Rihal, Peter M. Pollak, and Mandeep Singh
Subjects: medicine.medical_specialty, Bypass grafting, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, medicine.disease, Culprit, surgical procedures, operative, medicine.anatomical_structure, St elevation myocardial infarction, Internal medicine, medicine, Cardiology, Long term outcomes, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Artery
Abstract: Patients with a prior history of coronary artery bypass grafting (CABG) undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) are frequently encountered. Little is known regarding long term outcomes with respect to culprit (i.e, native vs graft)
Published: 2019
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37. PREDICTORS OF MAJOR ADVERSE EVENTS IN PATIENTS UNDERGOING ORTHOTOPIC LIVER TRANSPLANTATION

Author: Pragnesh Parikh, Patrick Fitzgerald, Jordan Ray, Peter M. Pollak, Surakit Pungapong, Shahyar M. Gharacholou, and Ronald G. Racho
Subjects: Coronary angiography, medicine.medical_specialty, Cirrhotic liver, Orthotopic liver transplantation, business.industry, Stress testing, Disease, surgical procedures, operative, Internal medicine, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, Adverse effect, business, Mace
Abstract: Despite improvements in post-operative outcomes, patients with cirrhotic liver disease undergoing orthotopic liver transplantation (OLT) continue to experience major adverse cardiac events (MACE). Use of routine stress testing and coronary angiography is common prior to OLT, however, the utility of
Published: 2019
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38. RIGHT VENTRICULAR CONTRACTILE RESERVE CHARACTERIZED BY TREADMILL EXERCISE CARDIAC MAGNETIC RESONANCE IMAGING IN PULMONARY ARTERIAL HYPERTENSION

Author: Alhusain Rashid, Jordan Ray, Charles D. Burger, Brian P. Shapiro, Patricia Mergo, and Peter M. Pollak
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Treadmill exercise, Cardiac magnetic resonance imaging, Internal medicine, cardiovascular system, medicine, Cardiology, In patient, Bicycle ergometer, Cardiology and Cardiovascular Medicine, business, Cardiac magnetic resonance
Abstract: Cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) may aid in assessment of right ventricular (RV) morphology and function as well as contractile reserve (RVCR). Previous data suggests that RVCR may be diminished in patients with PAH patients by bicycle ergometer (eCMR
Published: 2019
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39. von Willebrand Factor Abnormalities and Heyde Syndrome in Dysfunctional Heart Valve Prostheses

Author: Peter M. Pollak, Dong Chen, Robert E. Safford, Ewa M. Wysokinska, Mark E. Stark, Joseph L. Blackshear, Chad McRee, Colleen S. Thomas, and Candido E. Rivera
Subjects: Aortic valve, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Severity of Illness Index, Angiodysplasia, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Valve replacement, Internal medicine, Mitral valve, von Willebrand Factor, medicine, Humans, 030212 general & internal medicine, Heart valve, Aged, Aged, 80 and over, business.industry, Heyde's syndrome, Mitral valve replacement, Mitral Valve Insufficiency, Aortic Valve Stenosis, Middle Aged, medicine.disease, Surgery, Prosthesis Failure, Molecular Weight, von Willebrand Diseases, medicine.anatomical_structure, Echocardiography, Aortic valve stenosis, Heart Valve Prosthesis, cardiovascular system, Cardiology, Female, Blood Coagulation Tests, Heart-Assist Devices, Stress, Mechanical, Cardiology and Cardiovascular Medicine, business, Gastrointestinal Hemorrhage, Shear Strength
Abstract: Limited data suggest that von Willebrand factor (VWF) abnormalities may accompany the high-shear state associated with prosthetic valve dysfunction. If true, laboratory testing could add value in quantifying prosthesis dysfunction and could suggest a pathophysiological explanation for acquired bleeding in some patients.To determine whether dysfunctional valve prostheses are associated with VWF abnormalities compared with normally functioning valve prostheses, to identify the severity of the VWF abnormality relative to other conditions, and to describe associated bleeding and the occurrence of gastrointestinal angiodysplasia.Cohort study in a multispecialty practice setting from August 2010 through November 2015. To assess the severity of VWF dysfunction, data were compared with those from previously reported healthy controls and patients with aortic stenosis, mitral regurgitation, and left ventricular assist devices. Patients underwent assessment of multiple VWF laboratory tests and echocardiography.Loss of high-molecular-weight multimers of VWF.A total of 136 patients were included in this study. During the study period, we assessed 26 patients with normally functioning surgical or transcatheter aortic valve replacement, 24 patients with dysfunctional aortic valve replacement, 36 patients with normally functioning mitral valve replacement or repair, 19 patients with dysfunctional mitral valve replacement or repair, and 31 patients with native aortic regurgitation without coexisting aortic stenosis. von Willebrand factor multimers were abnormal in 1 of 26 normal aortic valve replacements and in 2 of 36 normal mitral valve replacements or repairs but were abnormal in 20 of 24 dysfunctional aortic valve replacements and in 14 of 19 dysfunctional mitral valve replacements or repairs (P .001 for both). Normal aortic valve replacement also had a higher VWF activity to antigen ratio, mean (range) 0.94 (0.84-0.99) compared to dysfunctional aortic valve replacement, 0.78 (0.73-0.87), P .001, as did normal mitral valve replacement or repair, 0.90 (0.86-0.93) compared to dysfunctional mitral valve replacement or repair, 0.78 (0.70-0.90), P = .005. Platelet function analyzer closure times were lower with normal aortic valve replacement, mean (range) 92 (82-112) seconds compared to dysfunctional aortic valve replacement, 139 (122-177) seconds, P .001, and also in normally functioning mitral valve replacement or repair, 85 (74-96) seconds compared to dysfunctional mitral valve replacement or repair, 143 (128-192) seconds, P .001. Gastrointestinal bleeding was noted in 6 of 24 patients with aortic prosthesis dysfunction and in 5 of 19 patients with mitral prosthesis/repair dysfunction and was associated with a lower normalized VWF multimer ratio than in patients without bleeding. Gastrointestinal angiodysplasia was noted in 5 of 6 bleeding patients with dysfunctional aortic prostheses and in 3 of 5 bleeding patients with dysfunctional mitral prostheses/repair.Acquired abnormalities of VWF multimers are associated with aortic and mitral prosthesis dysfunction, with occasional gastrointestinal bleeding and gastrointestinal angiodysplasia. Quantitative VWF tests may provide adjunctive value in the difficult assessment of prosthetic valve dysfunction.
Published: 2016

40. Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure

Author: Guy S. Reeder, Donald J. Hagler, Mohammad Sarraf, Charanjit S. Rihal, Saurabh Sanon, Mohamad Alkhouli, Allison K. Cabalka, Peter M. Pollak, Elad Maor, and Mackram F. Eleid
Subjects: Male, Leak, medicine.medical_specialty, Cardiac Catheterization, Percutaneous, Time Factors, Echocardiography, Three-Dimensional, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Risk Factors, medicine, Humans, 030212 general & internal medicine, Paravalvular leak, Adverse effect, Aged, Retrospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, business.industry, Equipment Design, Recovery of Function, Middle Aged, bacterial infections and mycoses, medicine.disease, Surgery, Cardiac surgery, Echocardiography, Doppler, Color, Catheter, Treatment Outcome, Heart failure, Aortic Valve, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract: The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients.Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited.All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms.Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004).Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.
Published: 2016

41. Vanishing V-Wave: Percutaneous Edge-to-Edge Repair for Severe Mitral Regurgitation

Author: Mackram F, Eleid, Peter M, Pollak, Sorin V, Pislaru, Guy S, Reeder, and Charanjit S, Rihal
Subjects: Aged, 80 and over, Humans, Minimally Invasive Surgical Procedures, Mitral Valve Insufficiency, Atrial Function, Left, Female, Ultrasonography
Abstract: Transcatheter mitral valve repair is an effective treatment option for patients with symptomatic mitral regurgitation and high surgical risk. Typically, transcatheter mitral valve repair is less effective in reducing mitral regurgitation severity compared to surgical mitral valve repair. Herein is presented a case of complete resolution of mitral regurgitation, as assessed by Doppler echocardiography and left atrial V-wave.
Published: 2016

42. Novel pericardial access device: design features andin vitroevaluation

Author: Peter M. Pollak, Srijoy Mahapatra, Jessleen K. Kanwal, and George T. Gillies
Subjects: Cardiac Catheterization, Parietal Pericardium, business.industry, Biomedical Engineering, Equipment Design, General Medicine, Pericardial space, medicine.anatomical_structure, Polyethylene, cardiovascular system, Medicine, Pericardium, Ventricular Perforation, business, Spiral, Biomedical engineering
Abstract: We have designed, built and tested a novel needle for percutaneously accessing the pericardial space. The problem with accessing pericardial space is that the pericardium is against the heart. Our novel device incorporates a single spiral tine at the distal tip of a10-gauge needle, which engages the parietal pericardium tangentially to the surface of the heart. One can then pull the pericardium away, thus minimizing the risk of ventricular perforation associated with oblique axial approaches. Using linear low-density polyethylene film as a surrogate pericardium, we have demonstrated reliable pericardial engagement with successful first-time engagement rates of up to 72% (n = 25 attempts) at approach angles ranging from 0° (normal incidence) to 30°. The associated torques were approximately 1 N mm. The performance limits of the model and the implications for clinical use of such a device are discussed.
Published: 2011
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43. Platypnea-Orthodeoxia Syndrome: Diagnostic Challenge and the Importance of Heightened Clinical Suspicion

Author: Stanislav Henkin, D. Fearghas O'Cochlain, Michael W. Cullen, R. Scott Wright, Peter M. Pollak, and Sara M Negrotto
Subjects: medicine.medical_specialty, Cardiac Catheterization, Percutaneous, Supine position, Septal Occluder Device, medicine.medical_treatment, Posture, Case Reports, Intracardiac injection, Heart Septal Defects, Atrial, Patient Positioning, Hypoxemia, Predictive Value of Tests, Internal medicine, medicine, Supine Position, Humans, Hypoxia, Cardiac catheterization, Aged, 80 and over, business.industry, Hemodynamics, Models, Cardiovascular, Syndrome, medicine.disease, Pulmonary hypertension, Shunt (medical), respiratory tract diseases, Echocardiography, Doppler, Color, Shunting, Dyspnea, Treatment Outcome, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract: Platypnea-orthodeoxia syndrome is an uncommon condition of positional dyspnea and hypoxemia; symptoms occur when the patient is upright and resolve with recumbency. Causes can be broadly categorized into 4 groups: intracardiac shunting, pulmonary shunting, ventilation-perfusion mismatch, or a combination of these. Platypnea-orthodeoxia syndrome should be suspected when normal arterial oxygen saturations are recorded while an individual is supine, followed by abrupt declines in those saturations when upright. Further investigations with use of imaging and cardiac catheterization aid in the evaluation. When platypnea-orthodeoxia syndrome is due to intracardiac shunting without pulmonary hypertension, intracardiac shunt closure can be curative. In this article, we report a case of platypnea-orthodeoxia syndrome in an 83-year-old woman who was successfully treated by means of percutaneous transcatheter closure of an atrial septal defect.
Published: 2015

44. TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT: RESULTS OF MIDTERM FOLLOWUP

Author: Allison K. Cabalka, Donald J. Hagler, Peter M. Pollak, Nathaniel W. Taggart, Frank Cetta, Guy S. Reeder, Joseph T. Poterucha, Alex C. Egbe, and Heidi M. Connolly
Subjects: medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, business.industry, Closure (topology), Medicine, business, Single Center, Cardiology and Cardiovascular Medicine, Surgery
Abstract: There are limited data about transcatheter closure of ventricular septal defect (VSD). We present the largest single center cohort of transcatheter VSD closure in USA. We reviewed 28 patients (pt) with transcatheter VSD closure performed between 1999-2013 (Table/Figure). Indications included post
Published: 2015
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45. Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience

Author: Alexander C, Egbe, Joseph T, Poterucha, Charanjit S, Rihal, Nathaniel W, Taggart, Frank, Cetta, Allison K, Cabalka, Peter M, Pollak, Guy S, Reeder, and Donald J, Hagler
Subjects: Adult, Aged, 80 and over, Male, Cardiac Catheterization, Time Factors, Septal Occluder Device, Minnesota, Iatrogenic Disease, Myocardial Infarction, Kaplan-Meier Estimate, Middle Aged, Disease-Free Survival, Radiography, Postoperative Complications, Treatment Outcome, Risk Factors, Heart Septum, Humans, Female, Aged, Proportional Hazards Models, Retrospective Studies, Ventricular Septal Rupture
Abstract: To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup.There are limited data on mid-term follow-up after transcatheter VSD closure.Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention.In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years.Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.
Published: 2015

46. Use of Mechanical Devices to Reduce Stroke in Atrial Fibrillation

Author: David R. Holmes and Peter M. Pollak
Subjects: medicine.medical_specialty, Percutaneous, business.industry, Warfarin, Atrial fibrillation, medicine.disease, Left atrial, Internal medicine, Occlusion, cardiovascular system, Cardiology, Medicine, cardiovascular diseases, business, Ligation, Stroke, Mechanical devices, medicine.drug
Abstract: Atrial fibrillation is common, and its incidence is increasing. The preponderance of strokes occurring in non-valvular atrial fibrillation is attributable to thromboembolism from clot formed within the left atrial appendage (LAA). Current standard of care involves long-term oral anticoagulation to decrease the risk of clot formation; however, this strategy is complicated by a narrow therapeutic window with a significant incidence of bleeding complications. Early evidence suggests that surgical obliteration of the left atrial appendage reduces stroke risk, and more recently several percutaneous approaches to left atrial appendage treatment have been developed aimed at eliminating the appendage cavity to reduce stroke risk through plugging or ligation. The most studied device, the Watchman device (Boston Scientific, Marlborough, MA), has been shown to be non-inferior to adjusted-dose warfarin in non-valvular atrial fibrillation at reducing the risk of stroke. Unanswered questions surround optimal patient selection criteria for device occlusion of the left atrial appendage and comparison with novel oral anticoagulants. Moreover, multiple devices are in development and early stages of evaluation. Device-based occlusion of the left atrial appendage is a promising alternative to long-term oral anticoagulation to reduce stroke risk in patients with non-valvular atrial fibrillation.
Published: 2015
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47. Resolution of GI Bleeding After Percutaneous Plugging of Perimitral Leaks in a Patient With Acquired von Willebrand Syndrome

Author: Joseph L. Blackshear, Pragnesh Parikh, Jordan Ray, Taryn Smith, Peter M. Pollak, Divya Padmanabhan Menon, Dong Chen, J Colt Cowdell, Carolyn Landolfo, and J Saadi Imam
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Percutaneous, Acquired von Willebrand syndrome, GI bleeding, business.industry, Resolution (electron density), Medicine, Radiology, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, business, Surgery
Published: 2017
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48. Percutaneous mitral valve replacement using a transvenous, transseptal approach: transvenous mitral valve replacement

Author: Megan, Coylewright, Allison K, Cabalka, Joseph A, Malouf, Jeffrey B, Geske, Peter M, Pollak, Rakesh M, Suri, and Charanjit S, Rihal
Subjects: Aged, 80 and over, Heart Valve Prosthesis Implantation, Male, Cardiac Catheterization, Time Factors, Echocardiography, Three-Dimensional, Recovery of Function, Middle Aged, Prosthesis Design, Risk Assessment, Echocardiography, Doppler, Color, Prosthesis Failure, Treatment Outcome, Risk Factors, Heart Valve Prosthesis, Feasibility Studies, Humans, Mitral Valve, Female, Tomography, X-Ray Computed, Echocardiography, Transesophageal, Aged
Abstract: The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access.Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay.We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve.From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea.We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.
Published: 2014

49. Abstract 20383: The Impact of Flow Measurement After Mitral Paravalvular Leak Closure and Survival

Author: Mohammad Sarraf, Peter M Pollak, Joseph F Malouf, Vuisile T Nkomo, Allison K Cabalka, Rick A Nishimura, and Charanjit S Rihal
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Mitral paravalvular leak (PVL) occurs in 7-17% of patients after mitral valve surgery. The percutaneous closure of these defects has become a novel treatment to prevent repeat operations. Hypothesis: We hypothesize flow dynamics correlate with clinical outcomes of patients undergoing percutaneous mitral PVL closure. Methods: We retrospectively studied 148 patients who underwent percutaneous PVL closure between 2004 and 2014 at Mayo Clinic. We measured the continuous wave (CW) Doppler time velocity integral (TVI), E velocity (as a surrogate for V wave) across the mitral valve and left ventricular ejection fraction (LVEF) by transthoracic echocardiogram within 7 days before and after PVL closure. We identified patients as non-responders if there was moderate to severe residual mitral regurgitation. t-Test was used for continuous variables and Fisher exact test was used mortality. Results: Overall, the mean CW TVI was markedly reduced by PVL closure (93±14 vs. 58±5cm, p Conclusions: The flow dynamics across the mitral valve immediately after PVL closure may correlate with long term clinical outcomes. Real time assessment of flow by transesophageal echocardiogram can be used to guide the extent of PVL closure required to change the long term clinical outcomes. Further validation and prospective studies are required.
Published: 2014
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50. Quality, economics, and national guidelines for transcatheter aortic valve replacement

Author: David R. Holmes, Peter M. Pollak, and Michael J. Mack
Subjects: medicine.medical_specialty, Cardiac Catheterization, Cost effectiveness, medicine.medical_treatment, Cost-Benefit Analysis, Risk Assessment, Appropriate Use Criteria, Aortic valve replacement, Valve replacement, Risk Factors, medicine, Humans, Intensive care medicine, Quality Indicators, Health Care, Heart Valve Prosthesis Implantation, business.industry, valvular heart disease, Aortic Valve Stenosis, Health Care Costs, medicine.disease, United States, Quality-adjusted life year, Surgery, Europe, Stenosis, Outcome and Process Assessment, Health Care, Treatment Outcome, Practice Guidelines as Topic, Cardiology and Cardiovascular Medicine, business, Incremental cost-effectiveness ratio
Abstract: Transcatheter aortic valve replacement (TAVR) is a transformative technology for the treatment of aortic stenosis, requiring a multidisciplinary collaboration in the form of a "heart team" that includes interventional cardiologists and cardiac surgeons. As this new technology continues to disperse rapidly, its proper therapeutic role evolves and leads to important questions regarding who should perform the procedure, where it should be performed, and who should pay for it. Herein, we review the most recent guidelines governing the use of TAVR in the United States and Europe. We then summarize the available registry data, which, despite its limitations, presents the clearest picture of TAVR in clinical use. Finally, we discuss the costs and relative cost-effectiveness of TAVR. Taken together, these are the elements from which the larger questions surrounding TAVR must be answered.
Published: 2014

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