Medicine and Health Sciences Commons^™

Impact Of Aortic Valve Effective Height Following Valve-Sparing Root Replacement On Postoperative Insufficiency And Reoperation, Puja Kachroo, Meghan O Kelly, Nadia H Bakir, Catherine Cooper, Alan C Braverman, Nicholas T Kouchoukos, Marc R Moon

2020-Current year OA Pubs

BACKGROUND: This study evaluated the impact of anatomic aortic root parameters during valve-sparing root replacement on the probability of postoperative aortic insufficiency and freedom from aortic valve reoperation.

METHODS: From 1995 to 2020, 177 patients underwent valve-sparing root replacement (163 reimplantations, 14 remodeling). Preoperative and postoperative echocardiograms were analyzed to measure annulus and sinus diameters, effective height of leaflet coaptation, and degree of aortic insufficiency. Logistic regression was used to evaluate predictors of 2+ or greater late postoperative aortic insufficiency. Fine-Gray regression determined predictors for aortic valve reintervention.

RESULTS: The study population included 122 (69%) men with a mean age …

Global Longitudinal Strain And Biomarkers Of Cardiac Damage And Stress As Predictors Of Outcomes After Transcatheter Aortic Valve Implantation, Andrew S Perry, Nishath Quader, Alan Zajarias, Et Al.

2020-Current year OA Pubs

Background Global longitudinal strain (GLS) is a sensitive measure of left ventricular function and a risk marker in severe aortic stenosis. We sought to determine whether biomarkers of cardiac damage (cardiac troponin) and stress (NT-proBNP [N-terminal pro-B-type natriuretic peptide]) could complement GLS to identify patients with severe aortic stenosis at highest risk. Methods and Results From a multicenter prospective cohort of patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation, we measured absolute GLS (aGLS), cardiac troponin, and NT-proBNP at baseline in 499 patients. Left ventricular ejection fraction <50% was observed in 19% and impaired GLS (aGLS <15%) in 38%. Elevations in cardiac troponin and NT-proBNP were present in 79% and 89% of those with impaired GLS, respectively, as compared with 63% and 60% of those with normal GLS, respectively (

Sex-Specific Considerations In Degenerative Aortic Stenosis For Female-Tailored Transfemoral Aortic Valve Implantation Management, Giulia Masiero, Valeria Paradies, Anna Franzone, Barbara Bellini, Chiara De Biase, Nicole Karam, Francesca Sanguineti, Mamas A Mamas, Hélène Eltchaninoff, Chiara Fraccaro, Battistina Castiglioni, Tiziana Attisano, Giovanni Esposito, Alaide Chieffo

Department of Medicine Faculty Papers

The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of …

Self-Expanding Transcatheter Vs Surgical Aortic Valve Replacement In Intermediate-Risk Patients: 5-Year Outcomes Of The Surtavi Randomized Clinical Trial, Nicolas M Van Mieghem, G Michael Deeb, Lars Søndergaard, Eberhard Grube, Stephan Windecker, Hemal Gada, Mubashir Mumtaz, Peter S Olsen, John C Heiser, William Merhi, Neal S Kleiman, Stanley J Chetcuti, Thomas G Gleason, Joon Sup Lee, Wen Cheng, Raj R Makkar, Juan Crestanello, Barry George, Isaac George, Susheel Kodali, Steven J Yakubov, Patrick W Serruys, Rüdiger Lange, Nicolo Piazza, Mathew R Williams, Jae K Oh, David H Adams, Shuzhen Li, Michael J Reardon

Journal Articles

IMPORTANCE: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.

OBJECTIVE: To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS: SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. …

Kat-Arc Accelerated 4d Flow Cmr: Clinical Validation For Transvalvular Flow And Peak Velocity Assessment, Hosamadin Assadi, Bhalraam Uthayachandran, Rui Li, James Wardley, Tha H Nyi, Ciaran Grafton-Clarke, Andrew J Swift, Ana Beatriz Solana, Jean-Paul Aben, Kurian Thampi, David Hewson, Chris Sawh, Richard Greenwood, Marina Hughes, Bahman Kasmai, Liang Zhong, Marcus Flather, Vassilios S Vassiliou, Pankaj Garg

Journal Articles

BACKGROUND: To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow.

METHODS: This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived. Thirty-five patients who had a clinical CMR scan were included. CMR protocol included cine and 4D flow using Kat-ARC acceleration factor 6. No respiratory navigation was applied. For validation, the agreement between mitral net flow (MNF) and the aortic net flow (ANF) was investigated. Additionally, …

Combined Disease Of The Quadricuspid Aortic Valve, Robert Blazekovic, Jasmina Catic, Stjepan Barisin, Marko Kusurin, Savica Gjorgjievska, Stanislav Glumbic

The Texas Heart Institute Journal

No abstract provided.

Transcatheter Aortic Valve Implantation For Severe Aortic Stenosis And Large Membranous Interventricular Septal Aneurysm, Maheedhar Gedela, Tomasz Stys, Terezia Petraskova, Adam Stys

The Texas Heart Institute Journal

No abstract provided.

Use Of Impella Devices For Acute Cardiogenic Shock In The Perioperative Period Of Cardiac Surgery, Serge Sicouri, Vishal N Shah, Meghan Buckley, Nicholas Imperato, Jacqueline Mcgee, Elena Casanova, Eric Gnall, Konstadinos A Plestis

Division of Cardiology Faculty Papers

Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery.

Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes.

Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, …

Papillary Fibroelastoma Incidentally Found On Left Atrial Wall During Minimally Invasive Aortic Valve Replacement, Qasim Al Abri, Lamees I El Nihum, M Mujeeb Zubair, Roberto Barrios, Michael J Reardon, Mahesh Ramchandani

The Texas Heart Institute Journal

A 60-year-old man was about to undergo minimally invasive aortic valve replacement when transesophageal echocardiography revealed an intracardiac mass on the left atrial free wall. Multimodal images from 5 months earlier had shown no mass. We converted the procedure to open surgery. The excised mass resembled a cardiac myxoma but was determined to be a papillary fibroelastoma. This case illustrates that papillary fibroelastomas can form and grow rapidly, warranting alertness for their unexpected discovery before and during cardiac surgical procedures.

Neutrophil-To-Lymphocyte Ratios In Patients Undergoing Aortic Valve Replacement: The Partner Trials And Registries, Bahira Shahim, Alan Zajarias, Et Al

2020-Current year OA Pubs

Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammation has been associated with worse prognosis in several chronic disease states, including heart failure. However, few data exist on the prognostic impact of elevated baseline NLR or change in NLR levels during follow-up in patients undergoing transcatheter or surgical aortic valve replacement (TAVR or SAVR) for aortic stenosis. Methods and Results NLR was available in 5881 patients with severe aortic stenosis receiving TAVR or SAVR in PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials/registries (median [Q1, Q3] NLR, 3.30 [2.40, 4.90]); mean NLR, 4.10; range, 0.5-24.9) …

Mortality After Transcatheter Aortic Valve Replacement For Aortic Stenosis Among Patients With Malignancy: A Systematic Review And Meta-Analysis, Muhammad U Siddiqui, Omar Yacob, Joey Junarta, Ahmed K Pasha, Farouk Mookadam, Mamas A Mamas, D L Fischman

Division of Internal Medicine Faculty Papers & Presentations

Background: With advancements in cancer treatment, the life expectancy of oncology patients has improved. Thus, transcatheter aortic valve replacement (TAVR) may be considered as a feasible option for oncology patients with severe symptomatic aortic stenosis (AS). We aim to evaluate the difference in short- and long-term all-cause mortality in cancer and non-cancer patients treated with TAVR for severe AS.

Methods: Medline, PubMed, and Cochrane Central Register of Controlled Trials were searched for relevant studies. Patients with cancer who underwent treatment with TAVR for severe AS were included and compared to an identical population without cancer. The primary endpoints were short- …

Left Ventricular Hypertrophy And Biomarkers Of Cardiac Damage And Stress In Aortic Stenosis, Elliot J Stein, Nishath Quader, Alan Zajarias, Anna Vatterott, Et Al

2020-Current year OA Pubs

Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP. LVH was defined by sex-specific guideline cut-offs and elevated biomarker levels were based on age and sex cut-offs. Adjusted Cox proportional hazards models evaluated …