Cardiology Commons^™

Combined Snare And Buddy-Balloon Strategy For Failed Valve Crossing In Valve-In-Valve Transcatheter Aortic Valve Replacement, Hira Sarfraz, Muhammad U. Javed, Parth K. Parikh, Joshua A. Cohen, Raymond L. Benza, Matthew R. Summers, Deepak R. Talreja

Department of Medicine Faculty Publications

Background

Retrograde valve crossing during valve-in-valve transcatheter aortic valve replacement (ViV TAVR) may fail despite modern delivery systems.

Case Summary

A 67-year-old man with a degenerated 27-mm Magna Ease bioprosthesis and unfavorable aortic geometry (kinked ascending aorta at a prior surgical graft site) underwent ViV TAVR, where retrograde valve crossing failed despite multiple stiff guidewires and snare traction alone. Successful delivery of a 29-mm Evolut FX+ was ultimately achieved by combining gooseneck-snare traction for coaxial realignment with a partially inflated Tyshak buddy balloon acting as a mechanical ramp across the surgical valve frame.

Discussion

This case demonstrates a structured, stepwise …

Balloon Aortic Valvuloplasty As A Bridge Therapy In Acute Valve Syndrome: A Narrative Review Of Evidence Gaps And Future Directions, Omar Saleh, Omar Jafar, Nicholas Valle, Shirish Yasa, Saleh Mostafa, Raymond L. Benza, Deepak R. Talreja, Benjamin D. Peterson, Matthew R. Summers

Department of Medicine Faculty Publications

Acute valve syndrome (AVS) represents a high-acuity, decompensated presentation of severe aortic stenosis (AS), often manifesting as acute heart failure, cardiogenic shock, or cardiac arrest. Transcatheter aortic valve replacement (TAVR) remains the only durable therapy for severe AS in patients with prohibitive surgical risk, yet AVS patients may be too unstable for standard preprocedural planning. Balloon aortic valvuloplasty (BAV) has re-emerged as a bridge strategy that can provide rapid hemodynamic stabilization and permit subsequent valve replacement. Registry analyses report lower mortality in emergent TAVR compared with BAV, but these comparisons are confounded by procedural indication and unmatched AS severity. Smaller …

Sex Differences In Clinical Characteristics, Treatment, And Outcomes Of Cardiovascular Disease: Kenya Heart Registry Analysis, Lilian Mbau, Martha Gulati, Mzee Ngunga, Jasmit Shah, Felix Barasa, Jeilan Mohamed, Anders Barasa, Bernard Gitura, Harun Otieno, Etienne Amendezo

Internal Medicine, East Africa

Background Cardiovascular disease is the leading cause of death globally, with approximately 80% of these deaths occurring in low- and middle-income countries. Sex differences in cardiovascular disease are well described in high-income countries but limited in low- and middle-income countries.

Objectives This study sought to evaluate the sex differences in clinical presentation, cardiovascular risk profile, diagnosis, treatment, and outcomes among patients in the Kenya Heart Registry.

Methods Data were prospectively collected from 3 tertiary hospitals, including patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation. Primary outcomes were in-hospital and 6-month mortality, as well as sex-specific differences …

Endovascular Arch Repair Using A Novel Single Branch Arch Stent Graft: 30-Day Results From The Chronic Dissection Arm Of The Nexus Aortic Arch Clinical Study To Evaluate Safety And Effectiveness Investigational Device Exemption Study, Bradley G. Leshnower, Jean Panneton, Himanshu J. Patel, Adam W. Beck, Mathew Wooster, Kyle W. Eudailey, Shinichi Fukuhara, Jae Cho, Sanford Zeigler, Westley Ohman, Puja Kachroo, Derek Brinster, Shahab Toursavadkohi, Mehrdad Ghoreishi, Brandley Taylor, Frank Arko, Paul Hayes, Ross Milner

Department Surgery Faculty Publications

Objective

Moderate levels of frailty or a previous sternotomy make open repair of aortic arch pathology high risk or even preclude any treatment. This study examined 30-day outcomes from the NEXUS Aortic Arch Clinical Study to Evaluate Safety and Effectiveness investigational device exemption (TRIOMPHE IDE) study of an off-the-shelf stent-graft system for Zone 0 endovascular aortic arch repair in patients with high-risk chronic dissection.

Methods

TRIOMPHE IDE is a prospective, multicenter study evaluating the NEXUS system (Endospan) in chronic aortic dissection (n = 54). Following cervical debranching, NEXUS was delivered into the arch first, followed by an ascending aortic stent-graft. …

Impact Of Social Determinants Of Health On Perioperative And Interstage Outcomes In Congenital Heart Surgery A Systematic Review, Sara Sakowitz, Jennifer S. Nelson, Justin Robinson, Camilla S. Rossi, David M. Shahian, David T. Cooke, Jeffrey P. Jacobs, Shelby Aughtman, Megan Schultz, Meena Nathan, Claude Beaty, Michal Shafer, Deborah Kozik, Glenn J. Pelletier

Department Surgery Faculty Publications

Importance: Social determinants of health (SDoH)- conditions in which patients live, grow, and age, - are increasingly recognized to influence the health of patients with congenital heart disease (CHD).

Objective: To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery.

Evidence Review: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria …

Myxedema Coma With Cardiogenic Shock: Diagnostic Challenges And Risks Of Amiodarone In Acute Thyroid Failure, Munachiso Egbo, Jean Ramos-Cardona, Gunjan Mundhra, Veniamin Melnychuk, Suzanne Martinez

South Atlantic Division GME Research Days 2026

No abstract provided.

Percutaneous Vegetectomy As An Emerging Alternative For Tricuspid Valve Endocarditis, Alexander Patel, Elias Wakim, William Zvagelsky, Ebad Ur Rahman, Youssef Al-Saghir, Ahmed Zaky

South Atlantic Division GME Research Days 2026

No abstract provided.

How Does Pulse Field Ablation Compare To Radiofrequency Ablation In The Creation Of Cavotriscupid Isthmus Line In Patients With Atrial Arrythmias?, Sharul Saxena, Veniamin Melnychuk, Sadhana Jonna, Gunjan Mundhra, Firas El Sabbagh

South Atlantic Division GME Research Days 2026

No abstract provided.

A Rare Case Of Ticagrelor-Induced Delirium, Mhd Osama Srour, Ebad Ur Rahman, Aliha Syeda, Tehmina Patel, Mubbasher Syed

South Atlantic Division GME Research Days 2026

No abstract provided.

Acute Stemi Hours After Cabg From Distal Lima–Lad Graft Occlusion Complicated By Ellis Iii Perforation During Pci Successfully Treated With A Covered Stent, Eboselumen Aigbe, Brett Sasseen `

South Atlantic Division GME Research Days 2026

No abstract provided.

Duplex Ultrasound For Detecting Functional Popliteal Vein Entrapment: A Case Series, Ebad Rahman, William Zvagelsky, Alexander Patel, Mubbasher Syed

South Atlantic Division GME Research Days 2026

No abstract provided.

Shone Syndrome: Where Childhood Repair Is Just The Beginning, William Zvagelsky, Ebad Rahman, Ibrahim Fahdi

South Atlantic Division GME Research Days 2026

No abstract provided.

Can An Atrial Fibrillation Template Comprehensively Address Modifiable Risk Factors For Atrial Fibrillation Patients?, Sharul Saxena, Jyoti Moorjani, Sadhanna Jonna, Firas El Sabbagh

South Atlantic Division GME Research Days 2026

No abstract provided.

Clinical Outcomes And Economic Impact Of Coronary Intravascular Lithotripsy In Calcified Lesions: Insights From Contemporary Real-World Registries, Ebad Rahman, Alexander Patel, William Zvagelsky, Mubbasher Syed, Youssef Al Saghir

South Atlantic Division GME Research Days 2026

No abstract provided.

An Analysis Of Heart Failure Among Cancer Patients In The United States Between 1999 And 2020, Abes A. Bautista Neughebauer, Deepak Talreja, Apostolos Gaitanidis

Department of Medicine Faculty Publications

Background: Cancer and heart failure (HF) are highly prevalent in the population and can co-exist, due to shared risk factors and an aging population. The HF-related mortality burden in cancer patients across in the United States (US) remains poorly understood. The goal of this study is to evaluate the patterns of HF-related deaths among cancer patients in the United States.

Methods: A retrospective analysis was performed using the Centers for Disease Control and Prevention (CDC) WONDER Multiple Cause of Death database between years 1999 and 2020. HF-related deaths were defined as death certificates listing HF as a contributing cause of …

Defining Clinically Meaningful Within-Patient Changes In Heart Failure: Jacc Heart Failure Position Statement, Amin Yehya, Rebecca Hahn, Barry Borlaug, Victoria Delgado, Andrew Ambrosy, Ross Arena, Nosheen Reza, Gregory Lewis, Natalie Tapaskar, Salvatore Carbone, Cynthia Chauhan, Mitchell A. Psotka, Norman Stockbridge, James Januzzi, Javed Butler, Jennifer Cowger, Biykem Bozkurt, John Spertus

Department of Medicine Faculty Publications

Heart failure (HF) clinical trials increasingly rely on diverse endpoints beyond mortality, including hospitalizations, imaging, hemodynamic status, biomarkers, functional capacity, and patient-reported outcomes. Although statistically significant differences between treatment groups are commonly reported, interpreting whether these changes are clinically meaningful for individual patients remains challenging. This JACC: Heart Failure position statement proposes a pragmatic framework for defining clinically meaningful within-patient change across commonly used HF outcomes by integrating measurement variability, prognostic associations, and patient-anchored evidence where available. Relative and absolute risk reductions should both inform interpretation of clinical events, while imaging, hemodynamic, biomarker, and functional measures require changes exceeding measurement …

The Treatment Of Obesity In The Context Of The Obesity Paradox In Patients With Heart Failure: A Narrative Review, Pamela L. Alebna, Sarah Martey, Anurag Mehta, Carl J. Lavie, Salvatore Carbone

EVMS School of Health Professions Faculty Publications

Purpose of review

While excess adiposity is a known risk factor for incident heart failure ( HF), once the condition is established, observational data suggest that increased body mass index (BMI) may confer a survival advantage. This paradox has emphasized the underlying roles of cardiorespiratory fitness (CRF), and body composition, particularly lean mass (LM), in influencing clinical outcomes.

Recent findings

In this review, we explore the multifaceted nature of the obesity paradox in HF, with a focus on emerging anti-obesity incretin-mimetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. These agents …

Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Incidence, Predictors, And Association With Reduced Ischemic Stroke Risk, Omar Saleh, Nicholas J. Valle, Shinjer Li, Saleh Mostafa, Israa Saleh, Raymond Benza, Deepak R. Talreja, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Development of conduction abnormalities requiring pacing after transcatheter aortic valve replacement (TAVR) is relatively common. The effects of post-TAVR permanent pacemaker (PPM) implantation on mortality, ischemic stroke, and cardiovascular outcomes remain incompletely characterized. AIMS: To evaluate the incidence, predictors, and cardiovascular outcomes of post-TAVR permanent pacemaker implantation, including its association with 1-year ischemic stroke risk.

Methods

Adults undergoing TAVR (2008-2019; n = 1101) were evaluated. Patients with prior PPM (n = 104) and/or valve-in-valve or redo TAVR (n = 11) were excluded. PPM placement was identified post-indexed TAVR admission based on procedure codes, including both in-hospital and post-discharge implantations. …

Percutaneous Closure Of Ventricular Septal Rupture After Myocardial Infarction:, Thomas A. Cook, Simone K. Schumaecker, Anjani Patibandla, Nicholas J. Valle, Matthew R. Summers

Department of Medicine Faculty Publications

BACKGROUND: Ventricular septal rupture (VSR) following acute myocardial infarction is a rare but deadly complication with mortality rates exceeding 90% when left untreated. Coronary ischaemia leads to myocardial necrosis and friability resulting in septal rupture, most commonly 3-5 days post-infarction. The sudden development of a left-to-right shunt causes volume overload in the right ventricle, pulmonary vasculature, and left atrium, precipitating biventricular failure, and cardiogenic shock. Management requires careful consideration of timing and modality of closure along with stabilization with mechanical circulatory support in severe cases.

CASE SUMMARY: A 65-year-old female presented with anterior ST-segment elevation myocardial infarction complicated by VSR …

Platypnea-Orthodeoxia Syndrome Caused By A Patent Foramen Ovale And Interatrial Septal Aneurysm: A Case Report, Abes A. Bautista Neughebauer, Raymond L. Benza, Deepak Talreja

Department of Medicine Faculty Publications

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by positional hypoxemia, often due to right-to-left shunting across a patent foramen ovale (PFO) despite normal right-sided pressures. Early recognition is essential as symptoms may be subtle and imaging is often unrevealing. A 78-year-old female patient with a known PFO presented with one week of lower abdominal pain and mild exertional dyspnea without chest pain. She was profoundly hypoxic to 76% on room air, with improvement when supine and worsening when upright. Initial labs were unremarkable, and arterial blood gas revealed primary respiratory alkalosis with severe hypoxemia. Despite unremarkable chest radiography, CT …

Differential Impact Of Catheter Ablation Across Heart Failure Phenotypes In Atrial Fibrillation: A Grade Assessed Systematic Review And Meta-Analysis, Faizan Ahmed, Ayesha Zulfiqar, Mohamed Nasser Elshabrawi, Omama Ayatullah, Sheraz Qasim, Hira Sarfraz, Haris Bin Tahir, Faseeh Haider, Maryam Fatima, Syed Ahmed Ali Shah, Ameema Kaleem, Muhammad Taha Altaf, Muhammad Bin Aslam Zahid, Nazila Dalir, Manal Zia, Amro Taha, Abdul Qadeer, Bhavin Patel, Khurram Arshad

Department of Medicine Faculty Publications

Introduction: Atrial fibrillation (AF) is highly prevalent in heart failure (HF) and is linked to increased mortality and hospitalization in both preserved (HFpEF) and reduced ejection fraction (HFrEF). Catheter ablation (CA) has emerged as an effective rhythm-control strategy beyond medical therapy (MT), but phenotype-specific differences remain unclear. We compared the efficacy and safety of CA versus MT in AF with HFpEF or HFrEF.

Methods: PubMed, Embase, Scopus, and Cochrane databases were searched through December 2025. Random-effects meta-analyses were conducted in R (version 4.5.3), reporting risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results: Fifteen studies involving …

Impact Of Rapid Response Team On In-Hospital Cardiac Arrest Events, Sara Everard Tucker, Julie Gale Bell, Stephanie Pigg, Shelby Austin, Kelsey Sawyer, Stephan Smith, Michelle Bradberry, Jonathan Ortegon, Matt Mitchell

Covenant Nurses Week 2026

No abstract provided.

Outcomes And Implications Of Patients Included Vs. Excluded For Extracorporeal Cardiopulmonary Resuscitation After Initial Activation, Kevin George, Joshua B. Wiener, Michael Zacharias, Frank Forde, Yasir Abu-Omar, Colin Mccloskey

Division of Cardiology Faculty Papers

BACKGROUND: The aim of this study is to describe the implementation of a new Extracorporeal Cardiopulmonary Resuscitation (ECPR) program in Cleveland, Ohio, USA. We also provide a novel comparison of outcomes between patients cannulated vs excluded from cannulation for ECPR after initial field activation.

METHODS: A prospective observational study of ECPR activations between September 2021 and February 2025. Patients meeting initial eligibility criteria for out-of-hospital cardiac arrest (OHCA)-namely based on age, bystander-CPR, and initial shockable rhythm-were transported to the emergency department where the ECPR team completed cannulation based on further biochemical criteria. Medical records were used to collect data after …

Stim1-Dependent Treg Dysfunction Promotes Cardiometabolic Hfpef: Insights From Patients And Animal Studies, Balaji Srinivas, Alluri Kiran, Hongmei Peng, Jiang Xu, Paula Fortuno, Jennifer May, Ismail El Moudden, Nour-Eddine Rhaleb, John M. Herre, Raymond L. Benza, Khalid Matrougui

Department of Biomedical and Translational Sciences Faculty Publications

Background

Heart failure with preserved ejection fraction (HFpEF) arises from chronic cardiometabolic and vascular stress and is increasingly recognized as an inflammatory syndrome with immune dysregulation. Regulatory T cells (Tregs) are critical modulators of cardiovascular inflammation, yet the mechanisms driving Treg dysfunction in HFpEF remain poorly defined. stromal interaction molecule 1 (STIM1)-dependent calcium signaling is a key stress-responsive pathway in immune cells; however, its role in Treg maladaptation during HFpEF remains unknown.

Methods

Circulating Tregs from patients with and without HFpEF were analyzed for abundance, STIM1 expression, and stress-associated signaling pathways. To establish causality, mice with Treg-specific deletion of STIM1 …

Increasing Repeat Blood Pressure Compliance Rates At A Primary Care Clinic, Anne Giampietro, Kristin Coulter, Sarah Fincham, Julie Nugent-Carney

Publications 2026-present

No abstract provided.

Effect Of Plant-Based Vs. Standard American Diet On Cardiovascular Parameters In College Students, Timothy J. Horanic

Honors Undergraduate Theses

This study examines how adherence to different dietary patterns—specifically a plant-based diet compared to the standard American diet—can influence physiological indicators tied to cardiovascular health, including heart rate variability (HRV), blood pressure (BP), and heart rate (HR). Among these markers, HRV is considered especially sensitive to autonomic nervous system (ANS) regulation and may offer earlier insight into physiological stress or dysfunction than HR or BP alone. Although nutritional habits are widely believed to impact heart health, few investigations have focused on how specific long-term diets affect autonomic and cardiovascular metrics in healthy, college-aged adults. This study aims to investigate if …

Incidental Extracardiac Findings In Cardaic Mr Imaging, Shaimaa S Mohamed, Elhardalo O Mohamed, Mohamed A Ali, Shimaa S Attia

Journal of Medicine in Scientific Research

Background: Cardiac magnetic resonance imaging (cMRI) is recently a pivotal noninvasive technique for comprehensive cardiac assessment, providing detailed cardiac anatomy and motility insights. Given its expansive field of view, cMRI facilitates the identification of incidental extracardiac findings (IEFs), that may have clinical significance beyond the primary cardiac evaluation.

Objective: This study aims to assess the prevalence of incidental extracardiac findings noted in cMRI and to address the most frequent detected lesions.

Methods: A retrospective study was conducted on patients who have done cMRI in the period between July 2021 and July 2023. The study cohort consisted of 219 individuals referred …

Microgravity-Induced Alterations In Left Atrial Hemodynamics And Thrombogenic Risk: Insights From Healthy And Atrial Fibrillation Models, Grace M. Hoeppner

Dissertations, Master's Theses and Master's Reports

Background: Microgravity exposure alters cardiovascular loading, yet its impact on left atrial flow dynamics and thrombotic risk remains poorly understood. This study investigates how spaceflight-relevant microgravity-induced changes in cardiac outflow affect left atrial hemodynamics in healthy individuals and patients with atrial fibrillation.

Methods: Patient-specific left atrial models were generated for three healthy individuals and three AF patients. Computational fluid dynamics (CFD) simulations were performed using each patient’s baseline mitral outflow waveform and two modified waveforms representing short- and long-duration post-flight cardiac loading changes derived from echocardiographic observations. Hemodynamic metrics included left atrial velocity, time averaged wall shear stress, oscillatory shear …

Racial Differences In Adverse Pregnancy Outcomes And Incident Hypertension: A Mediation Analysis, Lucia C. Petito, Xiaoning Huang, C. Noel Bairey, Natalie Bello, Janet Catov, Ernesto Licon, Abbi Lane, David M. Haas, Lisa D. Levine, Rebecca B. Mcneil, Eliza Miller, Uma M. Reddy, Bethany Barone Gibbs, George Saade, Lauren Theilen, Laura E. Wiener, Brian M. Mercer, Hyagriv N. Simhan, Lynn M. Yee, Philip Greenland, William A. Grobman, Sadiya S. Khan

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black-White hypertension disparities remains unknown.

Methods

The nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be-Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010-2013) with follow-up 2 to 7 years postpartum (2014-2017). Race, which represents a social construct, was self-identified. The primary outcome was incident hypertension at follow-up. APOs included hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) …