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Pedro A Villablanca, Verghese Mathew, Vinod H Thourani, Josep Rodés-Cabau, Sripal Bangalore, Mohammed Makkiya, Peter Vlismas, David F Briceno, David P Slovut, Cynthia C Taub, Patrick M McCarthy, John G Augoustides, Harish Ramakrishna
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥1year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS. METHODS: A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016...
October 6, 2016: International Journal of Cardiology
Jose F Condado, Hanna A Jensen, Aneel Maini, Yi-An Ko, Mohammad H Rajaei, Lillian L Tsai, Chandan Devireddy, Bradley Leshnower, Kreton Mavromatis, Eric L Sarin, James Stewart, Robert A Guyton, Vasilis Babaliaros, Edward P Chen, Michael Halkos, Amy Simone, Patricia Keegan, Peter C Block, Vinod H Thourani
BACKGROUND: Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear. METHODS: We retrospectively reviewed patients with artery stenosis who underwent ICAS screening before surgical (SAVR) or transcatheter aortic valve replacement (TAVR) between January 2007 and August 2014. Logistic regression models were used to determine the relation between post-procedure stroke and total (sum of left and right ICAS) and maximal unilateral ICAS...
October 4, 2016: Annals of Thoracic Surgery
W Brent Keeling, Jose Binongo, Michael E Halkos, Bradley G Leshnower, Duc Q Nguyen, Edward P Chen, Eric L Sarin, Jeffrey S Miller, Steven Macheers, Omar M Lattouf, Robert A Guyton, Vinod H Thourani
BACKGROUND: It has been established that outcomes for black patients undergoing coronary artery bypass graft surgery (CABG) are inferior to those of their white counterparts. The purpose of this study was to determine (1) whether rates of multiarterial grafting are different among black patients and white patients, and (2) whether racial differences exist in postoperative outcomes after accounting for grafting strategy. METHODS: A retrospective review of black patients (n = 2,810) and white patients (n = 13,569) who underwent isolated, primary CABG from January 2002 to June 2014 at a US academic institution was performed...
October 4, 2016: Annals of Thoracic Surgery
Richard C Gilmore, Vinod H Thourani, Hanna A Jensen, Jose F Condado, Michael O Kayatta, Mohammad H Rajaei, Amjad O Syed, Vasilis C Babaliaros, Eric L Sarin, Bradley G Leshnower
Transcatheter aortic valve replacement as an alternative to open surgical repair is rapidly becoming more used in high-risk patients with aortic stenosis. Transcatheter aortic valve replacement offers the benefit of being much less invasive than traditional surgical repair and has evolved as a therapeutic option for patients with prohibitive surgical risk or those deemed surgically inoperable. Nevertheless, despite its potential to mitigate risk in this frail population, it comes with its own unique set of complications...
July 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Sean M O'Brien, David J Cohen, John S Rumsfeld, J Matthew Brennan, David M Shahian, David Dai, David R Holmes, Rosemarie B Hakim, Vinod H Thourani, Eric D Peterson, Fred H Edwards
BACKGROUND: The use of transcatheter aortic valve replacement (TAVR) to treat aortic stenosis in the United States is growing, yet little is known about the variation in procedural outcomes in community practice. We developed a TAVR in-hospital mortality risk model and used it to quantify variation in mortality rates across United States (US) TAVR centers. METHODS AND RESULTS: We analyzed data from 22 248 TAVR procedures performed at 318 sites participating in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 to October 2014)...
September 2016: Circulation. Cardiovascular Quality and Outcomes
Vinod H Thourani, Jessica Forcillo
No abstract text is available yet for this article.
September 12, 2016: JACC. Cardiovascular Interventions
Samir Kapadia, Shikhar Agarwal, D Craig Miller, John G Webb, Michael Mack, Stephen Ellis, Howard C Herrmann, Augusto D Pichard, E Murat Tuzcu, Lars G Svensson, Craig R Smith, Jeevanantham Rajeswaran, John Ehrlinger, Susheel Kodali, Raj Makkar, Vinod H Thourani, Eugene H Blackstone, Martin B Leon
BACKGROUND: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events. METHODS AND RESULTS: From April 2007 to February 2012, 2621 patients, aged 84±7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry...
September 2016: Circulation. Cardiovascular Interventions
Vinod H Thourani, Jessica Forcillo, Nirat Beohar, Darshan Doshi, Rupa Parvataneni, Girma M Ayele, Ajay J Kirtane, Vasilis Babaliaros, Susheel Kodali, Chandan Devireddy, Wilson Szeto, Howard C Herrmann, Raj Makkar, Gorav Ailawadi, Scott Lim, Hersh S Maniar, Alan Zajarias, Rakesh Suri, E Murat Tuzcu, Samir Kapadia, Lars Svensson, Jose Condado, Hanna A Jensen, Michael J Mack, Martin B Leon
BACKGROUND: Although preoperative renal dysfunction (RD) is associated with increased mortality and morbidity after surgical aortic valve replacement, its impact on clinical outcomes after transcatheter aortic valve replacement (TAVR) is less defined. METHODS: TAVR patients in the PARTNER (Placement of Aortic Transcatheter Valves) trial with a calculable glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation were included. Patients were divided into three groups: GFR >60 mL/min (none/mild RD), GFR 31 to 60 mL/min (moderate RD), and GFR ≤30 mL/min (severe RD)...
October 2016: Annals of Thoracic Surgery
Jose F Condado, Parichart Junpaparp, Jose N Binongo, Yi Lasanajak, Christian F Witzke-Sanz, Chandan Devireddy, Bradley Leshnower, Kreton Mavromatis, James Stewart, Robert Guyton, David Wheeler, Jessica Forcillo, Ateet Patel, Peter C Block, Vinod Thourani, Janani Rangaswami, Vasilis Babaliaros
BACKGROUND: Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) mark systemic inflammation. Patients with high NLR and PLR have worse cardiovascular disease and outcomes. We assessed the role of these ratios in predicting outcomes after transcatheter aortic valve replacement (TAVR). METHODS: The association between NLR and PLR with baseline characteristics, 30-day outcomes, and 1-year readmission/survival was determined in patients that underwent TAVR between 2007 and 2014 and had baseline complete blood count with differential...
November 15, 2016: International Journal of Cardiology
Eric L Sarin, Weiwei Shi, Rajnish Duara, Todd A Melone, Kanika Kalra, Ashley Strong, Apoorva Girish, Bryant V McIver, Vinod H Thourani, Robert A Guyton, Muralidhar Padala
Mitral regurgitation (MR) is a common heart-valve lesion after myocardial infarction in humans. Because it is considered a risk factor for accelerated heart failure and death, various surgical approaches and catheter-based devices to correct it are in development. Lack of a reproducible animal model of MR after myocardial infarction and reliable techniques to perform open-heart surgery in these diseased models led to the use of healthy animals to test new devices. Thus, most devices that are deemed safe in healthy animals have shown poor results in human efficacy studies, hampering progress in this area of research...
2016: Comparative Medicine
Prem A Midha, Vrishank Raghav, Jose F Condado, Ikechukwu U Okafor, Stamatios Lerakis, Vinod H Thourani, Vasilis Babaliaros, Ajit P Yoganathan
OBJECTIVES: The purpose of this study was to optimize hemodynamic performance of valve-in-valve (VIV) according to transcatheter heart valve (THV) type (balloon vs. self-expandable), size, and deployment positions in an in vitro model. BACKGROUND: VIV transcatheter aortic valve replacement is increasingly used for the treatment of patients with a failing surgical bioprosthesis. However, there is a paucity in understanding the THV hemodynamic performance in this setting...
August 8, 2016: JACC. Cardiovascular Interventions
Venkatesh Y Anjan, Howard C Herrmann, Philippe Pibarot, William J Stewart, Samir Kapadia, E Murat Tuzcu, Vasilis Babaliaros, Vinod H Thourani, Wilson Y Szeto, Joseph E Bavaria, Susheel Kodali, Rebecca T Hahn, Mathew Williams, D Craig Miller, Pamela S Douglas, Martin B Leon
IMPORTANCE: Low-flow (LF) severe aortic stenosis (AS) is an independent predictor of mortality in patients undergoing aortic valve replacement (AVR). Little is known about improvement in flow after AVR and its effects on survival. OBJECTIVE: To determine whether higher flow (left-ventricular stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate better clinical outcomes in this at-risk population. DESIGN, SETTING, AND PARTICIPANTS: A substudy analysis of data from the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical trial and continued-access registry was conducted...
August 1, 2016: JAMA Cardiology
Fred H Edwards, David J Cohen, Sean M O'Brien, Eric D Peterson, Michael J Mack, David M Shahian, Frederick L Grover, E Murat Tuzcu, Vinod H Thourani, John Carroll, J Matthew Brennan, Ralph G Brindis, John Rumsfeld, David R Holmes
IMPORTANCE: Patient selection for transcatheter aortic valve replacement (TAVR) should include assessment of the risks of TAVR compared with surgical aortic valve replacement (SAVR). Existing SAVR risk models accurately predict the risks for the population undergoing SAVR, but comparable models to predict risk for patients undergoing TAVR are currently not available and should be derived from a population that underwent TAVR. OBJECTIVE: To use a national population of patients undergoing TAVR to develop a statistical model that will predict in-hospital mortality after TAVR...
April 1, 2016: JAMA Cardiology
Howard C Herrmann, Vinod H Thourani, Susheel K Kodali, Raj R Makkar, Wilson Y Szeto, Saif Anwaruddin, Nimesh Desai, Scott Lim, S Chris Malaisrie, Dean J Kereiakes, Steven Ramee, Kevin L Greason, Samir Kapadia, Vasilis Babaliaros, Rebecca T Hahn, Philippe Pibarot, Neil J Weissman, Jonathon Leipsic, Brian K Whisenant, John G Webb, Michael J Mack, Martin B Leon
BACKGROUND: In the initial PARTNER trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement for high-risk (HR) and inoperable patients, mortality at 1 year was 24% in HR and 31% in inoperable patients. A recent report of the 30-day outcomes with the low-profile SAPIEN 3 transcatheter aortic valve replacement system demonstrated very low rates of adverse events, but little is known about the longer-term outcomes with this device. METHODS: Between October 2013 and September 2014, 583 HR (65%) or inoperable (35%) patients were treated via the transfemoral (84%) or transapical/transaortic (16%) access route at 29 US sites...
July 12, 2016: Circulation
Vinay Badhwar, J Scott Rankin, Jeffrey P Jacobs, David M Shahian, Robert H Habib, Richard S D'Agostino, Vinod H Thourani, Rakesh M Suri, Richard L Prager, Fred H Edwards
The Society of Thoracic Surgeons Adult Cardiac Database (ACSD) is an international voluntary effort that is the foundation of our specialty's efforts in clinical performance assessment and quality improvement. Containing nearly 6,000,000 patient records, the ACSD is a robust resource for clinical research. Seven major original publications and four review articles were generated from the ACSD in 2015. The risk-adjusted outcome analyses and quality measures reported in these studies have made substantial contributions to inform daily clinical practice...
July 2016: Annals of Thoracic Surgery
Rakesh M Suri, Sa'ar Minha, Oluseun Alli, Ron Waksman, Charanjit S Rihal, Lowell P Satler, Kevin L Greason, Rebecca Torguson, Augusto D Pichard, Michael Mack, Lars G Svensson, Jeevanantham Rajeswaran, Ashley M Lowry, John Ehrlinger, Stephanie L Mick, E Murat Tuzcu, Vinod H Thourani, Raj Makkar, David Holmes, Martin B Leon, Eugene H Blackstone
OBJECTIVES: Introduction of hybrid techniques, such as transapical transcatheter aortic valve replacement (TA-TAVR), requires skills that a heart team must master to achieve technical efficiency: the technical performance learning curve. To date, the learning curve for TA-TAVR remains unknown. We therefore evaluated the rate at which technical performance improved, assessed change in occurrence of adverse events in relation to technical performance, and determined whether adverse events after TA-TAVR were linked to acquiring technical performance efficiency (the learning curve)...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Hanna A Jensen, Vinod H Thourani, Jessica Forcillo, Jose F Condado, Jose N Binongo, Vasilis Babaliaros, Yi Lasanajak, Bradley Leshnower, Chandan Devireddy, Robert Guyton, Kreton Mavromatis, Peter Block, Amy Simone, Patricia Keegan, James Stewart, Lillian L Tsai, Mohammad H Rajaei, Stamatios Lerakis, Eric L Sarin
BACKGROUND: Nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) is often associated with worse outcomes than TF TAVR. We investigated the relationship between increasing Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score and observed mortality and morbidity in TF and non-TF TAVR groups. METHODS: We reviewed 595 patients undergoing TAVR at Emory Healthcare between 2007 and 2014. Clinical outcomes were reported for 337 TF patients (57%) and 258 non-TF patients (43%)...
August 2016: Annals of Thoracic Surgery
Susheel Kodali, Vinod H Thourani, Jonathon White, S Chris Malaisrie, Scott Lim, Kevin L Greason, Mathew Williams, Mayra Guerrero, Andrew C Eisenhauer, Samir Kapadia, Dean J Kereiakes, Howard C Herrmann, Vasilis Babaliaros, Wilson Y Szeto, Rebecca T Hahn, Philippe Pibarot, Neil J Weissman, Jonathon Leipsic, Philipp Blanke, Brian K Whisenant, Rakesh M Suri, Raj R Makkar, Girma M Ayele, Lars G Svensson, John G Webb, Michael J Mack, Craig R Smith, Martin B Leon
AIMS: Based on randomized trials using first-generation devices, transcatheter aortic valve replacement (TAVR) is well established in the treatment of high-risk (HR) patients with severe aortic stenosis (AS). To date, there is a paucity of adjudicated, prospective data evaluating outcomes with newer generation devices and in lower risk patients. We report early outcomes of a large, multicentre registry of inoperable, HR, and intermediate-risk (IR) patients undergoing treatment with the next-generation SAPIEN 3 transcatheter heart valve (THV)...
July 21, 2016: European Heart Journal
David R Holmes, Rick A Nishimura, Frederick L Grover, Ralph G Brindis, John D Carroll, Fred H Edwards, Eric D Peterson, John S Rumsfeld, David M Shahian, Vinod H Thourani, E Murat Tuzcu, Sreekanth Vemulapalli, Kathleen Hewitt, Joan Michaels, Susan Fitzgerald, Michael J Mack
BACKGROUND: The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES: This report provides an overview on current U.S. TVT practice and trends...
February 2016: Annals of Thoracic Surgery
Thomas A Schwann, Robert H Habib, Rakesh M Suri, J Matthew Brennan, Xia He, Vinod H Thourani, Milo Engoren, Gorav Ailawadi, Brian R Englum, Mark R Bonnell, James S Gammie
BACKGROUND: Anticoagulation with warfarin following bioprosthetic mitral valve replacement (BMVR) is recommended by multiple practice guidelines. We assessed practice variability and patient characteristics associated with warfarin prescription following BMVR. METHODS: We analyzed 7,637 patients in the Society of Thoracic Surgeons Database (January 1, 2008 to June 30, 2011) who were discharged following isolated primary nonemergent BMVR. Patients requiring preoperative warfarin, those with preoperative atrial fibrillation, or those with a contraindication to warfarin were excluded...
September 2016: Chest
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