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https://www.readbyqxmd.com/read/28811003/the-impact-of-thoracic-endovascular-aortic-repair-on-long-term-survival-in-type-b-aortic%C3%A2-dissection
#1
Xiaoying Lou, Edward P Chen, Yazan M Duwayri, Ravi K Veeraswamy, William D Jordan, Carl A Zehner, Bradley G Leshnower
BACKGROUND: Currently, optimal medical therapy is first-line therapy for uncomplicated acute type B aortic dissection (aTBAD) despite poor long-term outcomes. This study examines the impact of thoracic endovascular aortic repair (TEVAR) in the acute and chronic phases on short-term and long-term survival of patients presenting with aTBAD. METHODS: A review of the Emory aortic database from 2000 to 2016 identified 398 patients diagnosed with aTBAD. At index hospitalization, complicated patients underwent TEVAR (aTEVAR [thoracic endovascular aortic repair in the acute phase], n = 80) and uncomplicated patients received optimal medical therapy (n = 318)...
August 12, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28673705/reoperative-aortic-root-replacement-outcome-in-a-contemporary-series
#2
Jiro Esaki, Bradley G Leshnower, Jose N Binongo, Yi Lasanajak, LaRonica McPherson, Vinod H Thourani, Edward P Chen
OBJECTIVES: Reoperative aortic root replacement is a challenging procedure associated with significant mortality and morbidity. The purpose of this study was to investigate the outcomes of reoperative aortic root replacement when performed in a number of complex clinical settings and to identify risk factors for operative mortality and long-term survival. METHODS: From 2006 to 2015, 280 consecutive patients at an academic center underwent reoperative aortic root replacement after a variety of previous aortic or cardiac operations...
September 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28669506/risk-factors-for-late-aortic-valve-dysfunction-after-the-david-v-valve-sparing-root-replacement
#3
Jiro Esaki, Bradley G Leshnower, Jose N Binongo, Yi Lasanajak, LaRonica McPherson, Robert A Guyton, Edward P Chen
BACKGROUND: Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR. METHODS: A retrospective review from 2005 to 2015 at a US academic center identified 282 patients who underwent VSRR. Cox proportional hazards regression analysis was used to identify risk factors for late AI and AS after VSRR...
June 29, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28608325/pulsatile-flow-leads-to-intimal-flap-motion-and-flow-reversal-in-an-in-vitro-model-of-type-b-aortic-dissection
#4
Joav Birjiniuk, Lucas H Timmins, Mark Young, Bradley G Leshnower, John N Oshinski, David N Ku, Ravi K Veeraswamy
Understanding of the hemodynamics of Type B aortic dissection may improve outcomes by informing upon patient selection, device design, and deployment strategies. This project characterized changes to aortic hemodynamics as the result of dissection. We hypothesized that dissection would lead to elevated flow reversal and disrupted pulsatile flow patterns in the aorta that can be detected and quantified by non-invasive magnetic resonance imaging. Flexible, anatomic models of both normal aorta and dissected aorta, with a mobile intimal flap containing entry and exit tears, were perfused with a physiologic pulsatile waveform...
June 12, 2017: Cardiovascular Engineering and Technology
https://www.readbyqxmd.com/read/28551049/hypothermia-and-selective-antegrade-cerebral-perfusion-is-safe-for-arch-repair-in-type-a-dissection
#5
W Brent Keeling, Bradley G Leshnower, John C Hunting, Jose Binongo, Edward P Chen
BACKGROUND: Unilateral selective antegrade cerebral perfusion with moderate hypothermic circulatory arrest has been shown to be a safe and effective method of cerebral protection during surgery for acute type A dissection. This study evaluates the impact of this cerebral protection strategy on clinical outcomes after extended aortic arch reconstruction in patients undergoing emergent repair of acute type A dissection. METHODS: A retrospective review from 2004 to 2016 at a US academic center of patients undergoing surgery for acute type A dissections using moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion was performed...
September 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28532575/readmission-rates-after-transcatheter-aortic-valve-replacement-in-high-and-extreme-risk-patients-with-severe-aortic-stenosis
#6
Jessica Forcillo, Jose F Condado, Jose N Binongo, Yi Lasanajak, Hope Caughron, Vasilis Babaliaros, Chandan Devireddy, Bradley Leshnower, Robert A Guyton, Peter C Block, Amy Simone, Patricia Keegan, Paul Khairy, Vinod H Thourani
OBJECTIVE: In high- or extreme-risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30-day and 1-year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1-year mortality. METHODS: A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University...
August 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28502542/contemporary-evaluation-of-mortality-and-stroke-risk-after-thoracic-endovascular-aortic-repair
#7
Frances Y Hu, Zachary B Fang, Bradley G Leshnower, Yazan Duwayri, William D Jordan, Theresa W Gillespie, Ravi K Veeraswamy
OBJECTIVE: During the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologic processes. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary data set have yet to be reported. Previous studies have shown periprocedural mortality rates between 1.5% and 9.5% and procedure-related stroke rates of 2.3% to 8.2%. With advances in device engineering and increased experience of physicians, we hypothesized that the rates of these complications would be reduced in a more recent sample set...
September 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28471092/anatomical-risk-models-for-paravalvular-leak-and-landing-zone-complications-for-balloon-expandable-transcatheter-aortic-valve-replacement
#8
Jose F Condado, Frank E Corrigan, Stamatios Lerakis, Ioannis Parastatidis, Arthur E Stillman, Jose N Binongo, James Stewart, Kreton Mavromatis, Chandan Devireddy, Bradley Leshnower, Robert Guyton, Jessica Forcillo, Ateet Patel, Vinod H Thourani, Peter C Block, Vasilis Babaliaros
BACKGROUND: Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed. METHODS: Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated...
May 4, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28460021/hypothermia-and-cerebral-protection-strategies-in-aortic-arch-surgery-a-comparative-effectiveness-analysis-from-the-sts-adult-cardiac-surgery-database
#9
Brian R Englum, Xia He, Brian C Gulack, Asvin M Ganapathi, Joseph P Mathew, J Matthew Brennan, T Brett Reece, W Brent Keeling, Bradley G Leshnower, Edward P Chen, Jeffrey P Jacobs, Vinod H Thourani, G Chad Hughes
OBJECTIVES: Hypothermic circulatory arrest is essential to aortic arch surgery, although consensus regarding optimal cerebral protection strategy remains lacking. We evaluated the current use and comparative effectiveness of hypothermia/cerebral perfusion (CP) strategies in aortic arch surgery. METHODS: Using the Society of Thoracic Surgeons Database, cases of aortic arch surgery with hypothermic circulatory arrest from 2011 to 2014 were categorized by hypothermia strategy-deep/profound (D/P; ≤20°C), low-moderate (L-M; 20...
September 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28279317/outcomes-after-paravalvular-leak-closure-transcatheter-versus-surgical-approaches
#10
John A Wells, Jose F Condado, Norihiko Kamioka, Andy Dong, Andrew Ritter, Stamatios Lerakis, Stephen Clements, James Stewart, Bradley Leshnower, Robert Guyton, Jessica Forcillo, Ateet Patel, Vinod H Thourani, Peter C Block, Vasilis Babaliaros
OBJECTIVES: The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL). BACKGROUND: Data comparing the treatment of PVL with TI and SI are limited. METHODS: A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016...
March 13, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28211605/end-stage-renal-disease-and-severe-aortic-stenosis-does-valve-replacement-improve-one-year-outcomes
#11
Jose F Condado, Aneel Maini, Bradley Leshnower, Vinod Thourani, Jessica Forcillo, Chandan Devireddy, Kreton Mavromatis, Eric L Sarin, James Stewart, Robert Guyton, Amy Simone, Patricia Keegan, Stamatios Lerakis, Peter C Block, Vasilis Babaliaros
BACKGROUND: Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. METHODS: A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR...
May 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28079579/detailed-2-dimensional-and-3-dimensional-transesophageal-evaluation-of-the-aortic-root-and-aortic-valve-in-complex-type-a-dissections
#12
J Kirk Edwards, Bradley G Leshnower, Michael Duggan, Kathryn E Glas
No abstract text is available yet for this article.
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27993378/aortic-remodeling-after-endovascular-repair-of-complicated-acute-type-b-aortic%C3%A2-dissection
#13
Bradley G Leshnower, Yazan M Duwayri, Edward P Chen, Chun Li, Carl A Zehner, Jose N Binongo, Ravi K Veeraswamy
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the optimal therapy for complicated acute type B aortic dissection (aTBAD). This study examined clinical outcomes and aortic remodeling parameters after TEVAR for patients with complicated aTBAD. METHODS: From January 2012 to December 2015, 51 patients underwent TEVAR for complicated aTBAD. Preoperative and postoperative imaging studies were analyzed for sizes of the true lumen (TL) and false lumen (FL) and for the FL thrombosis status at five locations in the thoracic and abdominal aorta...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27969802/tct-43-outcomes-after-paravalvular-leak-closure-percutaneous-versus-surgical-approaches
#14
John Wells, Jose Condado C, Norihiko Kamioka, Andy Dong, Andrew Ritter, Stamatios Lerakis, James Stewart, Bradley Leshnower, Kreton Mavromatis, Robert Guyton, Chandan Devireddy, Jessica Forcillo, Ateet Patel, Vinod Thourani, Peter Block, Vasilis Babaliaros
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27964919/clinical-outcomes-of-the-david-v-valve-sparing-root-replacement-compared-with-bioprosthetic-valve-conduits-for-aortic-root-aneurysms
#15
COMPARATIVE STUDY
Jiro Esaki, Bradley G Leshnower, Jose N Binongo, Yi Lasanajak, LaRonica McPherson, Michael E Halkos, Robert A Guyton, Edward P Chen
BACKGROUND: Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. Limited insight exists when the results of VSRR are compared with those of conventional root replacement with use of a bioprosthetic composite conduit (BIO). This study compares the operative and midterm results of VSRR and BIO. METHODS: A retrospective review from 2002 to 2015 at a United States academic center identified 282 patients who underwent VSRR and 425 patients who underwent BIO...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27862901/does-minimalist-transfemoral-transcatheter-aortic-valve-replacement-produce-better-survival-in-patients-with-severe-chronic-obstructive-pulmonary-disease
#16
COMPARATIVE STUDY
Jose F Condado, Moosa N Haider, Stamatios Lerakis, Patricia Keegan, Hope Caughron, Vinod H Thourani, Chandan Devireddy, Bradley Leshnower, Kreton Mavromatis, Eric L Sarin, James Stewart, Robert Guyton, Jessica Forcillo, Ateet Patel, Amy Simone, Peter C Block, Vasilis Babaliaros
OBJECTIVES: To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD). BACKGROUND: TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown. METHODS: We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% ≤50) who underwent minimalist vs...
March 1, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27821786/temperature-management-for-aortic-arch-surgery
#17
REVIEW
Edward P Chen, Bradley Graham Leshnower
Surgical treatment of aortic arch disease is a technically challenging procedure that requires complex circulation management strategies involving the use of hypothermic circulatory arrest. The definition of hypothermia has evolved with comfort and surgical adjuncts. This review describes the various circulation and temperature management strategies used during hemiarch and total arch replacement.
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27717427/should-we-perform-carotid-doppler-screening-before-surgical-or-transcatheter-aortic-valve-replacement
#18
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...
March 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27717426/the-racial-paradox-in-multiarterial-conduit-utilization-for-coronary-artery-bypass-grafting
#19
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...
April 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27666783/severity-of-preoperative-aortic-regurgitation-does-not-impact-valve-durability-of-aortic-valve-repair-following-the-david-v-valve-sparing-aortic-root-replacement
#20
W Brent Keeling, Bradley G Leshnower, Jose Binongo, Yi Lasanajak, LaRonica McPherson, Edward P Chen
BACKGROUND: The David V valve-sparing aortic root replacement (VSRR) is an established and durable method of root reconstruction for varying pathologies. However, the impact of the severity of preoperative aortic regurgitation (AR) on long-term durability remains unclear. The purpose of this research was to investigate the impact of the degree of preoperative AR on midterm durability following VSRR. METHODS: A retrospective review of the adult cardiac surgical database at a single academic center was undertaken from 2005 to 2015 for 223 adult patients who underwent VSRR...
March 2017: Annals of Thoracic Surgery
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