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Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Very Low Gradient Severe Aortic Stenosis [Meeting Abstract]

Medranda, Giorgio; Salhab, Khaled
ISI:000892594000439
ISSN: 0735-1097
CID: 5441232

Elevated Baseline B-Type Natriuretic Peptide Predicts Mortality in Transcatheter Aortic Valve Replacement [Meeting Abstract]

Medranda, G A; Brahmbhatt, K; Alawneh, B; Salhab, K; Schwartz, R K; Green, S J
Background: B-type natriuretic peptide (BNP) has been established as a predictor of outcomes in patients who undergo surgical aortic valve replacement (SAVR). Studies on the prognostic value of BNP in high-risk patients undergoing transcatheter aortic valve replacement (TAVR) have yielded conflicting results. Additionally, BNP has not been well-studied in low- and intermediate-risk patients undergoing TAVR. The purpose of this study was to clarify the prognostic utility of baseline BNP in low-, intermediate-, and high-risk patients with severe aortic stenosis (AS) undergoing TAVR.
Method(s): This was a retrospective observational study of 1544 low-, intermediate-, and high-risk patients who underwent TAVR at our institution from 2012-2019. Included were patients who had a BNP <7 days prior to TAVR. Patients were then trichotomized into those with a pre-TAVR BNP <250 pg/mL (cohort 1), between 250-500 pg/mL (cohort 2), and >500 pg/mL (cohort 3). Outcomes of interest were inpatient and 30-day mortality. Statistical analyses of outcomes were performed using multivariate binary logistic regression.
Result(s): Of the 1544 patients screened, 1487 patients had a BNP level <7 days prior to TAVR and thus were included in the study. Patients in cohort 3 with a baseline BNP >500 pg/mL were 3.31 times more likely to have inpatient death (CI 0.142, 0.643; P=0.0019), 2.70 times more likely to have death within 30 days (CI 0.192, 0.711; P=0.0029) and 1.81 times more likely to have death within 1 year (CI 0.348, 0.880, p=0.0152).
Conclusion(s): Our study of 1487 low-, intermediate-, and high-risk patients demonstrates a baseline BNP greater than 500 pg/mL is an independent predictor of inpatient, 30-day and 1-year mortality. BNP has prognostic implications in TAVR patients across all risk groups and can help identify the subset of patients who may warrant closer follow up following TAVR.
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EMBASE:2014132598
ISSN: 1878-0938
CID: 4987362

Outcome of Patients Having Transcatheter Mitral Valve Implantation for the Treatment of Degenerated Mitral Bioprostheses

Medranda, Giorgio A; Brahmbhatt, Kunal; Marzo, Kevin; Salhab, Khaled; Schwartz, Richard; Green, Stephen J
Transcatheter mitral valve implantation (TMVI) is at various levels of preclinical investigation and has proven to be more challenging than transcatheter aortic valve implantation due to more complex anatomy. The purpose of this study is to evaluate the short-term and long-term outcomes of high-risk patients who underwent TMVI for degenerated mitral bioprostheses. In this retrospective, observational study, we reviewed data on the first 26 patients with previous surgical mitral valve replacement or repair with annular ring that underwent TMVI using the balloon-expandable heart-valve system at our institution from 2014 to 2019. We reviewed pre/postprocedure echocardiographic data, in-hospital, 30-day data and 1-year outcomes. The indication for TMVI was mitral regurgitation (MR) in 9 patients, mitral stenosis in 9 patients and mixed mitral disease in 8 patients. There was a 100% device implantation success rate and a 96% in-hospital survival rate. Survival was 96% at 30 days and 85% at 1 year. Mean mitral gradient (MMG) improved postprocedure (13.3 mm Hg to 6.8 mm Hg, p <0.0001) and was sustained at 1 year (13.3 mm Hg to 7.2 mm Hg, p <0.0001). MR grade improved postprocedure (3+ to 1+, p <0.0001) and was sustained at 1 year (3+ to 0, p <0.0001). Additionally there was significant 30-day and 1-year improvements in patients' Kansas City Cardiomyopathy Questionnaire score after TMVI (47.8 to 75.7 to 84.0, p = <0.0001). In conclusion, our early experience with treatment of degenerated mitral bioprostheses using TMVI in high-risk patients resulted in significant short-term and sustained long-term improvements in mean mitral gradient, MR and heart failure symptoms.
PMID: 32713650
ISSN: 1879-1913
CID: 4581072

Prognostic Implications of Baseline B-type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation

Medranda, Giorgio A; Salhab, Khaled; Schwartz, Richard; Green, Stephen J
B-type natriuretic peptide (BNP) levels have been shown to predict outcomes in surgical aortic valve replacement patients. BNP levels have not been well studied in patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study is to define the utility of baseline BNP levels in predicting short-term outcomes after TAVI. In this retrospective, observational, study from 2012 to 2019, we reviewed data on 1297 low-risk, intermediate-risk and high-risk patients who underwent TAVI. Patients were dichotomized into those with baseline BNP levels above or below 500 pg/ml. Our primary outcome was a composite of inpatient stroke and death. Our secondary outcome was a composite of 30-day stroke, death and readmission. There were 975 patients with a baseline BNP level of <500 pg/ml and of those, 2% had our primary composite outcome and 13% of patients had our secondary composite outcome. There were 322 patients with a baseline BNP level of ≥500 pg/ml and of those, 6% had our primary composite outcome and 19% of patients had our secondary composite outcome. Those with a baseline BNP level ≥500 pg/ml were 3.47 times more likely (confidence of interval [CI] 1.727, 6.993, p = 0.0005) to have our primary composite outcome and were 1.72 times more likely (CI 1.186, 2.506, p = 0.0043) to have our secondary composite outcome. In conclusion, after adjustments for discrepant baseline characteristics, baseline BNP levels were independently predictive of a composite of inpatient stroke or death and a composite of 30-day stroke, death or readmission after TAVI. Those low, intermediate and high-risk patients whose baseline BNP is ≥500 pg/ml may ultimately require closer post-TAVI monitoring.
PMID: 32665134
ISSN: 1879-1913
CID: 4546362

The Utility of Transcatheter Aortic Valve Replacement in Very Low-Gradient Severe Aortic Stenosis [Meeting Abstract]

Medranda, Giorgio A.; Salhab, Khaled; Schwartz, Richard; Green, Stephen J.
ISI:000513916500137
ISSN: 1936-8798
CID: 4337102

Baseline B-Type Natriuretic Peptide Predicts Inpatient Outcomes in Transcatheter Aortic Valve Replacement [Meeting Abstract]

Medranda, Giorgio A.; Salhab, Khaled; Schwartz, Richard; Green, Stephen J.
ISI:000513916500127
ISSN: 1936-8798
CID: 4337092

DIRECT TRANSCATHETER AORTIC VALVE REPLACEMENT RESULTS IN SIMILAR RATES OF ATHEROEMBOLIC EVENTS [Meeting Abstract]

Medranda, Giorgio; Brahmbhatt, Kunal; Srivastava, Anjili; Hernandez, Rafael; Salhab, Khaled; Schwartz, Richard; Green, Stephen
ISI:000522979101246
ISSN: 0735-1097
CID: 5155622

Middle Aortic Syndrome in a Child-Bearing Age Patient

Rabenstein, Andrew P; Salhab, Khaled F; Spentzouris, Georgios; Paruchuri, Vijayapraveena; Hines, George; Vintzileos, Anthony M; Schubach, Scott L
We report a rare case of a 30-year-old female who had a long-standing history of middle aortic syndrome that was being managed nonsurgically. She presented with hypertension and buttock pain with plans to become pregnant. She underwent an aortoiliac bypass.
PMCID:6794142
PMID: 31614378
ISSN: 2325-4637
CID: 4146022

PREDICTORS OF PERSISTENT MITRAL REGURGITATION FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT [Meeting Abstract]

Medranda, Giorgio; Naidu, Srihari; Salhab, Khaled; Schwartz, Richard; Green, Stephen; Daggubati, Ramesh
ISI:000460565901362
ISSN: 0735-1097
CID: 4067992

THE UTILITY OF BASELINE B-TYPE NATRIURETIC PEPTIDE FOR SHORT-TERM OUTCOMES IN TRANSCATHETER AORTIC VALVE REPLACEMENT [Meeting Abstract]

Medranda, Giorgio; Rosenblum, Jake; Salhab, Khaled; Schwartz, Richard; Green, Stephen
ISI:000460565901361
ISSN: 0735-1097
CID: 4067982