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Aortic valve and ascending aorta guidelines for management and quality measures: executive summary

Svensson, Lars G; Adams, David H; Bonow, Robert O; Kouchoukos, Nicholas T; Miller, D Craig; O'Gara, Patrick T; Shahian, David M; Schaff, Hartzell V; Akins, Cary W; Bavaria, Joseph; Blackstone, Eugene H; David, Tirone E; Desai, Nimesh D; Dewey, Todd M; D'Agostino, Richard S; Gleason, Thomas G; Harrington, Katherine B; Kodali, Susheel; Kapadia, Samir; Leon, Martin B; Lima, Brian; Lytle, Bruce W; Mack, Michael J; Reece, T Brett; Reiss, George R; Roselli, Eric; Smith, Craig R; Thourani, Vinod H; Tuzcu, E Murat; Webb, John; Williams, Mathew R
The Society of Thoracic Surgeons Clinical Practice Guidelines are intended to assist physicians and other health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. Moreover, these guidelines are subject to change over time, without notice. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of the individual circumstances presented by the patient.
PMID: 23291103
ISSN: 0003-4975
CID: 1067032

Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature

Genereux, Philippe; Head, Stuart J; Hahn, Rebecca; Daneault, Benoit; Kodali, Susheel; Williams, Mathew R; van Mieghem, Nicolas M; Alu, Maria C; Serruys, Patrick W; Kappetein, A Pieter; Leon, Martin B
Paravalvular leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement. Recent reports indicating that PVL may be correlated with increased late mortality have raised concerns. However, the heterogeneity of methods for assessing and quantifying PVL, and lack of consistency in the timing of such assessments, is a hindrance to understanding its true prevalence, severity, and effect. This literature review is an effort to consolidate current knowledge in this area to better understand the prevalence, progression, and impact of post-TAVR PVL and to help direct future efforts regarding the assessment, prevention, and treatment of this troublesome complication.
PMID: 23375925
ISSN: 0735-1097
CID: 1067042

Efficacy and safety of postdilatation to reduce paravalvular regurgitation during balloon-expandable transcatheter aortic valve replacement

Daneault, Benoit; Koss, Elana; Hahn, Rebecca T; Kodali, Susheel; Williams, Mathew R; Genereux, Philippe; Paradis, Jean-Michel; George, Isaac; Reiss, George R; Moses, Jeffrey W; Smith, Craig R; Leon, Martin B
BACKGROUND: Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD after balloon expandable TAVR. METHODS AND RESULTS: Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon's C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3+/-17.1 versus 15.4+/-14.2 mm(2); P<0.0001). There was significant reduction in PVR area attributable to PD (21.7+/-9.3 mm(2); P<0.0001). Spontaneous regression of PVR was seen in both groups. PD increased stent dimensions. CONCLUSIONS: This study demonstrates the efficacy of PD at reducing PVR in patients with greater than mild PVR after balloon-expandable TAVR.
PMID: 23339841
ISSN: 1941-7640
CID: 750152

Transcatheter tricuspid valve-in-valve replacement resulting in 4 different prosthetic heart valves in a single patient [Case Report]

Daneault, Benoit; Williams, Mathew R; Leon, Martin B; Paradis, Jean-Michel; Kodali, Susheel K
PMID: 23273297
ISSN: 0735-1097
CID: 1067052

Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria

Genereux, Philippe; Kodali, Susheel K; Green, Philip; Paradis, Jean-Michel; Daneault, Benoit; Rene, Garvey; Hueter, Irene; Georges, Isaac; Kirtane, Ajay; Hahn, Rebecca T; Smith, Craig; Leon, Martin B; Williams, Mathew R
Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 +/- 11.4 vs 45.6 +/- 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 +/- 2.0 vs 2.4 +/- 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 +/- 12.99 vs 13.18 +/- 4.82 x 10(3)/mul, p = 0.001), a more severe platelet decrease (118 +/- 40 vs 75 +/- 43 x 10(3)/mul, p <0.0001), and longer hospitalization (10.7 +/- 6.4 vs 7.7 +/- 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.
PMCID:3703857
PMID: 23040657
ISSN: 0002-9149
CID: 1067062

Concomitant transcatheter aortic and mitral valve-in-valve replacements using transfemoral devices via the transapical approach: first case in United States [Case Report]

Paradis, Jean-Michel; Kodali, Susheel K; Hahn, Rebecca T; George, Isaac; Daneault, Benoit; Koss, Elana; Nazif, Tamim M; Leon, Martin B; Williams, Mathew R
PMID: 23347868
ISSN: 1876-7605
CID: 1067072

CLINICAL IMPLICATIONS OF NEW LEFT BUNDLE BRANCH BLOCK: SUB-ANALYSIS FROM THE PARTNER TRIAL [Meeting Abstract]

Nazif, Tamim; Williams, Mathew; Hahn, Rebecca T; Szeto, Wilson Y; Makkar, Raj; Kapadia, Samir; Jilaihawi, Hasan; Fearon, William; Dvir, Danny; Dizon, Jose; Dewey, Todd; Babaliaros, Vasilis; Xu, Ke; Smith, Craig; Leon, Martin B; Kodali, Susheel K
ISI:000316555202074
ISSN: 0735-1097
CID: 2248192

THE IMPACT OF SIX-MINUTE WALK TEST PERFORMANCE ON OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE PARTNER TRIAL [Meeting Abstract]

Green, Philip; Kirtane, Ajay; Genereux, Philippe; McAndrew, Tom; Hueter, Irene; Alu, Maria; Arnold, Suzanne; Beohar, Nirat; Rihal, Charanjit; Mack, Michael; Kapadia, Samir; Maurer, Mathew; Williams, Mathew; Kodali, Susheel; Leon, Martin; Cohen, David
ISI:000316555202175
ISSN: 0735-1097
CID: 5368212

The "Eyeball Test" in Aortic Stenosis: Characterizing Subjective Frailty with Objective Measures [Meeting Abstract]

Nazif, Tamim; Green, Philip; Hawk, Christopher W.; Harjai, Kishore; Paradis, Jean-Michel; Wong, Tiffany; Lazarte, Rosa M.; George, Isaac; Leon, Martin; Kirtane, Ajay J.; Williams, Mathew; Kodali, Susheel
ISI:000329845601072
ISSN: 0735-1097
CID: 5368232

Patient radiation exposure during transcatheter aortic valve replacement procedures

Daneault, Benoit; Balter, Stephen; Kodali, Susheel K; Williams, Mathew R; Genereux, Philippe; Reiss, George R; Paradis, Jean-Michel; Green, Philip; Kirtane, Ajay J; Smith, Craig; Moses, Jeffrey W; Leon, Martin B
AIMS: To describe patient radiation utilisation during transcatheter aortic valve replacement (TAVR) on a series of consecutive patients. METHODS AND RESULTS: Data on radiation exposure were prospectively collected for consecutive patients undergoing TAVR and percutaneous coronary interventions at our centre. Radiation dose during the procedure was recorded using the US Food and Drug Administration (FDA) reference point (Ka,r) and the dose area product (PKA). In addition to quantifying overall radiation doses during TAVR, radiation exposure during transfemoral (TF) (n=79) and transapical (TA) (n=26) cases was compared. The median radiation dose during TAVR was 1,639 mGy (983-2,420), or 188 (106-321) Gy*cm2. Radiation dose was significantly lower among TA patients using either the reference point (TA: 946 [777-1,261] vs. TF: 1,932 [1,383-2,614] mGy; p<0.001) or the dose area product (TA: 89 [60-115] vs. TF: 236 [164-338] Gy*cm2; p<0.001). Fluoroscopy time was lower for TA patients (TA: 10 [8-11] vs. TF: 30 [24-34] minutes; p<0.001). Operators experience did not affect radiation exposure for TF cases. CONCLUSIONS: Radiation exposure during TAVR appears similar to other percutaneous coronary interventions of moderate complexity. Radiation doses were significantly lower for TA procedures. A higher dose of radiation in TF patients may be related to additional imaging requirements to optimise percutaneous vascular access and closure.
PMCID:3718041
PMID: 23086785
ISSN: 1774-024x
CID: 750192