Objective: Although patients with significant coronary artery disease and aortic stenosis have traditionally undergone open valve replacement and bypass grafting, percutaneous coronary intervention ...(PCI) and transcatheter aortic valve replacement (TAVR) are increasingly considered. Because of the lack of data regarding timing of PCI/TAVR, in the present study we evaluated associations of staged and concomitant PCI/TAVR on outcomes in a nationally representative cohort. Methods: Adults who underwent TAVR and PCI were identified using the 2016 to 2018 Nationwide Readmissions Database. If PCI/TAVR occurred on the same day, patients were considered Concomitant and otherwise considered Staged. Staged were further classified as Early-Staged if both occurred in the same hospitalization or Late-Staged if TAVR ensued PCI in a subsequent hospitalization. Multivariable regression models were developed to evaluate the association of TAVR timing on outcomes. The primary end point was in-hospital mortality whereas perioperative complications including acute kidney injury and hospitalization costs were secondarily considered. Results: Of an estimated 5843 patients, 843 (14.4%) were Concomitant and 745 (12.7%) and 4255 (72.8%) were Early-Staged and Late-Staged, respectively. Although age and TAVR access were similar, Concomitant had a lower proportion of chronic kidney disease and more commonly underwent single-vessel PCI. Staged showed similar risk-adjusted mortality but greater odds of acute kidney injury (Early-Staged adjusted odds ratio: 2.68; 95% CI, 1.57-4.55 and Late-Staged: 1.97; 95% CI, 1.29-2.99) compared with Concomitant. Although post-TAVR hospitalization duration was similar, total length of stay and costs were increased in Staged. Conclusions: Concomitant PCI/TAVR was associated with similar rates of in-hospital mortality but reduced rates of acute kidney injury and lower resource utilization. While evaluating patient-specific factors, concomitant PCI/TAVR might be reasonable in select individuals.
Manpower: What is the Future Shemin, Richard J., MD; Fullerton, David A., MD; Mayer, John E., MD ...
Seminars in thoracic and cardiovascular surgery,
2014-Autumn, Letnik:
26, Številka:
3
Journal Article
Revascularization for Unprotected Left Main Stem Coronary Artery Stenosis: Stenting or Surgery David P. Taggart, Sanjay Kaul, William E. Boden, T. Bruce Ferguson, Jr, Robert Guyton, Michael Mack, ...Paul Sergeant, Richard J. Shemin, Peter K. Smith, Salim Yusuf This manuscript reviews current data regarding outcomes with surgery and stents for unprotected left main stem stenosis and concludes that coronary artery bypass grafting remains the preferred revascularization treatment for good surgical candidates.
Reply Kaul, Sanjay, MD, FACC; Boden, William E., MD, FACC; Ferguson, T. Bruce, MD, FACC ...
Journal of the American College of Cardiology,
2008, Letnik:
52, Številka:
7
Journal Article
Objective Our objective was to evaluate long-term stability of mitral repair and reverse remodeling in patients with severe ischemic left ventricular dysfunction and functional mitral regurgitation. ...Methods Since June 2000, a total of 37 patients with ischemic functional mitral regurgitation have benefited from a double-level mitral repair that comprises an intraventricular peripapillary muscle sling completed by a classic intra-atrial mitral annuloplasty ring (mean age, 56 years; left ventricular end-diastolic diameter, 70 ± 0 mm; left ventricular end-systolic diameter, 55 ± 5.6 mm; ejection fraction, 15% to 45%; pulmonary hypertension > 60 in all patients; all were in New York Heart Association class III-IV). All patients had both papillary muscles encircled with a 4-mm polytetrafluoroethylene tube, correcting their lateral and downward displacement. Annuloplasty rings were moderately undersized or normal. Efficiency was evaluated on mitral stability, ventricular parameters, and functional status. According to the Leyden algorithm based on preoperative end-diastolic and end-systolic left ventricular diameters, only a minority of our patients were expected to experience reverse remodeling. Results Regurgitation is none to trivial in 31 and mild to moderate in 4. Follow-up (3–84 months; mean, 55 ± 22 months) shows stability of all initially successful double-level mitral repairs. Follow-up beyond 1 year shows improvements in ventricular diameters (56 ± 5 mm), ejection fraction (49 ± 6), volume (130 ± 10 mL), and sphericity index (0.55). Two patients died during follow-up and 1 underwent transplantation. Conclusion Reapproximating the papillary muscles has an immediate effect on mitral leaflet mobility by suppressing the tethering resulting from displacement of the papillary muscles. It has an effect in preventing recurrent mitral regurgitation by avoiding further papillary muscle displacement. In this cohort of severely disabled patients, reverse remodeling can be expected with the double-level repair.
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