Publications by authors named "Adnan K Chhatriwalla"
Background And Aims: The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy versus medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity.
Methods: The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR and randomised 2:1 to TTVR (n=267) or control (n=133).
Background: The PASCAL Precision transcatheter valve repair system provides a new option for treating prohibitive surgical risk patients with significant, symptomatic degenerative mitral regurgitation (DMR).
Objectives: The authors report early U.S.
Redo-TAVI with the SAPIEN 3 valve in degenerated calcified CoreValve/Evolut explants.
EuroIntervention
November 2024
Article Synopsis
- Redo-transcatheter aortic valve implantation (TAVI) is often needed for failed aortic valves, specifically examining SAPIEN 3 (S3) valves in degenerated CoreValve/Evolut (CV/EV) valves, which is not fully understood.
- The study assessed the performance of S3 valves following implantation in calcified CV/EV valves through various hydrodynamic tests, measuring factors like mean gradient, effective orifice area, and leaflet behaviors.
- Results indicated that S3 valves generally performed well, showing decreased mean gradient and acceptable effective orifice area, but issues like underexpansion, leaflet pinwheeling, and calcium protrusion were noted, highlighting the need for further research on long
Background: Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain.
Objectives: This study sought to describe outcomes of MTEER for sMR with preserved LVEF.
Methods: Using the STS/ACC TVT (Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%.
Article Synopsis
- Patients with asymptomatic severe aortic stenosis were studied to determine if early TAVR (transcatheter aortic valve replacement) improves outcomes compared to routine clinical surveillance, as current guidelines suggest a lack of definitive data on this topic.
- A total of 901 patients, mostly around 76 years old and generally at low surgical risk, were randomly assigned to undergo either TAVR or clinical surveillance, with outcomes measured by the occurrence of death, stroke, or unplanned hospitalizations.
- Results indicated that those who underwent TAVR had significantly better outcomes, with only 26.8% experiencing the composite primary endpoint versus 45.3% in the surveillance group, suggesting that early intervention with TAVR can reduce severe complications
Article Synopsis
- Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) was studied using either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) for guidance, but there's a lack of comparative data on these methods.
- The study analyzed data from 964 patients who underwent these procedures between 2016 and 2020, matching 327 patients in each group for a fair comparison of outcomes like in-hospital adverse events, length of stay, cost, and 30-day readmissions.
- Results showed no significant difference in adverse events between the methods, but ICE was linked to lower hospitalization costs compared to TEE, indicating ICE
Editorial: MTEER in cardiogenic shock: Time to close the treatment gap?
Cardiovasc Revasc Med
October 2024
Normal-Flow Low-Gradient Aortic Stenosis: Comparing the U.S. and European Guidelines.
JACC Cardiovasc Imaging
August 2024
Patients with normal-flow low-gradient (NFLG) severe aortic stenosis present both diagnostic and management challenges, with debate about the whether this represents true severe stenosis and the need for valve replacement. Studies exploring the natural history without intervention have shown similar outcomes of patients with NFLG severe aortic stenosis to those with moderate aortic stenosis and better outcomes after valve replacement than those with low-flow low-gradient severe aortic stenosis. Most studies (all observational) have shown that aortic valve replacement was associated with a survival benefit vs surveillance.
View Article and Find Full Text PDFNational Variation in Hospital MTEER Outcomes and Correlation With TAVR Outcomes: STS/ACC TVT Registry Analysis.
JACC Cardiovasc Interv
February 2024
Background: A single, multitiered valve center designation has been proposed to publicly identify centers with expertise for all valve therapies. The correlation between transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) procedures is unknown.
Objectives: The authors sought to examine the relationship between site-level volumes and outcomes for TAVR and MTEER.
Background: Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR.
Methods: Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed.
Article Synopsis
- - The study focused on Mitral valve transcatheter edge-to-edge repair (MTEER) for functional mitral regurgitation (FMR), evaluating patients not included in the COAPT trial, analyzing outcomes through the Transcatheter Valve Therapy Registry data from 2013 to 2020.
- - Out of 6,675 patients, 55.7% were eligible and 44.3% were ineligible for the trial, with ineligible patients experiencing lower procedural success and more in-hospital complications but similar health status improvements at 30 days post-procedure.
- - However, trial-ineligible patients had a significantly higher risk of death or hospitalization due to heart failure within a year, highlighting differences in
Background: Despite an association between operator volumes and procedural success, there remains an incomplete understanding of the contemporary utilization and procedural volumes for mitral valve transcatheter edge-to-edge repair (MTEER). We aimed to identify annual operator procedural volumes, temporal trends, and geographic variability for MTEER among Medicare patients in the United States (US).
Methods: We queried the National Medicare Provider Utilization and Payment Database for a CPT code (33418) specific for MitraClip device from 2015 through 2019.
Article Synopsis
- The study examines the use of cerebral embolic protection devices (CEPD) during transcatheter aortic valve implantation (TAVI) across US hospitals to understand their effectiveness in preventing strokes.
- Out of over 41,800 TAVI procedures analyzed, only 10.6% utilized CEPD, with 65.8% of hospitals not using these devices.
- Results indicated no significant differences in stroke or death rates between hospitals that used CEPD and those that did not, while costs were found to be lower in non-user hospitals.
Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study.
Circ Cardiovasc Interv
November 2023
Background: Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging.
Methods: A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed.
Unlabelled: Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve.
View Article and Find Full Text PDFOutcomes of Transcatheter Aortic Valve Replacement in Asymptomatic or Minimally Symptomatic Aortic Stenosis.
JACC Cardiovasc Interv
November 2023
Background: Little is known about the outcomes of transcatheter aortic valve replacement (TAVR) in minimally symptomatic patients.
Objectives: The authors aimed to evaluate the outcomes of patients with minimally symptomatic severe aortic stenosis treated with TAVR in the STS/ACC TVT registry.
Methods: Minimally symptomatic status was defined as a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) ≥75.
Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or MitraClip.
Catheter Cardiovasc Interv
September 2023
Background: There is a paucity of data regarding the comparative efficacy and safety of Mitral valve transcatheter edge-to-edge repair (MTEER) using the PASCAL or MitraClip systems for patients with mitral regurgitation (MR).
Methods: An electronic search was conducted for MEDLINE, COCHRANE, and EMBASE, through February 2023, for studies comparing the clinical outcomes of MTEER using PASCAL versus MitraClip systems among patients with severe MR. The primary study outcome was residual MR ≤ 2 at discharge.
Introduction: Valve-in-valve (VIV) transcatheter valve replacement has emerged as a feasible and potentially safer treatment option for failed bioprosthetic surgical valves (BSVs). However, the VIV procedure carries an inherent risk of prosthesis-patient mismatch (PPM). Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) by either fracturing or stretching the surgical valve ring allows for a more optimal expansion of the transcatheter heart valve (THV) and beneficial effects on post-implant valve hemodynamics and perhaps long-term valve durability.
View Article and Find Full Text PDFOutcomes of Bioprosthetic Valve Fracture in Patients Undergoing Valve-in-Valve TAVR.
JACC Cardiovasc Interv
March 2023
Background: Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) is increasingly used to treat degenerated surgical bioprostheses. Bioprosthetic valve fracture (BVF) has been shown to improve hemodynamic status in VIV TAVR in case series. However, the safety and efficacy of BVF are unknown.
View Article and Find Full Text PDFRehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial.
Circ Cardiovasc Interv
December 2022
Background: Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status.
Methods: The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I' II' and III trials (Placement of Aortic Transcatheter Valves).
Background: Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability.
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