Publications by authors named "Keith B Allen"

Transcatheter aortic valve replacement (TAVR) has become a widely accepted procedure for treating patients with symptomatic aortic stenosis. While transfemoral access remains the primary route due to its lower complication rates and favorable outcomes, a subset of patients have anatomical or clinical factors precluding this approach. For these patients, alternative access routes such as transaxillary, transcarotid, and transcaval provide viable options.

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  • 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
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  • Tricuspid valve annuloplasty (TA) during mitral valve repair (MVr) increases the risk of needing a permanent pacemaker (PPM) post-surgery, with a higher 90-day PPM implantation rate for MVr with TA (14.0%) compared to isolated MVr (7.7%).
  • This study analyzed data from New York and California between 2004 and 2019 to evaluate the long-term effects of PPM implantation on survival and complications like heart failure hospitalization and endocarditis.
  • Results indicated that PPM recipients had significantly reduced long-term survival and higher risks of heart failure hospitalizations and endocarditis, regardless of whether they underwent isolated MVr or MVr with TA.
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  • 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.
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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.

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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.

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Background: Indications and outcomes for percutaneous ventricular assist device (pVAD) use in surgically ineligible patients undergoing percutaneous coronary intervention (PCI) remain poorly characterized.

Aims: We sought to describe the use and timing of pVAD and outcome in surgically ineligible patients.

Methods: Among 726 patients enrolled in the prospective OPTIMUM study, clinical and health status outcomes were assessed in patients who underwent pVAD-assisted PCI and those without pVAD.

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Objective: HAART 300 300 (BioStable Science and Engineering, Inc) aortic annuloplasty rings restore physiologic annular geometry during aortic valve repair. Transcatheter valve-in-ring implantation is appealing for recurrent valve dysfunction but may necessitate balloon fracture of downsized annuloplasty rings. We characterized the feasibility of ring fracture and changes in ring geometry preceding fracture.

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Background: There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV).

Objectives: This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation.

Methods: VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc).

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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.

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Background: Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes.

Objectives: This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).

Methods: Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI.

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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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Mycotic aneurysm management balances the urgency of excising infected vasculature with the need to revascularize in or near an infected field. We present a case of a 47-year-old man with sepsis, a failed kidney transplant, and a ruptured, previously stented right external iliac pseudoaneurysm. After excision of the infected pseudoaneurysm and stents, lower extremity revascularization was delayed through the innovative use of isolated limb perfusion using extracorporeal membrane oxygenation followed by staged extra-anatomic femoral-femoral bypass.

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A 68-year-old woman who had a retrievable inferior vena cava filter implanted 10 years ago presented with sudden-onset back pain. Initial computed tomography angiography demonstrated migration of a fractured strut that appeared embedded in the anterior right ventricular free wall without pericardial effusion. Subsequent gated computed tomography of the chest demonstrated further migration of the fragment, which was now penetrating the right ventricular free wall and extending into the pericardial sac.

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Objectives: Evaluate the cost of illness associated with the 90-day period following acute myocardial infarction (AMI) and the implication of care pathway (percutaneous coronary intervention [PCI] vs medical management [MM]), in order to assess the potential financial risk incurred by providers for AMI as an episode of care.

Perspective: Reimbursement payment systems for acute care episodes are shifting from 30-day to 90-day bundled payment models. Since follow-up care and readmissions beyond the early days/weeks post-AMI are common, financial risk may be transferred to providers.

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Background: Guidelines endorse coronary artery bypass as the preferred revascularization strategy for patients with left main and/or multivessel coronary artery disease (CAD). However, many patients are deemed excessively high risk for surgery after Heart Team evaluation. No prospective studies have examined contemporary treatment patterns, rationale for surgical decision-making, completeness of revascularization with percutaneous coronary intervention (PCI), and outcomes in this high-risk population with advanced CAD.

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Background: Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR.

Methods: Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV).

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Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively.

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