Michael Ragosta - Academia.edu (original) (raw)
Papers by Michael Ragosta
Journal of Cardiac Surgery, Feb 5, 2016
Transcatheter valve placement complicated by left ventricular embolization is often treated with ... more Transcatheter valve placement complicated by left ventricular embolization is often treated with sternotomy, valve removal through the aorta, and conventional aortic valve replacement. We report three cases of ventricular embolization of aortic valves during deployment. We successfully placed a second transcatheter aortic valve in the correct position and retrieved the embolized valve through an apical ventriculotomy. All patients recovered well and survived for more than one year.
American Heart Journal, Mar 1, 2001
Background The presence of viability in an infarct zone implies an intact microvasculature. We hy... more Background The presence of viability in an infarct zone implies an intact microvasculature. We hypothesized that coronary flow reserve (CFR), which assesses the microcirculation, would correlate with the extent of viability in infarction zones. Methods CFR was measured after stenting in 17 patients with single vessel disease >48 hours from infarction. Viability was determined with use of single-photon emission computed tomography sestamibi imaging. Results Sestamibi uptake in the infarct zone correlated with CFR in the infarct artery (r = 0.62, P = .008) and sestamibi uptake in the infarct zone was greater in patients with normal CFR than in patients with abnormal CFR (61.9 ± 9.1% vs 46.3 ± 9.6%, P = .004). In addition, CFR was greater in patients with viability compared with patients without viability (2.4 ± 1.3 vs 1.4 ± 0.4, P = .015). Conclusions CFR correlates with the extent of viability after infarction. Preserved CFR in an infarct-related artery implies preserved viability.
Journal of the American College of Cardiology, Jun 1, 2006
OBJECTIVES We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) ... more OBJECTIVES We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) early after myocardial infarction (MI) identifies inducible ischemia on noninvasive imaging. BACKGROUND Early after MI, IRAs frequently have angiographically indeterminant lesions. Whether FFR can detect reversible perfusion defects early after MI when dynamic microvascular abnormalities are present is not known. METHODS Rest and dipyridamole (DP)-stress 99m Tc sestamibi single-photon emission computed tomography (SPECT) were performed in 48 patients 3.7 Ϯ 1.3 days after MI, with 23 patients undergoing concurrent myocardial contrast echocardiography (MCE). Angiography, FFR, and percutaneous coronary intervention (PCI) of the IRA (as necessary) were subsequently performed. Follow-up SPECT was performed 11 weeks after PCI to identify true reversibility on baseline SPECT. RESULTS The sensitivity, specificity, positive and negative predictive value, and concordance of FFR Յ0.75 for detecting reversibility on SPECT were 88%, 50%, 68%, 89%, and 71% (chi-square Ͻ0.001), respectively; which improved to 88%, 93%, 88%, 93%, and 91% (chi-square Ͻ0.001), respectively, for the detection of true reversibility. The corresponding values of FFR Յ0.75 for detecting reversibility on DP-MCE were 90%, 100%, 100%, 75%, and 93% (chi-square Ͻ0.001), respectively, and on either SPECT or MCE were 88%, 93%, 91%, 91%, and 91% (chi-square Ͻ0.001), respectively. The optimal FFR value for discriminating inducible ischemia on noninvasive imaging was 0.78. CONCLUSIONS Fractional flow reserve of the IRA accurately identifies reversibility on noninvasive imaging early after MI. These findings support the utility of FFR early after MI.
Journal of Heart and Lung Transplantation, Apr 1, 2016
TandemHeart insertion enables the observation of the response to isolated left ventricular suppor... more TandemHeart insertion enables the observation of the response to isolated left ventricular support prior to permanent left ventricular assist device (LVAD) implantation. Our objective was to evaluate our 7-year experience of "rescuing" patients with TandemHeart prior to HeartMate II implantation. Methods: Between 2008-2015, 20 patients with severe refractory cardiogenic shock emergently received TandemHeart support as a bridge-to-decision for HeartMate II implantation. Patients were retrospectively reviewed to analyze their characteristics, hemodynamic variables, end organ function, and clinical management before, during, and after the transition. Primary outcomes included 60-day mortality, major complications, and long-term survival. Results: Median duration of TandemHeart support was 6 days (IQR 4-7). Care was withdrawn in 5 patients prior to HeartMate II implantation. Of the 15 patients who received a HeartMate II, 12 (80%) survived to 60 days and hospital discharge with a median survival of 1070 days (IQR 630-1859). Improvement in end organ function with TandemHeart support portended better outcomes. Patients who survived tended to have lower HeartMate II risk scores (1.3 v. 2.3), MELD scores (20.8 v. 27.3), pressor requirements (2.8 v. 3.7), and age (51 v. 59 years) prior to TandemHeart insertion as well as greater interval improvement prior to HeartMate II implantation. Major morbidity and mortality for patients who received a HeartMate II after TandemHeart was associated with sepsis (n= 5), transfusion requirement > 20 units (n = 5), peripheral vascular compromise (n = 1) and thromboembolic events (n = 2). Conclusion: With appropriate selection, a rescue-to-bridge strategy using TandemHeart to HeartMate II should be considered for patients with otherwise terminal cardiovascular collapse.
Journal of the American College of Cardiology, Mar 1, 2013
Journal of the American College of Cardiology, Nov 1, 2002
Catheterization and Cardiovascular Interventions, 2004
Few randomized studies compare outcomes for focal vs. diffuse in-stent restenosis (ISR) using con... more Few randomized studies compare outcomes for focal vs. diffuse in-stent restenosis (ISR) using conventional treatments. The purpose of this study was to compare the rates of major adverse cardiac events (MACEs) for focal vs. diffuse ISR using conventional techniques. One hundred thirteen patients with ISR were prospectively classified as focal (< 10 mm) or diffuse (> 10 mm). Focal ISR was randomized to balloon angioplasty (n ؍ 29) or restenting (n ؍ 29) and diffuse ISR randomized to rotational atherectomy (n ؍ 30) or restenting (n ؍ 25). At 9 months, patients with focal ISR had higher survival free of MACEs than patients with diffuse ISR (86% vs. 63%; P < 0.005), with no difference between techniques. Only the presence of diffuse ISR was an independent predictor of MACE at 9 months. Thus, focal ISR has a low rate of MACE compared to diffuse ISR, which carries a high event rate regardless of treatment employed. Catheter Cardiovasc Interv 2004;
American Journal of Cardiology, May 1, 2004
Fractional flow reserve (FFR) has been shown to be a useful physiologic index of coronary lesion ... more Fractional flow reserve (FFR) has been shown to be a useful physiologic index of coronary lesion severity in myocardial beds of patients without prior infarction and in those with remote infarction. Acute myocardial infarction (AMI) causes myocardial necrosis and microvascular stunning, embolization, and damage. Whether FFR remains a useful index of epicardial flow in the setting of recent myocardial infarction is not established. Cardiac risk factors, serum troponin I, angiographic minimal lumen diameter (MLD), percent diameter stenosis (DS), lesion length, vessel reference diameter, hyperemic central aortic pressure, hyperemic pressure distal to stenosis, and FFR were compared in 43 vessels subtending recent AMI beds to 25 control vessels, matched by lesion length and MLD, in patients without AMI. There were no differences in DS, MLD, lesion length, or reference diameter between AMI and non-AMI groups. Patients with AMI had mean troponin I levels of 91.8 ؎ 162 ng/ml. Left ventricular ejection fraction was significantly lower in patients with than without AMI (55 ؎ 9% vs 62 ؎ 8%, p <0.05). There were no significant differences in hyperemic central aortic pressure (92 ؎ 13 vs 99 ؎ 15 mm Hg, p ؍ NS), hyperemic pressure distal to the stenosis (62 ؎ 17 vs 66 ؎ 19 mm Hg, p ؍ NS), or FFR (0.67 ؎ 17 vs 0.68 ؎ 17, p ؍ NS) between recent AMI and non-AMI control patients. There was a significant correlation between DS and FFR for both patients with (p <0.001) and without (p ؍ 0.003) infarctions. Thus, FFR and the relation between FFR and DS of lesions subtending AMI was not significantly different from FFR of angiographically matched lesions in patients without AMI. ᮊ2004 by Excerpta Medica, Inc.
Journal of the American College of Cardiology
Journal of the American College of Cardiology, 2019
Background: Giant coronary artery aneurysm is a rare clinical entity. Interdisciplinary discussio... more Background: Giant coronary artery aneurysm is a rare clinical entity. Interdisciplinary discussion between cardiology and surgery should occur for optimal treatment. Case: A 70-year-old man with history of diabetes mellitus and recent abdominal abscess underwent follow-up computed tomography abdomen/pelvis to assess his abscess. While his abscess resolved, an incidental giant coronary artery aneurysm was found. A dedicated cardiac computed tomography angiography showed a proximal left anterior descending (LAD) aneurysm measuring 44mm x 41mm (image A and B). Coronary angiography showed a very large aneurysm in the proximal LAD with thrombus in the cavity (image C). Decision-making: Due to the proximal location of the aneurysm, it was not feasible to place a covered stent through the aneurysm. After interdisciplinary discussion, he was planned for a hybrid surgical and interventional approach. He underwent a left internal mammary artery to LAD bypass along with ligation of the LAD proximal to the anastomosis. A large LAD aneurysm was noted during his operation (image D). Two weeks after his surgery, he underwent placement of a covered stent across the proximal LAD to exclude the aneurysm. The stent extended from the ramus intermedius into the left main coronary artery (image E and F). He did well after his procedure and was maintained on aspirin and clopidogrel. Conclusion: A hybrid approach between cardiology and surgery was implemented to treat this patient's rare giant coronary artery aneurysm of the LAD.
Journal of the American College of Cardiology, May 1, 2021
Journal of the American College of Cardiology, Jan 14, 2018
The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD... more The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. CKD was present in 361 of 1,869 randomized patients (19.3%) ...
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 15, 2018
The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and ... more The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and is widely employed to assess treatment outcomes. Although mortality with transcatheter mitral valve repair (TMVr) using the MitraClip (Abbott Vascular, Menlo Park, CA) is significantly less than for open mitral valve surgery in high-risk patients, identifying which patient will benefit the most from TMVr remains a concern. There are limited prognostic metrics guiding patient selection and, no studies have reported relationship between prolonged hospitalization and 6MWT. This study aimed to determine if the 6MWT can predict prolonged hospitalization in patients undergoing TMVr by MitraClip. We retrospectively reviewed 162 patients undergoing 6MWT before TMVr. Patients were divided into three groups according to the 6MWT distance (6MWTD) using the median (6MWTD ≥219 m, 6MWTD <219 m, and Unable to Walk). Multivariate logistic regression model was applied to select the demographic charact...
Journal of the American College of Cardiology, 2016
BACKGROUND Interest in transcatheter mitral valve repair/replacement (TMVR) for primary and secon... more BACKGROUND Interest in transcatheter mitral valve repair/replacement (TMVR) for primary and secondary mitral regurgitation (pMR, sMR) is immense. Though several TMVR technologies are in development, many failed to achieve consistent reduction in MR and present with a risk of thrombosis from non-physiological hemodynamics. We report a novel bench model of pMR and sMR, to investigate the safety and efficacy of new TMVR devices.
The Annals of Thoracic Surgery, 2016
Fig 1. Three-dimensional transesophageal echocardiography showing a double-orifice mitral valve (... more Fig 1. Three-dimensional transesophageal echocardiography showing a double-orifice mitral valve (asterisks) created by MitraClip.
Journal of the American College of Cardiology, 2016
BACKGROUND-Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary ... more BACKGROUND-Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. OBJECTIVES-This National Institutes of Health-funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated
The American Journal of Cardiology, 2016
Frailty has become high-priority theme in cardiovascular diseases because of aging and increasing... more Frailty has become high-priority theme in cardiovascular diseases because of aging and increasingly complex nature of patients. Low muscle mass is characteristic of frailty, in which invasive interventions are avoided if possible because of decreased physiological reserve. This study aimed to determine if the psoas muscle area (PMA) could predict mortality and to investigate its utility in patients who underwent transcatheter aortic valve replacement (TAVR). We retrospectively reviewed 232 consecutive patients who underwent TAVR. Cross-sectional areas of the psoas muscles at the level of fourth lumbar vertebra were measured by computed tomography and normalized to body surface area. Patients were divided into tertiles according to the normalized PMA for each gender (men: tertile 1, 1,708 to 1,178 mm(2)/m(2); tertile 2, 1,176 to 1,011 mm(2)/m(2); and tertile 3, 1,009 to 587 mm(2)/m(2); women: tertile 1, 1,436 to 962 mm(2)/m(2); tertile 2, 952 to 807 mm(2)/m(2); and tertile 3, 806 to 527 mm(2)/m(2)). Smaller normalized PMA was independently correlated with women and higher New York Heart Association classification. After adjustment for multiple confounding factors, the normalized PMA tertile was independently associated with mortality at 6 months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21). Kaplan-Meier analysis showed that tertile 3 had higher mortality rates than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029). Receiver-operating characteristic analysis showed that normalized PMA provided the increase of C-statistics for predicting mortality for a clinical model and gait speed. In conclusion, PMA is an independent predictor of mortality after TAVR and can complement a clinical model and gait speed.
Journal of the American College of Cardiology, May 3, 2016
Journal of Cardiac Surgery, Feb 5, 2016
Transcatheter valve placement complicated by left ventricular embolization is often treated with ... more Transcatheter valve placement complicated by left ventricular embolization is often treated with sternotomy, valve removal through the aorta, and conventional aortic valve replacement. We report three cases of ventricular embolization of aortic valves during deployment. We successfully placed a second transcatheter aortic valve in the correct position and retrieved the embolized valve through an apical ventriculotomy. All patients recovered well and survived for more than one year.
American Heart Journal, Mar 1, 2001
Background The presence of viability in an infarct zone implies an intact microvasculature. We hy... more Background The presence of viability in an infarct zone implies an intact microvasculature. We hypothesized that coronary flow reserve (CFR), which assesses the microcirculation, would correlate with the extent of viability in infarction zones. Methods CFR was measured after stenting in 17 patients with single vessel disease >48 hours from infarction. Viability was determined with use of single-photon emission computed tomography sestamibi imaging. Results Sestamibi uptake in the infarct zone correlated with CFR in the infarct artery (r = 0.62, P = .008) and sestamibi uptake in the infarct zone was greater in patients with normal CFR than in patients with abnormal CFR (61.9 ± 9.1% vs 46.3 ± 9.6%, P = .004). In addition, CFR was greater in patients with viability compared with patients without viability (2.4 ± 1.3 vs 1.4 ± 0.4, P = .015). Conclusions CFR correlates with the extent of viability after infarction. Preserved CFR in an infarct-related artery implies preserved viability.
Journal of the American College of Cardiology, Jun 1, 2006
OBJECTIVES We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) ... more OBJECTIVES We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) early after myocardial infarction (MI) identifies inducible ischemia on noninvasive imaging. BACKGROUND Early after MI, IRAs frequently have angiographically indeterminant lesions. Whether FFR can detect reversible perfusion defects early after MI when dynamic microvascular abnormalities are present is not known. METHODS Rest and dipyridamole (DP)-stress 99m Tc sestamibi single-photon emission computed tomography (SPECT) were performed in 48 patients 3.7 Ϯ 1.3 days after MI, with 23 patients undergoing concurrent myocardial contrast echocardiography (MCE). Angiography, FFR, and percutaneous coronary intervention (PCI) of the IRA (as necessary) were subsequently performed. Follow-up SPECT was performed 11 weeks after PCI to identify true reversibility on baseline SPECT. RESULTS The sensitivity, specificity, positive and negative predictive value, and concordance of FFR Յ0.75 for detecting reversibility on SPECT were 88%, 50%, 68%, 89%, and 71% (chi-square Ͻ0.001), respectively; which improved to 88%, 93%, 88%, 93%, and 91% (chi-square Ͻ0.001), respectively, for the detection of true reversibility. The corresponding values of FFR Յ0.75 for detecting reversibility on DP-MCE were 90%, 100%, 100%, 75%, and 93% (chi-square Ͻ0.001), respectively, and on either SPECT or MCE were 88%, 93%, 91%, 91%, and 91% (chi-square Ͻ0.001), respectively. The optimal FFR value for discriminating inducible ischemia on noninvasive imaging was 0.78. CONCLUSIONS Fractional flow reserve of the IRA accurately identifies reversibility on noninvasive imaging early after MI. These findings support the utility of FFR early after MI.
Journal of Heart and Lung Transplantation, Apr 1, 2016
TandemHeart insertion enables the observation of the response to isolated left ventricular suppor... more TandemHeart insertion enables the observation of the response to isolated left ventricular support prior to permanent left ventricular assist device (LVAD) implantation. Our objective was to evaluate our 7-year experience of "rescuing" patients with TandemHeart prior to HeartMate II implantation. Methods: Between 2008-2015, 20 patients with severe refractory cardiogenic shock emergently received TandemHeart support as a bridge-to-decision for HeartMate II implantation. Patients were retrospectively reviewed to analyze their characteristics, hemodynamic variables, end organ function, and clinical management before, during, and after the transition. Primary outcomes included 60-day mortality, major complications, and long-term survival. Results: Median duration of TandemHeart support was 6 days (IQR 4-7). Care was withdrawn in 5 patients prior to HeartMate II implantation. Of the 15 patients who received a HeartMate II, 12 (80%) survived to 60 days and hospital discharge with a median survival of 1070 days (IQR 630-1859). Improvement in end organ function with TandemHeart support portended better outcomes. Patients who survived tended to have lower HeartMate II risk scores (1.3 v. 2.3), MELD scores (20.8 v. 27.3), pressor requirements (2.8 v. 3.7), and age (51 v. 59 years) prior to TandemHeart insertion as well as greater interval improvement prior to HeartMate II implantation. Major morbidity and mortality for patients who received a HeartMate II after TandemHeart was associated with sepsis (n= 5), transfusion requirement > 20 units (n = 5), peripheral vascular compromise (n = 1) and thromboembolic events (n = 2). Conclusion: With appropriate selection, a rescue-to-bridge strategy using TandemHeart to HeartMate II should be considered for patients with otherwise terminal cardiovascular collapse.
Journal of the American College of Cardiology, Mar 1, 2013
Journal of the American College of Cardiology, Nov 1, 2002
Catheterization and Cardiovascular Interventions, 2004
Few randomized studies compare outcomes for focal vs. diffuse in-stent restenosis (ISR) using con... more Few randomized studies compare outcomes for focal vs. diffuse in-stent restenosis (ISR) using conventional treatments. The purpose of this study was to compare the rates of major adverse cardiac events (MACEs) for focal vs. diffuse ISR using conventional techniques. One hundred thirteen patients with ISR were prospectively classified as focal (< 10 mm) or diffuse (> 10 mm). Focal ISR was randomized to balloon angioplasty (n ؍ 29) or restenting (n ؍ 29) and diffuse ISR randomized to rotational atherectomy (n ؍ 30) or restenting (n ؍ 25). At 9 months, patients with focal ISR had higher survival free of MACEs than patients with diffuse ISR (86% vs. 63%; P < 0.005), with no difference between techniques. Only the presence of diffuse ISR was an independent predictor of MACE at 9 months. Thus, focal ISR has a low rate of MACE compared to diffuse ISR, which carries a high event rate regardless of treatment employed. Catheter Cardiovasc Interv 2004;
American Journal of Cardiology, May 1, 2004
Fractional flow reserve (FFR) has been shown to be a useful physiologic index of coronary lesion ... more Fractional flow reserve (FFR) has been shown to be a useful physiologic index of coronary lesion severity in myocardial beds of patients without prior infarction and in those with remote infarction. Acute myocardial infarction (AMI) causes myocardial necrosis and microvascular stunning, embolization, and damage. Whether FFR remains a useful index of epicardial flow in the setting of recent myocardial infarction is not established. Cardiac risk factors, serum troponin I, angiographic minimal lumen diameter (MLD), percent diameter stenosis (DS), lesion length, vessel reference diameter, hyperemic central aortic pressure, hyperemic pressure distal to stenosis, and FFR were compared in 43 vessels subtending recent AMI beds to 25 control vessels, matched by lesion length and MLD, in patients without AMI. There were no differences in DS, MLD, lesion length, or reference diameter between AMI and non-AMI groups. Patients with AMI had mean troponin I levels of 91.8 ؎ 162 ng/ml. Left ventricular ejection fraction was significantly lower in patients with than without AMI (55 ؎ 9% vs 62 ؎ 8%, p <0.05). There were no significant differences in hyperemic central aortic pressure (92 ؎ 13 vs 99 ؎ 15 mm Hg, p ؍ NS), hyperemic pressure distal to the stenosis (62 ؎ 17 vs 66 ؎ 19 mm Hg, p ؍ NS), or FFR (0.67 ؎ 17 vs 0.68 ؎ 17, p ؍ NS) between recent AMI and non-AMI control patients. There was a significant correlation between DS and FFR for both patients with (p <0.001) and without (p ؍ 0.003) infarctions. Thus, FFR and the relation between FFR and DS of lesions subtending AMI was not significantly different from FFR of angiographically matched lesions in patients without AMI. ᮊ2004 by Excerpta Medica, Inc.
Journal of the American College of Cardiology
Journal of the American College of Cardiology, 2019
Background: Giant coronary artery aneurysm is a rare clinical entity. Interdisciplinary discussio... more Background: Giant coronary artery aneurysm is a rare clinical entity. Interdisciplinary discussion between cardiology and surgery should occur for optimal treatment. Case: A 70-year-old man with history of diabetes mellitus and recent abdominal abscess underwent follow-up computed tomography abdomen/pelvis to assess his abscess. While his abscess resolved, an incidental giant coronary artery aneurysm was found. A dedicated cardiac computed tomography angiography showed a proximal left anterior descending (LAD) aneurysm measuring 44mm x 41mm (image A and B). Coronary angiography showed a very large aneurysm in the proximal LAD with thrombus in the cavity (image C). Decision-making: Due to the proximal location of the aneurysm, it was not feasible to place a covered stent through the aneurysm. After interdisciplinary discussion, he was planned for a hybrid surgical and interventional approach. He underwent a left internal mammary artery to LAD bypass along with ligation of the LAD proximal to the anastomosis. A large LAD aneurysm was noted during his operation (image D). Two weeks after his surgery, he underwent placement of a covered stent across the proximal LAD to exclude the aneurysm. The stent extended from the ramus intermedius into the left main coronary artery (image E and F). He did well after his procedure and was maintained on aspirin and clopidogrel. Conclusion: A hybrid approach between cardiology and surgery was implemented to treat this patient's rare giant coronary artery aneurysm of the LAD.
Journal of the American College of Cardiology, May 1, 2021
Journal of the American College of Cardiology, Jan 14, 2018
The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD... more The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. CKD was present in 361 of 1,869 randomized patients (19.3%) ...
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 15, 2018
The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and ... more The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and is widely employed to assess treatment outcomes. Although mortality with transcatheter mitral valve repair (TMVr) using the MitraClip (Abbott Vascular, Menlo Park, CA) is significantly less than for open mitral valve surgery in high-risk patients, identifying which patient will benefit the most from TMVr remains a concern. There are limited prognostic metrics guiding patient selection and, no studies have reported relationship between prolonged hospitalization and 6MWT. This study aimed to determine if the 6MWT can predict prolonged hospitalization in patients undergoing TMVr by MitraClip. We retrospectively reviewed 162 patients undergoing 6MWT before TMVr. Patients were divided into three groups according to the 6MWT distance (6MWTD) using the median (6MWTD ≥219 m, 6MWTD <219 m, and Unable to Walk). Multivariate logistic regression model was applied to select the demographic charact...
Journal of the American College of Cardiology, 2016
BACKGROUND Interest in transcatheter mitral valve repair/replacement (TMVR) for primary and secon... more BACKGROUND Interest in transcatheter mitral valve repair/replacement (TMVR) for primary and secondary mitral regurgitation (pMR, sMR) is immense. Though several TMVR technologies are in development, many failed to achieve consistent reduction in MR and present with a risk of thrombosis from non-physiological hemodynamics. We report a novel bench model of pMR and sMR, to investigate the safety and efficacy of new TMVR devices.
The Annals of Thoracic Surgery, 2016
Fig 1. Three-dimensional transesophageal echocardiography showing a double-orifice mitral valve (... more Fig 1. Three-dimensional transesophageal echocardiography showing a double-orifice mitral valve (asterisks) created by MitraClip.
Journal of the American College of Cardiology, 2016
BACKGROUND-Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary ... more BACKGROUND-Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. OBJECTIVES-This National Institutes of Health-funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated
The American Journal of Cardiology, 2016
Frailty has become high-priority theme in cardiovascular diseases because of aging and increasing... more Frailty has become high-priority theme in cardiovascular diseases because of aging and increasingly complex nature of patients. Low muscle mass is characteristic of frailty, in which invasive interventions are avoided if possible because of decreased physiological reserve. This study aimed to determine if the psoas muscle area (PMA) could predict mortality and to investigate its utility in patients who underwent transcatheter aortic valve replacement (TAVR). We retrospectively reviewed 232 consecutive patients who underwent TAVR. Cross-sectional areas of the psoas muscles at the level of fourth lumbar vertebra were measured by computed tomography and normalized to body surface area. Patients were divided into tertiles according to the normalized PMA for each gender (men: tertile 1, 1,708 to 1,178 mm(2)/m(2); tertile 2, 1,176 to 1,011 mm(2)/m(2); and tertile 3, 1,009 to 587 mm(2)/m(2); women: tertile 1, 1,436 to 962 mm(2)/m(2); tertile 2, 952 to 807 mm(2)/m(2); and tertile 3, 806 to 527 mm(2)/m(2)). Smaller normalized PMA was independently correlated with women and higher New York Heart Association classification. After adjustment for multiple confounding factors, the normalized PMA tertile was independently associated with mortality at 6 months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21). Kaplan-Meier analysis showed that tertile 3 had higher mortality rates than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029). Receiver-operating characteristic analysis showed that normalized PMA provided the increase of C-statistics for predicting mortality for a clinical model and gait speed. In conclusion, PMA is an independent predictor of mortality after TAVR and can complement a clinical model and gait speed.
Journal of the American College of Cardiology, May 3, 2016