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  1. Article ; Online: Transcatheter Pulmonary Valve Replacement With the Harmony Valve in Patients Who Do Not Meet Recommended Oversizing Criteria on the Screening Perimeter Plot.

    McElhinney, Doff B / Gillespie, Matthew J / Aboulhosn, Jamil A / Cabalka, Allison K / Morray, Brian H / Balzer, David T / Qureshi, Athar M / Hoskoppal, Arvind K / Goldstein, Bryan H

    Circulation. Cardiovascular interventions

    2024  , Page(s) e013889

    Abstract: Background: Anatomic selection for Harmony valve implant is determined with the aid of a screening report and perimeter plot (PP) that depicts the perimeter-derived radius along the right ventricular outflow tract (RVOT) and projects device oversizing. ... ...

    Abstract Background: Anatomic selection for Harmony valve implant is determined with the aid of a screening report and perimeter plot (PP) that depicts the perimeter-derived radius along the right ventricular outflow tract (RVOT) and projects device oversizing. The PP provides an estimation of suitability for implant, but its sensitivity as a screening method is unknown. This study was performed to describe anatomic features and outcomes in patients who underwent Harmony TPV25 implant despite a PP that predicted inadequate oversizing.
    Methods: We reviewed RVOT anatomic features and measurements in patients who underwent transcatheter pulmonary valve replacement with the Harmony TPV25 device despite a PP that predicted inadequate oversizing.
    Results: This study included 22 patients. There were no unsuccessful implants or adverse valve-related events. Anatomic features varied, but all patients fit into 1 of 3 anatomic types characterized by differences in RVOT dimensions. Type 1 patients (n=9) had a long RVOT with a choke point and a wide main pulmonary artery. Type 2 patients (n=6) had a short RVOT that was pyramidal in shape, with no choke point, and extensive main pulmonary artery lengthening/expansion during systole. Type 3 patients (n=7) had a short, bulbous main pulmonary artery with a choke point and an open pulmonary artery bifurcation.
    Conclusions: Transcatheter pulmonary valve replacement with the Harmony valve is feasible in some patients whose PP fit analysis predicts inadequate oversizing. All cases in this series fit into 1 of 3 anatomic patterns, which are not identified in the screening report. Implanters must review cases individually to assess the feasibility of the implant.
    Language English
    Publishing date 2024-04-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2450797-0
    ISSN 1941-7632 ; 1941-7640
    ISSN (online) 1941-7632
    ISSN 1941-7640
    DOI 10.1161/CIRCINTERVENTIONS.123.013889
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Thromboprophylaxis in Patients With Fontan Circulation.

    Van den Eynde, Jef / Possner, Mathias / Alahdab, Fares / Veldtman, Gruschen / Goldstein, Bryan H / Rathod, Rahul H / Hoskoppal, Arvind K / Saraf, Anita / Feingold, Brian / Alsaied, Tarek

    Journal of the American College of Cardiology

    2023  Volume 81, Issue 4, Page(s) 374–389

    Abstract: Background: The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown.: Objectives: The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in ... ...

    Abstract Background: The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown.
    Objectives: The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis.
    Methods: Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score.
    Results: A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile.
    Conclusions: Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.
    MeSH term(s) Humans ; Warfarin/adverse effects ; Anticoagulants/adverse effects ; Fontan Procedure/adverse effects ; Fontan Procedure/methods ; Administration, Oral ; Hemorrhage/epidemiology ; Thromboembolism/epidemiology ; Thromboembolism/etiology ; Thromboembolism/prevention & control ; Aspirin/adverse effects ; Atrial Fibrillation/complications ; Stroke/prevention & control ; Treatment Outcome
    Chemical Substances Warfarin (5Q7ZVV76EI) ; Anticoagulants ; Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2023-01-07
    Publishing country United States
    Document type Meta-Analysis ; Journal Article
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2022.10.037
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Echocardiographic Assessment of Melody Versus Sapien Valves Following Transcatheter Pulmonary Valve Replacement.

    Samayoa, Juan Carlos / Boucek, Dana / McCarthy, Elisa / Riley, Michelle / Ou, Zhining / Tani, Lloyd Y / Hoskoppal, Arvind K / Gray, Robert G / Martin, Mary Hunt

    JACC. Cardiovascular interventions

    2022  Volume 15, Issue 2, Page(s) 165–175

    Abstract: Objectives: The aim of this study was to compare the immediate and midterm echocardiographic performance of the Melody (Medtronic Inc) and Sapien (Edwards Lifesciences Inc) valves after transcatheter pulmonary valve replacement (TPVR) in native and ... ...

    Abstract Objectives: The aim of this study was to compare the immediate and midterm echocardiographic performance of the Melody (Medtronic Inc) and Sapien (Edwards Lifesciences Inc) valves after transcatheter pulmonary valve replacement (TPVR) in native and conduit right ventricular outflow tracts (RVOTs).
    Background: TPVR is now a common procedure, but limited data exist comparing postimplantation echocardiographic findings between Melody and Sapien valves.
    Methods: This was a single-institution retrospective cohort study of all patients who underwent successful TPVR from 2011 to 2020. Patient demographics, procedural details, and immediate and midterm echocardiographic findings were collected and compared between valve types using the Wilcoxon rank sum, chi-square, or Fisher exact test as appropriate. Subgroups were analyzed individually and were adjusted for multiple comparisons using the Bonferroni method.
    Results: A total of 328 patients underwent successful TPVR (Melody: n = 202, Sapien: n = 126). The groups had a similar baseline age, weight, and diagnosis. The most common indications for TPVR were pulmonary stenosis (32.2%) or mixed disease (46%) in the Melody group and pulmonary insufficiency in the Sapien group (52.4%) (P < 0.001). Sapien valves were more often placed in native RVOTs (43.7% vs 18.8%; P < 0.001). The discharge and follow-up mean and peak Doppler gradients were similar between the Melody and Sapien groups. Valves implanted in native RVOTs had significantly lower postimplantation gradients at each follow-up period.
    Conclusions: Echocardiographic performance after TPVR was generally acceptable and similar when comparing Melody and Sapien valves despite differences in the indication and anatomy in each group. The peak and mean gradients were lower in transcatheter valves implanted in native RVOTs compared with those implanted in conduits or bioprosthetic valves.
    MeSH term(s) Cardiac Catheterization/adverse effects ; Cardiac Catheterization/methods ; Echocardiography ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Humans ; Prosthesis Design ; Pulmonary Valve/diagnostic imaging ; Pulmonary Valve/surgery ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-01-17
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2452157-7
    ISSN 1876-7605 ; 1936-8798
    ISSN (online) 1876-7605
    ISSN 1936-8798
    DOI 10.1016/j.jcin.2021.11.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6669: Show issues Location:
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  4. Article ; Online: Association between pregnancy and long-term cardiac outcomes in individuals with congenital heart disease.

    Son, Shannon L / Hosek, Lauren L / Stein, Miranda C / Allshouse, Amanda A / Catino, Anna B / Hoskoppal, Arvind K / Cox, Daniel A / Whitehead, Kevin J / Lindsay, Ian M / Esplin, Sean / Metz, Torri D

    American journal of obstetrics and gynecology

    2021  Volume 226, Issue 1, Page(s) 124.e1–124.e8

    Abstract: Background: As early life interventions for congenital heart disease improve, more patients are living to adulthood and are considering pregnancy. Scoring and classification systems predict the maternal cardiovascular risk of pregnancy in the context of ...

    Abstract Background: As early life interventions for congenital heart disease improve, more patients are living to adulthood and are considering pregnancy. Scoring and classification systems predict the maternal cardiovascular risk of pregnancy in the context of congenital heart disease, but these scoring systems do not assess the potential subsequent risks following pregnancy. Data on the long-term cardiac outcomes after pregnancy are unknown for most lesion types. This limits the ability of healthcare practitioners to thoroughly counsel patients who are considering pregnancy in the setting of congenital heart disease.
    Objective: We aimed to evaluate the association between pregnancy and the subsequent long-term cardiovascular health of individuals with congenital heart disease.
    Study design: This was a retrospective longitudinal cohort study of individuals identifying as female who were receiving care in two adult congenital heart disease centers from 2014 to 2019. Patient data were abstracted longitudinally from a patient age of 15 years (or from the time of entry into the healthcare system) to the conclusion of the study, death, or exit from the healthcare system. The primary endpoint, a composite adverse cardiac outcome (death, stroke, heart failure, unanticipated cardiac surgery, or a requirement for a catheterized procedure), was compared between parous (at least one pregnancy >20 weeks' gestation) and nulliparous individuals. By accounting for differences in the follow-up, the effect of pregnancy was estimated based on the time to the composite adverse outcome in a proportional hazards regression model adjusted for the World Health Organization class, baseline cardiac medications, and number of previous sternotomies. Participants were also categorized according to their lesion type, including septal defects (ventricular septal defects, atrial septal defects, atrioventricular septal defects, or atrioventricular canal defects), right-sided valvular lesions, left-sided valvular lesions, complex cardiac anomalies, and aortopathies, to evaluate if there is a differential effect of pregnancy on the primary outcome when adjusting for lesion type in a sensitivity analysis.
    Results: Overall, 711 individuals were eligible for inclusion; 209 were parous and 502 nulliparous. People were classified according to the World Health Organization classification system with 86 (12.3%) being classified as class I, 76 (10.9%) being classified as class II, 272 (38.9%) being classified as class II to III, 155 (22.1%) being classified as class III, and 26 (3.7%) being classified as class IV. Aortic stenosis, bicuspid aortic valve, dilated ascending aorta or aortic root, aortic regurgitation, and pulmonary insufficiency were more common in parous individuals, whereas dextro-transposition of the great arteries, Turner syndrome, hypoplastic right heart, left superior vena cava, and other cardiac diagnoses were more common in nulliparous individuals. In multivariable modeling, pregnancy was associated with the composite adverse cardiac outcome (36.4%% vs 26.1%%; hazard ratio, 1.83; 95% confidence interval, 1.25-2.66). Parous individuals were more likely to have unanticipated cardiac surgery (28.2% vs 18.1%; P=.003). No other individual components of the primary outcome were statistically different between parous and nulliparous individuals in cross-sectional comparisons. The association between pregnancy and the primary outcome was similar in a sensitivity analysis that adjusted for cardiac lesion type (hazard ratio, 1.61; 95% confidence interval, 1.10-2.36).
    Conclusion: Among individuals with congenital heart disease, pregnancy was associated with an increase in subsequent long-term adverse cardiac outcomes. These data may inform counseling of individuals with congenital heart disease who are considering pregnancy.
    MeSH term(s) Adult ; Cohort Studies ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular/epidemiology ; Heart Septal Defects, Ventricular/mortality ; Humans ; Longitudinal Studies ; Pregnancy ; Pregnancy Complications, Cardiovascular/epidemiology ; Pregnancy Complications, Cardiovascular/mortality ; Retrospective Studies ; Risk Factors ; Utah/epidemiology ; Young Adult
    Language English
    Publishing date 2021-07-28
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2021.07.015
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  5. Article ; Online: COVID-19 in Adults With Congenital Heart Disease.

    Broberg, Craig S / Kovacs, Adrienne H / Sadeghi, Soraya / Rosenbaum, Marlon S / Lewis, Matthew J / Carazo, Matthew R / Rodriguez, Fred H / Halpern, Dan G / Feinberg, Jodi / Galilea, Francisca Arancibia / Baraona, Fernando / Cedars, Ari M / Ko, Jong M / Porayette, Prashob / Maldonado, Jennifer / Sarubbi, Berardo / Fusco, Flavia / Frogoudaki, Alexandra A / Nir, Amiram /
    Chaudhry, Anisa / John, Anitha S / Karbassi, Arsha / Hoskoppal, Arvind K / Frischhertz, Benjamin P / Hendrickson, Benjamin / Bouma, Berto J / Rodriguez-Monserrate, Carla P / Broda, Christopher R / Tobler, Daniel / Gregg, David / Martinez-Quintana, Efren / Yeung, Elizabeth / Krieger, Eric V / Ruperti-Repilado, Francisco J / Giannakoulas, George / Lui, George K / Ephrem, Georges / Singh, Harsimran S / Almeneisi, Hassan Mk / Bartlett, Heather L / Lindsay, Ian / Grewal, Jasmine / Nicolarsen, Jeremy / Araujo, John J / Cramer, Jonathan W / Bouchardy, Judith / Al Najashi, Khalid / Ryan, Kristi / Alshawabkeh, Laith / Andrade, Lauren / Ladouceur, Magalie / Schwerzmann, Markus / Greutmann, Matthias / Meras, Pablo / Ferrero, Paolo / Dehghani, Payam / Tung, Poyee P / Garcia-Orta, Rocio / Tompkins, Rose O / Gendi, Salwa M / Cohen, Scott / Klewer, Scott / Hascoet, Sebastien / Mohammadzadeh, Shabnam / Upadhyay, Shailendra / Fisher, Stacy D / Cook, Stephen / Cotts, Timothy B / Aboulhosn, Jamil A

    Journal of the American College of Cardiology

    2021  Volume 77, Issue 13, Page(s) 1644–1655

    Abstract: Background: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.: Objectives: This study sought to define the impact of COVID-19 in adults ... ...

    Abstract Background: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.
    Objectives: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes.
    Methods: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined.
    Results: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not.
    Conclusions: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
    MeSH term(s) Adult ; COVID-19/mortality ; COVID-19/therapy ; COVID-19 Testing/methods ; Cardiac Surgical Procedures/methods ; Cardiac Surgical Procedures/statistics & numerical data ; Causality ; Comorbidity ; Cyanosis/diagnosis ; Cyanosis/etiology ; Cyanosis/mortality ; Female ; Global Health/statistics & numerical data ; Heart Defects, Congenital/classification ; Heart Defects, Congenital/epidemiology ; Heart Defects, Congenital/physiopathology ; Heart Defects, Congenital/therapy ; Hospitalization/statistics & numerical data ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/mortality ; Male ; Mortality ; Patient Acuity ; Risk Factors ; SARS-CoV-2/isolation & purification ; Symptom Assessment
    Language English
    Publishing date 2021-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2021.02.023
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