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  1. Article ; Online: Virtual reality to predict paravalvular leak in bicuspid severe aortic valve stenosis in transcatheter aortic valve implants.

    Chahine, Johnny / Mascarenhas, Lorraine / Yannopoulos, Demetris / Raveendran, Ganesh / Gurevich, Sergey

    The Journal of invasive cardiology

    2024  

    Abstract: Objectives: Severe aortic stenosis (AS) in bicuspid aortic valves (BAV) is associated with an increased risk of paravalvular leak (PVL) after a transcatheter aortic valve replacement (TAVR). Virtual reality (VR) has been shown to be an effective tool in ...

    Abstract Objectives: Severe aortic stenosis (AS) in bicuspid aortic valves (BAV) is associated with an increased risk of paravalvular leak (PVL) after a transcatheter aortic valve replacement (TAVR). Virtual reality (VR) has been shown to be an effective tool in surgical training, but its utility in clinical practice has not been studied. Here we present the first study to evaluate the use of VR simulation in pre-procedure planning and prediction of PVL in TAVR in patients with severe BAV AS.
    Methods: Twenty-two patients with severe BAV AS undergoing TAVR between 2014 and 2018 at the University of Minnesota were included in the study. VR simulation of TAVR implants was performed and implants were analyzed for PVL. The primary endpoint was the percent circumference of valve malapposition in VR as compared to the severity of PVL on post-procedure echocardiography.
    Results: The median age was 78.26 years (IQR 63.77-86.79) and 40.9% (n = 9) were female. Our VR model accurately predicted the presence and absence of PVL in all patients (17/17 and 5/5, respectively). The mean circumferential PVL was 3.73 % ± 7.71. The receiver operator characteristic curve showed an area under the curve of 0.83 (0.59-1.00, P = .03) for malapposition in the VR-TAVR simulated model.
    Conclusions: VR-TAVR implantation may predict PVL in severe BAV AS undergoing TAVR.
    Language English
    Publishing date 2024-03-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1154372-3
    ISSN 1557-2501 ; 1042-3931
    ISSN (online) 1557-2501
    ISSN 1042-3931
    DOI 10.25270/jic/24.00019
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  2. Article ; Online: Transcatheter closure of a large post-myocardial infarction ventricular septal defect using the GORE cardioform ASD Occluder.

    Tsangaris, Adamantios / Raveendran, Ganesh / Hiremath, Gurumurthy

    The Journal of invasive cardiology

    2023  Volume 35, Issue 11

    Abstract: A 49-year-old man presented late with an anterior wall myocardial infarction (MI) status post-primary coronary intervention of the left anterior descending artery that resulted in no reflow of the vessel. The patient was transferred to our institution in ...

    Abstract A 49-year-old man presented late with an anterior wall myocardial infarction (MI) status post-primary coronary intervention of the left anterior descending artery that resulted in no reflow of the vessel. The patient was transferred to our institution in cardiogenic shock.
    MeSH term(s) Male ; Humans ; Middle Aged ; Anterior Wall Myocardial Infarction ; Treatment Outcome ; Cardiac Catheterization/methods ; Septal Occluder Device ; Heart Septal Defects, Ventricular/diagnosis ; Heart Septal Defects, Ventricular/surgery
    Language English
    Publishing date 2023-11-20
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1154372-3
    ISSN 1557-2501 ; 1042-3931
    ISSN (online) 1557-2501
    ISSN 1042-3931
    DOI 10.25270/jic/23.00181
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  3. Article ; Online: Impact of age on survival for patients receiving ECPR for refractory out-of-hospital VT/VF cardiac arrest.

    Chahine, Johnny / Kosmopoulos, Marinos / Raveendran, Ganesh / Yannopoulos, Demetris / Bartos, Jason A

    Resuscitation

    2023  Volume 193, Page(s) 109998

    Abstract: Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior ... ...

    Abstract Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior studies of the impact of age on outcomes in ECPR have demonstrated mixed results and we aim to investigate this relationship.
    Methods: Patients treated with ECPR at the University of Minnesota Medical Center for refractory out-of-hospital VT/VF arrest from December 2015 to February 2023 were included. The primary endpoints included neurologically favorable survival to discharge. A receiver operating characteristic curve was used to determine an optimal predictive age limit with the highest accuracy for neurologically favorable survival.
    Results: 391 consecutive patients were included: 22% (n = 86) were female and the mean age was 56.9 ± 11.8 years. Age was independently associated with neurologically favorable survival to discharge, with a 30% decrease in survival with every 10-year increase in age (OR 0.7 (0.57-0.87), p = 0.001. Among those with neurologically favorable survival to discharge, older patients had longer length of hospital stay compared to younger age groups (p = 0.002) while patients who failed to achieve neurologically favorable survival to discharge had similar length of stay independent of age (p = 0.51).
    Conclusions: Age is associated with neurologically favorable survival to discharge for patients receiving ECPR for refractory out-of-the-hospital VT/VF cardiac arrest. However, with a survival rate of 23% in the oldest age group, caution should be used when choosing age criteria for patient selection.
    MeSH term(s) Humans ; Female ; Middle Aged ; Aged ; Male ; Out-of-Hospital Cardiac Arrest ; Extracorporeal Membrane Oxygenation/methods ; Cardiopulmonary Resuscitation/methods ; Hospitals ; Survival Rate ; Retrospective Studies
    Language English
    Publishing date 2023-10-12
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 189901-6
    ISSN 1873-1570 ; 0300-9572
    ISSN (online) 1873-1570
    ISSN 0300-9572
    DOI 10.1016/j.resuscitation.2023.109998
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  4. Article ; Online: TAVR Beyond Fetal Viability: An Alternative to Preterm Delivery in Symptomatic Severe Aortic Stenosis.

    Hoover, Elizabeth / Corlin, Tiffany / Lohr, Jamie / Sabol, Bethany / Yamamura, Yasuko / Jacobs, Katherine / March, S Kimara / Gorbaty, Benjamin / Raveendran, Ganesh

    JACC. Case reports

    2023  Volume 27, Page(s) 102104

    Abstract: A patient with structural valve degeneration of an aortic bioprosthesis with stenosis stage 3 underwent valve-in-valve transcatheter aortic valve replacement (TAVR) at 29 weeks with improvement. This is the first reported TAVR in the third trimester. ... ...

    Abstract A patient with structural valve degeneration of an aortic bioprosthesis with stenosis stage 3 underwent valve-in-valve transcatheter aortic valve replacement (TAVR) at 29 weeks with improvement. This is the first reported TAVR in the third trimester. TAVR may be an alternative to preterm delivery in cases of symptomatic aortic stenosis.
    Language English
    Publishing date 2023-12-06
    Publishing country Netherlands
    Document type Case Reports
    ISSN 2666-0849
    ISSN (online) 2666-0849
    DOI 10.1016/j.jaccas.2023.102104
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  5. Article ; Online: Effect of Combination of Balloon Pulmonary Angioplasty and Medical Therapy on Reverse Right Ventricular Remodeling and Hemodynamics in Chronic Thromboembolic Pulmonary Hypertension.

    Kazmirczak, Felipe / Prisco, Sasha Z / Knoper, Ryan / Huddleston, Steve / Raveendran, Ganesh / Pritzker, Marc / Thenappan, Thenappan / Prins, Kurt W / Gurevich, Sergey

    The Journal of invasive cardiology

    2023  Volume 35, Issue 6, Page(s) E312–E320

    Abstract: Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive and debilitating disorder that results from incomplete resolution of vascular obstructions resulting in pulmonary hypertension. Surgical pulmonary thromboendarterectomy ...

    Abstract Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive and debilitating disorder that results from incomplete resolution of vascular obstructions resulting in pulmonary hypertension. Surgical pulmonary thromboendarterectomy (PTE) is the treatment of choice for CTEPH. Unfortunately, many CTEPH patients are ineligible for PTE or do not have access to an expert surgical center. Medical therapy imparts important symptomatic and exercise benefits for CTEPH patients, but it does not extend survival. Balloon pulmonary angioplasty (BPA) is an emerging transcatheter approach that is both safe and efficacious. However, the potential synergy between upfront BPA and medical therapy treatment approaches in patients with inoperable CTEPH is unknown. Here, we evaluated how the combination of BPA and medical therapy compared to medical therapy alone in a newly established BPA program.
    Methods: Twenty-one patients with inoperable or residual CTEPH were evaluated in this single-center observational study. Ten patients underwent upfront BPA and medical therapy while 11 patients were treated with medical therapy alone. Hemodynamic and echocardiographic assessments were performed at baseline and at least 1 month after completion of therapy. Continuous variables were compared using t-test or Mann-Whitney U-test. Categorical variables were analyzed with Chi squared and Fisher's exact test where appropriate.
    Results: Combination therapy significantly reduced mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR), but medical therapy only significantly lowered PVR. Comprehensive echocardiographic analysis revealed a more robust reverse right ventricular (RV) remodeling effect and augmentation of RV function with combination therapy. At the end of study, the combination therapy group had lower mPAP and PVR and better RV function. Importantly, there were no significant adverse effects in patients treated with BPA.
    Conclusion: Combination therapy significantly improves hemodynamics and RV function in inoperable CTEPH while carrying an acceptable risk profile, even in a newly developed program. Further studies comparing upfront combination therapy to medical therapy with larger, long-term, and randomized approaches should be considered.
    MeSH term(s) Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/therapy ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/therapy ; Ventricular Remodeling ; Hemodynamics ; Angioplasty, Balloon/methods ; Chronic Disease ; Pulmonary Artery/diagnostic imaging ; Pulmonary Artery/surgery
    Language English
    Publishing date 2023-07-06
    Publishing country United States
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 1154372-3
    ISSN 1557-2501 ; 1042-3931
    ISSN (online) 1557-2501
    ISSN 1042-3931
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  6. Article ; Online: Left ventricular hemodynamics with veno-arterial extracorporeal membrane oxygenation.

    Kalra, Rajat / Alexy, Tamas / Bartos, Jason A / Prisco, Anthony R / Kosmopoulos, Marinos / Maharaj, Valmiki R / Bernal, Alejandra Gutierrez / Elliott, Andrea M / Garcia, Santiago / Raveendran, Ganesh / John, Ranjit / Burkhoff, Daniel / Yannopoulos, Demetris

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2024  Volume 103, Issue 3, Page(s) 472–481

    Abstract: Background: There is considerable debate about the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).: Aims: To evaluate the changes in left ventricular (LV) function, volumes, and work in patients treated with VA- ... ...

    Abstract Background: There is considerable debate about the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
    Aims: To evaluate the changes in left ventricular (LV) function, volumes, and work in patients treated with VA-ECMO using invasive LV catheterization and three-dimensional echocardiographic volumes.
    Methods: Patients on VA-ECMO underwent invasive hemodynamic evaluation due to concerns regarding candidacy for decannulation. Hemodynamic parameters were reported as means±standard deviations or medians (interquartile ranges) after evaluating for normality. Paired comparisons were done to evaluate hemodynamics at the baseline (highest) and lowest tolerated levels of VA-ECMO support.
    Results: Twenty patients aged 52.3 ± 15.8 years were included. All patients received VA-ECMO for refractory cardiogenic shock (5/20 SCAI stage D, 15/20 SCAI stage E). At 3.0 (2.0, 4.0) days after VA-ECMO cannulation, the baseline LV ejection fraction was 20% (15%, 27%). The baseline and lowest VA-ECMO flows were 4.0 ± 0.6 and 1.5 ± 0.6 L/min, respectively. Compared to the lowest flow, full VA-ECMO support reduced LV end-diastolic volume [109 ± 81 versus 134 ± 93 mL, p = 0.001], LV end-diastolic pressure (14 ± 9 vs. 19 ± 9 mmHg, p < 0.001), LV stroke work (1858 ± 1413 vs. 2550 ± 1486 mL*mmHg, p = 0.002), and LV pressure-volume area (PVA) (4507 ± 1910 vs. 5193 ± 2388, p = 0.03) respectively. Mean arterial pressure was stable at the highest and lowest flows (80 ± 16 vs. 75 ± 14, respectively; p = 0.08) but arterial elastance was higher at the highest VA-ECMO flow (4.9 ± 2.2 vs lowest flow 2.7 ± 1.6; p < 0.001).
    Conclusions: High flow VA-ECMO support significantly reduced LV end-diastolic pressure, end-diastolic volume, stroke work, and PVA compared to minimal support. The Ea was higher and MAP was stable or minimally elevated on high flow.
    MeSH term(s) Humans ; Extracorporeal Membrane Oxygenation/adverse effects ; Treatment Outcome ; Shock, Cardiogenic/diagnostic imaging ; Shock, Cardiogenic/therapy ; Hemodynamics ; Heart Ventricles
    Language English
    Publishing date 2024-01-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.30951
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  7. Article ; Online: Embolization of a complex coronary to pulmonary artery fistula using balloon assisted liquid embolic injection: A novel technique.

    Jagadeesan, Bharathi D / Liao, Kenneth K / Raveendran, Ganesh

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2018  Volume 92, Issue 7, Page(s) E453–E455

    Abstract: Complex Coronary artery to Pulmonary artery fistulas (CPFs) can be difficult to manage with embolization or ligation. An 88-year-old woman with exertional angina was found to have a complex precordial CPF, severe Mitral regurgitation, and Pulmonary ... ...

    Abstract Complex Coronary artery to Pulmonary artery fistulas (CPFs) can be difficult to manage with embolization or ligation. An 88-year-old woman with exertional angina was found to have a complex precordial CPF, severe Mitral regurgitation, and Pulmonary Hypertension. CPF treatment was recommended prior to minimally invasive mitral valve replacement (to avoid postoperative myocardial ischemia from worsened steal). The CPF was supplied by multiple branches from the LAD and RCA, and formed a complex common varicosity with multiple drainage channels to the pulmonary artery. The CPF was treated by injecting a liquid embolic agent, Ethylene Vinyl Alcohol Copolymer (Onyx, Medtronic, MN), into two of the feeding arteries arising from the RCA through a Scepter C Dual lumen balloon micro catheter (Microvention, Aliso Viejo, CA. This resulted in complete obliteration of the fistula, and the patient subsequently underwent successful mitral valve replacement surgery.
    MeSH term(s) Aged, 80 and over ; Arterio-Arterial Fistula/diagnostic imaging ; Arterio-Arterial Fistula/therapy ; Balloon Occlusion ; Coronary Vessel Anomalies/diagnostic imaging ; Coronary Vessel Anomalies/therapy ; Embolization, Therapeutic/instrumentation ; Embolization, Therapeutic/methods ; Female ; Humans ; Injections, Intra-Arterial ; Polyvinyls/administration & dosage ; Pulmonary Artery/abnormalities ; Pulmonary Artery/diagnostic imaging ; Treatment Outcome
    Chemical Substances Polyvinyls ; ethylene-vinyl alcohol copolymer (25067-34-9)
    Language English
    Publishing date 2018-07-18
    Publishing country United States
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.27677
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  8. Article ; Online: Invasive hemodynamics are equivocal for functional outcomes after MitraClip.

    Power, Juliette E / Reiff, Chris / Tsangaris, Adamantios / Hall, Alexandra / Raveendran, Ganesh / Yannopoulos, Demetris / Gurevich, Sergey

    Health science reports

    2022  Volume 5, Issue 1, Page(s) e471

    Abstract: Objectives: To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes.: Background: Mitral regurgitation grade is a poor predictor of functional outcomes after a ... ...

    Abstract Objectives: To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes.
    Background: Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes.
    Methods: Sixty-nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's
    Results: A total of 69 patients were included in the study. The mean age was 83 (75-87) years and 38 (55%) were male. Eighty-one percentage had >/= NYHA III symptoms. Eighty-seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15-24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes.
    Conclusion: Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.
    Language English
    Publishing date 2022-01-12
    Publishing country United States
    Document type Journal Article
    ISSN 2398-8835
    ISSN (online) 2398-8835
    DOI 10.1002/hsr2.471
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  9. Article: The native aortic valve reduces paravalvular leak in TAVR patients.

    Prisco, Anthony R / Zhingre-Sanchez, Jorge / Mattison, Lars / Yannopoulos, Demetris / Raveendran, Ganesh / Iaizzo, Paul A / Gurevich, Sergey

    Frontiers in physiology

    2022  Volume 13, Page(s) 910016

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2022-08-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564217-0
    ISSN 1664-042X
    ISSN 1664-042X
    DOI 10.3389/fphys.2022.910016
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  10. Article ; Online: Physicians' perspectives and attitudes toward surgical bailout in transcatheter aortic valve replacement.

    Robbins, Alexandria J / Grande, Stuart W / Alwan, Fatima / Soule, Matthew R / Raveendran, Ganesh / Helmer, Gregory / Andrade, Rafael / Perry, Tjorvi

    JTCVS open

    2022  Volume 9, Page(s) 74–81

    Abstract: Objectives: The incidence of surgical bailout during transcatheter aortic valve replacement (TAVR) is ∼1%, with an associated 50% in-hospital mortality. We performed an exploratory qualitative study of TAVR team perceptions regarding routine surgical ... ...

    Abstract Objectives: The incidence of surgical bailout during transcatheter aortic valve replacement (TAVR) is ∼1%, with an associated 50% in-hospital mortality. We performed an exploratory qualitative study of TAVR team perceptions regarding routine surgical bailout planning with patients.
    Methods: We developed a semistructed interview guide to explore clinician perspectives on the TAVR consent process, managing intraoperative emergencies, and involving patients in surgical contingency planning. We interviewed surgeons, cardiologists, and anesthesiologists involved with TAVR in 4 hospitals. We performed qualitative thematic analysis via independent coding of salient quotations from the transcribed texts. Codes were categorized based on shared meaning and the final themes were derived by identifying key content, and examining its relational nature.
    Results: Thirteen interviews were conducted, identifying 4 major themes. Participants agreed that eliciting patient preference for bailout is crucial, particularly when surgical outcome is ambiguous. In those cases, participants offered criteria for determining which patients should be engaged in a more nuanced discussion. The ethos of specialty clinicians impacted anticipation and response to procedural emergencies. Finally, physician attitudes reflected strong emotional responses to patient death/morbidity, particularly in iatrogenic injury. Participants expressed anxiety with performing TAVR without surgical backup, while also demonstrating willingness to respect patients' wishes.
    Conclusions: The TAVR team supports engaging patients regarding potential surgical bailout and honoring their preferences in the event of complication. However, clinical judgment about the expected outcome of bailout would frame that discussion. Participants described the emotional weight of not pursuing bailout if indicated and the importance of good coping mechanisms.
    Language English
    Publishing date 2022-01-21
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-2736
    ISSN (online) 2666-2736
    DOI 10.1016/j.xjon.2022.01.015
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