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Article ; Online: Sternal-Sparing Surgical Options in Combined Aortic Valve and Coronary Artery Disease: Proof of Concept.

Watanabe, Tatsuya / Kitahara, Hiroto / Shah, Atman P / Blair, John / Nathan, Sandeep / Balkhy, Husam H

Innovations (Philadelphia, Pa.)

2023 Volume 18, Issue 4, Page(s) 346–351

Abstract: Objective: The standard management of concomitant aortic valve (AV) and coronary artery disease has been coronary artery bypass and AV replacement (AVR). With the advent of minimally invasive options, many isolated lesions have been successfully managed ...

Abstract	Objective: The standard management of concomitant aortic valve (AV) and coronary artery disease has been coronary artery bypass and AV replacement (AVR). With the advent of minimally invasive options, many isolated lesions have been successfully managed using a sternal-sparing approach. In our institution, patients with isolated AV disease are offered minimally invasive surgical or transcatheter AVR, and those with isolated coronary artery disease are routinely managed with robotic totally endoscopic coronary artery bypass or percutaneous coronary intervention. Various combinations of these techniques can be used when a sternal-sparing posture is desired because of patient risk or preference. The aim of this study was to review the outcomes in patients with combined AV and coronary disease who were managed using sternal-sparing approaches. Methods: We reviewed the records of 10 patients in our minimally invasive surgical database who presented with concomitant AV and coronary artery disease and underwent combined sternal-sparing management of these 2 lesions using various combinations of minimally invasive approaches. Results: Four patients had totally endoscopic coronary artery bypass and minimally invasive AVR at the same time, 2 patients underwent transcatheter AVR followed by totally endoscopic coronary artery bypass, and 4 patients underwent minimally invasive AVR with percutaneous coronary intervention. There was no 30-day mortality. The duration of postoperative surgical hospital stay was 3.1 ± 0.9 days. Conclusions: Sternal-sparing approaches in combined AV and coronary artery disease are feasible with patient-specific treatment selection of minimally invasive techniques.
MeSH term(s)	Humans ; Aortic Valve/surgery ; Coronary Artery Disease/complications ; Coronary Artery Disease/surgery ; Coronary Artery Bypass/methods ; Aortic Valve Stenosis/surgery ; Heart Valve Prosthesis Implantation/methods ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2023-07-17
Publishing country	United States
Document type	Journal Article
ISSN	1559-0879
ISSN (online)	1559-0879
DOI	10.1177/15569845231185566
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA.

Dia, AbdulRahman / Cifu, Adam S / Shah, Atman P

JAMA

2021 Volume 325, Issue 1, Page(s) 81–82

MeSH term(s)	Anticoagulants/therapeutic use ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/etiology ; Electrocardiography ; Foramen Ovale, Patent/complications ; Foramen Ovale, Patent/drug therapy ; Foramen Ovale, Patent/surgery ; Humans ; Ischemic Attack, Transient/etiology ; Platelet Aggregation Inhibitors/therapeutic use ; Secondary Prevention ; Septal Occluder Device ; Stroke/etiology ; Stroke/prevention & control
Chemical Substances	Anticoagulants ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2021-01-05
Publishing country	United States
Document type	Journal Article ; Practice Guideline
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2020.22176
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Article ; Online: Multimodality Imaging and Percutaneous Closure of a Large Left Main Coronary Artery to Superior Vena Cava Fistula.

Mehta, Sanjay S / Shah, Atman P

The Journal of invasive cardiology

2018 Volume 30, Issue 2, Page(s) E16–E17

Abstract: Images illustrate 3D reconstruction CT showing fistula arising from the left main coronary artery draining into the superior vena cava. Additional angiographic images show the fistula before and after percutaneous closure with Amplatzer Vascular plugs. ...

Abstract	Images illustrate 3D reconstruction CT showing fistula arising from the left main coronary artery draining into the superior vena cava. Additional angiographic images show the fistula before and after percutaneous closure with Amplatzer Vascular plugs.
MeSH term(s)	Arteriovenous Fistula/diagnostic imaging ; Arteriovenous Fistula/physiopathology ; Arteriovenous Fistula/surgery ; Computed Tomography Angiography/methods ; Coronary Angiography/methods ; Coronary Vessel Anomalies/diagnostic imaging ; Coronary Vessels/diagnostic imaging ; Female ; Humans ; Middle Aged ; Vascular Surgical Procedures/methods ; Vena Cava, Superior/abnormalities ; Vena Cava, Superior/diagnostic imaging
Language	English
Publishing date	2018-01-26
Publishing country	United States
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
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Article ; Online: Challenges in Implementation of Institutional Protocols for Patients With Acute Coronary Syndrome.

Shah, Atman P / Nathan, Sandeep

The American journal of cardiology

2018 Volume 122, Issue 2, Page(s) 356–363

Abstract: The diagnosis of acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (non-STEMI and unstable angina). In recent years, there have been improvements in the rates of death, ... ...

Abstract	The diagnosis of acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (non-STEMI and unstable angina). In recent years, there have been improvements in the rates of death, cardiogenic shock, and recurrent myocardial infarction in patients with ACS, primarily due to the introduction of new pharmacological and interventional therapies, as well as the introduction of and adherence to new treatment guidelines. However, ACS still represents a considerable public health burden. Treatment recommendations for STEMI and non-ST-segment elevation differ and there is wide variation in practice patterns and adherence among and within hospitals especially for the latter diagnosis. Adoption of institutional protocols may help decrease variability and improve quality of care, efficiency, and, ultimately, patient outcomes. This report discusses the process of developing and implementing institutional protocols for patients with ACS, from initial medical contact to discharge and beyond.
MeSH term(s)	Acute Coronary Syndrome/therapy ; Clinical Protocols/standards ; Disease Management ; Humans ; Practice Guidelines as Topic ; Registries
Language	English
Publishing date	2018-04-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2018.03.354
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Article ; Online: Guided by the Light-Transillumination of a Paravalvular Leak.

Karagodin, Ilya / Shah, Atman P / Lang, Roberto M

JAMA cardiology

2020 Volume 5, Issue 8, Page(s) e203260

MeSH term(s)	Adult ; Echocardiography, Transesophageal ; Female ; Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/surgery ; Septal Occluder Device ; Transillumination/methods
Language	English
Publishing date	2020-08-19
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2020.3260
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Article ; Online: Recurrent ST-elevation myocardial infarction: a case report of a rare complication of caseous mitral annular calcification.

Singh, Nikhil / Shah, Atman P / Torregrossa, Gianluca / Blair, John E

European heart journal. Case reports

2021 Volume 6, Issue 1, Page(s) ytab502

Abstract: Background: Caseous mitral annular calcification (MAC) is an under-diagnosed division of calcific mitral valve disease that has recently been reported to have increased propensity for embolic disease. Early recognition of this entity as a cause of ... ...

Abstract	Background: Caseous mitral annular calcification (MAC) is an under-diagnosed division of calcific mitral valve disease that has recently been reported to have increased propensity for embolic disease. Early recognition of this entity as a cause of embolic disease can lead to prevention of occlusive vascular disease and long-standing complications. Case summary: We present the case of a patient with end-stage renal disease who presented for evaluation of chest pain and was found to have ST-segment myocardial infarction. Despite thrombectomy and stenting, he had multiple recurrent events, and imaging evaluation demonstrated caseous MAC with mobile components. He was taken for surgical replacement of the mitral valve, with pathology confirming diagnosis. Discussion: Caseous MAC may represent an increased risk of embolic disease. Better understanding of this pathology and it's propensity for embolic disease will be important to best determine treatment plans and timing of operative intervention.
Language	English
Publishing date	2021-12-11
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytab502
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Article: Transcatheter aortic valve replacement in patients undergoing robotic totally endoscopic coronary artery bypass: A case series.

Srivastava, Ankur / Smazil, Jennifer / Roark, Lauren / Shah, Hayla A / Balkhy, Husam H / Shah, Atman P

Frontiers in cardiovascular medicine

2022 Volume 9, Page(s) 988029

Abstract: Transcatheter aortic valve replacement (TAVR) has been utilized to treat patients with symptomatic aortic stenosis (AS). Recent trials suggest comparable efficacy compared to surgical aortic valve replacement (SAVR). Robotic off-pump totally endoscopic ... ...

Abstract	Transcatheter aortic valve replacement (TAVR) has been utilized to treat patients with symptomatic aortic stenosis (AS). Recent trials suggest comparable efficacy compared to surgical aortic valve replacement (SAVR). Robotic off-pump totally endoscopic coronary artery bypass graft surgery (TECAB) had been shown to be a minimally invasive revascularization strategy with clinical results comparable to traditional coronary artery bypass graft surgery (CABG). Traditionally, pre-surgical coronary evaluation is considered necessary to optimize coronary revascularization at the time of AVR. The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Disease gives a moderate recommendation, based on limited data, for CABG at the time of AVR in patients with significant coronary artery disease (CAD). This paper presents two patients with known significant CAD awaiting robotic TECAB who were treated with TAVR, prior to surgical revascularization. Robotic TECAB is unique in that it offers patients the ability to have complete coronary revascularization without a sternotomy and with early ambulation, discharge, and recovery. The case series demonstrates a hybrid approach that offers complete sternotomy sparing cardiovascular care to treat severe symptomatic AS and CAD. Since patients with severe aortic stenosis are at high risk of developing cardiac arrest and cardiogenic shock upon induction of anesthesia, the ability to treat severe symptomatic AS with TAVR under conscious sedation prior to TECAB can be considered as a safe an effective treatment.
Language	English
Publishing date	2022-09-12
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2022.988029
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Article: Extensive pulmonary venous stenoses as a complication of radiofrequency catheter ablation for atrial fibrillation.

Cotella, Juan I / Chelala, Lydia / Shah, Atman P / Chung, Ben / Slivnick, Jeremy

Radiology case reports

2022 Volume 17, Issue 11, Page(s) 4299–4301

Abstract: Although pulmonary veins stenosis (PVS) is a well documented complication of radiofrequency-catheter ablation (RFCA) of atrial fibrillation (AF), simultaneous involvement of multiple PVs is extremely rare. We present the case of a 69 years-old male ... ...

Abstract	Although pulmonary veins stenosis (PVS) is a well documented complication of radiofrequency-catheter ablation (RFCA) of atrial fibrillation (AF), simultaneous involvement of multiple PVs is extremely rare. We present the case of a 69 years-old male patient, with prior medical history of persistent AF, who had been treated with RFCA two years ago. After RFCA, he started with shortness of breath and needed hospitalization for bilateral pneumonia. One year after the procedure, he was on home oxygen, but still referred dyspnea, cough and hemoptysis. A transthoracic echocardiogram showed moderate right ventricular (RV) systolic dysfunction and elevated RV systolic pressure. Dedicated cardiac tomography for PV assessment revealed severe narrowing and pre-stenotic engorgement of all 5 PVs, with subtotal ostial occlusion of both the left lower and right middle PVs. PV angiography confirmed the diagnosis. Only the left and right upper PV were able to be wire-crossed and stented, with substantial reductions in stenosis from 90 % to 10 %. After 3 months of follow-up, the patient improved substantially, and home O2 was withdrawn.
Language	English
Publishing date	2022-09-14
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2022.08.032
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Article: Percutaneous transapical access to facilitate complex thoracic endovascular aortic repair.

Venturini, Joseph M / Milner, Ross / Shah, Atman P

Journal of vascular surgery cases and innovative techniques

2019 Volume 5, Issue 3, Page(s) 205–209

Abstract: Thoracic endovascular aortic repair (TEVAR) provides an alternative to open surgery for a variety of aortic diseases. However, complex anatomy and previous operations may preclude traditional approaches to TEVAR. Percutaneous transapical access through ... ...

Abstract	Thoracic endovascular aortic repair (TEVAR) provides an alternative to open surgery for a variety of aortic diseases. However, complex anatomy and previous operations may preclude traditional approaches to TEVAR. Percutaneous transapical access through the left ventricle is a feasible option to facilitate externalized "rail" wire support for complex TEVAR. We present the case of TEVAR for a residual type B aortic dissection facilitated by percutaneous transapical access.
Language	English
Publishing date	2019-06-21
Publishing country	United States
Document type	Journal Article
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2019.03.003
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Article ; Online: The use of PK Papyrus covered coronary stent for carotid reconstruction: an initial institutional experience.

Morsi, Rami Z / Thind, Sonam / Chahine, Ahmad / Zakaria, Jehad / Desai, Harsh / Kothari, Sachin A / Shah, Atman P / Nathan, Sandeep / Coleman, Elisheva / Mendelson, Scott / Siegler, James E / Prabhakaran, Shyam / Mansour, Ali / Kass-Hout, Tareq

Journal of neurointerventional surgery

2024

Abstract: Background: The use of covered stent grafts for the treatment of carotid rupture is increasingly being used given their ability to preserve the parent artery while simultaneously occluding the fistula or rupture point.: Methods: This case series ... ...

Abstract	Background: The use of covered stent grafts for the treatment of carotid rupture is increasingly being used given their ability to preserve the parent artery while simultaneously occluding the fistula or rupture point. Methods: This case series describes the technical feasibility of using, and the performance of, the PK Papyrus covered coronary stent (Biotronik, Inc., Lake Oswego, Oregon, USA) in six patients with carotid rupture, including carotid cavernous fistulas, between July 2021 and October 2023 in a single-center institution in the USA. Results: The median decade of life was 5 (IQR 3) with a 1:1 male-to-female ratio. The majority were black patients (n=5/6, 83.3%). The most common disease pathology was carotid cavernous fistula (n=4/6, 66.7%), followed by traumatic carotid rupture (n=2/6, 33.3%). All the stent embolization procedures were successfully treated with the PK Papyrus covered coronary stent. None of the patients had any recurrence or re-treatment. The number of stents required ranged from 1 to 3. A balloon guide catheter was used in 66.7% of cases (n=4/6). In-hospital mortality was 0.0% (n=0/6). No in-stent thrombosis was observed, but there was one case of cangrelor-associated hemorrhagic stroke conversion. Transfemoral access was used in all cases with one access site complication. Median follow-up time was 1.8 months (IQR 3.5). Conclusions: To our knowledge, this is the largest case series in the USA demonstrating the feasibility and safety of using the PK Papyrus covered coronary stent for the treatment of carotid rupture, including carotid cavernous fistulas.
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2023-021226
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