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Article: Early vs. Late Readmission following Percutaneous Coronary Intervention: Predictors and Impact on Long-Term Outcomes.

Eccleston, David / Duong, My-Ngan / Chowdhury, Enayet / Schwarz, Nisha / Reid, Christopher / Liew, Danny / Conradie, Andre / Worthley, Stephen G

Journal of clinical medicine

2023 Volume 12, Issue 4

Abstract: Background: Readmissions within 1 year after percutaneous coronary intervention (PCI) are common (18.6-50.4% in international series) and a burden to patients and health services, however their long-term implications are not well characterised. We ... ...

Abstract	Background: Readmissions within 1 year after percutaneous coronary intervention (PCI) are common (18.6-50.4% in international series) and a burden to patients and health services, however their long-term implications are not well characterised. We compared predictors of 30-day (early) and 31-day to 1-year (late) unplanned readmission and the impact of unplanned readmission on long-term clinical outcomes post-PCI. Methods: Patients enrolled in the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from 2008 to 2020 were included in the study. Multivariate logistic regression analysis was performed to identify predictors of early and late unplanned readmission. A Cox proportion hazards regression model was used to explore the impact of any unplanned readmission during the first year post-PCI on the clinical outcomes at 3 years. Finally, patients with early and late unplanned readmission were compared to determine which group was at the highest risk of adverse long-term outcomes. Results: The study comprised 16,911 consecutively enrolled patients who underwent PCI between 2009-2020. Of these, 1422 patients (8.5%) experienced unplanned readmission within 1-year post-PCI. Overall, the mean age was 68.9 ± 10.5 years, 76.4% were male and 45.9% presented with acute coronary syndromes. Predictors of unplanned readmission included increasing age, female gender, previous CABG, renal impairment and PCI for acute coronary syndromes. Unplanned readmission within 1 year of PCI was associated with an increased risk of MACE (adjusted HR 1.84 (1.42-2.37), Conclusions: Unplanned readmissions in the first year following PCI, particularly those occurring more than 30 days after discharge, were associated with a significantly higher risk of adverse outcomes, such as MACE and death at 3 years. Strategies to identify patients at high risk of readmission and interventions to reduce their greater risk of adverse events should be implemented post-PCI.
Language	English
Publishing date	2023-02-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12041684
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Article ; Online: Thirty-day and one-year outcomes of the Navitor transcatheter heart valve in patients with aortic stenosis: the prospective, multicentre, global PORTICO NG Study.

Sondergaard, Lars / Walton, Antony S / Worthley, Stephen G / Smith, Dave / Chehab, Bassem / Manoharan, Ganesh / Yong, Gerald / Bedogni, Francesco / Bates, Nicholas / Reardon, Michael J

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2023 Volume 19, Issue 3, Page(s) 248–255

Abstract: Background: The Navitor transcatheter heart valve (THV) is a self-expanding valve, with an intra-annular leaflet position and an outer cuff intended to reduce paravalvular leak (PVL).: Aims: The aim of the PORTICO NG Study is to assess the safety and ...

Abstract	Background: The Navitor transcatheter heart valve (THV) is a self-expanding valve, with an intra-annular leaflet position and an outer cuff intended to reduce paravalvular leak (PVL). Aims: The aim of the PORTICO NG Study is to assess the safety and performance of the Navitor THV in patients with symptomatic, severe aortic stenosis who are at high or extreme surgical risk. Methods: PORTICO NG is a prospective, multicentre, global, single-arm, investigational study with follow-up at 30 days, 1 year, and annually up to 5 years. The primary endpoints are all-cause mortality and moderate or greater PVL at 30 days. Valve Academic Research Consortium-2 events and valve performance are assessed by an independent clinical events committee and echocardiographic core laboratory. Results: A total of 120 high- or extreme-risk subjects (age 83.5±5.4 years; 58.3% female; Society of Thoracic Surgeons score 4.0±2.0%) were enrolled in the European conformity (CE) mark cohort. Procedural success was high at 97.5%. At 30 days, the rate of all-cause mortality was 0%, and no subjects had moderate or greater PVL. The rate of disabling stroke was 0.8%, life-threatening bleeding was 2.5%, stage 3 acute kidney injury 0%, major vascular complications 0.8%, and new pacemaker implantation 15.0%. At 1 year, the rates of all-cause mortality and disabling stroke were 4.2% and 0.8%, respectively. The rate of moderate PVL was 1.0% at 1 year. Haemodynamic performance with a mean gradient of 7.5±3.2 mmHg and effective orifice area of 1.9±0.4 cm Conclusions: The PORTICO NG Study demonstrates low rates of adverse events and PVL up to 1 year in patients at high or extreme surgical risk, confirming the safety and efficacy of the Navitor THV system.
MeSH term(s)	Humans ; Female ; Aged ; Aged, 80 and over ; Male ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Transcatheter Aortic Valve Replacement/adverse effects ; Prospective Studies ; Treatment Outcome ; Prosthesis Design ; Heart Valve Prosthesis ; Aortic Valve Stenosis/surgery ; Stroke/etiology
Language	English
Publishing date	2023-03-09
Publishing country	France
Document type	Multicenter Study ; Journal Article
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJ-D-22-01108
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Zs.A 6680: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome.

Azarisman, Shah M / Teo, Karen S / Worthley, Matthew I / Worthley, Stephen G

The Journal of international medical research

2017 Volume 45, Issue 6, Page(s) 1680–1692

Abstract: Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with ... ...

Abstract	Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with underlying ACS. The conventional methods of assessing ACS, which include electrocardiography and serological markers of infarct, can take time to manifest. Recent studies have investigated more sensitive and specific imaging modalities that can be used. Diastolic dysfunction occurs early following coronary artery occlusion and its detection is useful in confirming the diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic resonance provides a single imaging modality for comprehensive evaluation of chest pain in the acute setting. In particular, cardiac magnetic resonance has many imaging techniques that assess diastolic dysfunction post-coronary artery occlusion. Techniques such as measurement of left atrial size, mitral inflow, and mitral annular and pulmonary vein flow velocities with phase-contrast imaging enable general assessment of ventricular diastolic function. More novel imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and myocardial tagging, allow early determination of regional diastolic dysfunction and oedema. These findings may correspond to specific infarcted arteries that may be used to tailor eventual percutaneous coronary artery intervention.
MeSH term(s)	Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/physiopathology ; Clinical Trials as Topic ; Diastole ; Humans ; Magnetic Resonance Imaging ; Myocardium/pathology ; Regional Blood Flow
Language	English
Publishing date	2017-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/0300060517698265
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Zs.A 925: Show issues

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Article ; Online: 30-Day Clinical Outcomes of a Self-Expanding Transcatheter Aortic Valve: The International PORTICO NG Study.

Reardon, Michael J / Chehab, Bassem / Smith, Dave / Walton, Antony S / Worthley, Stephen G / Manoharan, Ganesh / Sultan, Ibrahim / Yong, Gerald / Harrington, Katherine / Mahoney, Paul / Kleiman, Neal / Makkar, Raj R / Fontana, Gregory / DeLago, Augustin / Ramana, Ravi K / Bates, Nicholas / Søndergaard, Lars

JACC. Cardiovascular interventions

2023 Volume 16, Issue 6, Page(s) 681–689

Abstract: Background: The self-expanding, intra-annular Navitor (Abbott Structural Heart) valve includes an outer cuff to reduce paravalvular leak (PVL) and large stent cells for future coronary access.: Objectives: The purpose of the PORTICO NG (Evaluation of ...

Abstract	Background: The self-expanding, intra-annular Navitor (Abbott Structural Heart) valve includes an outer cuff to reduce paravalvular leak (PVL) and large stent cells for future coronary access. Objectives: The purpose of the PORTICO NG (Evaluation of the Portico NG [Next Generation] Transcatheter Aortic Valve in High and Extreme Risk Patients With Symptomatic Severe Aortic Stenosis) study is to evaluate the safety and effectiveness of the Navitor valve in patients with symptomatic, severe aortic stenosis who are at high or extreme surgical risk. Methods: PORTICO NG is a prospective, multicenter, global study with follow-up at 30 days, 1 year, and annually through 5 years. The primary endpoints are all-cause mortality and moderate or greater PVL at 30 days. Valve Academic Research Consortium-2 events and valve performance are assessed by an independent clinical events committee and echocardiographic core laboratory. Results: A total of 260 subjects were treated at 26 clinical sites across Europe, Australia, and the United States between September 2019 and August 2022. The mean age was 83.4 ± 5.4 years, 57.3% were female, and the average Society of Thoracic Surgeons score was 3.9% ± 2.1%. At 30 days, the rate of all-cause mortality was 1.9%, and no subjects had moderate or greater PVL. The rate of disabling stroke was 1.9%, life-threatening bleeding was 3.8%, stage 3 acute kidney injury was 0.8%, major vascular complications were 4.2%, and new permanent pacemaker implantation was 19.0%. Hemodynamic performance included a mean gradient of 7.4 ± 3.5 mm Hg and an effective orifice area of 2.00 ± 0.47 cm Conclusions: The Navitor valve is safe and effective for the treatment of subjects with severe aortic stenosis who are at high or greater risk for surgery, which is supported by low rates of adverse events and PVL. (Evaluation of the Portico NG [Next Generation] Transcatheter Aortic Valve in High and Extreme Risk Patients With Symptomatic Severe Aortic Stenosis [PORTICO NG]; NCT04011722).
MeSH term(s)	Humans ; Female ; United States ; Aged ; Aged, 80 and over ; Male ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Aortic Valve Stenosis/complications ; Transcatheter Aortic Valve Replacement/adverse effects ; Prospective Studies ; Treatment Outcome ; Postoperative Complications/etiology ; Heart Valve Prosthesis/adverse effects ; Prosthesis Design
Language	English
Publishing date	2023-02-27
Publishing country	United States
Document type	Multicenter Study ; Journal Article ; 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.2023.02.002
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Zs.A 6669: Show issues

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Article ; Online: 30-Day Outcomes With the Portico Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study.

Camuglia, Anthony C / Cole, Christopher M W / Boyne, Nicholas / Hayman, Sam M / Cox, Stephen V / Moore, Peter T / Lau, Jerrett K / Delacroix, Sinny / Williamson, Anna Emilie / Duong, MyNgan / Schwarz, Nisha / Montarello, Joseph K / Worthley, Stephen G

Heart, lung & circulation

2022 Volume 32, Issue 2, Page(s) 224–231

Abstract: Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico transcatheter heart valve (THV), (Abbott ...

Abstract	Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico transcatheter heart valve (THV), (Abbott Structural Heart, St Paul, MN, USA) have demonstrated the technical feasibility of this system albeit in the hands of relatively inexperienced Portico users. The objective of this study was to assess the real-world safety and efficacy of the Portico THV (with and without the FlexNav delivery system, Abbott Structural Heart) at the 30-day timepoint in an Australian cohort. Methods and results: This study was a retrospective real-world cohort analysis of 269 consecutive patients with severe aortic valve disease who underwent TAVI at multiple centres within Australia between February 2015 and April 2021. Of the 269 patients, 51.7% were female, mean Society of Thoracic Surgeons (STS) score was 5.2 (±6.8) and 98.5% had successful implantations. Thirty (30)-day post-implantation all-cause mortality was observed in one (0.4%) patient, major vascular complications in two (0.7%) patients, more-than-mild paravalvular leak in six (2.2%) patients and requirement for new permanent pacemaker implantation in 27 (10.2%) patients. Haemodynamic parameters at 30 days included mean effective orifice area (EOA) of 2.3 (±0.9) cm Conclusion: This analysis of the Portico THV in a real-world setting suggested that the system is associated with satisfactory safety and efficacy parameters. Previously published datasets may not have found similar findings owing to lower operator experience with the Portico THV system.
MeSH term(s)	Humans ; Female ; Male ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/surgery ; Retrospective Studies ; Treatment Outcome ; Heart Valve Prosthesis ; Australia/epidemiology ; Transcatheter Aortic Valve Replacement/methods ; Aortic Valve Disease/surgery ; Prosthesis Design
Language	English
Publishing date	2022-11-04
Publishing country	Australia
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2022.09.012
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Zs.A 4988: Show issues

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Article ; Online: Regarding "Severe bilateral renal artery stenosis after transluminal radiofrequency ablation of renal sympathetic nerve plexus".

Worthley, Stephen G / Tsioufis, Costas P / Papademetriou, Vasilios

Journal of vascular surgery

2015 Volume 62, Issue 2, Page(s) 539

MeSH term(s)	Catheter Ablation/adverse effects ; Female ; Humans ; Hypertension/surgery ; Hypertension, Renovascular/etiology ; Kidney/innervation ; Renal Artery Obstruction/etiology ; Sympathectomy/adverse effects
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2014.02.047
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Article: Intravenous Recombinant Tissue Plasminogen Activator Therapy for Acute Basilar Artery Ischemic Stroke Following Transfemoral Transcatheter Aortic Valve Implantation.

Montarello, Nicholas J / Nelson, Adam J / Sidharta, Samuel L / Worthley, Stephen G

The Journal of heart valve disease

2016 Volume 25, Issue 1, Page(s) 14–17

Abstract: Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the ... ...

Abstract	Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur. Many cardiologists would not instinctively consider the use of thrombolytic therapy for post-transfemoral TAVI ischemic stroke because of concern about the risk of major bleeding from the access site, despite it being a standard of care for ischemic stroke in other circumstances. The present case highlights the benefit of using intravenous thrombolytic therapy for an acute basilar artery thrombotic stroke after transfemoral TAVI (TF-TAVI) that would otherwise have almost certainly resulted in the patient's death. The case may also prompt interventional cardiologists to consider performing TF-TAVI under conscious sedation rather than general anesthesia, as this can result in an earlier detection of acute stroke and allow an earlier intervention with thrombolytic agents, with an improved outcome.
Language	English
Publishing date	2016-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1205265-6
ISSN	2053-2644 ; 0966-8519
ISSN (online)	2053-2644
ISSN	0966-8519
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Book: Cardiovascular imaging for clinical practice

Nicholls, Stephen J / Worthley, Stephen G

2011

Author's details	edited by Stephen J. Nicholls, Stephen G. Worthley
MeSH term(s)	Cardiovascular Diseases/diagnosis ; Diagnostic Imaging/methods ; Diagnostic Techniques, Cardiovascular
Language	English
Size	viii, 370 p. :, ill.
Publisher	Jones and Bartlett
Publishing place	Sudbury, Mass
Document type	Book
ISBN	9780763756222 ; 0763756229
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Peripheral embolization of aortic valve calcium following trans-femoral Sapien XT valve implantation requiring emergency surgical embolectomy.

Montarello, Natalie / Copus, Barbara / Prakash, Roshan / Worthley, Stephen G

International journal of cardiology

2015 Volume 181, Page(s) 17–18

MeSH term(s)	Aged, 80 and over ; Aorta, Thoracic/diagnostic imaging ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/surgery ; Calcinosis/diagnosis ; Calcinosis/etiology ; Humans ; Iliac Artery/diagnostic imaging ; Male ; Multidetector Computed Tomography ; Postoperative Complications/diagnosis ; Postoperative Complications/surgery ; Reoperation/methods ; Severity of Illness Index ; Thrombectomy/methods ; Thrombosis/diagnosis ; Thrombosis/etiology ; Thrombosis/surgery ; Transcatheter Aortic Valve Replacement/adverse effects ; Transcatheter Aortic Valve Replacement/methods ; Treatment Outcome
Language	English
Publishing date	2015-02-15
Publishing country	Netherlands
Document type	Case Reports ; Letter
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2014.11.215
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Zs.A 1673: Show issues

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Article ; Online: Endoventricular electromechanical mapping-the diagnostic and therapeutic utility of the NOGA XP Cardiac Navigation System.

Psaltis, Peter J / Worthley, Stephen G

Journal of cardiovascular translational research

2008 Volume 2, Issue 1, Page(s) 48–62

Abstract: Combined analysis of the electrical and mechanical function of the heart holds promise as a means of acquiring a better understanding of a variety of cardiac diseases that ultimately may lead to heart failure. The NOGA XP Cardiac Navigation System is a ... ...

Abstract	Combined analysis of the electrical and mechanical function of the heart holds promise as a means of acquiring a better understanding of a variety of cardiac diseases that ultimately may lead to heart failure. The NOGA XP Cardiac Navigation System is a unique, nonfluoroscopic, catheter-based technology that achieves real-time acquisition of three-dimensional, endoventricular electromechanical maps. Through the provision of point-by-point measurements of endocardial electrical activation and voltage and mechanical shortening, electromechanical mapping has been evaluated for its ability to identify regional myocardial ischemia and characterize tissue viability. A decade of preclinical and clinical research has verified its safety and feasibility and raised the possibility of its application as a diagnostic adjunct to conventional angiography in the catheterization laboratory. However, this role has not yet been realized outside of the research setting. Instead, a more prominent niche for NOGA XP has emerged as a therapeutic tool for guiding direct myocardial interventions, most notably the targeted administration of regenerative therapies (e.g., cells, genes) to the heart. In this review, we discuss the fundamental aspects of this electromechanical mapping system and the evidence for both its diagnostic and therapeutic utility.
MeSH term(s)	Action Potentials ; Algorithms ; Animals ; Cardiac Catheterization/instrumentation ; Electrophysiologic Techniques, Cardiac/instrumentation ; Equipment Design ; Heart Conduction System/pathology ; Heart Conduction System/physiopathology ; Heart Diseases/diagnosis ; Heart Diseases/physiopathology ; Heart Diseases/therapy ; Heart Ventricles/pathology ; Heart Ventricles/physiopathology ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Myocardial Contraction ; Predictive Value of Tests ; Reproducibility of Results ; Therapy, Computer-Assisted/instrumentation ; Time Factors ; Tissue Survival
Language	English
Publishing date	2008-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2422411-X
ISSN	1937-5395 ; 1937-5387
ISSN (online)	1937-5395
ISSN	1937-5387
DOI	10.1007/s12265-008-9080-7
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