Abhilash Akinapelli

Cardiac Rehabilitation in Patients With Left Ventricular Assist Device: A SYSTEMATIC REVIEW AND META-ANALYSIS

Purpose: Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to improve functional capacity in heart failure (HF). However, there are limited data on the effect of EBCR in patients with advanced HF and left ventricular assist devices (LVADs). This meta-analysis sought to evaluate the effects of EBCR on functional capacity in patients with LVAD. Methods: PubMed, Web of Science, CINAHL, and Cochrane Library databases were searched for randomized studies assessing the impact of EBCR in patients following LVAD implantation compared with standard therapy (ST). Using pre-defined criteria, appropriate studies were identified and selected. Data from selected studies were extracted in a standardized fashion and a meta-analysis was performed using a random-effects model with DerSimonian Liard weighting. Analysis employed weighted mean difference (WMD) as the effect size and intention-to-treat (ITT) principle. Study quality, publication bias, and heterogeneity were assessed. Results: Six trials with a total of 183 patients (EBCR: 125; ST: 58) were identified. Mean age was 51 years and 83% were males. The initiation of EBCR varied from LVAD implantation during the index hospitalization to 10 mo post-LVAD implantation. The median rehabilitation period ranged from 6 to 10 wk. Exercise-based cardiac rehabilitation was associated with improved peak oxygen uptake ( O2) in all trials. Quantitative analysis was performed on 3 randomized studies involving 61 patients (EBCR = 39, ST = 22). Exercise-based cardiac rehabilitation was associated with significantly greater peak O2 (WMD: 3.00 mL/kg/min; 95% CI: 0.64-5.35, P = .001). Similarly, 6-minute walk distance (6MWD) showed significantly greater improvement in the EBCR group than in the ST group (WMD: 60.06 m; 95% CI, 22.61-97.50, P = .002). Heterogeneity was low among the included trials. Exclusion sensitivity and per-protocol analysis demonstrated results consistent with ITT analysis. None of the included studies reported serious adverse events related to EBCR, which supports the safety of EBCR after LVAD implantation. Conclusion: This systematic review and meta-analysis demonstrated that EBCR following LVAD implantation is associated with greater improvement in functional capacity compared with ST as reflected by improved peak O2 and 6MWD. However, given the small number of patients, further research into the clinical impact of EBCR in LVAD patients is necessary.

Left Atrial Appendage Closure -The WATCHMAN Device.

Atrial fibrillation (AF) is one of the most common arrhythmias seen in clinical cardiology practice. Patients with non-valvular AF have an approximately 5-fold increase in the risk of stroke, with an exponential increase with advancing age. Cardioembolic strokes carry a high mortality risk. Although the potential of warfarin to reduce systemic embolization in AF patients is well established, its use is difficult due to narrow therapeutic windows and additional complications (e.g. increased risk of bleeding), especially for aging patients. Therefore, alternative means of treatment to reduce stroke risk in these patients are needed. The left atrial appendage is the major source of thrombus formation in patients with non-valvular AF. The WATCHMAN device (Boston Scientific, MA) is a percutaneous left atrial appendage closure device which has been tested prospectively in multiple randomized trials. It offers a new stroke risk reduction option for high-risk patients with non-valvular atrial fibrillation who are seeking an alternative to long-term warfarin therapy. Based on the robust WATCHMAN clinical program which consists of numerous studies, with more than 2,400 patients and nearly 6,000 patient-years of follow-up, the WATCHMAN LAAC Device is approved by FDA. In this article we reviewed the preclinical studies and clinical trials, as well as the next generation of the device.

Current State of Bioabsorbable Polymer-Coated Drug-Eluting Stents.

Drug-eluting stents (DES) have been shown to significantly reduce clinical and angiograph-ic restenosis compared to bare metal stents (BMS). The polymer coatings on DES elute antiproliferative drugs to inhibit intimal proliferation and prevent restenosis after stent implantation. Permanent poly-mers which do not degrade in vivo may increase the likelihood of stent-related delayed arterial healing or polymer hypersensitivity. In turn, these limitations may contribute to an increased risk of late clinical events. Intuitively, a polymer which degrades after completion of drug release, leaving an inert metal scaffold in place, may improve arterial healing by removing a chronic source of inflammation, neoath-erosclerosis, and/or late thrombosis. In this way, a biodegradable polymer may reduce late ischemic events. Additionally, improved healing after stent implantation could reduce the requirement for long-term dual antiplatelet therapy and the associated risk of bleeding and cost. This review will focus on bioabsorbable polymer-coated DES currently being evaluated in clinical trials.

TCT-771 Clinical and Hemodynamic Efficacy of Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Meta-Analysis

nos: 769 809 TCT-769 Ultrasound-assisted Catheter-Directed Thrombolysis in the Treatment of High Risk Pulmonary Embolism: A Meta-analysis Georges El Hayek, Michael McDaniel, henry liberman, Chandan Devireddy, Pete Fong, Gautam Kumar, Wissam Jaber Emory University, Atlanta, Georgia, United States; Emory, Atlanta, Georgia, United States; Emory, atlanta, Georgia, United States; Emory University, Atlanta, Georgia, United States; Unknown, Nashville, Tennessee, United States; Emory University / Atlanta VA Medical Center, Atlanta, Georgia, United States; Atlanta, Georgia, United States BACKGROUND Ultrasound-assisted Catheter-Directed Thrombolysis (US-CDT) has emerged as an alternative to systemic thrombolysis, known to be associated with up to 20% risk of major bleeding, in the treatment of high risk pulmonary embolism (PE). However its safety and efficacy remain controversial in the absence of randomized trials. We sought to perform a meta-analysis of the available studies evaluating the use of US-CDT. METHODS We searched Pubmed and Scopus databases for studies that used the US-CDT catheter for the treatment of PE. We excluded studies that involved thrombus fragmentation, rheolytic or rotational thrombectomy, suction thrombectomy or local thrombolysis without Ultrasound assistance. Our safety outcomes included mortality and major bleeding, defined as intracranial hemorrhage (ICH) or bleeding that requires interruption of thrombolytics, transfusion or surgical intervention. Our efficacy outcomes included post procedure reduction in mean pulmonary artery pressure (mPAP), in right ventricle/Left ventricle (RV/LV) ratio and in Miller score after the US-CDT therapy. RESULTS We included 15 studies in this analysis comprising 698 patients (Table). There was a 4% mortality rate and 5% risk of major bleeding; Only 3 patients (0.4%) experienced ICH. For efficacy outcomes, we observed a significant reduction in the mPAP by 8 mm Hg (95% CI 5.4-10.7; p<0.0001), a decrease in the RV/LV ratio by 0.35 (95% CI 0.27-0.45) and 10.2 points drop in Miller score (95% CI 7.2-13.2) after therapy. CONCLUSION US-CDT for high risk PE, though effective in reducing early signs of RV strain, is associated with a 5% risk of major bleeding. Randomized trials are needed to evaluate this therapy against anticoagulation alone and against systemic thrombolysis. CATEGORIES ENDOVASCULAR: Peripheral Vascular Disease and Intervention TCT-770 Abstract Withdrawn TCT-771 Clinical and Hemodynamic Efficacy of Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Meta-Analysis Arun Kanmanthareddy, alok saurav, Hemantha Koduri, JItendra Pandya, Abhilash Akinapelli, Aiman Smer, Muhammad Azzouz, Michael White, Anjali Vaidya, Scott Lilly Creighton University School of Medicine, Omaha, Nebraska, United States; Creighton University Medical Center, Omaha, Nebraska, United States; Creighton University School of Medicine, Omaha, Nebraska, United States; Creighton University School of Medicine; German Heart Center Munich; Omaha, Nebraska, United States; Creighton University, Omaha, Nebraska, United States; Creighton University, Omaha, Nebraska, United States; Temple University Hospital; univ penn, philadelphia, Pennsylvania, United States BACKGROUND Balloon pulmonary angioplasty (BPA) is an alternative to patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have contraindications to undergo pulmonary endarterectomy. METHODS We performed electronic search of PubMed, Google Scholar, EBSCO databases to identify studies evaluating the efficacy of BPA for the treatment of CTEPH. Pre-procedure and follow up hemodynamic data and 6-minute walk distance (6MWD) were extracted from the included studies. Weighted mean difference (WMD) with 95% confidence intervals were calculated using random or fixed effects model based on heterogeneity. All statistical analyses were performed using STATA 13.0 software. RESULTS A total of 10 studies with 268 patients were included in this study. The 6MWD increased by 83 meters (95% CI 59 – 108) after BPA. The mean pulmonary artery pressure (WMD 15.6, 95% CI 12.7 – 18.5 mm Hg), pulmonary capillary wedge pressure (WMD 1.2, 95% CI 0.5 – 1.9 mm Hg), pulmonary vascular resistance (WMD 295, 95% CI 75 – 515 dynes/cm/sec5), right atrial pressure (WMD 2.3, 95% CI 1.3 – 3.3 mm Hg) and BNP (WMD 158, 95% CI 123 – 194 pg/ml) decreased following BPA. The cardiac output (WMD 0.75, 95% CI 0.42 – 1.8 l/min) and cardiac index (WMD 0.53, 95% CI 0.22 – 0.84 l/min/m2) improved significantly after the BPA procedure. CONCLUSION BPA in the treatment of inoperable CTEPH appears to favorably improve functional capacity and is also associated with improvement in cardiopulmonary hemodynamic parameters. Our study results are limited by the small study population and lack of control subjects. CATEGORIES CORONARY: Angioplasty Overview and Outcomes TCT-772 High prevalence of pelvic venous compression syndrome among patients with chronic venous insufficiency and effective treatment with venous stenting Yu Xie, Abhimanyu Uberoi, Jill Tannerc, Samir Mehrotra, Norman Leporv, Hooman Madyoon

TCT-816 Trend of Utilization & Procedural Outcomes of Endomyocardial Biopsy in United States: A Nationwide Inpatient Sample Based Study

There is limited data on recent trends of utilization and procedural outcomes of endomyocardial biopsy (EMB) in the United States. In this report we aim to study the nationwide trends in the performance EMB and in-hospital outcomes using the National Inpatient Sample (NIS) database. NIS data was

EFFICACY OF ANTICOAGULATION IN PREVENTING THROMBOEMBOLISM AFTER BIO PROSTHETIC AORTIC VALVE REPLACEMENT: A META-ANALYSIS

The efficacy of oral anticoagulation (AC) after bio prosthetic aortic valve replacement (BPAVR) remains unclear. Current guidelines recommend AC for first three months after BPAVR, but there is significant variation in clinical practice. We performed a meta-analysis of studies comparing AC to

NATIONWIDE TRENDS IN PULMONARY ARTERY ENDARTERECTOMY FOR CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

Pulmonary artery endarterectomy (PAE) is a complex curative surgery for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and is performed in a limited number of centers across the United States. We used the nationwide inpatient sample (NIS), which is a 20% stratified sample of

MITRAL ANNULAR CALCIFICATION AND RISK OF STROKE IN SEVERE AORTIC STENOSIS: A PROPENSITY SCORE ANALYSIS

Mitral annular calcification (MAC) & aortic valve sclerosis/stenosis (AS) are both known to be associated with increased risk of ischemic stroke. The independent association of MAC with stroke in the presence of severe AS is largely unknown, which we wanted to explore in this study. We

Efficacy of Ezetimibe and Statin Versus Statin: A Meta-Analysis of Randomized Controlled Trials

Current ACC/AHA guidelines do not make recommendation to use Ezetimibe to reduce Atherosclerotic cardiovascular disease. Most recently, the IMPROVE-IT trial demonstrated improved cardiovascular outcomes with addition of Ezetimibe to statin (ES) compared to statin alone (S). We performed a Meta-

A SYSTEMATIC REVIEW OF PERCUTANEOUS CLOSURE OF RUPTURED SINUS OF VALSALVA ANEURYSM IN ADULTS

Sinus of Valsalva aneurysm (SVA) is a rare anomaly and is mostly congenital. It can rupture into one of the cardiac chambers leading to aorto-cardiac fistula. Urgent repair is recommended to prevent heart failure. Surgical repair with patch closure has been the treatment of choice. Percutaneous