Donald Williams

New-Onset Atrial Fibrillation After Aortic Valve Replacement : Comparison of Transfemoral, Transapical, Transaortic, and Surgical Approaches

OBJECTIVES This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. BACKGROUND The relative incidences of AF associated with the various access routes for AVR have not been well characterized. METHODS In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. RESULTS AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). CONCLUSIONS AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.

Management of paravalvular regurgitation after Edwards SAPIEN transcatheter aortic valve replacement: management of paravalvular regurgitation after TAVR.

With the expansion in the use of transcatheter valve therapies for aortic stenosis, the incidence of hemodynamically significant paravalvular regurgitation (PVR) has become a clinical challenge.

Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement

We investigated the long‐term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States.

Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery

OBJECTIVES Improved understanding of presurgical risk factors for transfusions will lead to reduction in their number and related complications. The goal of this study is to identify these factors in coronary artery bypass graft (CABG) surgery. METHODS Presented herein are results of analyses of data from an ongoing study of transfusion in CABG surgery. Of 122 patients, 81 received transfusion (Tx) and 41 did not (NoTx). In addition to routine tests, presurgical levels of microparticles from platelets (PMPs), red cells (RMPs), and other lineages were assayed. RESULTS The Tx and NoTx groups were similar with respect to most presurgical variables but differed in distribution of gender, blood type, diabetes prevalence, activated partial thromboplastin time (aPTT), hemoglobin (HGB), and microparticle levels. Stepwise multiple logistic regression was used to evaluate presurgical variables and to develop a model to assess risk factors for transfusion. CD41(+) PMP and CD235(+) RMP levels were found to be the main risk factors for transfusion. The Models discriminating ability was assessed using receiver operating characteristic curve analysis, which showed that the area under the model curve (± standard error) was 0.86 ± 0.04 (95% confidence interval, 0.77-0.94). According to the model, patients with higher presurgical levels of circulating CD41(+) PMP, CD235a(+) RMP, and HGB, as well as a shorter aPTT, are less likely to receive transfusion(s). CONCLUSIONS Presurgical levels of CD41(+) PMPs and CD235a(+) RMPs are the main risk factors for transfusion in CABG, followed by HGB and aPTT.

TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN A LOW TO INTERMEDIATE RISK POPULATION

The results of studies comparing the clinical efficacy of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (AVR) in low to intermediate risk patients are not yet available. We compared outcomes in patients undergoing TAVR with low Society for Thoracic Surgery (

Clinical outcomes with on‐label and off‐label use of the transcatheter heart valve in the United States

We explored the efficacy, safety, and clinical consequences of on‐label and off‐label transcatheter aortic valve replacement (TAVR) in the real‐world setting.

Impact of CMS coverage decision on access to transcatheter aortic valve replacement

To assess the impact of the Centers for Medicare and Medicaid Services (CMS) national coverage determination (NCD) on access for patients with aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) in a tertiary care center.

Management of transcatheter aortic valve embolization into the left ventricle

Embolization of transcatheter aortic valve replacement (TAVR) prostheses is a rare and serious procedural complication. While embolization into the aorta can sometimes be managed by transcatheter techniques, embolization into the left ventricle (LV) often requires immediate open heart surgery. We report three TAVR cases complicated by LV embolization. In each case, successful implantation of a second transcatheter prosthesis was accomplished, followed by surgical removal of the first embolized device. doi: 10.1111/jocs.12475 (J Card Surg 2015;30:360–363)

Case Report of Cardiac Arrest, Abdominal Compartment Syndrome, and Thoracic Aortic Injury with Endovascular Repair of Thoracic Aortic Tear

Abstract  The introduction of thoracic endografts has revolutionized the management of thoracic aortic disease. Currently, endografts are not FDA‐approved for treating thoracic aortic injury (TAI). We report a case of TAI who presented in hemorrhagic shock and preoperative cardiac arrest who was successfully treated with large volume resuscitation, closed chest cardiac massage, exploratory laparotomy, and thoracic endografting.

Harmonic Scalpel for Pericardiectomy: Novel Approach to an Old Cardiac Dilemma

BACKGROUND Pericardiectomy for constrictive or calcific pericarditis is a technical challenge because of dense adhesions to the epicardial surface of the heart. The procedure is fraught with the possibility of urgent cardiopulmonary bypass from excessive bleeding or cardiac laceration. We propose the use of a harmonic scalpel to perform adhesiolysis with less bleeding and cardiac trauma. METHODS AND MATERIALS A retrospective review of 7 pericardiectomies performed with a handheld harmonic scalpel over the past 2 years was performed. Requirements for blood products, the need for cardiopulmonary bypass, and mortality were examined. RESULTS Four of the patients underwent pericardiectomy alone, and 3 patients underwent pericardiectomy with additional cardiac procedures. The 30-day mortality was zero. No patient needed blood transfusions or urgent cardiopulmonary bypass for bleeding. No patient developed malignant arrhythmias. CONCLUSIONS Use of a harmonic scalpel is a safe and efficient technique for pericardiectomy. Adhesiolysis is less treacherous because of the bloodless operative field; moreover, the harmonic scalpel is not arrhythmogenic.