Pradeep K. Yadav

Training in Structural Heart Interventions

Over the last decade, there have been tremendous advances in our ability to treat valvular heart disease and anatomic cardiac defects utilizing catheter-based approaches. At the same time, the number of patients with acquired valvular heart disease or adult congenital heart disease who may benefit

Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures

Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid‐term assessment of thirteen cases.

Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty: Results from the Global cVAD Registry

BACKGROUND Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. METHODS Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >10 patients. RESULTS A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41±9.03years and most patients were male. Mean STS score was 18.77%±18.32, LVEF was 27.14%±16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p=0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p<0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. CONCLUSION In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.

Causes and hemodynamic findings in chronic severe pulmonary regurgitation

Severe pulmonary regurgitation (PR) most commonly occurs as a sequelae of treatment of pulmonic stenosis or Tetralogy of Fallot with fewer cases of primary pulmonic valvular regurgitation. The amount of PR is influenced by valvular integrity, right ventricular (RV) size, and RV diastolic pressures. In chronic severe PR, the RV remodels to accommodate the regurgitant flow and RV stroke volume increases to maintain effective forward blood flow. Hemodynamic changes include a widened pulmonary artery (PA) pulse pressure and low PA diastolic pressures. As the amount of regurgitation increases, RV end diastolic pressure becomes elevated and systemic cardiac output is reduced, especially with exercise. “Ventricularization” of the PA pressure tracing, in which the contour of the PA pressure is similar to the contour of the RV pressure, is a specific but not sensitive finding in severe PR.

State of Structural and Congenital Heart Disease Interventional Training in United States and Canada: An Assessment by the American College of Cardiology Fellows-in-Training Section Leadership Council.

The field of adult and pediatric interventional cardiology (PIC) has expanded considerably over the last decade. Given the recent advances like transcatheter aortic valve replacement, percutaneous mitral valve repair, and left atrial appendage closure, many cardiology training programs are offering

TCT-136 Outcomes of Hemodynamic Support with Impella in very high-risk patients undergoing Balloon Aortic Aortic Valvuloplasty: Results From the Global cVAD Registry

TCT-135 Increased circulating plasma-free hemoglobin levels, not lactate dehydrogenase, levels identify hemolysis among patients with cardiogenic shock treated with an Impella micro-axial flow catheter Michele Esposito, Ryan O’Kelly, Nima Aghili, Shiva Annamalai, Anas Hamadeh, Michael Kiernan, Amanda Vest, David DeNofrio, Navin Kapur Hospital U. Central de la Defensa “Gómez Ulla”, Boston, Massachusetts, United States; Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany; Tufts Medical Center, Boston, Massachusetts, United States; Departmenf of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany; 2 Dept. of Cardiology-Fondazione IRCCS Policlinico San Matteo, Pavia/Italy; Hospital U. Central de la Defensa “Gómez Ulla”; University Clinic of Jena, 1st Medical Department; University Clinic of Jena, 1st Medical Department; Tufts Medical Center, Boston, Massachusetts, United States

Size does matter but is there an obesity paradox in TAVR

Patients with low body mass index (<20 kg/m2) undergoing transcatheter aortic valve replacement have higher short‐ and long‐term mortality Low BMI is an important tool to consider in patient screening and prognostication Prospective study is needed to accurately assess the effects of BMI in TAVR patients, to prove or refute the obesity paradox

Fellows-in-Training & Early Career Page--The First Anniversary: A Vision, a Motivation, an Opportunity.

It has been 1 year since the publication of the inaugural Fellows-in-Training (FIT) & Early Career (EC) Page. Since then, every week, we have seen an incredible selection of ideas, concerns, advice, and questions from FIT and EC physicians. The interesting diversity of topics has provided an insight

Safety and Feasibility of Transradial Catheterization in Breast Cancer Survivors: A 2-Center International Experience.

The technical feasibility of transradial access (TRA) in breast cancer survivors is usually not a concern; even so, the perceived fear of lymphedema, both on the part of the survivor and medical staff, is the limiting factor. Cardiac catheterization and percutaneous coronary intervention using TRA

The role of multivessel coronary intervention in ST-segment elevation myocardial infarction complicated by cardiogenic shock: have we reached a verdict?

192 www.ccmjournal.org Cardiogenic shock (CS) complicates 7–10% of ST-segment elevation myocardial infarctions (STEMI). In the last decade, increased availability of percutaneous coronary intervention (PCI) has decreased the prevalence of CS in STEMI; despite this, mortality in these patients remains above 50%. It has been demonstrated that prompt PCI can improve outcomes among patients with STEMI complicated by CS (1, 2). A majority of these patients have associated multivessel disease (MVD) (3, 4) that is an independent predictor of mortality (5, 6). Optimal revascularization strategies in these patients remain controversial (7–13). Guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology state that only the infarctrelated artery (IRA) should be treated during the initial intervention for patients not in CS (14, 15). There are exceptions, although present guidelines do not explicitly recommend it. The Role of Multivessel Coronary Intervention in ST-Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Have We Reached a Verdict?*