Publications by authors named "Andrew Czarnecki"
Article Synopsis
- Acute mitral regurgitation (MR) following myocardial infarction (MI) can result from papillary muscle rupture (PMR), leading to high risks for patients; this study explores using transcatheter edge-to-edge mitral valve repair (TEER) as a treatment option.
- Data from 30 centers across Europe, North America, and the Middle East revealed that TEER was performed on 23 high-risk patients within a week of their MI, achieving procedural success in 87% and a significant reduction in MR severity.
- The outcomes indicated that 70% of patients could be discharged after treatment, showcasing TEER's potential as a viable emergency intervention or a bridge to further surgical options for critically ill patients with PM
Background: Wide geographic variation in access to transcatheter (TAVR) and surgical (SAVR) aortic valve replacement exists, but the impact of socioethnic factors on the geographic variation of AS management in Ontario, Canada, is unknown.
Methods: Neighbourhood rates of AS admissions, as a proxy for AS burden, and downstream TAVR and SAVR referrals and procedures were estimated for the 76 subregions in Ontario. To determine if the socioethnic geographic variations in referrals and procedures were concordant or discordant with AS burden, we calculated Pearson correlation coefficients to determine the relationship between AS burden and each of TAVR referrals, TAVR procedures, SAVR referrals, or SAVR procedures.
Article Synopsis
- - The study explored the effectiveness of transcatheter edge-to-edge repair (TEER) for patients with significant mitral regurgitation (MR) who are also experiencing cardiogenic shock (CS), analyzing data from almost 3,800 patients over eight years.
- - It found that a successful TEER procedure, defined by notable reductions in MR, was achieved in 85.6% of patients, leading to better health outcomes, including significantly lower rates of mortality and heart failure hospitalizations one year post-procedure.
- - The authors concluded that while TEER can be effectively applied in CS patients, further randomized trials are necessary to fully validate its benefits as a treatment option.
Article Synopsis
- Functional mitral regurgitation (MR) is critical in heart failure patients, and the CAPITAL MINOS trial investigates the impact of transcatheter edge-to-edge repair (TEER) on patients with cardiogenic shock (CS) and MR since this area hasn't been randomized before.!* -
- The study involves 144 patients with advanced CS and significant MR, comparing TEER against standard medical therapy to see which provides better clinical outcomes, including survival and quality of care during hospitalization.!* -
- Findings from the CAPITAL MINOS trial will help clarify the effectiveness of TEER in this high-risk group, potentially leading to improved treatment strategies for patients experiencing both CS and MR.!*
Objectives: The objective of this study was to determine the effect of transcatheter mitral valve repair (TMVr) on hospitalization rates by assessing pre- and postprocedural hospitalization patterns.
Background: TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation, but the impact of these procedures on hospital utilization remains unclear.
Methods: All patients who underwent TMVr in Ontario, Canada, between 2011 and 2017 were included in this observational study using population-based data.
Article Synopsis
- Severe mitral regurgitation (MR) after acute myocardial infarction (MI) is linked to high mortality, prompting a study of outcomes for different treatment methods, including conservative, surgical, and percutaneous interventions.
- A total of 471 patients were analyzed, showing that early intervention (either surgical or percutaneous) led to lower in-hospital and one-year mortality rates compared to conservative treatment, despite patients in intervention groups being in worse clinical condition.
- While immediate success rates were similar for surgical mitral valve repair and percutaneous methods, the surgical approach had higher in-hospital and one-year mortality rates, suggesting percutaneous repair may be a safer alternative to surgery.
Article Synopsis
- * A study analyzed data from 21 centers and included 105 patients treated with MitraClip within 90 days post-MI, comparing outcomes between those with left ventricle ejection fraction (LVEF) below and above 35%.
- * Results showed significant improvements in MR severity and heart function for both groups, with similar mortality rates in the hospital and after a year, indicating that even patients with severe heart dysfunction can safely undergo this procedure.
Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: Effect of cardiogenic shock on outcomes (IREMMI Registry).
Catheter Cardiovasc Interv
May 2021
Objectives: To assess outcomes in patients with acute mitral regurgitation (MR) following acute myocardial infarction (AMI) who received percutaneous mitral valve repair (PMVR) with the MitraClip device and to compare outcomes of patients who developed cardiogenic shock (CS) to those who did not (non-CS).
Background: Acute MR after AMI may lead to CS and is associated with high mortality.
Methods: This registry analyzed patients with MR after AMI who were treated with MitraClip at 18 centers within eight countries between January 2016 and February 2020.
Article Synopsis
- Implementation of gene editing technologies like CRISPR/Cas9 could revolutionize cell-based therapies with precise and lasting genome modifications without using viral vectors.
- A new microfluidic device for electroporation was developed to enhance the delivery of gene-editing components to target cells, overcoming limitations of current commercial machines designed for research rather than mass production.
- The device achieved up to 95% efficiency in gene delivery to human T cells, processing up to 500 million cells at a rapid rate, and has potential to scale production for large-scale cellular therapies.
Background: Rehospitalization rates post-transcatheter aortic valve replacement (TAVR) are high; however, it is not known how these compare with pre-TAVR hospitalization rates. Our objective was to determine the association between the index TAVR and hospitalization rates pre- and postprocedure.
Methods: A retrospective observational study was performed including all TAVR procedures performed in Ontario, Canada, between 2013 and 2017.
Association Between Hospital Teaching Status and Outcomes After Out-of-Hospital Cardiac Arrest.
Circ Cardiovasc Qual Outcomes
December 2019
Article Synopsis
- There is ongoing debate regarding the best way to organize care for patients with out-of-hospital cardiac arrest (OHCA), particularly in Canada, where teaching hospitals could offer better treatment options.
- A study analyzed data from Ontario to compare 30-day survival rates of OHCA patients treated at teaching hospitals versus non-teaching hospitals, including over 25,000 patients from 2007 to 2014.
- Results indicated a higher survival rate (13.9% vs. 11.0%) for patients at teaching hospitals, especially among younger age groups, supporting the idea that specialized hospitals may provide better care for these patients.
Treatment of patients presenting with cardiogenic shock due to acute mitral regurgitation related to papillary muscle rupture poses significant challenges, owing to the high risk associated with conventional surgery. We hereby report successful transcatheter mitral valve edge-to-edge repair with the new Mitraclip XTR device (Abbott Vascular, Santa Clara, CA) in a patient with acute myocardial infarction and cardiogenic shock. Although surgical intervention remains the standard of care, the new MitraClip XTR system offers a novel treatment option for patients with papillary muscle rupture by overcoming the anatomic challenges often seen in this pathology.
View Article and Find Full Text PDFBackground Readmission rates are a widely accepted quality indicator. Our objective was to develop models for calculating case-mixed adjusted readmission rates after transcatheter aortic valve replacement for the purpose of profiling hospitals. Methods and Results In this population-based study in Ontario, Canada, we identified all transcatheter aortic valve replacement procedures between April 1, 2012, and March 31, 2016.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to analyze differences in treatment approaches for asymptomatic patients with stable ischemic heart disease, specifically focusing on revascularization versus medical therapy, and to identify predictors of these variations and their impact on clinical outcomes.
- Researchers conducted a retrospective analysis of 9,897 patients from Ontario, Canada, revealing that 53% underwent revascularization, with a significant 2-fold difference in treatment rates across hospitals.
- Despite the observed variation in treatment, the study found that revascularization was associated with lower risks of death and nonfatal myocardial infarction, indicating consistent clinical benefits regardless of hospital practices.
Article Synopsis
- High rates of hospital readmission (49%) were found among patients who underwent trans-catheter aortic valve replacement (TAVR), mainly due to heart failure and bleeding complications.
- The study analyzed data from 937 TAVR patients in Ontario, linking clinical outcomes with transitional care factors like rehab and follow-up care.
- No transitional care factors were found to be associated with reduced readmission rates, indicating the need for further research to enhance post-procedural care.
Article Synopsis
- A study in Ontario, Canada tracked nearly 38,000 patients hospitalized for aortic stenosis (AS) from 2004 to 2013, revealing a slight rise in hospitalization rates, especially in those aged 85 and older.
- The rate of hospitalization for this age group jumped by 29%, reflecting an increasing burden of AS on the healthcare system.
- While 36.2% of patients received aortic valve treatments shortly after hospitalization, significant improvements in survival rates were noted among those who were treated, unlike those who did not receive intervention.
Wireless neural stimulators are being developed to address problems associated with traditional lead-based implants. However, designing wireless stimulators on the sub-millimeter scale (<1 mm) is challenging. As device size shrinks, it becomes difficult to deliver sufficient wireless power to operate the device.
View Article and Find Full Text PDFBackground: Routine stress testing is commonly used after percutaneous coronary intervention (PCI) to detect in-stent restenosis or suboptimal procedure results; however, recent studies suggest that such testing is rarely indicated. Our main objectives were to assess temporal trends in utilization of stress testing and to determine factors associated with its use.
Methods: We conducted an observational study involving all patients who had undergone PCI in Ontario, Canada, from Apr.
Article Synopsis
- Elderly patients who undergo transcatheter aortic valve replacement (TAVR) may face hospital readmissions, and this study aims to understand the relationship between hospital stay length and readmission risk.
- Researchers analyzed data from 709 patients who had elective TAVR procedures, measuring their hospital stay length and tracking readmissions at 30 days and 1 year.
- The findings revealed that a shorter hospital stay after TAVR was not linked to increased readmission within 30 days or 1 year, but longer stays were associated with a higher risk of readmission after one year.
An implantable, designed-for-human-use peripheral nerve stimulation and recording system for advanced prosthetics.
Annu Int Conf IEEE Eng Med Biol Soc
August 2016
Complex suture prostheses that deliver sensory and position feedback require a more sophisticated integration with the human user. Here a micro-size active implantable system that provides many-degree-of-freedom neural feedback in both sensory stimulation and motor control is shown, as one potential human-use solution in DARPA's HAPTIX program. Various electrical and mechanical challenge and solutions in meeting both sensory /motor performance as well as ISO 14708 FDA-acceptable human use in an aspirin-size active implementation are discussed.
View Article and Find Full Text PDFTranscatheter aortic valve implantation (TAVI) is the treatment of choice for inoperable and high-risk patients with severe aortic stenosis. Our objectives were to elucidate potential differences in clinical outcomes and safety between balloon-expandable versus self-expandable transcatheter heart valves (THV). We performed a retrospective cohort study of all transfemoral TAVI procedures in Ontario, Canada, from 2007 to 2013.
View Article and Find Full Text PDFClinical outcomes after trans-catheter aortic valve replacement in men and women in Ontario, Canada.
Catheter Cardiovasc Interv
September 2017
Objective: Our objective was to evaluate sex-differences in outcomes after trans-catheter aortic valve replacement (TAVR) in a population-based cohort from Ontario, Canada.
Background: Prior studies comparing outcomes in men and women after TAVR have yielded divergent results. Some studies have suggested that women have better survival than men while others have not corroborated this finding.
An implantable 64-channel neural interface with reconfigurable recording and stimulation.
Annu Int Conf IEEE Eng Med Biol Soc
August 2015
Article Synopsis
- Next-generation implantable medical devices aim to enhance therapies using adaptive closed-loop controllers that can sense and stimulate multiple electrode channels.
- A key challenge is balancing increased functionality and channel counts with the need for miniaturization for successful implantation in small anatomical spaces.
- The solution involves a miniaturized, fully-reconfigurable system that can dynamically configure up to 64 electrodes for improved sensing and stimulation, with safety features and robust communication capabilities, designed for applications like brain neuromodulation.
Unlabelled: β-Blocker therapy is one of the most commonly prescribed treatments for patients with cardiac conditions. In patients with out-of-hospital cardiac arrest (OHCA), however, recent data suggest that prior treatment with β-blockers could be harmful by lowering the incidence of a shockable presenting rhythm. The main objective of our study was to determine the association between prior β-blocker use and mortality in OHCA patients.
View Article and Find Full Text PDF