Publications by authors named "Anthony A Bavry"
Article Synopsis
- Transcatheter aortic valve replacement (TAVR) is a treatment for severe aortic stenosis, mainly affecting older adults, requiring accurate frailty assessments for optimal patient selection.* -
- This study analyzed data from 14,000 patients at the University of Florida to improve frailty prediction for TAVR candidates by combining structured electronic health records and unstructured clinical notes, using advanced modeling techniques.* -
- The integrated model significantly outperformed those using only electronic health record data, identifying key frailty predictors, which may enhance patient outcomes in TAVR procedures.*
Article Synopsis
- Cardiogenic shock after acute myocardial infarction remains highly lethal, prompting researchers to analyze data from 16,337 cases across 440 centers to identify characteristics linked to lower mortality.
- The study found that centers with lower risk-adjusted in-hospital mortality rates typically had patients with fewer co-morbidities, performed more revascularizations, and showed better adherence to clinical processes.
- Despite the presence of some beneficial factors, not all low-mortality centers demonstrated these characteristics, indicating the complexity of treating cardiogenic shock and the challenges in evaluating outcomes in such cases.
Background: A single, multitiered valve center designation has been proposed to publicly identify centers with expertise for all valve therapies. The correlation between transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) procedures is unknown.
Objectives: The authors sought to examine the relationship between site-level volumes and outcomes for TAVR and MTEER.
Article Synopsis
- Frailty linked to worse outcomes post-transcatheter aortic valve replacement (TAVR) and is often underpinned by sarcopenia, which includes muscle mass, strength, and performance, though their impact on TAVR outcomes hasn't been fully studied.
- In a study of 445 patients with severe aortic stenosis, significant percentages were found to have slow gait (56%), weak grip (59%), and low muscle mass (42%); only slower gait speed showed a clear link to increased mortality after TAVR.
- The research indicates that while overall body fat measurements and sarcopenia criteria influence mortality risk, lower visceral fat and slow gait speed are main factors affecting post-TAVR death rates.
Background: Depression and cognitive dysfunction (CD) are not routinely screened for in patients before transcatheter aortic valve replacement (TAVR) and their association with postprocedural outcomes is poorly understood. The objectives of this study are to determine the prevalence of depression and CD in patients with aortic stenosis undergoing TAVR and evaluate their association with mortality and quality of life.
Methods: We analyzed a prospective, multicenter TAVR registry that systematically screened patients for preexisting depression and CD with the Patient Health Questionnaire-2 and Mini-Cog, respectively.
Article Synopsis
- Research indicates that metabolic dysfunction plays a role in heart changes due to aortic stenosis, but a significant study on human metabolism hasn't been done yet.
- In a study involving 519 patients, researchers examined 12 heart function metrics before valve implantation and identified three patterns of heart remodeling, linking these to specific metabolic profiles.
- A distinctive metabolite score for heart function was found to predict higher death rates post-surgery and was related to overall health issues, emphasizing the need to explore metabolic factors to improve patient outcomes after transcatheter aortic valve placement.
Background: Cardiac amyloidosis can coexist in patients with severe aortic stenosis. There are limited outcomes data on whether this impacts the risk of transcatheter aortic valve replacement (TAVR).
Objectives: The authors aimed to investigate the effect of amyloidosis on outcomes of TAVR.
The importance of medical therapy to ameliorate the incidence and impact of left ventricular assistance device-related gastrointestinal bleeding has been highlighted recently with several single-center studies. Electronic databases were searched for studies that compared the incidence of gastrointestinal bleeding for those people on left ventricular assist support with and without angiotensin II inhibition. Angiotensin II inhibition was associated with a lower incidence of gastrointestinal bleeding (pooled RR 0.
View Article and Find Full Text PDFObjective: Surgical aortic valve replacement (SAVR) has been the standard of care for severe aortic stenosis. In 2019, annual transcatheter aortic valve replacement (TAVR) implantations surpassed SAVR. We compared in-hospital costs and outcomes between these two procedures.
View Article and Find Full Text PDFObjective: Monitored anesthesia care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a Veterans Affairs Medical Center.
Methods: A single-center retrospective review was performed of 349 patients who underwent transfemoral TAVR (MAC, = 244 vs GA, = 105) from January 2014 to December 2019.
Article Synopsis
- Global longitudinal strain (GLS) serves as a measure of left ventricular function, and the study aimed to see if cardiac damage (troponin) and stress (NT-proBNP) biomarkers can enhance GLS effectiveness in identifying high-risk patients with severe aortic stenosis.
- In a study involving 499 patients who underwent transcatheter aortic valve implantation, it was found that patients with impaired GLS had higher levels of cardiac troponin and NT-proBNP compared to those with normal GLS.
- The analysis revealed that while lower GLS indicated increased mortality likelihood, the biomarkers of cardiac damage and stress were independently linked to mortality risk, suggesting that these biomarkers may be more reliable for assessing patient risk and timing for valve replacement.
Background: Low ejection fraction (EF) and low flow as determined by an echocardiographic stroke volume index (SVi) <35 mL/m are associated with low transvalvular gradients and increased mortality in both severe aortic stenosis (AS) and post-transcatheter aortic valve replacement (TAVR). Absence of an elevated echocardiographic transaortic gradient post-TAVR is considered a marker of procedural success despite the absence of data on its impact on mortality.
Objectives: The authors sought to examine the association of invasive and echocardiographic gradients post-TAVR with all-cause mortality in relation to flow and EF.
Background P2Y12 inhibitor medications are critical following percutaneous coronary intervention (PCI); however, adherence remains suboptimal. Our objective was to assess the effectiveness of a multifaceted intervention to improve P2Y12 inhibitor adherence following PCI. Methods and Results This was a modified stepped wedge trial of 52 eligible hospitals, of which 15 were randomly selected and agreed to participate (29 hospitals declined, and 8 eligible hospitals were not contacted).
View Article and Find Full Text PDFA 60-year-old female underwent a left ventricular assist device implantation during which a 1-mm Gore-Tex sheet was used to cover the device and outflow graft to prevent future sternal re-entry injury. Seven years later, she developed low-flow alarms with a pattern of gradual decline in flow and power suggestive of outflow graft obstruction. After a discussion with the multidisciplinary team, percutaneous stenting of the outflow graft was pursued.
View Article and Find Full Text PDFBackground Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP.
View Article and Find Full Text PDFCommentary: Shades of gray: The right aortic valve for the right patient in 2022.
J Thorac Cardiovasc Surg
September 2023
Objective: Elevated red blood cell distribution width (RDW) level has been shown to be associated with poor outcomes in patients with cardiovascular disease. Limited data are available regarding the prognostic value of RDW in transcatheter aortic valve replacement (TAVR) patients. Therefore, we aimed to investigate the impact of RDW variation on outcomes of TAVR patients.
View Article and Find Full Text PDFIntroduction: Limited data are available about the outcomes of transcatheter mitral valve replacement (TMVR) using transseptal approach in patients with prior mitral valve repair (valve-in-ring) or replacement (valve-in-valve) (TMViVR) and on modes of the prior surgical valve failures. We report our tertiary center TMVR experience in high surgical risk patients with prior mitral valve repair or replacement.
Methods: From December 2016 to January 2020, patients with symptomatic severe mitral valve stenosis and/or insufficiency at increased redo surgical risk were included.
Article Synopsis
- * In a study involving 6 inoperable patients with severe TR, they underwent percutaneous caval valve implantation (CAVI), which was successful with no procedural complications.
- * Improvements in TR severity were noted in some patients after the procedure, and the left ventricular ejection fraction increased significantly, suggesting that CAVI can be a viable short-term option for those with severe TR.