Publications by authors named "Chetan Huded"
Article Synopsis
- This study investigated the effect of mitral stenosis (MS) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with modern balloon-expandable valves, using data from over 327,000 patients across multiple centers.
- It was found that while patients with severe MS initially had worse outcomes, when matched for similar characteristics, their 30-day outcomes were similar to those with mild or less MS, except for a higher rate of pacemaker implantation.
- However, by three years post-TAVR, patients with severe MS showed a significantly higher mortality rate compared to those with mild or less MS, suggesting long-term risks associated with severe MS.
Background: Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain.
Objectives: This study sought to describe outcomes of MTEER for sMR with preserved LVEF.
Methods: Using the STS/ACC TVT (Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%.
Article Synopsis
- Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) was studied using either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) for guidance, but there's a lack of comparative data on these methods.
- The study analyzed data from 964 patients who underwent these procedures between 2016 and 2020, matching 327 patients in each group for a fair comparison of outcomes like in-hospital adverse events, length of stay, cost, and 30-day readmissions.
- Results showed no significant difference in adverse events between the methods, but ICE was linked to lower hospitalization costs compared to TEE, indicating ICE
Normal-Flow Low-Gradient Aortic Stenosis: Comparing the U.S. and European Guidelines.
JACC Cardiovasc Imaging
August 2024
Patients with normal-flow low-gradient (NFLG) severe aortic stenosis present both diagnostic and management challenges, with debate about the whether this represents true severe stenosis and the need for valve replacement. Studies exploring the natural history without intervention have shown similar outcomes of patients with NFLG severe aortic stenosis to those with moderate aortic stenosis and better outcomes after valve replacement than those with low-flow low-gradient severe aortic stenosis. Most studies (all observational) have shown that aortic valve replacement was associated with a survival benefit vs surveillance.
View Article and Find Full Text PDFBackground: Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed.
Methods: This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre.
Article Synopsis
- - The study focused on Mitral valve transcatheter edge-to-edge repair (MTEER) for functional mitral regurgitation (FMR), evaluating patients not included in the COAPT trial, analyzing outcomes through the Transcatheter Valve Therapy Registry data from 2013 to 2020.
- - Out of 6,675 patients, 55.7% were eligible and 44.3% were ineligible for the trial, with ineligible patients experiencing lower procedural success and more in-hospital complications but similar health status improvements at 30 days post-procedure.
- - However, trial-ineligible patients had a significantly higher risk of death or hospitalization due to heart failure within a year, highlighting differences in
Article Synopsis
- The study examines the use of cerebral embolic protection devices (CEPD) during transcatheter aortic valve implantation (TAVI) across US hospitals to understand their effectiveness in preventing strokes.
- Out of over 41,800 TAVI procedures analyzed, only 10.6% utilized CEPD, with 65.8% of hospitals not using these devices.
- Results indicated no significant differences in stroke or death rates between hospitals that used CEPD and those that did not, while costs were found to be lower in non-user hospitals.
Severe aortic stenosis (AS) carries a poor prognosis with the onset of heart failure (HF) symptoms, and surgical or transcatheter aortic valve replacement (AVR) is its only definitive treatment. The management of AS has seen a paradigm shift with the adoption of transcatheter aortic valve replacement (TAVR), allowing for the treatment of AS in patients who would not otherwise be candidates for surgical AVR. Despite improving long-term survival after TAVR in recent years, residual HF symptoms and HF hospitalization are common and are associated with an increased mortality and a poor health status.
View Article and Find Full Text PDFBackground: Little is known about the outcomes of transcatheter aortic valve replacement (TAVR) in minimally symptomatic patients.
Objectives: The authors aimed to evaluate the outcomes of patients with minimally symptomatic severe aortic stenosis treated with TAVR in the STS/ACC TVT registry.
Methods: Minimally symptomatic status was defined as a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) ≥75.
Background: Intracoronary (IC) imaging for percutaneous coronary intervention (PCI) is associated with better patient outcomes and carries a class IIA guideline recommendation, but it remains rarely used. We sought to characterize hospital-level variability in IC imaging for PCI in the United States and to identify factors that may explain this variability.
Methods: Patients who underwent PCI, with or without IC imaging, in the Nationwide Readmissions Database (2016-2020) were included.
Rehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial.
Circ Cardiovasc Interv
December 2022
Background: Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status.
Methods: The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I' II' and III trials (Placement of Aortic Transcatheter Valves).
Trends in invasive treatment of patients hospitalized with aortic stenosis complicated by cardiogenic shock.
Catheter Cardiovasc Interv
November 2022
Background: Before the development of transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty (BAV) was the only potential nonsurgical intervention for patients with aortic stenosis complicated by cardiogenic shock. Emergent TAVR is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for aortic stenosis and cardiogenic shock among patients received invasive intervention have shifted since TAVR was introduced.
View Article and Find Full Text PDFArticle Synopsis
- A study aimed to examine if a comprehensive STEMI protocol reduced disparities between sexes in heart attack treatment over five years.
- Before the protocol was implemented, females had worse outcomes compared to males, including lower rates of guideline-directed therapy and higher in-hospital mortality.
- After the protocol was introduced, sex differences in treatment outcomes improved, but higher bleeding rates in females remained a concern.
Article Synopsis
- A study evaluated the impact of a comprehensive protocol for treating ST-segment-elevation myocardial infarction (STEMI) on patient outcomes based on their socioeconomic status.
- The protocol included guideline-driven medical therapy, transradial procedures, and quicker response times, leading to improved efficiency in achieving treatment goals across all socioeconomic groups.
- Results showed a significant decrease in in-hospital mortality for patients from moderate and high deprivation areas after implementing the protocol, indicating that standardized care can effectively reduce health disparities.
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively.
View Article and Find Full Text PDFBackground: Cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI).
Methods: We reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI.
Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge.
View Article and Find Full Text PDFOutpatient follow-up after hospital discharge improves continuity of care and reduces readmissions, but rates of follow-up remain low. It is not known whether electronic medical record (EMR)-based tools improve follow-up. The aim of this study was to determine if an EMR-based order to secure cardiology follow-up appointments at hospital discharge would improve follow-up rates and hospital readmission rates.
View Article and Find Full Text PDFObjectives: The objective of this study is to identify and model risk factors for major adverse cardiac events (MACE) and all-cause mortality among patients with ESRD treated with PCI using DES.
Background: Patients with end-stage renal disease (ESRD) have poor long-term outcomes after percutaneous coronary intervention (PCI) compared with non-ESRD patients. However, there is a paucity of literature regarding risk factors associated with outcomes of ESRD patients after PCI with drug-eluding stents (DES).
Article Synopsis
- TAVI is a heart procedure for fixing a valve called the aortic valve, but it's rarely used for a problem called aortic regurgitation (AR) in the USA.
- There are no approved devices specifically for AR, and other medical studies show that TAVI doesn't work as well for AR as it does for related conditions like aortic stenosis (AS).
- Newer devices like the JenaValve and J-Valve are being developed that might work better for AR, but more research is needed to prove they are safe and effective.