Publications by authors named "George Isaac"
One-year patency of a novel biorestorative polymeric coronary artery bypass conduit.
Interdiscip Cardiovasc Thorac Surg
December 2024
Coronary artery bypass graft (CABG) surgery remains the gold standard in the treatment of complex coronary artery disease. Saphenous vein grafts (SVG) are commonly used for the non-left anterior descending artery. However, SVG failure rates in CABG surgery have been reported to be as high as 30% at 1 year and ∼50% at 10 years.
View Article and Find Full Text PDFImportance: It remains unknown whether outcomes of the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) and Evolut Low Risk trials are comparable with surgical outcomes in nontrial settings, considering the added risk of concomitant cardiac operations.
Objective: To compare 30-day mortality and stroke incidences of patients in the surgical aortic valve replacement (SAVR) arm of low-risk trials with those of similar patients in the US Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).
Design, Setting, And Participants: A cross-sectional sampling study was conducted of adults in the STS ACSD with severe aortic stenosis at low surgical risk for AVR who underwent SAVR during the years low-risk AVR trials (PARTNER 3 and Evolut Low Risk) were enrolling (calendar years 2016-2018).
Aortic Dissection Following Transcatheter Aortic Valve Replacement.
Semin Thorac Cardiovasc Surg
December 2024
Transcatheter Aortic Valve Replacement (TAVR) continues to grow in popularity and has become the preferred mechanism for the treatment of aortic stenosis in most patients. Despite significant improvements in the safety of TAVR, complications remain inevitable. Aortic dissection, although rare, is a feared complication following TAVR.
View Article and Find Full Text PDFValve-in-valve transcatheter aortic valve replacement for failed Perceval sutureless valves has been shown to be safe and feasible. However, it is technically challenging and warrants understanding of potential risks and complications. We present a case of successful valve-in-valve implantation complicated by inadvertent wire passage outside of the Perceval frame.
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- Aortic stenosis is the most common heart valve disease in the West, traditionally treated with surgical aortic valve replacement (SAVR) but now increasingly with transcatheter aortic valve replacement (TAVR).
- Patients over 65 usually receive bioprosthetic tissue valves, and there's uncertainty in choosing between TAVR and SAVR.
- The management of patients with bioprosthetic valves should be personalized based on individual anatomy and overall risk to enhance life expectancy and reduce long-term complications.
Article Synopsis
- Limited data on strain changes after TAVI in patients with aortic regurgitation (AR) was explored in this study.
- Three patients experienced an initial decrease in global longitudinal strain (GLS) after TAVI, but showed significant improvement within the first year.
- The results suggest that GLS may be a better indicator than left ventricular end-diastolic diameter ratio for evaluating patients with severe volume overload.
Article Synopsis
- New postprocessing software enables 3D echocardiographic assessment of mitral annular and neo-left ventricular outflow tract dimensions in patients undergoing transcatheter mitral valve replacement.
- This study compares the accuracy of 3D echocardiographic analysis to that of baseline computed tomography in these measurements among 105 patients.
- Results show TEE underestimates mitral annular dimensions but gives comparable predictions for neo-LVOT area and peak gradients when compared to CT measurements.
Article Synopsis
- * The microbiology of IE has changed, with Staphylococci now being the main culprits, surpassing Streptococci, and new pathogens contributing to more severe cases, which lead to higher morbidity and mortality rates.
- * Due to the high virulence and increasing drug resistance of these pathogens, timely diagnosis and often surgical intervention are critical, necessitating advancements in diagnostic and treatment methods as the disease continues to evolve.
Article Synopsis
- * Researchers investigated somatostatin receptor (SSTR) expression in cardiac samples from patients with end-stage ischemic cardiomyopathy (ICM) and controls, finding decreased SSTR5 and increased SSTR1 and SSTR2 in the ICM samples.
- * The findings suggest SSTR can be upregulated in cardiac fibrotic areas, indicating that when using 68Ga-DOTATATE PET imaging for detecting cardiac conditions, unusual tracer uptake in these fibrotic areas
The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx).
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- Augmented reality (AR) can enhance transcatheter aortic valve replacement (TAVR) procedures by providing visualization of 3D patient-specific anatomical models, potentially increasing safety and efficiency during the placement of cerebral embolic protection devices (CEP).
- A study involving 24 patients compared those using AR guidance to a control group, finding that AR guidance significantly reduced the contrast volume needed for the procedure while not affecting the time taken for filter placement or fluoroscopy.
- Postprocedure feedback from physicians indicated that AR guidance boosted their confidence in performing the procedure, suggesting it improved overall intervention performance despite similar procedural times.
Background: Although adverse technical events during aortic root replacement (ARR) are not uncommon and are extremely challenging, there is scant literature to help surgeons prepare for such situations. We describe our experience of outstanding technical events during ARR.
Methods: This is a retrospective study of 830 consecutive ARRs at a single center from 2012 to 2022.
Article Synopsis
- A study on patients undergoing transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve found that 12.5% required a permanent pacemaker (PPM) within 30 days post-procedure.
- Predictors of needing PPM included factors like older age, pre-existing heart block, larger valve size, and deeper implantation.
- Despite requiring a new PPM, these patients did not experience higher rates of death or hospitalization over 5 years, and factors like valve sizing may help lower PPM rates in the future.
Article Synopsis
- * RMVI procedures were mostly successful at a rate of 80%, but patients who underwent RMVI experienced increased heart failure hospitalizations compared to those who did not.
- * Characteristics of patients needing RMVI included larger mitral annular diameters and more severe MR at discharge, with potential reasons for RMVI stemming from initial procedure failures or residual severe MR.
Article Synopsis
- New echo software helps with screening patients before they get a transcather mitral valve (MV) implantation.
- It allows the virtual valve to be displayed directly within 3D datasets for better visualization.
- This tool is particularly beneficial for patients who can't have contrast-enhanced cardiac CT scans.
Article Synopsis
- Orthotopic transcatheter tricuspid valve replacement (TTVR) devices are effective in treating tricuspid regurgitation (TR) and have gained attention after the first device received commercial approval.
- Studies show that about 35% of patients undergoing TTVR have preexisting cardiac implantable electronic device (CIED) leads, which may become entrapped during the procedure, raising concerns about safety.
- A consensus document outlines the patient demographics concerning CIED lead-related TR, evaluates the risks of lead entrapment versus transvenous lead extraction, and suggests that a specialized electrophysiologist be included in the treatment team for better decision-making.
Treatment options for isolated aortic valve insufficiency: a review.
Front Cardiovasc Med
April 2024
Aortic insufficiency (AI) is a valvular disease with increasing prevalence in older patients. The modern era provides numerous options for the management of AI which is explored here. Traditional interventions included aortic valve replacement with either mechanical or bioprosthetic aortic valves.
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- Surgical mitral valve repairs may not hold up over time, leading to potential repeat surgeries; transcatheter mitral valve-in-ring (MViR) offers a new option for high-risk patients.
- A study analyzed outcomes of MViR involving 820 patients, with most in poor heart function classes and significant mitral regurgitation; initial results showed a 30-day mortality rate of 8.3% and a 1-year rate of 22.4%.
- At one year, MViR patients experienced improvements in heart function and reduced mitral regurgitation, but there were concerns about elevated pressure gradients and a 9.1% reintervention rate, affirming MViR as a viable
Article Synopsis
- The study investigates the Trilogy transcatheter heart valve as a treatment for patients with native aortic regurgitation who are at high risk for surgery-related complications and mortality.
- Conducted as the ALIGN-AR trial, it enrolled 180 symptomatic patients across 20 US sites, assessing both safety and efficacy of the heart valve over a one-year period.
- Results showed a high technical success rate (95%), with low incidences of 30-day complications, including deaths and strokes, indicating potential benefits of this non-surgical intervention for high-risk patients.
Background: There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI).
Aims: We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3.
Methods: Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV.
The treatment of aortic and mitral valve disease requiring replacement has shifted to an increasing use of bioprosthetic heart valves. Due to their limited durability, there is a growing need for reintervention in the setting of failing bioprosthesis. Even though the gold standard for the treatment of failed bioprosthesis remains surgical repair or replacement, valve-in-valve (ViV) transcatheter aortic and mitral valve replacement have emerged as safe and effective alternatives for patients who are at high or prohibitive risk for surgery.
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- The study aimed to assess the effects of patient-prosthesis mismatch (PPM) on patients who underwent surgical aortic valve replacement over a two-year period as part of the PARTNER trials.
- It classified PPM into moderate and severe categories, finding that patients without PPM had better outcomes compared to those with moderate or severe PPM.
- The results indicated that while severe PPM was less common than predicted, it was linked to worse health outcomes, highlighting the importance of surgical techniques to reduce the occurrence of PPM.