Publications by authors named "Grant Reed"
The Canadian Cardiovascular Society recently put forth a new classification of acute reperfused myocardial infarction (MI) based on stages of myocardial injury. Backed by more than 5 decades of intense investigation in the field, the key message of this new classification is that not all MIs are the same and that the type and extent of myocardial injury should be considered in diagnosing and treating MI. We review the literature with the goal of highlighting the progressive advances that enabled the synthesis of the Canadian Cardiovascular Society classification into 4 distinct stages of tissue injury.
View Article and Find Full Text PDFPercutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice.
View Article and Find Full Text PDFBackground: Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).
Methods: Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database.
Background: Angulation of virtual basal ring (VBR), also known as aortic annulus, in relation to sino-tubular junction (STJ) may lead to greater exposure of implanted stent to the conduction system, consequently increasing the risk of left bundle branch block (LBBB).
Aims: We sough to measure the VBR-STJ angle and explore its impact on the development of LBBB post-TAVR.
Methods: Patients undergoing TAVR using the Sapiens 3 valve between 2016 and 2021, without pre-TAVR conduction anomalies were included.
This study sought to explore the clinical factors associated with classical low-flow low-gradient (C-LFLG) and normal-flow low-gradient (NFLG) aortic stenosis (AS) compared with high-gradient (HG) AS. We also compared clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) across flow-gradient patterns. Patients with C-LFLG AS have a higher mortality rate after TAVR than those with HG AS.
View Article and Find Full Text PDFBackground: Data supporting the use of transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) is limited compared to tricuspid aortic valve (TAV) anatomy, as the BAV anatomy poses unique challenges to prosthesis expansion and symmetric deployment.
Aims: We aim to compare the acute recoil and asymmetry of the SAPIEN-3 valve between BAV and TAV anatomies and their impact on procedural outcomes.
Methods: We conducted a single-center study of patients who underwent TAVR with the SAPIEN-3 valve.
A 72-year-old man with a history of aortic valve replacement (AVR), mitral valve (MV) repair, and recent valve-in-valve transcatheter aortic valve replacement (TAVR) presented with bacteremia. Computed tomography (CT) and fluorodeoxyglucose positron emission tomography (F-FDG PET) imaging noted a pseudoaneurysm, and he successfully underwent TAVR explant with aortic root and valve replacement.
View Article and Find Full Text PDFArticle 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.
Article Synopsis
- * Out of 2,754 CS patients, 442 (16%) had VCS, with a higher median age (70 years) and a greater proportion of females (40.3%) compared to non-VCS patients, and the majority had native valve issues, particularly affecting the aortic valve.
- * Patients with VCS had worse outcomes, showing higher 1-year (44% vs 37%)
Article Synopsis
- Novel transcatheter therapies for tricuspid regurgitation (TR) show promise, but their suitability for the general TR patient population is still uncertain.
- In a study involving 178 patients with moderate symptomatic TR, only 10.7% qualified for investigative therapies, while many received off-label clipping, surgery, or medical treatment due to factors like unsuitable anatomy or existing health issues.
- Although the investigative group experienced significant improvement in TR severity after one year compared to the medical treatment group, their outcomes were similar to off-label clipping but not as favorable as surgery, highlighting the need for broader access to effective therapies for TR patients.
Article Synopsis
- The study investigates the relationship between chronic kidney disease (CKD) stages and the occurrence of acute congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) from data collected between 2009 and 2017.
- Results show that patients with CKD stage 3a or worse experience significantly more acute heart failure events and higher in-hospital mortality rates compared to those with CKD stages 1-2.
- The findings highlight that a lower estimated glomerular filtration rate (eGFR) is a strong predictor of these acute events, suggesting that patients with advanced CKD may benefit from targeted interventions to reduce the risk of heart failure after PCI.
The Hemodynamic Effects of Interatrial Septostomy in Iatrogenic Mitral Stenosis Following MitraClip.
J Soc Cardiovasc Angiogr Interv
July 2024
Article Synopsis
- - Iatrogenic mitral stenosis is an uncommon complication that can occur after the MitraClip procedure, with few treatment options available.
- - The text discusses a specific case where real-time echocardiographic and hemodynamic data were used to explore a new treatment approach.
- - It suggests that creating an interatrial septostomy could be a potential percutaneous management option for patients facing this complicated condition.
Balloon Aortic Valvuloplasty in the Modern Era: A Review of Outcomes, Indications, and Technical Advances.
J Soc Cardiovasc Angiogr Interv
July 2023
Balloon aortic valvuloplasty (BAV) improves the hemodynamics and symptoms of patients with severe aortic stenosis in the short term with low rates of complications, but has not been shown to be an effective destination therapy. Our pooled analysis of >14,300 patients from studies published between January 1, 1991, and April 31, 2022, reported intraprocedural mortality and in-hospital mortality rates as 1.94% (95% CI, 1.
View Article and Find Full Text PDFArticle Synopsis
- A study analyzed the effectiveness of cerebral protection devices (CPDs) in patients undergoing transcatheter aortic valve replacement, using data from the Nationwide Readmissions Database (2017-2020) which included over 271,000 patients.
- Results indicated that while CPD use did not significantly lower overall stroke rates, it was linked to a reduced rate of major strokes, shorter hospital stays, and lower mortality rates compared to patients without CPD.
- The study concludes that while CPDs may not affect overall stroke risk, they appear beneficial for reducing major strokes; further randomized trials are needed to clarify which patients would gain the most from using these devices.
Article Synopsis
- Skeletal muscle mass (SMM) is important for assessing risks in candidates for transcatheter aortic valve replacement (TAVR), but it's often overlooked compared to traditional measures like weakness or performance.
- A study evaluated three risk models that combined SMM data with frailty assessments to predict complications, rehospitalization, or mortality after TAVR in a cohort of 184 patients.
- Results showed that patients with sarcopenia and those identified as frail had significantly higher rates of adverse outcomes, and incorporating CT-based SMM into frailty assessments improved predictive accuracy for these risks.
Article Synopsis
- * The V-Wave interatrial shunt system is being studied as a potential solution; it aims to improve heart function by shunting blood between the atria, thereby reducing pressure in the left atrium.
- * The V-Wave Shunt MitraClip Study is assessing the safety and efficacy of implanting this shunt during the MitraClip surgery, with results expected in late 2024 after following participants for up to 5 years.
Article Synopsis
- * In a study involving 1,421 patients monitored for about 6 years, those receiving AVR showed significantly lower risks for both all-cause and cardiovascular mortality compared to those who were managed with clinical surveillance.
- * The benefits of AVR were particularly evident in patients with preserved left ventricular ejection fraction (LVEF ≥50%), as they also showed improvements in heart function over time.
Background: The aims of this study were to understand the incidence and outcomes of patients with cardiogenic shock (CS) due to severe aortic stenosis (AS), and the impact of conventional treatment strategies in this population.
Methods And Results: All patients admitted to the Cleveland Clinic cardiac intensive care unit between January 1, 2010 and December 31, 2021 with CS were retrospectively identified and categorized into those with CS in the setting of severe AS versus CS without AS. The impact of various treatment strategies on mortality was further assessed.
Article Synopsis
- The study aimed to investigate how the severity of left ventricular ejection fraction (LVEF) impairment affects bleeding events after percutaneous coronary intervention (PCI).
- It analyzed data from over 13,500 PCI procedures between 2009 and 2017, categorizing patients based on their pre-procedure LVEF levels.
- Results indicated that patients with mildly reduced or reduced LVEF had a significantly higher risk of major bleeding events, particularly from blood transfusions and gastrointestinal issues, but LVEF did not predict certain types of bleeding such as access site complications.
Background: Candidates for transcatheter aortic valve replacement (TAVR) occasionally have a "borderline-size" aortic annulus between 2 transcatheter heart valve sizes, based on the manufacturer's sizing chart. Data on TAVR outcomes in such patients are limited.
Methods: We retrospectively reviewed 1816 patients who underwent transfemoral-TAVR with balloon-expandable valve (BEV) at our institution between 2016 and 2020.