Publications by authors named "Howard Herrmann"
Background: Surgery remains an important treatment for low-risk patients with severe symptomatic aortic stenosis (AS). We evaluated 5-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized PARTNER 3 trial.
Methods: In the PARTNER 3 trial, 454 patients underwent surgery for severe, symptomatic, tri-leaflet AS and were followed for 5 years.
Background: Hospitals and health systems must balance the demand for transcatheter aortic valve replacement (TAVR) against financial sustainability. Patients may be eligible for both TAVR and surgical aortic valve replacement (SAVR), but financial realities for hospitals may affect differential access to those therapies. We sought to understand the landscape of costs and reimbursement for TAVR and SAVR in the US and to understand the association of procedural reimbursement with receipt of either.
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- Historically, women with aortic stenosis have been underdiagnosed and faced worse outcomes compared to men, leading to the need for better treatment recognition and participation in clinical trials.
- The SMART trial aimed to compare the clinical and hemodynamic outcomes of women with small aortic annuli receiving either self-expanding valves (SEVs) or balloon-expandable valves (BEVs) during transcatheter aortic valve replacement.
- In a study of 621 women, no significant differences were observed in the main clinical outcomes between the SEV and BEV groups after 12 months, but SEVs showed a lower rate of bioprosthetic valve dysfunction.
Article Synopsis
- Systemic arterial properties play a crucial role in determining clinical outcomes and variations in patients with degenerative calcific aortic stenosis (AS), yet many previous studies overlooked pulsatile pressure-flow relations as a critical assessment method.
- A retrospective study of 135 AS patients examined the relationship between pulsatile load and risk of mortality and heart failure hospital admissions using advanced modeling techniques.
- Results show that pressure-dependent total arterial compliance is a significant predictor of mortality and adverse heart failure events, outperforming traditional measures of arterial load, suggesting that understanding arterial wall pressure can better identify high-risk patients.
Background And Objectives: Whether patent foramen ovale (PFO) closure benefits older patients with PFO and cryptogenic stroke is unknown because randomized controlled trials (RCTs) have predominantly enrolled patients younger than 60 years of age. Our objective was to estimate anticipated effects of PFO closure in older patients to predict the numbers needed to plan an RCT.
Methods: Effectiveness estimates are derived from major observational studies (Risk of Paradoxical Embolism [RoPE] Study and Oxford Vascular Study, together referred to as the "RoPE-Ox" database) and all 6 major RCTs (Systematic, Collaborative, PFO Closure Evaluation [SCOPE] Consortium).
Aims: Evaluation of left and right ventricular (RV) longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and RV longitudinal systolic function and RV-pulmonary artery (RV-PA) coupling from baseline to 30 days and 1 year after AVR.
Methods And Results: Left ventricular (LV) longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV-PA coupling were evaluated in patients from the PARTNER 2A surgical AVR (SAVR) arm (n = 985) and from the PARTNER 2 SAPIEN 3 registry (n = 719).
Background: Patients with severe aortic stenosis and a small aortic annulus are at risk for impaired valvular hemodynamic performance and associated adverse cardiovascular clinical outcomes after transcatheter aortic-valve replacement (TAVR).
Methods: We randomly assigned patients with symptomatic severe aortic stenosis and an aortic-valve annulus area of 430 mm or less in a 1:1 ratio to undergo TAVR with either a self-expanding supraannular valve or a balloon-expandable valve. The coprimary end points, each assessed through 12 months, were a composite of death, disabling stroke, or rehospitalization for heart failure (tested for noninferiority) and a composite end point measuring bioprosthetic-valve dysfunction (tested for superiority).
Background: Studies comparing transcatheter and surgical aortic valve replacement (TAVR and SAVR) for patients with trileaflet aortic stenosis (AS) have found similar or larger effective orifice area (EOA) for TAVR prostheses. To our knowledge, no studies have compared EOA in patients undergoing TAVR versus SAVR for bicuspid AS.
Methods: We retrospectively compared prosthetic valvular sizing and predicted EOA for patients with bicuspid AS undergoing TAVR or SAVR at our institution between January 1, 2016, and December 31, 2021.
Article Synopsis
- 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.
Background And Aims: For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter tricuspid valve (TV) intervention studies have shown significant improvements in functional status and quality of life associated with right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained improvements in these outcomes.
Methods: The prospective, single-arm, multicentre TRISCEND study enrolled 176 patients to evaluate the safety and performance of transcatheter TV replacement in patients with ≥moderate, symptomatic TR despite medical therapy.
Article Synopsis
- * TAVR showed a lower rate of the composite end point (death, stroke, rehospitalization) at one year (22.8%) compared to surgery (27.2%), but the difference was not statistically significant.
- * Overall, while TAVR had slightly better outcomes, there were no major long-term differences in safety or effectiveness between TAVR and surgery, as indicated by the various measured endpoints.
Article Synopsis
- Inadequate representation of older patients, women, and racial and ethnic minorities in cardiovascular clinical trials hampers the applicability of findings and access to new treatments.
- A study analyzed 139 clinical trials on valvular heart disease from 2005 to 2020 to assess the trends in the inclusion of these underrepresented groups.
- Results showed that while the average age of participants slightly increased, the proportion of women remained steady at 41.1%, and racial/ethnic data was reported in only 9.4% of trials, with no significant changes in minority representation over time.
Background: Atrial fibrillation (AF) is a common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and in heart failure with mildly reduced ejection fraction (HFmrEF).
Objectives: This study sought to describe AF burden and its clinical impact among individuals with HFpEF and HFmrEF who participated in a randomized clinical trial of atrial shunt therapy (REDUCE LAP-HF II [A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]) and to evaluate the effect of atrial shunt therapy on AF burden.
Methods: Study investigators characterized AF burden among patients in the REDUCE LAP-HF II trial by using ambulatory cardiac patch monitoring at baseline (median patch wear time, 6 days) and over a 12-month follow-up (median patch wear time, 125 days).
Article Synopsis
- The Evolut FX TAVR system from Medtronic is a new heart valve replacement method that has shown improvements over older versions, but not many people have used it yet.
- In a study, 226 patients had this procedure done, mostly for a condition called aortic stenosis, and the results were analyzed after 30 days.
- The study found that the Evolut FX system had fewer problems and worked better in terms of fitting the valve correctly and using less complicated methods compared to the earlier Evolut PRO+ system.
Article Synopsis
- Previous studies showed that older balloon-expandable valves for transcatheter aortic valve replacement (TAVR) were as effective as surgical aortic valve replacement (SAVR) in preventing death and disabling strokes for intermediate-risk patients.
- This study compared 5-year outcomes of TAVR using the newer SAPIEN 3 valve against SAVR in intermediate-risk patients with severe aortic stenosis.
- The findings indicated that the rates of death and disabling stroke were similar for both TAVR and SAVR, but S3 TAVR patients experienced more mild paravalvular regurgitation, highlighting the need for further long-term studies on valve durability and complications.
Background: In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain.
Methods: Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves).
Article Synopsis
- Study Purpose
- : The study aims to compare the outcomes of TAVR surgical explantation (TAVR-explant) and redo-TAVR in patients who experienced failures after the initial transcatheter aortic valve replacement (TAVR).
- Findings
- : TAVR-explant was associated with a shorter median time to reintervention compared to redo-TAVR and resulted in higher rates of mortality at both 30 days and 1 year. The reasons for reintervention differed between the two groups, with TAVR-explant showing more prosthesis-patient mismatch and redo-TAVR showing more structural valve degeneration.
- Conclusion
- : Overall, TAVR-explant