Publications by authors named "Kush P Patel"

Article Synopsis
  • Cerebrovascular events (CVEs) can happen during or after a procedure called TAVR, which replaces a heart valve, and can lead to serious health problems.
  • Even though strokes have become less common since TAVR started, they’re still a major concern because TAVR is being used more often.
  • New devices and treatments are being tested to help prevent CVEs, but current options may not reduce stroke risk enough, and there are concerns about bleeding from the medication used.
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Aortic regurgitation (AR) is a common clinical disease associated with significant morbidity and mortality. Investigations based largely on non-invasive imaging are pivotal in discerning the severity of disease and its impact on the heart. Advances in technology have contributed to improved risk stratification and to our understanding of the pathophysiology of AR.

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Background: Severe pure aortic regurgitation (AR) carries a high mortality and morbidity risk, and it is often undertreated because of the inherent surgical risk. Transcatheter heart valves (THVs) have been used off-label in this setting with overall suboptimal results. The dedicated "purpose-built" Jena Valve Trilogy (JVT, JenaValve Technology) showed an encouraging performance, although it has never been compared to other THVs.

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Background: Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECV), and has prognostic utility in several diseases. This study aims to map out regional differences in ECV to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications.

Methods: Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts.

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Article Synopsis
  • The TARGET AC study evaluated the long-term effectiveness and safety of biodegradable polymer sirolimus-eluting stents (BP SES) compared to durable polymer everolimus-eluting stents (DP EES) in patients with acute coronary syndromes (ACS) and chronic coronary syndromes (CCS).
  • Results showed that both stent types had similar rates of target lesion failure, patient-oriented outcomes, and stent thrombosis at the 5-year mark for both ACS and CCS patients.
  • This study suggests that the BP SES is noninferior to the DP EES for patients with both ACS and CCS, although further research may be needed to fully understand long-term outcomes, especially in ACS settings.
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A 54-year-old woman who had recently undergone surgical mitral and tricuspid valve repair was diagnosed with severe aortic regurgitation. She was scheduled for percutaneous treatment and underwent successful transcatheter aortic valve implantation with a 27-mm Trilogy valve (JenaValve Technology). The case documents feasibility of percutaneous treatment in the presence of a mitral ring.

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Objectives: Grading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide timely treatment. This study aims to identify prognostic haemodynamic markers in patients with moderate MAVD.

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Aims: Surgical ablation of atrial fibrillation (AF) has been demonstrated to be a safe procedure conducted concomitantly alongside cardiac surgery. However, there are conflicting guideline recommendations surrounding indications for surgical ablation. We conducted a systematic review of current recommendations on concomitant surgical AF ablation.

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Article Synopsis
  • Transcatheter aortic valve replacement (TAVR) for severe native aortic valve regurgitation has shown suboptimal outcomes, particularly with older valve technologies; this study evaluates newer devices.
  • The PANTHEON study analyzed 201 patients who received TAVR with both self-expanding and balloon-expandable valves, focusing on success rates and health outcomes after one year.
  • Results revealed that while technical success was high, issues like transcatheter valve embolization occurred in a significant number of cases, indicating that TAVR still poses challenges despite advancements in valve technology.
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Aortic regurgitation (AR) is associated with morbidity and premature mortality. Surgical aortic valve replacement is not an option for many patients due to an adverse surgical risk profile, whilst transcatheter aortic valve implantation with most available prostheses has demonstrated suboptimal implantation success and outcomes. The JenaValve Trilogy™ system provides an attractive solution for such patients as it utilizes clips that directly attach onto the native valve leaflets to anchor.

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Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS).

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Aims: Aortic stenosis is characterized by fibrosis and calcification of the valve, with a higher proportion of fibrosis observed in women. Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may also influence the relative composition of the valve. We aimed to investigate the influence of cusp morphology on quantitative aortic valve composition quantified from contrast-enhanced computed tomography angiography in severe aortic stenosis.

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Patients with classic low-flow low-gradient (cLFLG) aortic stenosis (AS) have a poor prognosis but still benefit from aortic valve replacement. There is a paucity of evidence to guide the choice between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). This study compared procedural and midterm outcomes in patients with cLFLG AS between TAVR and SAVR.

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Article Synopsis
  • Acute decompensated aortic stenosis (ADAS) leads to higher mortality and longer hospital stays compared to stable aortic stenosis (AS), and this study aimed to reduce hospital length of stay (LoS) with a new treatment pathway.
  • The ASTRID-AS pathway expedited the treatment process for ADAS patients, significantly cutting down the time to transcatheter aortic valve implantation (TAVI) and decreasing hospital LoS compared to a conventional approach.
  • While the dedicated pathway saved an average of 13.4 bed days per patient and did not compromise safety, there was a slight increase in acute kidney injury or death within 30 days post-TAVI for the ASTRID-AS cohort.
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Background: Light chain (AL) and transthyretin (ATTR) amyloid fibrils are deposited in the extracellular space of the myocardium, resulting in heart failure and premature mortality. Extracellular expansion can be quantified by computed tomography, offering a rapid, cheaper, and more practical alternative to cardiac magnetic resonance, especially among patients with cardiac devices or on renal dialysis.

Objectives: This study sought to investigate the association of extracellular volume fraction by computed tomography (ECV), myocardial remodeling, and mortality in patients with systemic amyloidosis.

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Aortic stenosis (AS) is a progressive disease that carries a poor prognosis. Patients are managed conservatively until satisfying an indication for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) based on AS severity and the presence of symptoms or adverse impact on the myocardium. Up to 1 in 3 TAVIs are performed for patients with acute symptoms of dyspnea at rest, angina, and/or syncope - termed acute decompensated aortic stenosis (ADAS) and require urgent aortic valve replacement.

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Objectives: This study evaluates predictors of conduction abnormalities (CA) following transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valves (BAV).

Background: TAVI is associated with CA that commonly necessitate a permanent pacemaker. Predictors of CA are well established among patients with tricuspid aortic valves but not in those with BAV.

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Acute decompensated aortic stenosis (ADAS) is common and associated with poor outcomes. Myocardial remodeling and function, including a novel echo staging classification (0 to 4, representing increasing degrees of cardiac damage/dysfunction), impact outcomes in stable aortic stenosis. However, this has not been assessed in patients with ADAS.

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The incidence and prevalence of valvular heart disease (VHD) is increasing and has been described as the next cardiac epidemic. Advances in imaging and therapeutics have revolutionized how we assess and treat patients with VHD. Although echocardiography continues to be the first-line imaging modality to assess the severity and the effects of VHD, advances in cardiac computed tomography (CT) now provide novel insights into VHD.

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Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services.

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Synopsis of recent research by authors named "Kush P Patel"

  • - Kush P Patel's recent research primarily focuses on the advancements and complications associated with transcatheter heart valve therapies, particularly in the context of aortic regurgitation and stenosis, highlighting the clinical implications of cerebrovascular events and patient outcomes post-transcatheter aortic valve replacement (TAVR).
  • - His studies emphasize the need for improved risk stratification and diagnosis in patients with aortic valve diseases, employing advanced imaging technologies to enhance understanding of disease mechanisms and guide treatment decisions, such as in cases of acute decompensated aortic stenosis (ADAS).
  • - Patel's research also explores the comparative effectiveness of different valve replacement strategies, including purpose-built devices versus off-label options, aiming to optimize patient safety and outcomes in high-risk cardiovascular scenarios.