Publications by authors named "Michael J Reardon"
An 86-year-old male with multiple medical comorbidities was referred for an elective transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis with an ejection fraction of 35%. A self-expanding valve was deployed successfully, but intraoperative transesophageal echocardiography (TEE) confirmed an acute type A aortic dissection (ATAAD), necessitating immediate intervention. Multiple intraoperative imaging modalities were utilized for deployment of a conformable GORE TAG (cTAG) stent graft for thoracic endovascular aortic repair (TEVAR).
View Article and Find Full Text PDFBackground: Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.
Objectives: This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG.
Methods: The FAME 3 trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease.
Article Synopsis
- The study examined differences in echocardiographic assessments of native and bioprosthetic aortic valves between core laboratories and clinical centers, finding clinically relevant discrepancies.
- Data was collected from the PERIGON trial, which involved patients undergoing surgical aortic valve replacement, and involved comparing echocardiographic results from centers to independent analysis by a core lab.
- Results showed that while some continuous measurements had high agreement (around 0.90), there were notable variances, particularly in left ventricular outflow tract area and stroke volume, indicating the need for standardized evaluation practices.
Background: Transcatheter aortic valve replacement (TAVR) for high surgical risk patients with severe native aortic regurgitation (AR) presents unique challenges. Dedicated devices such as the JenaValve (JenaValve Technology) and J-Valve (JC Medical Inc) show promising results in addressing these challenges.
Objectives: This study compares the safety and efficacy of dedicated vs off-label devices among high surgical risk patients with pure native AR.
Objectives: Safety, efficacy, and durability are important considerations when selecting a bioprosthesis for aortic valve replacement (AVR). This study assessed 7-year clinical outcomes and haemodynamic performance of the Avalus bioprosthesis.
Methods: Patients indicated for surgical AVR were enrolled in this prospective, nonrandomized trial, conducted across 39 sites globally.
Article Synopsis
- Redo-transcatheter aortic valve implantation (TAVI) is often needed for failed aortic valves, specifically examining SAPIEN 3 (S3) valves in degenerated CoreValve/Evolut (CV/EV) valves, which is not fully understood.
- The study assessed the performance of S3 valves following implantation in calcified CV/EV valves through various hydrodynamic tests, measuring factors like mean gradient, effective orifice area, and leaflet behaviors.
- Results indicated that S3 valves generally performed well, showing decreased mean gradient and acceptable effective orifice area, but issues like underexpansion, leaflet pinwheeling, and calcium protrusion were noted, highlighting the need for further research on long
Background: The impact of mitral annular calcification (MAC) on the clinical outcomes of patients undergoing mitral transcatheter edge-to-edge repair (MTEER) remains unclear. This meta-analysis aims to evaluate the clinical outcomes of MTEER among patients with moderate to severe MAC compared to those with mild or no MAC.
Methods: We systematically searched PubMed, EMBASE, and Cochrane CENTRAL databases through March 31st, 2024, comparing clinical outcomes of MTEER among patients with moderate/severe (MAC+) versus no/mild MAC (MAC-).
Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice.
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- The study explored the impact of residual transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER) on patient outcomes, focusing on all-cause mortality and hospitalizations related to heart failure.
- Higher baseline TMPG was found to predict increased residual TMPG post-procedure, with patients in the highest quartile experiencing significantly worse outcomes, including higher risks of mortality and heart failure hospitalization over three years.
- The findings suggest that efforts should be made to minimize residual TMPG after M-TEER, particularly in patients with primary mitral regurgitation (MR).
Article Synopsis
- A study compared transcatheter aortic valve replacement (TAVR) with traditional surgery in low-risk patients under 75 years old with severe aortic stenosis to evaluate safety and effectiveness over three years.* -
- Results showed that TAVR patients had similar overall mortality rates but significantly fewer disabling strokes (0.6%) compared to surgery patients (2.9%), while TAVR also resulted in better valve performance.* -
- Both treatment options had comparable low rates of valve reinterventions, but TAVR patients experienced higher rates of pacemaker implantation (21.0% vs. 7.1%).*
Article Synopsis
- The study investigates the significance of measuring pulmonary venous flow (PVF) patterns during mitral transcatheter edge-to-edge repair (TEER) to predict patient outcomes, focusing on systolic dominant-PVF (SD-PVF) morphology.
- Researchers analyzed data from 187 patients and found that those with SD-PVF had lower rates of severe residual mitral regurgitation (MR) and were less likely to experience all-cause mortality or heart failure hospitalization within one year.
- The findings suggest that post-TEER PVF morphology could serve as an effective and straightforward prognostic tool, but more large-scale studies are needed to validate its impact further.
Background: We aimed to perform a meta-analysis of randomized trials comparing long-term outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) for severe aortic stenosis. The short-term efficacy and safety of TAVR are proven, but long-term outcomes are unclear.
Methods: We included randomized controlled trials comparing TAVR vs SAVR at the longest available follow-up.
Article Synopsis
- - The Navitor IDE study examines the safety and effectiveness of the Navitor valve for patients with severe aortic stenosis who are at high surgical risk, focusing on the connection between patient factors and the rate of new permanent pacemaker implantation (PPI) within 30 days post-surgery.
- - Researchers analyzed data from 260 patients, excluding those with prior pacemakers, and found that specific conduction abnormalities, like first-degree atrioventricular block and right bundle branch block, increased the likelihood of new PPI, while the depth of the valve implantation also played a significant role.
- - The study concludes that both existing conduction issues and the surgical technique (implant depth) are critical predictors of whether patients will need a new pacemaker
Background: Outcomes from transcatheter aortic valve replacement (TAVR) in low-surgical risk patients with bicuspid aortic stenosis beyond 2 years are limited.
Objectives: This study aimed to evaluate 3-year clinical and echocardiographic outcomes from the Evolut Low Risk Bicuspid Study.
Methods: The Evolut Low Risk Bicuspid Study is a prospective, multicenter, single-arm study conducted in 25 U.
Objective: New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement.
Methods: Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up.
Transcatheter aortic valve replacement (TAVR) has undergone significant advancements in the last two decades, expanding its indications and refining transcatheter heart valve (THV) and delivery system designs to improve procedural success and patient outcomes. This review focuses on the Navitor™ valve, a third-generation intra-annular Portico™ valve (Abbott Structural Heart, St Paul, MN, USA) designed to address TAVR complications, particularly paravalvular leak (PVL). We present an overview of the Navitor™ system, comparing it to the first-generation Portico™ THV in terms of THV design, key iterations and clinical outcomes.
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- A study evaluated permanent pacemaker implantation (PPI) rates in patients who underwent transcatheter aortic valve replacement (TAVR) using Evolut valves from July 2018 to June 2021, reporting significant trends in PPI rates over time.
- Out of 54,014 procedures, the 30-day PPI rate dropped from 16.6% in 2018 to 10.8% in 2021, and in-hospital rates decreased by 40.1% during the same period, indicating improved outcomes.
- Key factors associated with a higher likelihood of needing a new PPI included existing conduction defects, atrial fibrillation, use of home
Two families of randomized trials comparing transcatheter aortic valve replacement (TAVR) to surgery for both the Balloon Expandable Valve and the Supra Annular Self-Expanding Valve have been completed to include all surgical risk levels. The result of these trials has led to the approval of TAVR for symptomatic severe aortic stenosis without using risk level as the sole criterion. We have seen an explosion of TAVR in the US to over 98,000 commercial cases in 2022.
View Article and Find Full Text PDFImpact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair.
Circ Cardiovasc Interv
September 2024
Background: Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment.
Methods: We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring.
Background And Aims: Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE.
Methods: All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified.
Purpose Of Review: This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology.
Recent Findings: Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors.
Background: Coronary microvascular function and hemodynamics may play a role in coronary circulation and myocardial remodeling in patients with aortic stenosis (AS). We aimed to evaluate the relationship between myocardial blood flow and myocardial function in patients with AS, no AS, and aortic valve sclerosis.
Methods And Results: We included consecutive patients who had resting transthoracic echocardiography and clinically indicated positron emission tomography myocardial perfusion imaging to capture their left ventricular ejection fraction, global longitudinal strain (GLS), and myocardial flow reserve (MFR).
Article Synopsis
- The identification and management of patients at high bleeding risk (HBR) during transcatheter aortic valve implantation (TAVI) is critical, but inconsistent definitions complicate trials and clinical choices.
- The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) involves global experts aiming to create a standard definition for HBR patients based on extensive research.
- This initiative, led by the Cardiovascular European Research Center (CERC), seeks to enhance the safety and effectiveness of TAVI interventions and improve future clinical guidelines.