Publications by authors named "Nikolaos Kakouros"

This paper present a challenging case of a right ventricular mass in a patient who was at high surgical risk for open removal. The minimally invasive AngioVac device has been used with a successful 50% reduction in mass burden. This report illustrates AngioVac as a safe alternative to invasive surgery.

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Article Synopsis
  • - The FUTURE-AS Registry is a study designed to evaluate the effectiveness and safety of using computed tomography coronary angiography (CTCA) and fractional flow reserve (FFR) for assessing coronary artery disease (CAD) in patients with severe aortic stenosis (AS) who are candidates for transcatheter aortic valve replacement (TAVR).
  • - The study will measure key outcomes such as the accuracy of CTCA and FFR in detecting significant CAD compared to traditional methods, as well as the safety of the procedures with respect to potential complications.
  • - By exploring the feasibility of these imaging techniques, the registry aims to determine if they can help reduce unnecessary invasive procedures before TAVR, ultimately improving patient care.
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Despite advancements in technology, operator experience, and procedural planning, transcatheter aortic valve replacement (TAVR) procedures are complex, and complications remain inevitable. Valve embolization may prove to be fatal and conventional rescue techniques are dependent on the anatomy of the aorta. We describe a case of postimplant embolization of a self-expanding valve during valve-in-valve application where the valve could not be stabilized due to the anatomy of the aorta and a novel technique was utilized to stabilize the valve in the aortic arch using a wire fixed to the left axillary artery.

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Background: Acute myocardial infarction may concomitantly occur with acute ischemic stroke. The prevalence, complications, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) in patients hospitalized with acute ischemic stroke are not well studied.

Methods: We examined hospitalized patients with acute ischemic stroke who were included in the National Inpatient Sample from 2016 to 2019.

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Background: The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported.

Objectives: The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR).

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The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax.

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Objective: Outcomes of cardiac arrest among patients who had cardiopulmonary resuscitation (CPR) in intensive care units (ICU) has limited data on the national level basis in the United States. We aimed to study the outcomes of ICU CPRs.

Methods: Data from the national readmissions database (NRD) sample that constitutes 49.

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Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI.

Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV).

Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers.

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Newer generation transcatheter heart valves (THV) are presumed to yield better clinical efficacy and postprocedural complication profile as compared to transcatheter aortic valve replacement (TAVR) using older generation THVs. The real impact of newer generation valves on TAVR outcomes is not well known. Studies comparing older and newer generation THVs were identified from online databases including PubMed, EMBASE, Cochrane, and ClinicalTrials.

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Nonplatelet thromboxane generation, stimulated largely by oxidative stress, is a novel mortality risk factor in individuals with coronary artery disease. Though inversely associated with left ventricular ejection fraction (LVEF), a potential role in the pathobiology of heart failure (HF) remains poorly defined. Nonplatelet thromboxane generation and oxidative stress were assessed by measuring urine thromboxane-B metabolites (TXB-M) and 8-isoPGF by ELISA in 105 subjects taking aspirin and undergoing right heart catheterization for evaluation of HF, valve disease, or after transplantation.

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Background: Moderate aortic valve stenosis occurs twice as often as severe aortic stenosis (AS) and carries a similarly poor prognosis. Current European and American guidelines offer limited insight into moderate AS (MAS) patients with unexplained symptoms. Measuring valve physiology at rest while most patients experience symptoms during exertion might represent a conceptual limitation in the current grading of AS severity.

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Background: Persistent systemic thromboxane generation, predominantly from nonplatelet sources, in aspirin (ASA) users with cardiovascular disease (CVD) is a mortality risk factor.

Objectives: This study sought to determine the mortality risk associated with systemic thromboxane generation in an unselected population irrespective of ASA use.

Methods: Stable thromboxane B metabolites (TXB-M) were measured by enzyme-linked immunosorbent assay in banked urine from 3,044 participants (mean age 66 ± 9 years, 53.

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Article Synopsis
  • Transcatheter aortic valve implantation (TAVI) using a percutaneous axillary approach is being evaluated for its safety and effectiveness compared to traditional surgical access.
  • An international study analyzed data from 432 patients, revealing that while the percutaneous approach had a higher rate of primary hemostasis failure, it led to shorter hospital stays and lower risks of major complications.
  • The findings suggest that percutaneous axillary access is as effective or potentially superior to surgical access for TAVI, especially for patients who cannot use the femoral approach.
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Background: Outcomes of cardiac arrest (CA) remain dismal despite therapeutic advances. Literature is limited regarding outcomes of CA in emergency departments (ED).

Objective: To study the possible causes, predictors, and outcomes of CA in ED and in-patient settings throughout the United States (US).

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Mitral valve prolapse (MVP) is the most common valvular heart disease in women of reproductive age. Whether MVP increases the likelihood of adverse outcomes in pregnancy is unknown. The study objective was to examine the cardiac and obstetric outcomes associated with MVP in pregnant women.

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Background: Literature regarding outcomes of cardiac arrest with associated NSTEMI is limited. We aim to study the predictors and survival outcomes of cardiac arrest patients presenting to the emergency department who were diagnosed with non-ST elevated myocardial infarction (NSTEMI).

Methods: Data from the nationwide emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments in the United States was analyzed for the cardiac arrest related visits from 2009-2018.

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Vas deferens calcification is a chronic arterio-sclerotic process that develops over many years and is strongly associated with infertility. Incidental findings on imaging are the most common means of diagnosing this condition. We report a case of a 56-year man who likely has male factor infertility and was found to have bilateral vas deferens calcification on CT imaging.

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Low-flow, low-gradient (LF-LG) aortic stenosis with depressed left ventricular (LV) ejection fraction is a diagnostic challenge that is frequently encountered in the management of valvular heart disease. True-severe LF-LG aortic stenosis is amenable to valve replacement, whereas pseudo-severe aortic stenosis requires management of the underlying cardiomyopathy. This distinction is important as it serves as a critical branch point in guiding therapeutic decisions.

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Article Synopsis
  • A meta-analysis was conducted to compare the minimalist and standard approaches to transcatheter aortic valve replacement (TAVR) using studies up to September 2020.
  • The analysis included 9 studies with 2,880 patients and found that the minimalist approach showed reduced risks for complications such as acute kidney injury, major bleeding, and major vascular issues.
  • Although there were no significant differences in mortality or readmission rates, the minimalist approach resulted in shorter hospital stays, less procedural time, and lower contrast volume used.
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Background: Antiplatelet therapy is paramount to reduce the risk of coronary stent thrombosis after percutaneous coronary intervention (PCI). Newer agents are reliable and have a fast onset of action, but have significantly higher cost, leading to compliance concerns. We adopted and evaluated an acute agent-switching strategy, using prasugrel or ticagrelor for rapid and reliable periprocedural antiplatelet action, followed by a switch to generic clopidogrel.

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Article Synopsis
  • A 61-year-old male with NSTEMI had a challenging subacute total occlusion in his tortuous mid right coronary artery (RCA) due to atherosclerosis.
  • To navigate the tortuous anatomy, an angled SuperCross™ microcatheter was used after the initial Corsair microcatheter failed to guide the wire correctly into the lumen.
  • The successful deployment of drug eluting stents demonstrates the effectiveness of this SuperCross™ microcatheter technique for treating complex occlusions in difficult vascular conditions.
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Transcatheter aortic valve replacement (TAVR) for transcatheter heart valve failure has been suggested for high-risk patients. TAVR-in-TAVR, however, may lead to complex leaflet interactions causing coronary ostial obstruction, which is a devastating complication. Coronary protection with provisional stent placement may be challenging.

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