Publications by authors named "Ofir Koren"
Background: Valve-in-valve transcatheter aortic valve replacement (TAVR) is a recognized alternative for treating the structural valve deterioration of bioprosthetic valves. Recent guidelines and trials have expanded the indications for TAVR to include younger patients with structural valve deterioration. In this study, we aimed to examine the outcomes of valve-in-valve TAVR across different age groups to understand the age-related clinical outcomes of treating structural valve deterioration following surgical aortic valve replacement and TAVR.
View Article and Find Full Text PDFBackground: Lifetime treatment of aortic valve disease is a matter of increasing debate. Although the risks of a second aortic valve intervention are recognized, little attention has been given to the challenges of a third.
Objectives: This study delves into the clinical characteristics, indications, and outcomes of patients undergoing 3 aortic valve interventions.
Article Synopsis
- The study examines the outcomes of mitral transcatheter edge-to-edge repair (TEER) performed during off-hours (before 7:30 am, after 5:30 pm, or on weekends/holidays) to see how they compare to procedures done during regular hours.
- The analysis included 1,177 procedures, with 117 (9.9%) occurring off-hours; off-hours procedures were often urgent and involved higher-risk patients, yet technical success was high in both groups.
- Although baseline MR severity and functional class improved for both groups, off-hours patients experienced higher rates of deaths and heart failure hospitalizations, with no procedural timing linked to outcomes in matched comparisons, suggesting experienced interventionalists can conduct these procedures safely regardless
Background: Prognostically meaningful tricuspid regurgitation (TR) is not well-defined in the mitral transcatheter edge-to-edge repair arena. We aimed to explore the prevalence, correlates, and consequences of TR grades and postprocedural trends in this setting.
Methods And Results: A single-center registry of isolated, first-time interventions was retrospectively assessed for pre-, intra-, and postprocedural aspects up to 1 year, of them the primary composite outcome of all-cause deaths or heart failure (HF) hospitalizations, all according to TR severity at baseline and at 1 month following mitral transcatheter edge-to-edge repair.
Article Synopsis
- Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are compared for their effects on patients with Sievers type 1 bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve replacement.
- The analysis, based on a registry of 955 patients, found no significant difference in midterm major adverse events or technical success between BEVs and SEVs after adjusting for baseline differences.
- However, BEVs had lower risks of new permanent pacemaker implantation and moderate or greater paravalvular regurgitation, but a higher risk of severe patient-prosthesis mismatch compared to SEVs.
Background: An enhanced classification of primary mitral regurgitation (PMR) based on extramitral cardiac involvement may refine patient selection and optimize the timing of transcatheter edge-to-edge repair (TEER).
Aims: This study aimed to assess the prognostic significance of a recently established classification system that characterizes the extent of extramitral cardiac damage in patients undergoing TEER for PMR.
Methods: Consecutive PMR patients who received MitraClip implantation were categorized according to the presence of extramitral cardiac damage, determined through preprocedural echocardiography.
Article Synopsis
- The study examines the characteristics and outcomes of patients with tapered raphe-type bicuspid aortic valve (BAV) when undergoing trans-catheter aortic valve replacement (TAVR), focusing on the safety and effectiveness of modern heart valves.
- Researchers analyzed data from 897 patients, finding that those with tapered configurations showed similar success rates and safety between two sizing strategies: annular and supra-annular.
- The results indicate that TAVR is a safe and effective procedure for these patients, regardless of the sizing method used, maintaining a high rate of clinical efficacy at mid-term follow-up.
Background: Research on the role of transcatheter heart valve (THV) deformation and calcium distribution in patients with bicuspid aortic valves (BAVs) undergoing transcatheter aortic valve replacement (TAVR) remains limited.
Objectives: The aim of this study was to evaluate the impact of THV deformation on clinical outcomes in individuals with BAVs undergoing TAVR and the influence of calcium on these outcomes.
Methods: In total, 229 consecutive patients with BAVs who underwent TAVR with balloon-expandable valves and had computed tomography (CT) performed 30 days post-TAVR were analyzed.
Residual significant mitral regurgitation (MR) can increase the risk of adverse events after transcatheter aortic valve replacement (TAVR). The clinical benefits of staged transcatheter edge-to-edge repair (TEER) after TAVR remain underexplored. This study aimed to investigate the clinical outcomes of staged TEER for residual significant MR after TAVR.
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- Transcatheter aortic valve replacement (TAVR) for patients with bicuspid aortic valve (BAV) stenosis can lead to complications like paravalvular regurgitation (PVR), which is the leakage of blood around the valve.
- A study involving 946 patients aimed to understand how often PVR occurs after TAVR, what factors predict it, and its impact on patient outcomes, finding that 44.7% experienced some level of PVR.
- Moderate or severe PVR was linked to higher risks of major adverse events (MAEs) like death or hospitalization, highlighting the importance of careful monitoring and management in these patients.
Introduction: Paravalvular leak (PVL) is a severe complication of transcatheter aortic valve replacement (TAVR) that can lead to poor outcomes. TAVR-in-TAVR is a promising treatment for PVL; however, reports on its safety or efficacy are limited. In this study, we aimed to investigate the clinical outcomes of TAVR-in-TAVR using balloon-expandable prostheses for PVLs after TAVR.
View Article and Find Full Text PDFAims: Left ventricular global longitudinal strain (LVGLS) is a known outcome predictor in transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic primary MR.
Methods And Results: We conducted a single-centre, retrospective analysis of 323 consecutive patients undergoing isolated, first-time procedures.
Background: There are scarce data regarding mitral transcatheter edge-to-edge repair (TEER) in individuals aged 90 years and above. We aimed to evaluate patient characteristics, procedural aspects, and outcomes in this rapidly growing group.
Methods: We retrospectively studied a single-centre database of 967 isolated, first-time interventions, 103 (10.
Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair.
Circ Cardiovasc Interv
February 2024
Background: Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR).
Methods: We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70-86] years; 60.0% males; 51.
Introduction And Objectives: Limited data exist on the prognostic usefulness of transthoracic echocardiography preceding MitraClip for chronic primary mitral regurgitation (MR). We evaluated the predictive ability of transthoracic echocardiography in this setting.
Methods: A total of 410 patients (median age, 83 years, 60.
Background: Little is known about mitral transcatheter edge-to-edge repair (TEER) in patients with mitral annular disjunction (MAD).
Objectives: The authors sought to explore TEER for degenerative mitral regurgitation (MR) according to MAD status.
Methods: We retrospectively analyzed 271 consecutive patients (median age 82 [Q1-Q3: 75-88] years, 60.
Article Synopsis
- TAVR is a less invasive alternative for patients with severe aortic stenosis, but concerns about leaflet thrombosis question its long-term effectiveness and durability.
- Leaflet thrombosis can lead to blood clots on valve leaves, affecting valve function, and is influenced by various factors, including blood flow patterns and patient characteristics.
- Prevention and treatment focus on identifying high-risk patients, using antithrombotic therapies, and may include intensified treatments or additional surgical options when thrombosis occurs.
Multidetector computed tomography (MDCT) can provide valuable information for mitral assessment, but its role in transcatheter mitral edge-to-edge repair (TEER) planning has been poorly elucidated. We aimed to compare MDCT with 3-dimensional transesophageal echocardiography (3D-TEE) for TEER preprocedural evaluation. We analyzed the preprocedural MDCT and 3D-TEE of 108 consecutive patients with mitral regurgitation (MR) who underwent MitraClip implantation.
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- A study compared outcomes of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) using new-generation valves and re-operative surgical aortic valve replacement (Redo-SAVR) from 2015 to 2021 at Cedars-Sinai Medical Center.
- The analysis showed no significant difference in all-cause mortality between the two groups at 30 days and 2 years after the procedures.
- However, ViV-TAVR had lower in-hospital complication rates compared to Redo-SAVR (11.7% vs 28.6%).
Background: Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.
Methods: This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline.
Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation.
Eur Heart J Cardiovasc Imaging
December 2023
Aims: To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure.
Methods And Results: We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment.
Current guidelines, supported by limited data, prioritize the use of cardiac resynchronization therapy (CRT) over mitral transcatheter edge-to-edge repair (TEER) in eligible patients. To examine TEER results and outcomes in CRT-eligible patients with functional mitral regurgitation (MR) according to CRT status, we conducted a single-center, retrospective analysis of 126 consecutive patients who underwent TEER while fulfilling guideline criteria for CRT before the procedure. The primary outcome was the composite of all-cause mortality or heart failure hospitalizations at 1 year.
View Article and Find Full Text PDFObjective: Design a predictive risk model for minimizing iliofemoral vascular complications (IVC) in a contemporary era of transfemoral-transcatheter aortic valve replacement (TF-TAVR).
Background: IVC remains a common complication of TF-TAVR despite the technological improvement in the new-generation transcatheter systems (NGTS) and enclosed poor outcomes and quality of life. Currently, there is no accepted tool to assess the IVC risk for calcified and tortuous vessels.
Background: There is scarce data on transcatheter edge-to-edge repair (TEER) for chronic functional mitral regurgitation (FMR) in the setting of very severe left ventricular dysfunction (LVD), defined by a left ventricular ejection fraction (LVEF) of <20%.
Methods: We retrospectively explored periprocedural characteristics and one-year clinical and echocardiographic outcomes of consecutive patients with chronic FMR and very severe LVD who underwent an isolated, first-time TEER. The composite of all-cause mortality or heart failure hospitalizations constituted the primary outcome.
Background There are limited data on repeat mitral transcatheter edge-to-edge repair for recurrent significant mitral regurgitation (MR). Methods and Results We conducted a single-center, retrospective analysis of consecutive patients referred to a second mitral transcatheter edge-to-edge repair after a technically successful first procedure. Clinical, laboratory, and echocardiographic measures were assessed up to 1 year after the intervention.
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