Publications by authors named "Rishi Puri"
Aortic stenosis (AS) is the most common form of valvular heart disease in older adults requiring intervention. Severe symptomatic AS, if left untreated, is typically associated with a poor prognosis. Over the past two decades, there have been significant advances in the field of transcatheter aortic valve replacement (TAVR), leading to its emergence as an alternative to the well-established surgical aortic valve replacement (SAVR) for treating severe AS.
View Article and Find Full Text PDFBackground: The native aortic annulus for self-expanding transcatheter aortic valve replacement (TAVR) has variable ellipticity. A noncircular and underexpanded transcatheter aortic valve (TAV) may impact hemodynamic performance. This study aimed to quantify Evolut TAV (Medtronic) frame ellipticity and expansion 30 days post-TAVR and evaluate their impact on 1-year hypoattenuating leaflet thickening and 4-year hemodynamics.
View Article and Find Full Text PDFBackground: Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).
Methods: Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database.
Oral tumors are relatively common in dogs, and canine oral squamous cell carcinoma (COSCC) is the most prevalent oral malignancy of epithelial origin. COSCC is locally aggressive with up to 20% of patients showing regional or distant metastasis at the time of diagnosis. The treatment of choice most typically involves wide surgical excision.
View Article and Find Full Text PDFBackground: Angulation of virtual basal ring (VBR), also known as aortic annulus, in relation to sino-tubular junction (STJ) may lead to greater exposure of implanted stent to the conduction system, consequently increasing the risk of left bundle branch block (LBBB).
Aims: We sough to measure the VBR-STJ angle and explore its impact on the development of LBBB post-TAVR.
Methods: Patients undergoing TAVR using the Sapiens 3 valve between 2016 and 2021, without pre-TAVR conduction anomalies were included.
Background: The ongoing residual cardiovascular risks despite lowering low-density lipoprotein cholesterol (LDL-C) levels suggest the need to identify additional drivers associated with atherosclerosis. Circulating lipoprotein(a) [Lp(a)]promotes formation of foam cells via its proatherogenic properties. However, whether a lower Lp(a) level in combination with favorable LDL-C control could induce a more stable form of disease remains unknown.
View Article and Find Full Text PDFThis study sought to explore the clinical factors associated with classical low-flow low-gradient (C-LFLG) and normal-flow low-gradient (NFLG) aortic stenosis (AS) compared with high-gradient (HG) AS. We also compared clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) across flow-gradient patterns. Patients with C-LFLG AS have a higher mortality rate after TAVR than those with HG AS.
View Article and Find Full Text PDFBackground: Data supporting the use of transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) is limited compared to tricuspid aortic valve (TAV) anatomy, as the BAV anatomy poses unique challenges to prosthesis expansion and symmetric deployment.
Aims: We aim to compare the acute recoil and asymmetry of the SAPIEN-3 valve between BAV and TAV anatomies and their impact on procedural outcomes.
Methods: We conducted a single-center study of patients who underwent TAVR with the SAPIEN-3 valve.
Background: Left ventricular (LV) dilatation and extensive scar portend a poor prognosis in heart failure (HF). The Revivent TC system (BioVentrix Inc) is used either during a hybrid transcatheter-surgical or a surgical-only procedure to exclude transmural scar and reduce LV dimensions.
Objectives: The purpose of this study was to examine the safety and efficacy of the Revivent TC® anchor system in patients with HF.
Purpose Of Review: We describe the evolution of caval valve implantation (CAVI) as a treatment for severe symptomatic tricuspid regurgitation (TR) in the high surgical risk patient.
Recent Findings: Surgical treatment of severe TR is often limited by the high surgical risk of the patients who tend to develop severe secondary TR. Coaptation, annuloplasty, and orthotopic replacement strategies are all limited by annular and leaflet geometry, prior valve repair, and the presence of cardiac implantable device leads.
Article Synopsis
- This study investigated the effect of mitral stenosis (MS) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with modern balloon-expandable valves, using data from over 327,000 patients across multiple centers.
- It was found that while patients with severe MS initially had worse outcomes, when matched for similar characteristics, their 30-day outcomes were similar to those with mild or less MS, except for a higher rate of pacemaker implantation.
- However, by three years post-TAVR, patients with severe MS showed a significantly higher mortality rate compared to those with mild or less MS, suggesting long-term risks associated with severe MS.
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
Article Synopsis
- Novel transcatheter therapies for tricuspid regurgitation (TR) show promise, but their suitability for the general TR patient population is still uncertain.
- In a study involving 178 patients with moderate symptomatic TR, only 10.7% qualified for investigative therapies, while many received off-label clipping, surgery, or medical treatment due to factors like unsuitable anatomy or existing health issues.
- Although the investigative group experienced significant improvement in TR severity after one year compared to the medical treatment group, their outcomes were similar to off-label clipping but not as favorable as surgery, highlighting the need for broader access to effective therapies for TR patients.
Article Synopsis
- The study investigates the relationship between chronic kidney disease (CKD) stages and the occurrence of acute congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) from data collected between 2009 and 2017.
- Results show that patients with CKD stage 3a or worse experience significantly more acute heart failure events and higher in-hospital mortality rates compared to those with CKD stages 1-2.
- The findings highlight that a lower estimated glomerular filtration rate (eGFR) is a strong predictor of these acute events, suggesting that patients with advanced CKD may benefit from targeted interventions to reduce the risk of heart failure after PCI.
Background & Aim: The extent and composition of coronary plaque, and its progression differ with patients' age. The interplay of patient's age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression.
View Article and Find Full Text PDFDiffuse large B-cell lymphomas (DLBCLs) are heterogeneous cancers that still require better and less toxic treatments. SIRT3, a member of the sirtuin family of NAD-dependent protein deacylase, is critical for DLBCL growth and survival. A mitochondria-targeted SIRT3 small-molecule inhibitor, YC8-02, exhibits promising activity against DLBCL.
View Article and Find Full Text PDFBackground: The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated.
Methods And Results: We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after.
Balloon Aortic Valvuloplasty in the Modern Era: A Review of Outcomes, Indications, and Technical Advances.
J Soc Cardiovasc Angiogr Interv
July 2023
Balloon aortic valvuloplasty (BAV) improves the hemodynamics and symptoms of patients with severe aortic stenosis in the short term with low rates of complications, but has not been shown to be an effective destination therapy. Our pooled analysis of >14,300 patients from studies published between January 1, 1991, and April 31, 2022, reported intraprocedural mortality and in-hospital mortality rates as 1.94% (95% CI, 1.
View Article and Find Full Text PDFThe Current Landscape of Transcatheter Tricuspid Valve Intervention.
J Soc Cardiovasc Angiogr Interv
December 2023
Tricuspid regurgitation (TR) is common, and its prevalence increases with age. It was previously estimated that there are 1.6 million patients in the United States with moderate or worse TR, and more contemporary data suggest the age-adjusted prevalence of TR is 0.
View Article and Find Full Text PDFArticle Synopsis
- A study analyzed the effectiveness of cerebral protection devices (CPDs) in patients undergoing transcatheter aortic valve replacement, using data from the Nationwide Readmissions Database (2017-2020) which included over 271,000 patients.
- Results indicated that while CPD use did not significantly lower overall stroke rates, it was linked to a reduced rate of major strokes, shorter hospital stays, and lower mortality rates compared to patients without CPD.
- The study concludes that while CPDs may not affect overall stroke risk, they appear beneficial for reducing major strokes; further randomized trials are needed to clarify which patients would gain the most from using these devices.
Article Synopsis
- Left ventricular (LV) function is linked to the elasticity of the ascending aorta (AA), with stiffness in the AA potentially leading to reduced LV performance in patients with heart failure with preserved ejection fraction (HFpEF).
- A study using the Living Left Heart Human Model simulated different scenarios, including models with elastic and stiff AAs, as well as a stiff AA with a free LV apex.
- Results indicate that allowing the LV apex to move freely could counteract the negative effects of a stiff AA, suggesting a potential therapeutic approach to improve LV function in HFpEF patients.
Article Synopsis
- Skeletal muscle mass (SMM) is important for assessing risks in candidates for transcatheter aortic valve replacement (TAVR), but it's often overlooked compared to traditional measures like weakness or performance.
- A study evaluated three risk models that combined SMM data with frailty assessments to predict complications, rehospitalization, or mortality after TAVR in a cohort of 184 patients.
- Results showed that patients with sarcopenia and those identified as frail had significantly higher rates of adverse outcomes, and incorporating CT-based SMM into frailty assessments improved predictive accuracy for these risks.
Article Synopsis
- During systole, the left ventricle shortens, moving the aortic root and stretching the ascending aorta, which impacts heart function.
- A study revealed that stiffening of the ascending aorta increases stress in the left ventricle and leads to decreased muscle strain, particularly in the septal area.
- Overall, aortic stiffening negatively affects left ventricular function, but increasing myofiber contractility could help recover some lost stroke volume despite persistent reductions in specific muscle strains.