bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term outcomes for adults with complete atrioventricular septal defects
Authors: Seitler S , Al-Sakini N , Lacerna A , Flick C , West C , Senior R , Gatzoulis M A , Li W 
Published: October 2021

Abstract

Background/Introduction
Complete Atrio-Ventricular septal defect (AVSD) is a complex congenital cardiac disease, characterised by malformation at the atrio-ventricular junction and AV valve abnormalities. Long- term outcome data is limited.

Purpose
We sought to describe the long-term outcomes of adults with repaired complete AVSD in a tertiary adult congenital heart centre.

Methods
We retrospectively recruited patients with complete AVSD who underwent surgical repair between 1973 and 2001 in our centre. All clinical and echocardiographic data were collected and analysed for evidence of atrio-ventricular valve (AVV) deterioration, or cardiac dysfunction. We also assessed for the requirement for further surgical intervention throughout the follow up period.

Results
A total of 345 patients with AVSD were identified, partial AVSD 211, unrepaired 82. Fifty-two with repaired complete AVSD formed study group, female 36 (69%) and male 16 (31%), Trisomy 21 (23, 44%). Mean age at initial repair was 44 months (median 12, IQR 31.5). Mean follow up was 25.3 years (Median 24, IQR 9.75).
Clinical status: At the latest follow-up, most patient were asymptomatic with NYHA I-II (n=46) Majority (n=36, 69%) required only initial repair and no further intervention. Further surgeries were performed in 16 patients including AVV repair (n=9) and LVOTO relief (n=3). Permanent pacemaker insertion needed in 6 (12%), all for heart block following valve repair. 7 patients (14%) had documented arrythmia, 4 (8%) requiring ablations and only 1 had endocarditis.
Echo findings: AV Valve dysfunction was more commonly regurgitant rather than stenotic. More than moderate AVV regurgitation was present in 83% of patients, Left AVV (n=25, 48%), Right AVV (n=18, 35%) compared to 4% stenosis (LAVV n=1, RAVV n=1). Ventricular outflow tract obstruction was present in 8% of patients, RVOT obstruction (2, one native, one secondary to prior banding), LVOT obstruction (2, both native, one requiring surgical intervention).
Right ventricular systolic dysfunction was present in 6% of patients (n=3), with mean TAPSE 14.1mm (SD± 3.1mm). Left ventricular dysfunction was present in 4% (n=2), mean LVEF 58.9% (SD±7.1%) and mean LV EDVi 55.06mL/m2 (SD±13.2 mL/m2). Only one patient had significant pulmonary hypertension (Mean PAP 48 mmHg).

Conclusion
Long-term outcomes of surgically repaired AVSD are highly favourable. Left AVV regurgitation is the most common residual lesion requiring further surgical intervention. Ventricular outflow tract obstruction was much less common, as was ventricular systolic dysfunction. Complete heart block was associated with surgical repair and arrhythmias were potential late complications.

Funding Acknowledgement
Type of funding sources: None.
Usefulness of transthoracic echocardiography for pulmonary artery aneurysm screening in patients with pulmonary arterial hypertension
Authors: Guisasola Cienfuegos M , Nuche J , Lareo A , Alonso S , Arribas-Ynsaurriaga F , Escribano Subias P , Jimenez Lopez-Guarch C 
Published: October 2021

Abstract

Background/Introduction
Pulmonary artery aneurysm (PAA), defined as a pulmonary artery (PA) diameter &gt;40 mm, is a common finding among pulmonary arterial hypertension (PAH) patients. Although often asymptomatic, PAA may lead to life-threatening complications such as left main coronary artery compression or PA dissection. Transthoracic echocardiography (TTE) is regularly employed for risk assessment in PAH patients. However, TTE accuracy for PA measurement has not been evaluated, and current practice guidelines lack formal recommendations for PAA screening and follow-up. We aim to determine whether TTE is an appropriate tool for PA diameter measurement and determine an optimal cut-off point to diagnose a PAA through TTE.

Methods
We retrospectively analyzed a cohort of 657 PAH patients followed up at a national referral centre. For this analysis, we selected those patients who had undergone at least one TTE and one computed tomography (CT) or magnetic resonance (MR) within six months before or after the TTE. We performed an agreement analysis between CT/MR-based and TTE-based PA diameter using the Passing–Bablok method. Furthermore, we calculated the area under the curve for the identification of a PAA with a TTE (compared to CT/MR).

Results
We analyzed 281 simultaneous CT/MR and TTE of a total of 178 PAH patients (71% women). Median age at diagnosis was 42.1 (32.2–58.0) years. PAH etiology was idiopathic or familial in 67 (38%), associated with congenital heart disease in 28 (16%) and associated with connective tissue disease in 36 (20%) patients. In 46 (26%) patients PAH was associated with other entities, such as human immunodeficiency virus, pulmonary veno-occlusive disease, drugs or portal hypertension. We found a significant correlation between PA diameter measured in TTE and CT/CMR (Lin's concordance correlation coefficient = 0.851) (Figure 1). The area under the curve for the detection of PAA was 0.91 (95% CI 0.88–0.95, p=0.018) (Figure 2). We selected a TTE-based PA diameter 37 mm as the optimal cut-off point for PAA identification. This diameter correctly classified 85.4% of measurements with a sensitivity and a specificity of 83.2% and 87.2%, respectively.

Conclusion
Our study demonstrates that TTE is an adequate tool for PA diameter quantification with a strong correlation with CT/MR. This good correlation makes TTE an excellent tool for PAA screening among PAH patients, avoiding unnecessary CT or MR scan and helping to identify those patients in whom close follow-up is advisable. Based on these results, we recommend the inclusion of PA diameter measurement in TTE acquisition protocols for PAH patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Passing–Bablok regression lineFigure 2. ROC curve for PAA detection with TTE
Mitral annular disjunction and cardiovascular outcome in Marfan syndrome
Authors: Demolder A , Muino-Mosquera L , Timmermans F , Duytschaever M , De Backer J 
Published: October 2021

Abstract

Background
Mitral annular disjunction (MAD) has received growing interest in patients with mitral valve prolapse (MVP), ventricular tachycardia (VT) and sudden cardiac death (SCD). The clinical significance of MAD in Marfan syndrome (MFS) remains largely unexplored.

Purpose
To define the prevalence of MAD and examine the relation with cardiovascular outcomes and arrhythmia in patients with MFS.

Methods
The presence of MAD was assessed by echocardiography and the extent of MAD was categorized in tertiles. Patients also underwent resting ECG and 24-hour Holter monitoring. Outcomes included aortic events (aortic dissection or prophylactic aortic surgery), arrhythmic events (VT/SCD) and mitral valve surgery.

Results
A total of 142 patients (median age 25 years [range 2–64], 51% women) were evaluated. Forty-eight (34%) patients had MAD. Patients with MAD had larger aortic root Z-scores (4.1 [2.8–5.7] vs. 3.0 [1.8–4.0], p&lt;0.001) and more often showed MVP (71% vs. 15%, p&lt;0.001), ventricular ectopy (42% vs. 21%, p=0.027) and non-sustained ventricular tachycardia (39% vs. 17%, p=0.014) than patients without MAD. During follow-up, aortic events occurred at similar rates in patients with vs. without MAD (35% vs. 25%, p=0.103), but patients in the upper MAD tertile (&gt;10mm) showed a higher occurrence of aortic events (60% vs. 21%, p=0.011) compared to patients with MAD(+) ≤10mm. Arrhythmic events and a need for mitral valve surgery were observed exclusively in patients with MAD (p=0.004 and p&lt;0.001, respectively).

Conclusions
MAD is associated with a higher need for mitral valve intervention, occurrence of arrhythmic events and, in patients with extensive MAD, more aortic events. Cardiac imaging in MFS should consider the assessment of MAD as a potential marker for adverse outcome.

Funding Acknowledgement
Type of funding sources: None. Cardiovascular outcome and arrhythmia
Angioplasty of flow limiting stenosis improves left ventricular diastolic dysfunction in patients with peripheral artery disease
Authors: Baasen S , Stern M , Heinen Y , Goerdes L , Sansone R , Heiss C , Kelm M , Busch L 
Published: October 2021

Abstract

Background
Peripheral artery disease (PAD) is associated with hypertension and left ventricular diastolic dysfunction (LVDD).

Objective
We hypothesized that endovascular treatment of flow limiting peripheral stenosis may improve LVDD.

Methods
In this prospective single center trial, 23 patients with PAD Rutherford stage 2–4 were included. Augmentation index (AIx), central systolic blood pressure (cSBP) and ankle brachial index (ABI) were measured at baseline one day before, one day after and at follow up 4 months after angioplasty. LVDD was assessed by echocardiography at baseline and at follow up.

Results
Mean E/E' ratio was significantly lower at follow up (11.9±4.4 to 10.2±4.4; p&lt;0.01). Likewise, left atrial size (17.2±5.3 to 13.6±4.7 mm; p=0.014) decreased significantly, but not left atrial volume index (LAVI, 49.73±21.6 to 38.29±17.3 mL/m2; p=0.062). ABI acutely increased in the intervened leg and remained stable at follow up (0.71±0.13 to 0.84±0.13 to 0.89±0.18; p&lt;0.001). AIx (from 30.5±6.1 to 26.5±9.2; p=0.03) and cSBP (from 133±21 to 126±20 mmHg; p=0.05) acutely decreased after angioplasty. At follow up, there was no significant change in central hemodynamics (AIx, cSBP) as compared to baseline.

Conclusion
Chronic effects of angioplasty are associated with favorable improvement of diastolic function but not central hemodynamics.

Funding Acknowledgement
Type of funding sources: None.
Repeat revascularization impact on 10-year survival after PCI or CABG: post-hoc analysis of the SYNTAXES trial
Authors: Lunardi M , Ono M , Onuma Y , Serruys P 
Published: October 2021

Abstract

Background
Available data comparing Percutaneous Coronary Interventions (PCI) and Coronary Artery Bypass Graft (CABG) in multivessel or left main coronary artery disease (CAD) suggest higher rates of repeat revascularization events after PCI than CABG, with a negative influence on outcomes up to 5 years. The impact of repeat revascularization on very long-term outcomes remains unclear.

Aims
This study aims to investigate the impact on 10-year all-cause death of repeat revascularizations in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD).

Methods
The SYNTAXES study evaluated the vital status out to 10-year of patients with 3VD and/or LMCAD enrolled in the SYNTAX trial. Repeat revascularization events occurred within the first 5 years from the index procedure were adjudicated by an independent clinical events committee. Effects of repeat revascularizations on 10-year all-cause death were investigated through time-dependent Cox regression analysis.

Results
During the first 5 years, 330 out of 1800 patients (18.3%) underwent a minimum of one repeat revascularization, for a total of 459 repeat revascularization procedures, mostly consisting of repeat-PCI (393, 85.6%). Repeat revascularizations were more frequent among patients initially randomized to PCI (HR 2.3, 95% CI: 1.8–3.0, p&lt;0.0001). At 10 years, all-cause death was comparable between patients underwent any repeat revascularization and those not (27.6% vs. 25.1%, adjusted HR 2.3, 95% CI: 0.8–6.2, p=0.11). However, among patients requiring repeat revascularizations, who underwent initial PCI versus initial CABG presented a significantly higher 10-year all-cause death (32.7% vs 17.3%, p=0.004). The adjusted risk for 10-year all-cause death according to the subtypes of repeat revascularizations revealed only revascularization with CABG was an independent predictor (HR 6.2, 95% CI: 1.5–25.2, p=0.011).

Conclusions
In the SYNTAX trial, repeat revascularizations were more frequent after initial PCI. Although no difference on 10-year all-cause death was observed between patients who did undergo repeat revascularizations and who did not, higher death rates were reported among those required any repeat procedures after initial PCI or revascularization with CABG. These exploratory findings should be investigated with larger population in future studies.

Funding Acknowledgement
Type of funding sources: None. Survival curves at 10-year follow-up
Biodegradable polymer drug eluting stents versus durable polymer drug eluting stents for percutaneous coronary intervention
Authors: Kheifets M , Levi A , Bental T , Perl L , Codner P , Wittberg G , Talmor-Barkan Y , Landes U , Samara A , Greenberg G , Erez A , Vaknin-Assa H , Kornowski R 
Published: October 2021

Abstract

Background
Invasive angiography with subsequent revascularization is a widely used treatment method in patients with coronary heart disease. Although biodegradable polymer drug eluting stents (BP-DES) have been used for almost a decade now, clinical trials regarding their long-term outcomes are both sparse and inconsistent. We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with BP-DES versus durable polymer drug eluting stents (DP-DES).

Methods
Among 11,517 PCIs with second generation drug eluting stents preformed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was the composite of all-cause mortality, recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG). Propensity score matching was used to create a well-balanced cohort.

Results
Mean follow up was 4.8 years. Of the 3,413 matched pairs, 21% were females, and the mean age was 66. At one year, the primary outcome occurred in 9.6% patients versus 8.3% (p=0.05), and TVR rate was 4.1% versus 3% (p=0.005) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in in 24.9% versus 24.8% (p=0.83), and the rate of TVR was 9.8% versus 9.1% (p=0.07) in patients with DP-DES and BP-DES respectively.

Conclusions
Similar rates of the composite outcome were observed throughout the entire follow-up. TVR rates were lower in the DP-DES group at 1-year but equalized within 5 years.

Funding Acknowledgement
Type of funding sources: None.
In hospital outcomes of orbital/rotational coronary atherectomy in diabetic vs non-diabetic population: insights from the nationwide inpatient sample
Authors: Kurpad K , Mehta H , Sohal S , Garg N , Gopal S , Zainib M , Suthar K , Jumkhawala S , Ahsan M , Hawthorne K 
Published: October 2021

Abstract

Background
Atherectomy (AT) using an orbital/rotational system is useful in altering calcified plaque thereby facilitating stent placement and optimal stent expansion. Patients with diabetes mellitus (DM) are known to have a higher rate of complications after percutaneous coronary intervention. We aimed to assess the incidence of major adverse cardiovascular events after atherectomy in the diabetic population using a nationwide inpatient sample (NIS).

Methods
NIS-HCUP database from 2015–2017 was used to identify patients who underwent atherectomy. A cohort of patients with and without diabetes was identified. Demographics, in-hospital outcomes, complications in both groups were compared. Statistical significance was assigned at p&lt;0.05.

Results
Out of 6184 patients who underwent AT, 3134 (50.6%) patients had DM. Baseline characteristics have been outlined in the table below. Complications were comparable between the two groups except for higher incidence of post-procedure VTE in Diabetic patients. In-hospital mortality was lower among patients with DM (2.24% vs 3.29%, p-0.27), while the mean length of stay (5.92 vs 4.91 days, p-0.002) and the hospitalization charges ($165118.4 vs 151226, p-0.04) were higher, but this difference in length of stay and hospitalization charges were nullified on multivariate regression.

Conclusion
Our study suggests that an AT for severely calcified plaque in the coronary artery is a safe option in patients with DM with comparable in-hospital complications and outcomes to non-DM patients.

Funding Acknowledgement
Type of funding sources: None. Demographics and Outcomes of Atherectomy
Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study
Authors: Li Q , Chen S Q , Huang H Z , Liu L W , Chen W H , Zhou J H , Tan N , Liu J , Liu Y 
Published: October 2021

Abstract

Background
The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG).

Methods
Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr &gt;0.3 mg/dL or &gt;50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality.

Results
Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47).

Conclusions
Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG.

Funding Acknowledgement
Type of funding sources: None. Association of AKI and mortalitySubgroups analysis
Left ventricular outflow morphology as a predictor of arrhythmic disturbances after TAVI
Authors: Espejo Paeres A C , Marroquin L , McInerney A , Hennessey B , Perez-Vizcayno M J , Tirado G , Macaya F , Nunez-Gil I , Mejia-Renteria H , Gonzalo N , Salinas-Sanguino P , Fernandez-Ortiz A , Escaned J , Nombela-Franco L , Jimenez-Quevedo P 
Published: October 2021

Abstract

Introduction
Left bundle branch block (LBBB) and permanent pacemaker (PM) are frequent complications after transcatheter aortic valve implantation (TAVI), but few predictors have been reported.

Purpose
This study sought to determine the relationship between left ventricular outflow tract (LVOT) morphology and the development of conduction disturbances after TAVI.

Methods
From 1/2020 to 12/2020 consecutive patients who underwent TAVI and an analyzable CT scan in our center were selected. Patients were categorized according to the LVOT morphology into three groups. The delta value between mean aortic root diameter (AA-d) and mean LVOT-d were calculated, and divided into terciles. In patients in the third tercile the AA-d was greater than LVOT-d and was defined as tapered-LVOT (group 1). First and second terciles had tubular or flared-LVOT shape and were defined as group 2. We compared conductance disorders after TAVI with and without tapered-LVOT. Primary endpoint was the combined of new-onset of transient/persistent LBBB, and PM. Factors with p&lt;0.05 on the univariate analysis were entered into the multivariate analysis.

Results
Among 98 eligible patients thirty-two patients (33%) presented a tapered-LVOT (Group 1) and 66 (67%) had tubular or flared-LVOT morphology (group 2). The mean age was 80.5±5.5 years and 60% were female. Baseline characteristics were similar between groups except for the incidence of dyslipidemia that was higher in group 2. The primary study endpoint was significantly higher in group 1 (78% vs. 59%: p=0.036). After adjusting for confounding factors, this relationship remained statistically significant (OR: 2.81 (CI95%: 1–7.96), p 0.046). Independent predictors of conduction disturbance were: tapered-LVOT, prior coronary artery disease and prior surgical valve replacement.

Conclusions
After TAVI, patients presenting a tapered-LVOT morphology have a 2.8-fold greater risk to develop LBBB or require permanent PM when compared to another LVOT shapes.

Funding Acknowledgement
Type of funding sources: None.
Transcatheter mitral valve-in-valve implantation: a 10-year single center experience
Authors: Akodad M , Sathananthan G , Chatfield A G , Trpkov C , Lounes Y , Chuang A , Wood D A , Boone R H , Moss R , Cheung A , Ye J , Blanke P , Leipsic J , Sathananthan J , Webb J G 
Published: October 2021

Abstract

Background
Transcatheter mitral valve-in-valve (TMVIV) appears a reasonable alternative to surgical redo mitral valve replacement in patients with degenerated mitral prosthesis and high surgical risk with favorable early and mid-terms outcomes. Long-term outcomes are limited by high mortality in a comorbid population.

Purpose
We aimed to evaluate early prosthesis hemodynamic performance and late clinical outcomes following TMVIV.

Methods
All patients who underwent TMVIV for degenerated surgical mitral bioprostheses from 2011 to 2020 in our center were included. Prospectively collected demographic, clinical, procedural, and imaging variables were analyzed. Clinical and echocardiographic outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions and assessed at 30-day and at the latest follow-up available.

Results
A total of 67 patients were included; mean age 76.9±9.6 years, mean STS score 11.0±6.2%, 53.7% male (n=36). Mechanisms of bioprosthetic failure were mitral stenosis (n=32, 47.8%), mitral regurgitation (n=24, 35.8%), and mixed (n=11, 16.4%). Mean time from mitral valve surgery to TMVIV was 10.2±4.3 years. Access was mostly transapical (n=45; 67.2%), followed by transseptal (n=22; 32.8%). Following the first transseptal procedure in 2016; transseptal access accounted for the majority of procedures (22 of 37 cases, 59.4%).
Technical success was achieved in 65 patients (97.0%). Mean hospitalization was 9.2±10.0 days; shorter with the transseptal as opposed to the transapical approach (6.3±8.1 days versus 11.0±10.5 days, p=0.001). At 30-day echographic follow-up, mean mitral valve gradient was 7.3±2.7 and 1 patient (1.9%) had mitral regurgitation &gt;mild.
At 30-day follow-up, 3 patients had died (4.5%); due to left ventricular outflow tract obstruction (1), heart failure (1), and stroke (1). New pacemakers were required in 2 patients (3.0%) and pacemaker lead dislodgement occurred in 1 patient (1.5%), 4 patients (6.2%) were hospitalized for heart failure. At a median follow-up of 3.8 years [1.7–5.1], 29 patients had died (43.3%), valve thrombosis was found in 6 (8.9%) and endocarditis in 4 patients (6.2%). Mitral valve reintervention was performed in 4 patients (6.2%); redo TMVIV due to valve migration in 1 (1.9%), surgical valve replacement in 1 (1.9%), and delayed redilation with a non-compliant balloon due to underexpansion in 2 patients (3.8%).

Conclusion
TMVIV is associated with acceptable 30-day mitral valve hemodynamics. Long-term mortality remains high in this high-surgical risk comorbid group.

Funding Acknowledgement
Type of funding sources: None.