cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.12091554
title: Contrast-Sparing Imaging Utilizing Spectral Detector CT for Transcatheter Aortic Valve Replacement Procedure Planning

description: <b>:</b> Cardiac CTA is an indispensable imaging tool for TAVR procedure planning. Post-processing of the dual-energy CT utilizing dual-source and kV-switching approach enables an increase in the density of iodine and allows the reduction of iodine dose. We hypothesized that the use of a dual-layer Spectral Detector CT (SDCT) can enhance the signal of intravascular iodine contrast material, reduce iodine contrast material volume, and facilitate pre-TAVR planning. <b>:</b> We tested this in a preclinical porcine animal model, with results suggesting that spectral imaging may be superior to conventional imaging even at 21-35% of the full contrast medium dose with regard to reader confidence, higher SNR and CNR at the level of the aortic annulus and root. We subsequently followed this up by a prospective human validation study of 24 patients undergoing TAVR. <b>:</b> We demonstrate that SNR and CNR with SDCT were significantly higher (highest in lower energy virtual mono-energetic images (VMI) (monoE 40 keV) compared to conventional images, with the spectral images preferred for procedure planning by an experienced TAVR operator and imaging specialist. This was associated with a reduction in inter-observer variability in TAVR sizing measurements in low dose contrast studies (33% of the full contrast dose) resulting in a higher rate of agreement on the choice of valve prosthesis size. <b>:</b> Low contrast dose spectral images achieved similar SNR and CNR compared to full contrast dose conventional images. Taken together, our results suggest that the use of SDCT imaging may facilitate the routine use of low contrast dose as part of pre-TAVR imaging.
DOI: 10.6084/m9.figshare.12091554.v1
title: Contrast-Sparing Imaging Utilizing Spectral Detector CT for Transcatheter Aortic Valve Replacement Procedure Planning

description: <b>:</b> Cardiac CTA is an indispensable imaging tool for TAVR procedure planning. Post-processing of the dual-energy CT utilizing dual-source and kV-switching approach enables an increase in the density of iodine and allows the reduction of iodine dose. We hypothesized that the use of a dual-layer Spectral Detector CT (SDCT) can enhance the signal of intravascular iodine contrast material, reduce iodine contrast material volume, and facilitate pre-TAVR planning. <b>:</b> We tested this in a preclinical porcine animal model, with results suggesting that spectral imaging may be superior to conventional imaging even at 21-35% of the full contrast medium dose with regard to reader confidence, higher SNR and CNR at the level of the aortic annulus and root. We subsequently followed this up by a prospective human validation study of 24 patients undergoing TAVR. <b>:</b> We demonstrate that SNR and CNR with SDCT were significantly higher (highest in lower energy virtual mono-energetic images (VMI) (monoE 40 keV) compared to conventional images, with the spectral images preferred for procedure planning by an experienced TAVR operator and imaging specialist. This was associated with a reduction in inter-observer variability in TAVR sizing measurements in low dose contrast studies (33% of the full contrast dose) resulting in a higher rate of agreement on the choice of valve prosthesis size. <b>:</b> Low contrast dose spectral images achieved similar SNR and CNR compared to full contrast dose conventional images. Taken together, our results suggest that the use of SDCT imaging may facilitate the routine use of low contrast dose as part of pre-TAVR imaging.
DOI: 10.6084/m9.figshare.11988591
title: Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets

description: This study sought to investigate the impact of extensive over-expansion of transcatheter heart valves (THVs) on leaflet structure. THVs may be over-expanded beyond recommended labeling in certain clinical scenarios. However, it is unknown whether over-expansion damages pericardial leaflets. Therefore, we assessed the effect of over-expansion on THV leaflets. SAPIEN 3 THVs (one of each a 23 mm, 26 mm, and 29 mm valve) were expanded to nominal dimensions and then over-expanded to larger than the recommended diameters. Leaflets from a nominally expanded THV were used as control. Structural changes to the leaflets were assessed by histology, scanning electron microscopy (SEM), and second-harmonic generation (SHG) microscopy. Analysis of leaflets by SHG microscopy using texture analysis demonstrated that over-expansion of 23 mm, 26 mm, and 29 mm THVs resulted in significant disorganization of the fibrilar collagen on both aortic and ventricular surfaces (<i>p</i> p p Sequential over-expansion by 1 mm increments up to 3 mm, which is not typically used in clinical practice, of SAPIEN 3 valves on the bench results in damage to the aortic and ventricular surfaces of pericardial leaflets. Whether a lesser degree of over-expansion or degree of over-expansion used clinically will cause similar leaflet injury will require further investigation. AS: Aortic stenosis; A.U.: Arbitrary units; CT: Computed tomography; ECM: Extracellular matrix; GLCM: Gray level co-occurrence matrix (GLCM); H&E: Hematoxylin and eosin; ROI: Region of interest; S3: SAPIEN 3 transcatheter valve; SEM: Scanning electron microscopy; SHG: Second-harmonic generation; TAVR: Transcatheter aortic valve replacement; THV: Transcatheter heart valve
DOI: 10.6084/m9.figshare.11988591.v2
title: Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets

description: This study sought to investigate the impact of extensive over-expansion of transcatheter heart valves (THVs) on leaflet structure. THVs may be over-expanded beyond recommended labeling in certain clinical scenarios. However, it is unknown whether over-expansion damages pericardial leaflets. Therefore, we assessed the effect of over-expansion on THV leaflets. SAPIEN 3 THVs (one of each a 23 mm, 26 mm, and 29 mm valve) were expanded to nominal dimensions and then over-expanded to larger than the recommended diameters. Leaflets from a nominally expanded THV were used as control. Structural changes to the leaflets were assessed by histology, scanning electron microscopy (SEM), and second-harmonic generation (SHG) microscopy. Analysis of leaflets by SHG microscopy using texture analysis demonstrated that over-expansion of 23 mm, 26 mm, and 29 mm THVs resulted in significant disorganization of the fibrilar collagen on both aortic and ventricular surfaces (<i>p</i> p p Sequential over-expansion by 1 mm increments up to 3 mm, which is not typically used in clinical practice, of SAPIEN 3 valves on the bench results in damage to the aortic and ventricular surfaces of pericardial leaflets. Whether a lesser degree of over-expansion or degree of over-expansion used clinically will cause similar leaflet injury will require further investigation. AS: Aortic stenosis; A.U.: Arbitrary units; CT: Computed tomography; ECM: Extracellular matrix; GLCM: Gray level co-occurrence matrix (GLCM); H&E: Hematoxylin and eosin; ROI: Region of interest; S3: SAPIEN 3 transcatheter valve; SEM: Scanning electron microscopy; SHG: Second-harmonic generation; TAVR: Transcatheter aortic valve replacement; THV: Transcatheter heart valve
DOI: 10.6084/m9.figshare.12018243.v2
title: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty

description: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty
DOI: 10.6084/m9.figshare.11988591.v1
title: Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets

description: <b>Background</b>: This study sought to investigate the impact of extensive over-expansion of transcatheter heart valves (THVs) on leaflet structure. THVs may be over-expanded beyond recommended labeling in certain clinical scenarios. However, it is unknown whether over-expansion damages pericardial leaflets. Therefore, we assessed the effect of over-expansion on THV leaflets. <b>Methods</b>: SAPIEN 3 THVs (one of each a 23mm, 26mm, and 29mm valve) were expanded to nominal dimensions and then over-expanded to larger than the recommended diameters. Leaflets from a nominally expanded THV were used as control. Structural changes to the leaflets were assessed by histology, scanning electron microscopy (SEM), and second-harmonic generation (SHG) microscopy. <b>Results</b>: Analysis of leaflets by SHG microscopyusing texture analysis demonstrated that over-expansion of 23mm, 26mm, and 29mm THVs resulted in significant disorganization of the fibrilar collagen on both aortic and ventricular surfaces (p&lt;0.05 for all). Histological analysis demonstrated significant thinning of leaflets in over-expanded THVs compared to control (p&lt;0.05 for over-expanded THVs) as well as a significant increase in pericardial tissue density within the leaflet (p&lt;0.05 for all over-expanded THVs) compared to control conditions. SEM analysis demonstrated breaks, stretching, and disorganization of collagen fibers within over-expanded THVs. <b>Conclusions</b>: Sequential over-expansion by 1mm increments up to 3mm, which is not typically used in clinical practice, of SAPIEN 3 valves on the bench results in damage to the aortic and ventricular surfaces of pericardial leaflets. Whether a lesser degree of over-expansion or degree of over-expansion used clinically will cause similar leaflet injury will require further investigation.
DOI: 10.6084/m9.figshare.13682141.v1
title: Temporal Trends of Transcatheter Edge-to-Edge Repair of the Mitral Valve Short-Term Outcomes in the United States: Nationwide Representative Study

description: <b>Background</b>: Transcatheter edge-to-edge repair of the mitral valve (TEER) has recently emerged as a viable treatment option in high-risk patients with severe mitral regurgitation. The present study investigated the trends in TEER short-term outcomes during 2014–2018. <b>Methods</b>: We performed a retrospective study using the Nationwide Readmissions Database. We analyzed data on the in-hospital and 30-day outcomes of patients who underwent TEER procedure during 2014–2018. <b>Results</b>: A total of 22,914 patients underwent TEER; 1,674 in 2014, 3,252 in 2015, 4,645 in 2016, 6,000 in 2017, and 7,343 in 2018 with a median age of 78, 80, 81, and 80 years, respectively, with a 4.2 fold increase in TEER utilization. Heart failure was present in 75.6%, and 83.6% of patients, in 2014, and 2018 respectively, while 73.3%, and 85.3% of patients, respectively, had hypertension. In-hospital mortality following TEER was significantly decreased from 3.9% in 2014 to 2% in 2018 (<i>P</i> P = 0.093), and the median length of hospital stay was significantly shortened from 4 to 2 days (<i>P</i> P = 0.876); however, the 30-day HF readmission rate exhibited a significant decline from 4.7% in 2014 to 0.6% in 2018 (<i>P</i> <b>Conclusion</b>: Although TEER therapy is now offered to a more critically ill and larger patient population in the United States, the outcomes of patients undergoing TEER are improving with decreasing mortality, morbidity, and hospital stay. <b>Abbreviations</b>: TEER: Transcatheter edge-to-edge repair of the mitral valve (TEER); NRD: National Readmissions Database; MR: Mitral Regurgitation; DMR: Degenerative Mitral Regurgitation; FMR: Functional Mitral Regurgitation; HF: Heart failure; LVEF: Left Ventricular Ejection Fraction; GDMT: Guideline-Directed Management and Therapy; AKI: Acute Kidney Injury; MI: Myocardial infarction
DOI: 10.6084/m9.figshare.14208253
title: Consensus Document on Non-Suitability for Transcatheter Mitral Valve Repair by Edge-to-Edge Therapy

description: As transcatheter therapies for mitral valve repair and replacement have increased, there exists a lack of clarity as to which patient and anatomic factors should determine patient selection for transcatheter repair versus replacement. At the request of the US Food & Drug Administration and under the auspices of the Heart Valve Collaboratory, a multi-disciplinary group convened to create this expert opinion document to identify patient and valvular factors that define non-suitability for transcatheter edge to edge repair, including 1) anatomic issues leading to the development of mitral stenosis, 2) anatomic factors associated with inadequate reduction in mitral regurgitation, 3) patient factors associated with inability to perform the TEER, and 4) clinical factors associated with futility in performing TEER. In such patients, barring futility, transcatheter mitral replacement could be considered.
DOI: 10.6084/m9.figshare.14208253.v1
title: Consensus Document on Non-Suitability for Transcatheter Mitral Valve Repair by Edge-to-Edge Therapy

description: As transcatheter therapies for mitral valve repair and replacement have increased, there exists a lack of clarity as to which patient and anatomic factors should determine patient selection for transcatheter repair versus replacement. At the request of the US Food & Drug Administration and under the auspices of the Heart Valve Collaboratory, a multi-disciplinary group convened to create this expert opinion document to identify patient and valvular factors that define non-suitability for transcatheter edge to edge repair, including 1) anatomic issues leading to the development of mitral stenosis, 2) anatomic factors associated with inadequate reduction in mitral regurgitation, 3) patient factors associated with inability to perform the TEER, and 4) clinical factors associated with futility in performing TEER. In such patients, barring futility, transcatheter mitral replacement could be considered.
DOI: 10.6084/m9.figshare.13682141
title: Temporal Trends of Transcatheter Edge-to-Edge Repair of the Mitral Valve Short-Term Outcomes in the United States: Nationwide Representative Study

description: <b>Background</b>: Transcatheter edge-to-edge repair of the mitral valve (TEER) has recently emerged as a viable treatment option in high-risk patients with severe mitral regurgitation. The present study investigated the trends in TEER short-term outcomes during 2014–2018. <b>Methods</b>: We performed a retrospective study using the Nationwide Readmissions Database. We analyzed data on the in-hospital and 30-day outcomes of patients who underwent TEER procedure during 2014–2018. <b>Results</b>: A total of 22,914 patients underwent TEER; 1,674 in 2014, 3,252 in 2015, 4,645 in 2016, 6,000 in 2017, and 7,343 in 2018 with a median age of 78, 80, 81, and 80 years, respectively, with a 4.2 fold increase in TEER utilization. Heart failure was present in 75.6%, and 83.6% of patients, in 2014, and 2018 respectively, while 73.3%, and 85.3% of patients, respectively, had hypertension. In-hospital mortality following TEER was significantly decreased from 3.9% in 2014 to 2% in 2018 (<i>P</i> P = 0.093), and the median length of hospital stay was significantly shortened from 4 to 2 days (<i>P</i> P = 0.876); however, the 30-day HF readmission rate exhibited a significant decline from 4.7% in 2014 to 0.6% in 2018 (<i>P</i> <b>Conclusion</b>: Although TEER therapy is now offered to a more critically ill and larger patient population in the United States, the outcomes of patients undergoing TEER are improving with decreasing mortality, morbidity, and hospital stay. <b>Abbreviations</b>: TEER: Transcatheter edge-to-edge repair of the mitral valve (TEER); NRD: National Readmissions Database; MR: Mitral Regurgitation; DMR: Degenerative Mitral Regurgitation; FMR: Functional Mitral Regurgitation; HF: Heart failure; LVEF: Left Ventricular Ejection Fraction; GDMT: Guideline-Directed Management and Therapy; AKI: Acute Kidney Injury; MI: Myocardial infarction
DOI: 10.6084/m9.figshare.13190820
title: Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Kidney Transplant Recipients: A Nationwide Representative Study

description: <b>Background</b>: Kidney transplant is the preferred treatment for end-stage kidney disease due to a better quality of life and lower morbidity and mortality than dialysis. These patients are considered high-risk patients for surgical interventions. Transcatheter aortic valve replacement (TAVR) has been introduced as an alternative to surgical aortic valve replacement in patients at high operative risk with aortic stenosis (AS). However, the outcomes of TAVR in kidney transplant patients regarding benefits and harms have not been well-studied in nationally representative data. <b>Methods</b>: Patients hospitalized for TAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database (NRD). Patients were subdivided based on having a previous history of kidney transplant. <b>Results</b>: Our study included 171,011 TAVR patients, of which 0.4% had a history of functioning kidney transplant. Patients with a history of kidney transplant generally had more rates of comorbidities and were more likely to develop in-hospital hemorrhagic stroke (0.7% vs. 0.1%, <i>P</i> = 0.004), ischemic stroke (4.5% vs. 2%, <i>P</i> P P <b>Conclusion</b>: Patients with a history of kidney transplantation experience an increased risk of adverse outcomes following TAVR compared to non-kidney transplant patients. Further attention should be directed to measures to improve such outcomes in kidney transplant patients undergoing TAVR. <b>Abbreviations:</b> KT: kidney transplant; KTRs: kidney transplant recipients; TAVR: transcatheter aortic valve replacement; AS: aortic stenosis; SAVR: surgical aortic valve replacement; IHS: in-hospital stroke; AKI: acute kidney injury; ESKD: end-stage kidney disease; CKD: chronic kidney disease; TCEP: transcatheter cerebral embolic protection; DSCT: dual source computed tomography; VLCV: very low contrast volume
DOI: 10.6084/m9.figshare.13190820.v1
title: Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Kidney Transplant Recipients: A Nationwide Representative Study

description: <b>Background</b>: Kidney transplant is the preferred treatment for end-stage kidney disease due to a better quality of life and lower morbidity and mortality than dialysis. These patients are considered high-risk patients for surgical interventions. Transcatheter aortic valve replacement (TAVR) has been introduced as an alternative to surgical aortic valve replacement in patients at high operative risk with aortic stenosis (AS). However, the outcomes of TAVR in kidney transplant patients regarding benefits and harms have not been well-studied in nationally representative data. <b>Methods</b>: Patients hospitalized for TAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database (NRD). Patients were subdivided based on having a previous history of kidney transplant. <b>Results</b>: Our study included 171,011 TAVR patients, of which 0.4% had a history of functioning kidney transplant. Patients with a history of kidney transplant generally had more rates of comorbidities and were more likely to develop in-hospital hemorrhagic stroke (0.7% vs. 0.1%, <i>P</i> = 0.004), ischemic stroke (4.5% vs. 2%, <i>P</i> P P <b>Conclusion</b>: Patients with a history of kidney transplantation experience an increased risk of adverse outcomes following TAVR compared to non-kidney transplant patients. Further attention should be directed to measures to improve such outcomes in kidney transplant patients undergoing TAVR. <b>Abbreviations:</b> KT: kidney transplant; KTRs: kidney transplant recipients; TAVR: transcatheter aortic valve replacement; AS: aortic stenosis; SAVR: surgical aortic valve replacement; IHS: in-hospital stroke; AKI: acute kidney injury; ESKD: end-stage kidney disease; CKD: chronic kidney disease; TCEP: transcatheter cerebral embolic protection; DSCT: dual source computed tomography; VLCV: very low contrast volume
DOI: 10.6084/m9.figshare.13171740
title: Contemporary Review of the Ross Procedure

description: The ideal aortic valve substitute in non-elderly adults requires a tailored approach and thoughtful consideration. The main principles remain however constant, seeking to optimize long-term survival and quality of life, while limiting the risks of valve-related complications and reinterventions. In recent years, considerable data has emerged focusing on long-term outcomes after aortic valve surgery in non-elderly adults. As such, the Ross procedure has gained renewed interest because it results in several clinically relevant advantages when compared with other valves substitutes. However, the Ross procedure is a more complex operation and involves two valves instead of one. In this review article, we will examine the theoretical and clinical rationale for the Ross procedure, optimal patient selection, and give an overview of technical details and patient management. Finally, we will present the broader clinical implications regarding the management of aortic valve disease in non-elderly adults in 2020.
DOI: 10.6084/m9.figshare.13171740.v1
title: Contemporary Review of the Ross Procedure

description: The ideal aortic valve substitute in non-elderly adults requires a tailored approach and thoughtful consideration. The main principles remain however constant, seeking to optimize long-term survival and quality of life, while limiting the risks of valve-related complications and reinterventions. In recent years, considerable data has emerged focusing on long-term outcomes after aortic valve surgery in non-elderly adults. As such, the Ross procedure has gained renewed interest because it results in several clinically relevant advantages when compared with other valves substitutes. However, the Ross procedure is a more complex operation and involves two valves instead of one. In this review article, we will examine the theoretical and clinical rationale for the Ross procedure, optimal patient selection, and give an overview of technical details and patient management. Finally, we will present the broader clinical implications regarding the management of aortic valve disease in non-elderly adults in 2020.
DOI: 10.6084/m9.figshare.13281492.v1
title: Complicated Bi-Pella Support: Acute Mitral Regurgitation and Bailout MitraClip Repair

description: Complicated Bi-Pella Support: Acute Mitral Regurgitation and Bailout MitraClip Repair
DOI: 10.6084/m9.figshare.13161825.v2
title: Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement

description: Degeneration of surgical bioprosthetic heart valves (BPVs) occurs in up to one third of surviving patients within a decade of implantation and is a common cause of cardiovascular morbidity. Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is a safe and effective treatment for patients with failed BPVs who are unsuitable for reoperation. However, there may be patient-prosthesis mismatch (PPM) following VIV TAVR, particularly in patients with small BPVs. This may influence both morbidity and mortality. Bioprosthetic valve fracture (BVF) has emerged as a novel technique to prevent PPM. It involves high-pressure inflation of a non-compliant balloon to fracture the ring of the BPV, allowing for further expansion of the implanted transcatheter heart valve (THV) and thereby reducing residual transvalvular gradients. Early experience with this technique has been promising. This review will describe the procedural technique of BVF, explore the lessons learned from bench testing and early clinical experience, and discuss the limitations of the current literature as well as future directions. <b>Abbreviations:</b> ACn: ACURATE neo; BPV: Bioprosthetic heart valve; BVF: Bioprosthetic valve fracture; BVR: Bioprosthetic valve remodeling; EOA: Effective orifice area; NYHA: New York Heart Association; PPM: Patient-prosthesis mismatch; PWI: Pin-wheeling index; S3: Sapien 3; SAVR: Surgical aortic valve replacement; TAVR: Transcatheter aortic valve replacement; TPVR: Transcatheter pulmonary valve replacement; THV: Transcatheter heart valve; VIV: Valve-in-valve