Publications by authors named "Charles H Choi"

9 Publications

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A novel technique for postclosure of large-bore sheaths using two Perclose devices.

Catheter Cardiovasc Interv 2020 Oct 24. Epub 2020 Oct 24.

Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina.

Objectives: This study aimed to assess the feasibility, efficacy, and safety of a novel percutaneous postprocedure closure technique for large arterial sheath removal with the use of two Perclose ProGlide (Abbott Vascular Devices, Redwood City, CA) devices.

Background: Postprocedural closing of large-bore arteriotomies using the Perclose system can be difficult given the subsequent inability of the device to capture sufficient wall tissue.

Methods: Our study was a single-center retrospective analysis of 22 consecutive patients who underwent large arteriotomy closure via the postclosure technique with a 12-16-Fr sheath. Efficacy endpoints included successful deployment of the system and hemostasis. Safety endpoints included the incidence of major or minor vascular complications as defined by the Vascular Academic Research Consortium-2 (VARC-2) definitions at 30-day follow-up.

Results: The postclosure technique resulted in 100% technical success rate and no postprocedural bleeding or vascular complications.

Conclusion: Postclosure technique is a safe, highly effective, and feasible percutaneous method to achieve large-bore arteriotomy hemostasis with low rates of major bleeding or vascular complications and favorable early outcome.
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http://dx.doi.org/10.1002/ccd.29351DOI Listing
October 2020

A comparison of valve-in-valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves.

Catheter Cardiovasc Interv 2019 05 27;93(6):1106-1115. Epub 2018 Dec 27.

Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Objectives: The objectives of this study were to compare short- and intermediate-term clinical outcomes, procedural complications, TAVR prosthesis hemodynamics, and paravalvular leak (PVL) in stentless and stented groups.

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is an alternative to surgical redo for bioprosthetic valve failure. There have been limited data on ViV in stentless surgical valves.

Methods: We retrospectively analyzed 40 patients who underwent ViV TAVR in prior surgical bioprosthetic valves at Wake Forest Baptist Medical Center from October 2014 to September 2017. Eighty percent (32/40) ViV TAVRs were in stentless, while 20% (8/40) were in stented bioprosthetic valves.

Results: The primary mode of bioprosthetic valve failure for ViV implantation in the stentless group was aortic insufficiency (78%, 25/32), while in the stented group was aortic stenosis (75%, 6/8). The ViV procedure success was 96.9% (31/32) in stentless group and 100% in stented group (8/8). There were no significant differences in all-cause mortality at 30 days between stentless and stented groups (6.9%, 2/31 versus 0%, 0/8, P = 0.33) and at 1 year (0%, 0/25 versus 0%, 0/5). In the stentless group, 34.4% (11/32) required a second valve compared to the stented group of 0% (0/8). There was a significant difference in the mean aortic gradient at 30-day follow-up (12.33 ± 6.33 mmHg and 22.63 ± 8.45 mmHg in stentless and stented groups, P < 0.05) and at 6-month follow-up (9.75 ± 5.07 mmHg and 24.00 ± 11.28 mmHg, P < 0.05), respectively.

Conclusions: ViV in the stentless bioprosthetic aortic valve has excellent procedural success and intermediate-term results. Our study shows promising data that may support the application of TAVR in stentless surgical aortic valve. However, further and larger studies need to further validate our single center's experience.
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http://dx.doi.org/10.1002/ccd.28039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590419PMC
May 2019

Comparison of paravalvular aortic leak characteristics in the Medtronic CoreValve versus Edwards Sapien Valve: Paravalvular aortic leak characteristics.

Catheter Cardiovasc Interv 2018 11 4;92(5):972-980. Epub 2018 May 4.

Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.

Objectives: Temporally quantify and localize paravalvular aortic leak (PVL) after transcatheter aortic valve replacement (TAVR) in the Medtronic CoreValve (MCV) versus the Edwards Sapien Valve (ESV).

Background: In order to increase the precision of THV selection and PVL intervention, an understanding of PVL characteristics is essential.

Methods: The frequency, severity, and location of post-TAVR PVL were evaluated with transthoracic echocardiography pre-discharge, one month, and one-year post-procedure in 202 patients receiving a MCV (N = 120) or ESV (N = 81). This was done through application of a clock face to the short axis of the aortic valve in order to divide the area into three tertiles.

Results: Pre-discharge differences between PVL frequency and severity in the MCV and ESV lost significance over time. Localizing these trends, MCV PVL frequency and severity significantly decreased in the first and third tertiles during most time periods while PVL in the second tertile of the MCV or in any of the tertiles of the ESV failed to improve. Presence of pre-discharge PVL was predictive of 30-day HF readmission and/or death (OR = 3.16, 95% CI: 0.99-10.12). Presence of pre-discharge and 30-day PVL was predictive of 1-year HF readmissions and/or death (OR = 2.12, 95% CI: 1.09-4.13 and OR = 1.99, 95% CI: 0.96-4.12).

Conclusions: When comparing the MCV and ESV, not all locations of PVL improve equally over time, which has implications for heart failure readmissions. This could be used to influence valve selection and to identify cases in which earlier intervention on PVL may be appropriate.
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http://dx.doi.org/10.1002/ccd.27643DOI Listing
November 2018

Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach.

Catheter Cardiovasc Interv 2018 06 10;91(7):1354-1362. Epub 2017 Oct 10.

Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157.

Objectives: The objective is to compare the short-term (30 days) and late (12 months) vascular adverse events in patients undergoing transfemoral (TF)-transcatheter aortic valve replacement (TAVR) by surgical cut-down (SC) vs. percutaneous (PC) approaches.

Background: Programs continue to utilize both approaches in TF-TAVR. There are limited data comparing outcomes by SC vs. PC approaches and long-term effects of endovascular intervention facilitated hemostasis on late vascular adverse events.

Methods: A total of 146 men and women aged 79.7 ± 10.0 years with severe aortic stenosis deemed extreme or high risk for surgery underwent TAVR via TF access. 61 had SC and 85 had PC approaches. Valve Academic Research Consortium (VARC-2) outcomes were assessed at an average of 12.1 months after TAVR.

Results: Hospital length of stay (LOS) post-TAVR was shorter for the PC group compared to the SC group (5.1 ± 3.9 vs. 8.2 ± 6.6 days; P < 0.001). More patients were discharged directly to home in the PC than the SC group (85.9% vs. 68.9%, P < 0.05). At 30 days, there were 13/61 (21.3%) and 16/85 (18.8%; P < 0.05) of any vascular events, and 2/61 (3.3%) and 2/85 (2.4%; P = 0.73) major vascular events in the SC and PC groups, respectively. There was no difference in all-cause mortality between the SC (14/61; 23%) and PC groups [17/85 (20%); P = 0.34]. There was no difference in any [4/33 (12%) vs. 3/43 (7%); P = 0.84] or major vascular adverse events [1/33 (3%) vs. 1/43 (2%); P = 0.79] in subjects that underwent adjunctive endovascular intervention compared to those who did not, respectively. There were no statistically significant univariate or multivariate predictors of any vascular event at 12 months when comparing SC to PC groups.

Conclusion: For TF TAVR, the PC approach, when compared to the SC approach, is associated with a shorter hospital LOS and higher rate of direct discharge to home with similar risk of vascular complications, late vascular adverse events, and all-cause mortality at 12 months.
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http://dx.doi.org/10.1002/ccd.27377DOI Listing
June 2018

Angiosarcoma of the right atrium presenting as hemoptysis.

Proc (Bayl Univ Med Cent) 2016 Jan;29(1):79-80

Division of Cardiothoracic Surgery, Department of Surgery, Texas A&M Health Science Center at Scott & White Memorial Hospital, Temple, Texas (Choi, Konda, Shake); the Department of Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina (Choi); and the Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi (Shake).

This case report describes a previously healthy 32-year-old man who presented with several weeks of hemoptysis. Initially he was treated with antibiotics with a preliminary diagnosis of pneumonia. With increasing hemoptysis and additional symptoms, he was referred to our institution. Cardiac magnetic resonance imaging suggested a diagnosis of right atrial angiosarcoma with extensive pulmonary metastases. His extensive pulmonary tumor burden caused the hemoptysis. Pulmonary biopsy was well tolerated, and he was referred to medical oncology for adjuvant therapy. Following the first cycle of chemotherapy, his hemoptysis lessened.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677866PMC
http://dx.doi.org/10.1080/08998280.2016.11929370DOI Listing
January 2016

Consequence of patient substitution of nattokinase for warfarin after aortic valve replacement with a mechanical prosthesis.

Proc (Bayl Univ Med Cent) 2015 Jan;28(1):81-2

Division of Cardiothoracic Surgery, Department of Surgery, Texas A&M Health Science Center at Scott & White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508. Dr. Shake is now at the University of Mississippi Medical Center.

This report describes a patient's self-substitution of nattokinase for the vitamin K antagonist warfarin after aortic valve replacement with a mechanical prosthesis. Nattokinase is an enzyme derived from a popular fermented soybean preparation in Japan (natto), which has fibrinolytic properties and is gaining popularity in nontraditional health journals and nonmedical health websites as an over-the-counter thrombolytic. After nearly a year of use of nattokinase without warfarin, the patient developed thrombus on the mechanical valve and underwent successful repeat valve replacement. We believe this is the first documented case of nattokinase being used as a substitute for warfarin after valve replacement, and we strongly discourage its use for this purpose.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264722PMC
http://dx.doi.org/10.1080/08998280.2015.11929198DOI Listing
January 2015

Transient hypothermia in HIV-1 with insulin-like growth factor-1 deficiency and severe protein calorie malnutrition.

Proc (Bayl Univ Med Cent) 2015 Jan;28(1):29-30

Division of Internal Medicine, Department of Medicine, Texas A&M Health Science Center College of Medicine at Scott and White Memorial Hospital, Temple, Texas.

Hypothermia is a multifactorial process that results from decreased heat production or increased heat loss, with the former due to, but not limited to, endocrine dysfunction, malnutrition, and central nervous system pathologies. We report an HIV-1 patient with transient hypothermia secondary to severe protein calorie malnutrition and elevated HIV viral load. In this patient, it is hypothesized that the etiology of the hypothermia was multifactorial due to severe protein calorie malnutrition, evidenced by decreased insulin-like growth factor-1 levels, severe hypothyroidism, and an elevated HIV viral load, since the patient began to improve with the initiation of highly active antiretroviral therapy, improved nutrition, and continuation of thyroid supplementation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264703PMC
http://dx.doi.org/10.1080/08998280.2015.11929177DOI Listing
January 2015

One problem two issues! Left ventricular systolic and diastolic dysfunction in aortic stenosis.

Ann Transl Med 2014 Jan;2(1):10

1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK.

Reports suggested that immediate post-aortic valve replacement (AVR); left ventricular (LV) dysfunction may be an important risk for morbidity and mortality in patients requiring positive inotropic support. Several factors have been identified as significant prognostic factors i.e., LV systolic dysfunction, LV diastolic dysfunction (LV-DD), heart failure and myocardial infarction (MI). Specific to pathophysiological changes associated with AS, markers of systolic LV function (e.g., LVEF) have been extensively studied in management, yet only a few studies have analysed the association between LV-DD and immediate post-operative LV dysfunction This review brings together the current body of evidence on this issue.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2013.06.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200657PMC
January 2014

Iatrogenic retained foreign body in the right atrium. Lessons to Learn.

Int J Surg Case Rep 2013 23;4(11):985-7. Epub 2013 Aug 23.

Division of Cardiothoracic Surgery, Department of Surgery, Texas A&M Health Science Center at Scott & White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508, USA.

Introduction: We report a case of a retained foreign body in the right atrium and the review of the literature discussing several cases where the poor attention and management of medical staff has led to worsening consequences to patient's health.

Presentation Of Case: In our case the mass demonstrated on MRI scan turned out to be an inflammatory process and organized clotted blood built around a broken piece of a plastic cannula protruding out of the right atrium. This caused debilitating pleuritic pain to the patient on presentation.

Discussion: The cause of this iatrogenic retained piece of cannula may well be from the patients prior diagnostic investigations.

Conclusion: Algorithm managed indications for surgical removal of such foreign bodies in symptomatic patients lead to better patient's outcomes and decreases the chances of infection, embolization, or erosions within the heart. Keeping this in view, we managed our patient with success.
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http://dx.doi.org/10.1016/j.ijscr.2013.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825962PMC
November 2013