Publications by authors named "Delair Gardi"

9 Publications

  • Page 1 of 1

Comparative safety of percutaneous ventricular assist device and intra-aortic balloon pump in acute myocardial infarction-induced cardiogenic shock.

Open Heart 2021 Jun;8(1)

Cardiology, Detroit Medical Center, Detroit, Michigan, USA

Background: The relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in patients with cardiogenic shock after acute myocardial infarction remain unknown.

Methods: Multiple databases were searched to identify articles comparing pVAD and IABP. An unadjusted OR was used to calculate hard clinical outcomes and mortality differences on a random effect model.

Results: Seven studies comprising 26 726 patients (1110 in the pVAD group and 25 616 in the IABP group) were included. The odds of all-cause mortality (OR 0.57, 95% CI 0.47 to 0.68, p=<0.00001) and need for revascularisation (OR 0.16, 95% CI, 0.07 to 0.38, p=<0.0001) were significantly reduced in patients receiving pVAD compared with IABP. The odds of stroke (OR 1.12, 95% CI 0.14 to 9.17, p=0.91), acute limb ischaemia (OR=2.48, 95% CI 0.39 to 15.66, p=0.33) and major bleeding (OR 0.36, 95% CI 0.01 to 25.39, p=0.64) were not significantly different between the two groups. A sensitivity analysis based on the exclusion of the study with the largest weight showed no difference in the mortality difference between the two mechanical circulatory support devices.

Conclusions: In patients with acute myocardial infarction complicated by cardiogenic shock, there is no significant difference in the adjusted risk of all-cause mortality, major bleeding, stroke and limb ischaemia between the devices. Randomised trials are warranted to investigate further the safety and efficacy of these devices in patients with cardiogenic shock.
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http://dx.doi.org/10.1136/openhrt-2021-001662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204163PMC
June 2021

Transcatheter Versus Surgical Aortic Valve Replacement in Renal Transplant Patients: A Meta-Analysis.

Cardiol Res 2020 Oct 1;11(5):280-285. Epub 2020 Aug 1.

Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.

Background: The outcome of transcutaneous aortic valve replacement (TAVR) in patients with kidney transplant is unknown, as majority of these patients were excluded from the major TAVR clinical trials. We sought to compare patients with severe aortic stenosis who underwent TAVR versus surgical aortic valve replacement (SAVR) with a history of kidney transplant.

Methods: PubMed, Google Scholar and Cochrane databases were searched to identify relevant articles. The incidence of all-cause mortality and acute kidney injury (AKI) was calculated using relative risk on a random effect model.

Results: A total of 1,538 patients (TAVR 328, SAVR 1,210) were included in the study. TAVR was associated with lower mortality as compared with SAVR at 30 days from the index procedure (odds ratio (OR) 0.48, 95% confidence interval (CI): 0.25 - 0.93; P = 0.03). One-year mortality was studied in three studies and showed comparable mortality in patients undergoing TAVR and SAVR (OR: 0.76, 95% CI: 0.10 - 5.51; P = 0.78). Compared to SAVR, TAVR carries an identical risk of AKI (OR: 0.44, 95% CI: 0.10 - 1.90; P = 0.27). A sensitivity analysis performed by exclusion of Voudris et al study showed a non-significant difference in the mortality incidence of two groups at 30 days (OR: 0.72, 95% CI: 0.27 - 1.91; P = 0.51).

Conclusions: In patients with a history of kidney transplant, TAVR was associated with a comparable risk of mortality and AKI compared to SAVR.
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http://dx.doi.org/10.14740/cr1092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430886PMC
October 2020

The impact of peripheral arterial disease on patients with mechanical circulatory support.

Int J Cardiol Heart Vasc 2020 Jun 7;28:100509. Epub 2020 Apr 7.

Wayne State University, Detroit Medical Center, United States.

Background: Left ventricular assist devices (LVAD) are indicated as bridging or destination therapy for patients with advanced (Stage D) heart failure and reduced ejection fraction (HFrEF). Due to the clustering of the mutual risk factors, HFrEF patients have a high prevalence of peripheral arterial disease (PAD). This, along with the fact that continuous flow LVAD influence shear stress on the vasculature, can further deteriorate the PAD.

Methods: We queried the National Inpatient Sample (NIS) database (2002-2014) to identify the burden of pre-existing PAD cases, its association with LVAD, in-hospital mortality, and other complications of LVAD. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test.

Results: A total of 20,817 LVAD patients, comprising of 1,625 (7.8%) PAD and 19,192 (91.2%) non-PAD patients were included in the study. The odds of in-hospital mortality in PAD patients were significantly higher compared to non-PAD group (OR 1.29, CI, 1.07-1.55, P = 0.007). The PAD group had significantly higher adjusted odds as compared to non-PAD group for acute myocardial infarction (aOR 1.29; 95% CI, 1.07-1.55, P = 0.007), major bleeding requiring transfusion (aOR, 1.286; 95% CI, 1.136-1.456, P < 0.001), vascular complications (aOR, 2.360; 95% CI, 1.781-3.126, P < 0.001), surgical wound infections (aOR, 1.50; 95% CI, 1.17-1.94, P = 0.002), thromboembolic complications (aOR, 1.69; 95% CI, 1.36-2.10, P < 0.001), implant-related complications (aOR, 1.47; 95% CI, 1.19-1.80, P < 0.001), and acute renal failure (aOR, 1.26; 95% CI, 1.12-1.43, P < 0.001).

Conclusion: PAD patients can have high LVAD associated mortality as compared to non-PAD.
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http://dx.doi.org/10.1016/j.ijcha.2020.100509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150524PMC
June 2020

Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention.

Cardiovasc Revasc Med 2011 Sep-Oct;12(5):299-303. Epub 2011 Mar 30.

Harper University Hospital, Detroit Medical Center, Detroit, MI, USA.

Background: Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI.

Methods And Materials: We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined.

Results: The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%.

Conclusions: The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible.
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http://dx.doi.org/10.1016/j.carrev.2011.02.002DOI Listing
January 2012

Coronary revascularization strategy for ST elevation myocardial infarction with multivessel disease: experience and results at 1-year follow-up.

Am J Ther 2011 Mar-Apr;18(2):92-100

Division of Cardiology, Wayne State University, Harper University Hospital, Detroit, MI 48201, USA.

Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the standard of care in patients presenting with ST elevation myocardial infarction (STEMI). However, optimal revascularization strategy for significant nonculprit lesions (non-CLs) in the setting of STEMI remains controversial. The importance of defining of such a strategy lies in the fact that approximately 50% of patients with STEMI have multivessel disease (MVD). The aim of this study was to describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 patients with STEMI and MVD obtained from a 5-year catheterization database. MVD was defined as ≥70% stenosis of ≥2 epicardial coronary arteries. This cohort was followed for a period of 1 year for major adverse cardiac events (MACE was defined as acute coronary syndrome, new onset heart failure, or death) and all-cause mortality. PCI with stent placement was the major therapeutic procedure (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of individuals (47.6%), while the remaining patients underwent PCI (29%) and coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, prevalence of MACE events and death in the entire cohort were 30% and 15%, respectively. A trend for better outcomes (1-year cumulative MACE events but not mortality) was observed in CL-only intervention cohort compared with non-CL intervention. The PCI and Coronary artery bypass graft surgery cohorts did not show any significant difference in clinical outcomes. In this retrospective cohort of patients with MVD who presented with STEMI, no intervention of noncritical lesions was the prevalent approach, reflecting guideline recommendations. CL-only intervention strategy showed a better clinical outcome than non-CL intervention. Intervention of noncritical lesions therefore did not seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in fact have had a detrimental effect on outcomes.
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http://dx.doi.org/10.1097/MJT.0b013e3181b809eeDOI Listing
June 2011

Stenting of left main conduit with use of the TandemHeart: an interventional challenge.

Tex Heart Inst J 2009 ;36(3):266-7

Departments of Internal Medicine, Wayne State University, Detroit, Michigan 48202, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696505PMC
September 2009

Percutaneous intervention of superior mesenteric artery stenosis in elderly patients.

Clin Cardiol 2009 May;32(5):232-5

Department of Cardiology, Wayne State University, Detroit, Michigan, USA.

This review article focuses on stent placement in mesenteric arteries in older patients with an increasingly common diagnosis of chronic mesenteric ischemia (CMI). We reviewed the articles that focused on the treatment of this gastrointestinal disorder by stenting/open surgical revascularization to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in mesenteric arteries are discussed in comparison to open surgical revascularization. In summary, the low morbidity and high technical success rate of catheter-based techniques have made this approach the first line of therapy for CMI due to superior mesenteric artery stenosis for many elderly patients especially high-risk operative candidates.
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http://dx.doi.org/10.1002/clc.20446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653523PMC
May 2009

Left ventricular "temporary pacemaker wire": a viable option in emergency situation.

Am J Emerg Med 2009 Mar;27(3):374.e1-374.e2

Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA.

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http://dx.doi.org/10.1016/j.ajem.2008.07.028DOI Listing
March 2009

Aberrant origin of the left anterior descending artery and quadrifurcation of coronary vessels associated with coronary artery disease: evaluation by computed tomographic angiography and coronary angiography.

J Invasive Cardiol 2008 Mar;20(3):147-8

Department of Internal Medicine, 2E UHC 4201 St. Antoine, Detroit, MI, 48201, USA.

Coronary artery anomalies occur in approximately 0.2-12.2% of the adult population. Origin of left anterior descending artery and left circumflex artery from the right coronary cusp is relatively rare. The case we present is unique in that all 4 vessels (right coronary, left anterior descending, left circumflex and atrioventricular nodal branch) take off from the right coronary cusp, making a quadrifurcation. In this case, the left main artery is also absent. To our knowledge, there are few published case reports of anomalous origin of left anterior descending artery, but the total absence of a left main artery and quadrifurcation are unique to our case.
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March 2008
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