Tanvir Bajwa

Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, United States

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Publications (82)314.57 Total impact

  • European Heart Journal – Cardiovascular Imaging 09/2014; · 3.67 Impact Factor
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    ABSTRACT: Background The EVEREST II (Endovascular Valve Edge-to-Edge REpair STudy) High-Risk registry and REALISM Continued Access Study High-Risk Arm are prospective registries of patients who received the MitraClip device (Abbott Vascular, Santa Clara, California) for mitral regurgitation (MR) in the United States. Objectives The purpose of this study was to report 12-month outcomes in high-risk patients treated with the percutaneous mitral valve edge-to-edge repair. Methods Patients with grades 3 to 4+ MR and a surgical mortality risk of ≥12%, based on the Society of Thoracic Surgeons risk calculator or the estimate of a surgeon coinvestigator following pre-specified protocol criteria, were enrolled. Results In the studies, 327 of 351 patients completed 12 months of follow-up. Patients were elderly (76 ± 11 years of age), with 70% having functional MR and 60% having prior cardiac surgery. The mitral valve device reduced MR to ≤2+ in 86% of patients at discharge (n = 325; p < 0.0001). Major adverse events at 30 days included death in 4.8%, myocardial infarction in 1.1%, and stroke in 2.6%. At 12 months, MR was ≤2+ in 84% of patients (n = 225; p < 0.0001). From baseline to 12 months, left ventricular (LV) end-diastolic volume improved from 161 ± 56 ml to 143 ± 53 ml (n = 203; p < 0.0001) and LV end-systolic volume improved from 87 ± 47 ml to 79 ± 44 ml (n = 202; p < 0.0001). New York Heart Association functional class improved from 82% in class III/IV at baseline to 83% in class I/II at 12 months (n = 234; p < 0.0001). The 36-item Short Form Health Survey physical and mental quality-of-life scores improved from baseline to 12 months (n = 191; p < 0.0001). Annual hospitalization rate for heart failure fell from 0.79% pre-procedure to 0.41% post-procedure (n = 338; p < 0.0001). Kaplan-Meier survival estimate at 12 months was 77.2%. Conclusions The percutaneous mitral valve device significantly reduced MR, improved clinical symptoms, and decreased LV dimensions at 12 months in this high-surgical-risk cohort. (Endovascular Valve Edge-to-Edge REpair STudy [EVERESTIIRCT]; NCT00209274)
    Journal of the American College of Cardiology 07/2014; 64(2):172–181. · 14.09 Impact Factor
  • European Heart Journal – Cardiovascular Imaging 03/2014; · 3.67 Impact Factor
  • Tonga Nfor, Suhail Allaqaband, Tanvir Bajwa
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    ABSTRACT: Improvements in the design of endovascular devices and technical skill of interventionalists have opened new possibilities for patients with a wide range of peripheral vascular diseases (PVD). In lower extremity peripheral artery disease, percutaneous treatments have become the predominant revascularization strategy for simple and complex lesions. Newer generations of stents and drug-coated balloons have demonstrated strong potential in treatment of femoropopliteal and infrainguinal diseases. One of the most dramatic advances in the recent past has been endovascular repair of thoracic and abdominal aortic aneurysms, which has become the preferred approach in lieu of open surgical repair. Contemporary trials have established the safety and effectiveness of carotid stenting in selected patients with severe stenosis. Endovascular treatments for venous occlusive disease have long been underutilized, but their effectiveness is being increasingly recognized. This review will cover new endovascular procedures performed by interventional cardiologists for PVD.
    Current Problems in Cardiology. 01/2014;
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    ABSTRACT: Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT(®), SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail with pre- and postprocedure angiography and echocardiography as well as illustrations reflecting the surgeon's findings on direct visualization of the left atrial lacerations postligation. Potential hypotheses of each injury are examined in light of the case timelines and findings at sternotomy. There was no suggestion that tamponade was related to pericardial or transseptal access, but rather a complication with device delivery. These three patients quickly progressed to clinical cardiac tamponade despite attempted drainage, stressing the importance of cardiovascular surgery backup, including a cardiopulmonary bypass pump, when delivering novel, percutaneous ligation devices for the left atrial appendage.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 11/2013;
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    ABSTRACT: OBJECTIVES: We sought to evaluate 4-year outcomes of percutaneous repair versus surgery for mitral regurgitation. BACKGROUND: Transcatheter therapies are being developed to treat valvular heart disease. In the EVEREST II Trial, treatment of mitral valve regurgitation (MR) with a novel percutaneous device was compared with surgery and showed superior safety, but less reduction in MR at one year overall. We report the four year outcomes from the EVEREST II Trial. METHODS: Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the MitraClip device or conventional mitral valve surgery in a 2:1 ratio (184:95). Patients were prospectively consented for five years of follow-up. RESULTS: At four years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the intention to treat population was 39.8% vs. 53.4% in the percutaneous repair group and surgical groups, respectively (p=0.070). Rates of death were 17.4% vs. 17.8% (p=0.914), and 3+ or 4+ MR was present in 21.7% vs. 24.7% (p=0.745) at 4 years of follow-up, respectively. Surgery for mitral valve dysfunction, however, occurred in 20.4% vs. 2.2% (p<0.001) at one year and 24.8% vs. 5.5% (p<0.001) at four years. CONCLUSIONS: Patients treated with percutaneous repair of the mitral valve more commonly required surgery to treat residual MR; however, after the first year of follow-up, there were few surgeries required after either percutaneous or surgical treatment and no difference in the prevalence of moderate-severe and severe MR or mortality at four years.
    Journal of the American College of Cardiology 05/2013; · 14.09 Impact Factor
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    ABSTRACT: SESSION TYPE: Heart FailurePRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AMPURPOSE: Atrial septal defects (ASD) and patent foramen ovale (PFO) are the most common adult congenital heart disorders. A common indication for ASD closure is right ventricular enlargement. We report our experience with a cohort of patients who presented with unexplained shortness of breath and hypoxia.METHODS: We performed retrospective chart review of patients with ASD/PFO who presented with hypoxia or dyspnea on exertion and were referred to our pulmonary hypertension clinic from January 2010 to February 2012.RESULTS: We identified 15 patients (12 female), ages 15-78 (female mean age, 56; male mean age, 67). Seven patients (46.7%) had a tunnel PFO (four with right-to-left shunting, three with bidirectional shunting). Eight patients (53.3%) had ASD (one sinus venosus, seven secundum). Of the seven patients with a secundum ASD, five had left-to-right shunting and two had bidirectional shunting. Baseline functional status was NYHA Class IV in three patients (20%), Class III in 11 (73.3%) and Class II in one (6.7%). Five patients (33.3%) required continuous-flow oxygen. Five patients (33.3%) had severe pulmonary hypertension at diagnosis. Fourteen patients (93.3%) underwent percutaneous closure; one (6.7%) underwent surgical closure. All patients had improvement in NYHA class. Four out of five (80%) oxygen-dependant patients were taken off oxygen, and one had a decrease in oxygen requirement. All five pulmonary hypertension patients were weaned off associated medications. Follow-up echocardiography showed no evidence of residual shunts. One patient with syncope had complete resolution of her symptoms.CONCLUSIONS: There is a subset of patients with atrial level shunts who present with disproportionate hypoxia or shortness of breath. In these patients, careful evaluation should include a transesophageal echocardiography with saline contrast imaging and exercise hemodynamics. In our cohort, closure of the atrial shunt led to absolute resolution of their signs and symptoms, improvement in the NYHA class, decrease in oxygen requirements and resolution of pulmonary hypertension.CLINICAL IMPLICATIONS: Patients with atrial shunts and dyspnea require additional evaluations as they frequently can be cured by closure.DISCLOSURE: The following authors have nothing to disclose: Krishna Nagendran, Bijoy K. Khandheria, Tanvir Bajwa, Suhail Allaqaband, Mary E. Wenzel, A. Jamil Tajik, Dianne ZwickeNo Product/Research Disclosure InformationAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.
    Chest 10/2012; 142(4_MeetingAbstracts):81A. · 7.13 Impact Factor
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    ABSTRACT: Therapeutic hypothermia is currently used to reduce neurological ischemic damage in postcardiac arrest patients. Nevertheless, it has been associated with relevant side effects such as infections, bleeding, hypotension and hyperkalemia. Although hypothermia-induced coronary spasm is rare, its occurrence needs to be considered attentively as it adds a high risk of ventricular arrhythmias and cardiac arrest in patients with already-existing critical heart conditions.
    Cardiology 07/2012; 122(2):126-8. · 1.52 Impact Factor
  • International journal of cardiology 07/2012; · 6.18 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 05/2012; 26(5):e52-4. · 1.06 Impact Factor
  • European heart journal cardiovascular Imaging. 05/2012; 13(10):807.
  • Journal of the American College of Cardiology 03/2012; 59(13S-1):E256. · 14.09 Impact Factor
  • Journal of the American College of Cardiology 03/2012; 59(13 S-1):E214. · 14.09 Impact Factor
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    ABSTRACT: In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion. To determine the incidence, predictors, and prognosis of false-positive STEMI. We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography. Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3-13.8) had no culprit lesion on coronary angiography. Independent predictors of false-positive STEMI were absence of chest pain (odds ratio [OR] 18.2, 95% CI 3.7-90.1), no reciprocal ST-segment changes (OR 11.8, 95% CI 5.14-27.3), fewer than three cardiovascular risk factors (OR 9.79, 95% CI 4.0-23.8), and symptom duration longer than 6h (OR 9.2, 95% CI 3.6-23.7); all p<0.001. Using predictors, we modeled a risk score that achieved 88% (95% CI 81-94%) accuracy in identifying patients with negative coronary angiography. Among the false-positive STEMI patients, 48.1% had other serious diagnoses related to their electrocardiographic findings. When the diagnosis of STEMI is in doubt, clinicians may use predictors to quickly reassess the likelihood of an alternative diagnosis.
    Journal of Emergency Medicine 01/2012; 43(4):561-7. · 1.33 Impact Factor
  • European heart journal cardiovascular Imaging. 01/2012; 13(6):536.
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    ABSTRACT: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study (HRS) assessed the safety and effectiveness of the MitraClip device (Abbott Vascular, Santa Clara, California) in patients with significant mitral regurgitation (MR) at high risk of surgical mortality rate. Patients with severe MR (3 to 4+) at high risk of surgery may benefit from percutaneous mitral leaflet repair, a potentially safer approach to reduce MR. Patients with severe symptomatic MR and an estimated surgical mortality rate of ≥12% were enrolled. A comparator group of patients screened concurrently but not enrolled were identified retrospectively and consented to compare survival in patients treated by standard care. Seventy-eight patients underwent the MitraClip procedure. Their mean age was 77 years, >50% had previous cardiac surgery, and 46 had functional MR and 32 degenerative MR. MitraClip devices were successfully placed in 96% of patients. Protocol-predicted surgical mortality rate in the HRS and concurrent comparator group was 18.2% and 17.4%, respectively, and Society of Thoracic Surgeons calculator estimated mortality rate was 14.2% and 14.9%, respectively. The 30-day procedure-related mortality rate was 7.7% in the HRS and 8.3% in the comparator group (p = NS). The 12-month survival rate was 76% in the HRS and 55% in the concurrent comparator group (p = 0.047). In surviving patients with matched baseline and 12-month data, 78% had an MR grade of ≤2+. Left ventricular end-diastolic volume improved from 172 ml to 140 ml and end-systolic volume improved from 82 ml to 73 ml (both p = 0.001). New York Heart Association functional class improved from III/IV at baseline in 89% to class I/II in 74% (p < 0.0001). Quality of life was improved (Short Form-36 physical component score increased from 32.1 to 36.1 [p = 0.014] and the mental component score from 45.5 to 48.7 [p = 0.065]) at 12 months. The annual rate of hospitalization for congestive heart failure in surviving patients with matched data decreased from 0.59 to 0.32 (p = 0.034). The MitraClip device reduced MR in a majority of patients deemed at high risk of surgery, resulting in improvement in clinical symptoms and significant left ventricular reverse remodeling over 12 months. (Pivotal Study of a Percutaneous Mitral Valve Repair System [EVEREST II]; NCT00209274).
    Journal of the American College of Cardiology 01/2012; 59(2):130-9. · 14.09 Impact Factor
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    ABSTRACT: We compared use of intravenous (IV) normal saline (NS) to sodium bicarbonate (NaHCO(3)) with or without oral N-acetylcysteine (NAC) for prevention of contrast-induced acute kidney injury (CI-AKI). CI-AKI is associated with significant adverse clinical events. Use of NAC has produced variable results. Recently, intravenous hydration with NaHCO(3) for CI-AKI prophylaxis has been adopted as standard treatment for patients with stable chronic renal disease undergoing catheterization procedures. We prospectively enrolled 320 patients with baseline renal insufficiency scheduled to undergo catheterization. Patients were randomly assigned to receive either IV NS ± NAC (n = 161) or IV dextrose 5% in water containing 154 mEq/l of NaHCO(3) ± NAC (n = 159). IV NS was administered at 1 ml/kg body weight for 12 hr preprocedure and 12 more hr postprocedure. IV NaHCO(3) was administered at 3 ml/kg body weight for 1 hr preprocedure followed by 1 ml/kg body weight postprocedure. A 1,200 mg oral dose of NAC was given 2-12 hr preprocedure and 6-12 hr postprocedure in 50% of patients in each study arm. CI-AKI was defined as an increase of >0.5 mg/dl or >25% above baseline creatinine. Overall incidence of CI-AKI was 10.3%. There was no significant difference in incidence among the two groups (NS ± NAC 11.8% vs. NaHCO(3) ± NAC 8.8%, p = ns). Incidence of CI-AKI increased with increasing age (p = 0.001), contrast agent use >3 ml/kg body weight (p = 0.038) and diuretic use (p = 0.005). Incidence of CI-AKI was no different in the NaHCO(3) group compared to NS group, and NAC did not reduce CI-AKI in the two study arms.
    Catheterization and Cardiovascular Interventions 05/2011; 79(6):929-37. · 2.51 Impact Factor
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    ABSTRACT: Primary percutaneous coronary intervention (PPCI) is the choice reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). However, data on PPCI in elderly patients are sparse. This study determined clinical outcome post-PPCI in elderly versus younger patients with STEMI.  A cohort of 790 consecutive STEMI patients was studied for survival and major adverse cardiovascular events (MACE) after PPCI using a precise cardiac catheterization protocol. Patients were divided into two groups: those ≥75 years (elderly) and those <75 years. Median door-to-balloon time (DBT) was 82 minutes in the elderly versus 66 minutes in the younger group (P = 0.002). In-hospital all-cause mortality was higher in the elderly group (15.5% vs. 2.7%, P < 0.001). In elderly patients, MACE were found to be higher (32.3% vs. 16.1%, P < 0.001). Using a multivariate logistic regression analysis, age (odds ratio [OR]= 1.04, 95% confidence interval [CI]= 1.02-1.05, P < 0.001), diabetes (OR = 2.17, 95% CI = 1.33-3.53, P = 0.002), renal failure (OR = 3.75, 95% CI = 1.30-10.79, P = 0.014) and coronary artery disease (OR = 1.61, 95% CI = 1.00-2.59, P = 0.050) were associated with higher in-hospital MACE, while age (OR = 1.05, 95% CI = 1.02-1.08, P = 0.001), diabetes (OR = 2.18, 95% CI = 1.06-4.47, P = 0.034) and renal failure (OR = 6.65, 95% CI = 2.01-22.09, P = 0.002) were associated with higher in-hospital mortality. Kaplan-Meier 1-year survival rate was lower in the elderly.  In a contemporary population of STEMI patients treated with PPCI, overall in-hospital MACE and mortality remain higher in elderly compared to younger patients. Although partly due to higher burden of preexisting comorbidities, a higher DBT may also be responsible. (J Interven Cardiol 2011;24:357-365).
    Journal of Interventional Cardiology 03/2011; 24(4):357-65. · 1.50 Impact Factor
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    ABSTRACT: We describe the case of a 38-year-old woman who presented with symptoms of chest pain and shortness of breath that had worsened over the previous 6 months and was found to have a large pseudoaneurysm (PSA) of the thoracic aorta. She underwent surgical repair of aortic coarctation at the age of 16 and a revision of her bypass graft at age 28 when she presented with hemoptysis due to aortic PSA and aortobronchial fistula. Our cardiothoracic surgical team deemed a third surgery very high risk; therefore, she was referred to us for percutaneous repair of aortic PSA. We describe the successful treatment of the PSA using a technique of microcoil embolization and Amplatzer® vascular plug (AGA Medical Corp., Plymouth, MN).
    Catheterization and Cardiovascular Interventions 03/2011; 78(4):619-24. · 2.51 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).

Publication Stats

1k Citations
314.57 Total Impact Points

Institutions

  • 2004–2014
    • Aurora St. Luke's Medical Center
      Milwaukee, Wisconsin, United States
  • 2012
    • Università degli Studi di Messina
      • Dipartimento di Medicina Clinica e Sperimentale
      Messina, Sicily, Italy
  • 1994–2009
    • University of Wisconsin - Milwaukee
      • • Center for Urban Population Health
      • • College of Health Sciences
      Milwaukee, WI, United States
    • Samaritan Medical Center
      Watertown, New York, United States
  • 1998–2003
    • Milwaukee Institute of Art & Design
      Milwaukee, Wisconsin, United States
  • 2002
    • University of Wisconsin–Madison
      Madison, Wisconsin, United States