Background Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking.
Introduction Restrictive annuloplasty is the primary surgical repair technique for mitral regurgitation (MR), improving leaflet coaptation and stabilizing annular dimensions (1). It is underused in high-risk patients, supporting the need for less invasive alternatives (2). We present images of the first-in-human experience of transeptal implantation of a complete, semirigid ring using the TS AMEND System (Valcare Medical).
Objectives The aim of this study was to develop and validate a score to accurately predict the probability of death for adult extracorporeal cardiopulmonary resuscitation (ECPR).
Objectives The aim of the study was to assess 24-month efficacy and safety of a novel drug-eluting stent (DES) for femoropopliteal interventions with an innovative stent design and abluminal reservoir technology releasing the amphilimus formulation (sirolimus plus fatty acid) for efficient drug transfer and optimized release kinetics.
A 79-year-old woman, who had atrial fibrillation and was on anticoagulation, and with prior cerebral infarction, was admitted to our hospital to undergo transcatheter aortic valve replacement (TAVR). She had mild renal dysfunction without serum calcium and phosphorus abnormalities. Pre-procedural computed tomography (CT) demonstrated that the annulus area was 445 mm2 and the minimum diameter of the sinus of Valsalva was 26.3 mm (Figure 1A). Because the diameter of the lower limb was suitable for transfemoral (TF) access, we performed TF-TAVR and successfully implanted a SAPIEN 3 26-mm device (Edwards Lifesciences, Irvine, California) after pre-dilatation using a 20-mm balloon (Figure 1B). Though post-procedural transthoracic echocardiography (TTE) showed moderate patient–prosthesis mismatch, it was improved at 6-month follow-up TTE. However, serial TTE demonstrated deterioration of effective aortic valve area indexed to the body surface area and mean pressure gradient, indicating hemodynamic structural valve deterioration (SVD) (Figure 1C). We changed the anticoagulant regimen from warfarin to a direct oral anticoagulant; however, this did not work to improve valve function. To exclude valve leaflet thrombosis, we performed contrast-enhanced CT and found valve leaflet calcification, which may cause the hemodynamic deterioration (Figure 1D, Video 1). Because there were no other symptoms and moderate hemodynamic SVD, we decide to closely follow up with TTE.
An 83-year-old man with a known aortic arch aneurysm of 60 mm in diameter was transferred due to cardiopulmonary arrest. After achieving return of spontaneous circulation supported by extracorporeal membrane oxygenation, the patient underwent heart catheterization followed by plain computed tomography to exclude evident aneurysm rupture and aortic dissection. Coronary angiogram revealed no obstructive disease. Subsequently, with a suspicion of pulmonary embolism, pulmonary angiogram was performed. Pulmonary angiogram from the right ventricular outflow tract demonstrated stenosis-like findings in the main pulmonary artery (PA) and faint visualization of the left PA (Figure 1A, Video 1). Contrast-enhanced computed tomography with an intravenous line and a Berman catheter placed at the right ventricular outflow tract indicated that the pinhole rupture of the arch on the minor curvature into the PA caused the dissection of PA and following intraluminal hematoma, which seemed to occlude the true lumen of the PA (Figures 1B and 1C, Video 2). Unfortunately, the patient died, although surgical repair was planned.
An 84-year-old man with severe bicuspid aortic valve stenosis and ascending aorta aneurysm (57 × 53 mm) underwent transfemoral aortic valve replacement with an ACURATE neo bioprosthesis (Symetis/Boston, Ecublens, Switzerland). Post-procedural permanent pacemaker implantation was needed for a complete atrioventricular block, and a moderate perivalvular aortic insufficiency was recorded before discharge.
A 73-year-old woman with a history of surgical aortic valve replacement with a Perimount 2800 (Edwards Lifesciences, Irvine, California) size 21 mm (true internal diameter 19 mm) was referred for a valve-in-valve (VIV) procedure with a transcatheter aortic valve prosthesis in view of symptomatic, severe structural valve deterioration. Transthoracic echocardiography showed a mean transprosthetic gradient of 86 mm Hg, and pre-procedural cardiac computed tomography revealed heavily calcified bioprosthetic leaflets (Figures 1A and 1B). VIV with a 23-mm Evolut R valve (Medtronic, Minneapolis, Minnesota) under local anesthesia was planned.
A 78-year-old man with symptomatic severe aortic valve stenosis was referred for transcatheter aortic valve replacement (TAVR). Pre-procedural computed tomography revealed a tricuspid aortic valve with moderate calcification of the aortic annular complex (Figure 1A); the perimeter-derived annular diameter was 23.0 mm, and the average sinus of Valsalva diameter was 30.8 mm. TAVR with an ACURATE neo2 valve M size (Boston Scientific, Marlborough, Massachusetts) was planned. Compared with the ACURATE neo, the new valve has a dedicated sealing skirt that is designed to reduce paravalvular leakage
Objectives The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) for structural valve degeneration (SVD).
Objectives This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).
Objectives The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the “double S-curve” and “cusp-overlap” techniques.
Objectives The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system.
Objectives This study hypothesized that cerebral protection prevents strokes in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) in clinical practice.
Objectives This study sought to test the superiority in terms of efficacy and safety of a dedicated plug-based vascular closure device (VCD) during transcatheter aortic valve replacement (TAVR) over a suture-based VCD.
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