01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Backward Migration of a MitraClip Through a Patent Transseptal Orifice. The Salmon Syndrome

Christophe Caussin, MD∗; Christelle Diakov, MD∗; Patrice Dervanian, MD†; Nicolas Amabile, MD, PhD∗

A 70-year-old man with severe mitral regurgitation (MR) was referred to our institution for percutaneous mitral valve repair. A Mitraclip (Abbott Vascular, Santa Clara, California) was implanted but did not correctly tether the posterior leaflet and was solely attached to the anterior leaflet. A second clip was thus implanted to stabilize the first clip. However, a residual severe eccentric MR was still present on final transesophageal echocardiographic control, after full retraction of the delivery system

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Expanding Indications of Transcatheter Heart Valve Interventions CME

Fabien Praz, MD∗; Stephan Windecker, MD∗; Christoph Huber, MD†; Thierry Carrel, MD†; Peter Wenaweser, MD∗

Transcatheter aortic valve replacement (TAVR) has been established as a less invasive alternative to open-heart surgery in inoperable or high-risk patients presenting with symptomatic severe aortic valve stenosis. The feasibility and efficacy of valve-in-valve implantation in degenerated surgical aortic bioprostheses have also been described and can currently be considered a valuable treatment option in patients deemed unsuitable for repeat cardiac surgery. However, the clinical use of TAVR devices is not limited to the treatment of the tricuspid stenotic aortic valve. Several additional indications including treatment of the bicuspid stenotic aortic valve, aortic regurgitation, and valve-in-valve or valve-in-ring implantation in the mitral or tricuspid position as well as treatment of pure mitral, tricuspid, or pulmonary regurgitation have been described. The purpose of the present review is to summarize the available evidence concerning the emerging off-label use of TAVR devices in current clinical practice. Case examples have been selected to highlight the main procedural steps of each particular intervention.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. A Randomized Evaluation of the SAPIEN XT Transcatheter Heart Valve System in Patients With Aortic Stenosis Who Are Not Candidates for Surgery

John G. Webb, MD∗; Darshan Doshi, MD, MSc†; Michael J. Mack, MD‡; Raj Makkar, MD§; Craig R. Smith, MD†; Augusto D. Pichard, MD‖; Susheel Kodali, MD†; Samir Kapadia, MD¶; D. Craig Miller, MD#; Vasilis Babaliaros, MD∗∗; Vinod Thourani, MD∗∗; Howard C. Herrmann, MD††; Mark Bodenhamer, MD‡‡; Brian K. Whisenant, MD§§; Stephen Ramee, MD‖‖; Hersh Maniar, Jr., MD¶¶; Dean Kereiakes, MD##; Ke Xu, PhD∗∗∗; Wael A. Jaber, MD¶; Venu Menon, MD¶; E. Murat Tuzcu, MD¶; David Wood, MD∗; Lars G. Svensson, MD, PhD¶; Martin B. Leon, MD†

Objectives: The purpose of this study was to determine the safety and effectiveness of the SAPIEN XT versus SAPIEN systems (Edwards Lifesciences, Irvine, California) in patients with symptomatic, severe aortic stenosis (AS) who were not candidates for surgery.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Outcomes After Transcatheter Aortic Valve Replacement Using a Novel Balloon-Expandable Transcatheter Heart Valve. A Single-Center Experience

Oliver Husser, MD∗; Costanza Pellegrini, MD∗; Thorsten Kessler, MD∗; Christof Burgdorf, MD∗; Hannah Thaller∗; N. Patrick Mayr, MD†; Ilka Ott, MD∗; Albert M. Kasel, MD∗; Heribert Schunkert, MD∗,‡; Adnan Kastrati, MD∗,‡; Christian Hengstenberg, MD∗,‡

Objectives: Evaluation of 30-day outcomes after transcatheter aortic valve replacement (TAVR) with the novel balloon-expandable SAPIEN 3 (S3) transcatheter heart valve (THV) (Edwards Lifesciences, Irvine, California) emphasizing the updated Valve Academic Research Consortium (VARC-2) criteria.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Transcatheter Pulmonary Valve Replacement With the Edwards Sapien System. The Toronto Experience

William M. Wilson, MBBS∗; Lee N. Benson, MD†; Mark D. Osten, MD∗; Ashish Shah, MD∗; Eric M. Horlick, MDCM∗

Objectives: This study sought to review the outcomes for the Sapien and Sapien XT valves (Edwards Lifesciences, Irvine, California) for percutaneous pulmonary valve implantation (PPVI).

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. A New Transcatheter Aortic Valve Replacement System for Predominant Aortic Regurgitation Implantation of the J-Valve and Early Outcome

Lai Wei, MD∗; Huan Liu, MD∗; Liming Zhu, MD∗; Ye Yang, MD∗; Jiayu Zheng, MD∗; Kefang Guo, MD†; Hong Luo, MD†; Weipeng Zhao, MD‡; Xue Yang, MD§; Aikebaier Maimaiti, MD∗; Chunsheng Wang, MD∗

Objectives: This study introduces a newly designed transcatheter aortic valve system, the J-Valve system, and evaluates its application in patients with predominant aortic regurgitation without significant valve calcification. We also report the early results of one of the first series of transapical implantations of this device and aim to offer guidance on the technical aspects of the procedure.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Transfemoral Implantation of a Fully Repositionable and Retrievable Transcatheter Valve for Noncalcified Pure Aortic Regurgitation

Joachim Schofer, MD, PhD∗,†; Fabian Nietlispach, MD, PhD‡; Klaudija Bijuklic, MD†; Antonio Colombo, MD§; Fernando Gatto, MD‖; Federico De Marco, MD, PhD¶; Antonio Mangieri, MD§; Lorenz Hansen, MD∗; Giuseppe Bruschi, MD¶; Neil Ruparelia, MD§; Friedrich-Christian Rieß, MD, PhD∗; Franscesco Maisano, MD, PhD‡; Azeem Latib, MD§

Objectives: This study sought to evaluate the use of the Direct Flow Medical (DFM) transcatheter heart valve (Direct Flow Medical, Santa Rosa, California) for the treatment of noncalcific pure aortic regurgitation (AR).

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Transcatheter Options for the Treatment of Noncalcified Aortic Regurgitation∗

John G. Webb, MD; Nay Htun, MD

Current transcatheter heart valves (THVs) have been developed primarily for patients with aortic stenosis. Most incorporate metallic frames that rely on high radial force to anchor the implant within a stenotic and calcified native valve. However, aortic regurgitation (AR) typically results from abnormalities of the aortic cusps or root, often without associated calcification. In patients with pure or predominant AR, it may not be possible to securely anchor a THV, with the potential for paravalvular regurgitation, malposition, or embolization.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access. The Campeau Radial Paradox

Lorenzo Azzalini, MD, PhD, MSc∗; Kunle Tosin, MD∗; Malorie Chabot-Blanchet, MSc†; Robert Avram, MD∗; Hung Q. Ly, MD, MSc∗; Benoit Gaudet, RN∗; Richard Gallo, MD∗; Serge Doucet, MD∗; Jean-François Tanguay, MD∗; Réda Ibrahim, MD∗; Jean C. Grégoire, MD∗; Jacques Crépeau, MD∗; Raoul Bonan, MD∗; Pierre de Guise, MD∗; Mohamed Nosair, MD∗; Jean-François Dorval, MD∗; Gilbert Gosselin, MD∗; Philippe L. L’Allier, MD∗; Marie-Claude Guertin, PhD†; Anita W. Asgar, MD∗; E. Marc Jolicœur, MD, MSc, MHS∗

Objectives: The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Transradial Versus Transfemoral Access in Patients Undergoing Rescue Percutaneous Coronary Intervention After Fibrinolytic Therapy

Mitul B. Kadakia, MD∗; Sunil V. Rao, MD†; Lisa McCoy, MS†; Paramita S. Choudhuri, PhD†; Matthew W. Sherwood, MD†; Scott Lilly, MD, PhD‡; Taisei Kobayashi, MD∗; Daniel M. Kolansky, MD∗; Robert L. Wilensky, MD∗; Robert W. Yeh, MD, MSc§; Jay Giri, MD, MPH∗

Objectives: The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Outcomes of Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Receiving an Oral Anticoagulant and Dual Antiplatelet Therapy. A Comparison of Clopidogrel Versus Prasugrel From the TRANSLATE-ACS Study

Larry R. Jackson, II, MD∗; Christine Ju, MS∗; Marjorie Zettler, PhD, MPH†; John C. Messenger, MD‡; David J. Cohen, MD§; Gregg W. Stone, MD‖; Brian A. Baker, PharmD¶; Mark Effron, MD†; Eric D. Peterson, MD, MPH∗; Tracy Y. Wang, MD, MHS, MSc∗

Objectives: The purpose of this study was to determine whether bleeding risk varies depending on which P2Y12 receptor inhibitor agent is used.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. 15-Year Patency and Life Expectancy After Primary Stenting Guided by Intravascular Ultrasound for Iliac Artery Lesions in Peripheral Arterial Disease

Hisao Kumakura, MD, PhD; Hiroyoshi Kanai, MD, PhD; Yoshihiro Araki, MD, PhD; Yoshiaki Hojo, MD; Toshiya Iwasaki, MD; Shuichi Ichikawa, MD, PhD

Objectives: The purpose of this study was to evaluate 15-year patency and life expectancy after endovascular treatment (EVT) with primary stenting guided by intravascular ultrasound (IVUS) for iliac artery lesions.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Not Your Typical Hole-in-the-Wall. Percutaneous Closure of an Acquired Post-Myocardial Infarction Ventriculoatrial Gerbode Defect

Richard Cheng, MD∗; Reza Arsanjani, MD∗; Emily Tat, BA∗; Justin Cox, MD∗; Abhimanyu Uberoi, MD, MS∗; Rebecca Aron, MD†; Saibal Kar, MD∗

A 58-year-old male patient presented with an inferior ST-segment elevation myocardial infarction complicated by a ventricular septal defect (VSD). The VSD was surgically repaired, but basal extension of necrotic tissue obligated a second repair 2 weeks later. Subsequently, he again presented in cardiogenic shock and was found to have a significant residual VSD; he was referred to our institution for cardiac transplantation.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Left Atrial Appendage Closure With the Watchman Device. Long-Term Results Up to 5 Years

Jens Wiebe, MD; Jennifer Franke, MD; Katharina Lehn, MD; Ilona Hofmann, MD; Laura Vaskelyte, MD; Stefan Bertog, MD; Horst Sievert, MD

Objectives: The aim of this study was to evaluate long-term outcomes in patients with atrial fibrillation undergoing percutaneous left atrial appendage (LAA) closure with the Watchman device.

01 diciembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Bleeding Outcomes After Left Atrial Appendage Closure Compared With Long-Term Warfarin. A Pooled, Patient-Level Analysis of the WATCHMAN Randomized Trial Experience

Matthew J. Price, MD∗; Vivek Y. Reddy, MD†; Miguel Valderrábano, MD‡; Jonathan L. Halperin, MD†; Douglas N. Gibson, MD∗; Nicole Gordon, BSEE§; Kenneth C. Huber, MD‖; David R. Holmes, Jr., MD¶

Objectives: The purpose of this study was to compare the relative risk of major bleeding with left atrial appendage (LAA) closure compared with long-term warfarin therapy.