Objectives The aim of this study was to evaluate the combined impact of race, ethnicity, and sex on in-hospital outcomes using data from the National Inpatient Sample.
Objectives The purpose of this study was to evaluate temporal trends in the frequency of revascularization and associated outcomes in patients with diabetes mellitus and critical limb ischemia (CLI).
Objectives The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index revascularization for patients with femoropopliteal peripheral artery disease.
Objectives The aim of this study was to evaluate the 2-year performance of a polymer-based drug-eluting stent (DES) for the treatment of complex femoropopliteal lesions.
A 54-year-old man presented with acute Stanford Type B aortic dissection with proximal tear originating at the vicinity of the left subclavian artery and concomitant sepsis of pulmonary origin. Percutaneous treatment was indicated due to progressive reduction of the true lumen leading to symptomatic right kidney and celiac trunk hypoperfusion: considering the need of left subclavian debranching, endovascular fenestration was preferred over thoracic endografting (1). After careful computed tomography scan evaluation (Figure 1A), bilateral femoral artery access to both the true and the false lumen was achieved. A 0.018-in wire mounted on a vertebral 4-F catheter crossed the flap proximal to renal arteries and was snared from contralateral access. Prolonged inflations of large balloons failed to restore flow between lumens (Video 1). Therefore, the guidewire was exchanged with a 0.014-inch coronary wire (300-cm BHW, Abbott, Chicago, Illinois) with a “Flying V” configuration. Wire isolation was achieved with 4-F catheters, and tissue vaporization throughout the dissection was attained by delivering radiofrequency via an electric scalpel set to pure cut at 70 W while gently pulling both catheters (Figure 1B, Video 2). Optimal flap laceration and splanchnic blood flow were obtained, and subsequent iliac stenting was performed to seal the flap (Figure 1C). Hypoperfusion symptoms resolved promptly, whereas follow-up computed tomography scan (Figure 1D) showed optimal results. Doppler examination at 6 months confirmed good perfusion of renal, visceral, and iliofemoral axes.
A 73-year-old man undergoing rehabilitation of a cerebellar infarction was transferred to our hospital because of Rutherford IIb acute left lower limb ischemia. Computed tomographic angiography revealed an abrupt disruption of the left middle superficial femoral artery (SFA) with a popliteal artery aneurysm (Figure 1). Only a few thrombi were removed by conventional catheter aspiration. After antegrade preclosing with a ProGlide (Abbott Vascular, Santa Clara, California), a 16-F DrySeal sheath (W. L. Gore, Flagstaff, Arizona) with an outer diameter approximately equal to the diameter of the proximal SFA was placed under local anesthesia in the common femoral artery (Figure 2A). An arterial thrombectomy using a 5.5-F Fogarty balloon catheter (Edwards Lifesciences, Irvine, California) with little blood loss and subsequent dilation of the anterior tibial artery with a 2.0-mm balloon was performed (Figures 2B and 2C). Final angiography confirmed successful reperfusion (Figure 2D). Complete hemostasis was achieved by tightening the preformed suture knot after removing the sheath, followed by manual compression for 10 min.
A 33-year-old woman with congenital bicuspid aortic stenosis had a complex surgical history, which included aortic valve replacement with a 21-mm Freestyle bioprosthesis (Medtronic, Dublin, Ireland) (2005), placement of a 22-mm Hancock valved apicoaortic conduit (Medtronic) (2006), and subsequent revision of the conduit with valve replacement (2009). An apicoaortic conduit relieves left ventricular (LV) outlet obstruction by shunting blood from the LV to the descending aorta via a valved conduit. It has been performed since 1962 via left thoracotomy, obviating the need for cardiopulmonary bypass. Our patient did well until she developed New York Heart Association functional class III heart failure 2 months before evaluation. Cardiac magnetic resonance imaging revealed severe bioprosthetic aortic stenosis (Videos 1 and 2) and severe apicoaortic conduit insufficiency (Figure 1, Video 3). After multidisciplinary heart team discussion, the patient was considered high risk for another redo surgery. Because she had done well with the apicoaortic conduit for >10 years, we decided to perform transcatheter valve replacement in the conduit valve. This could allow for another valve-in-valve procedure in the conduit while potentially saving transcatheter aortic valve replacement in the stenosed bioprosthesis at the native position for later.
Right ventricular mechanical circulatory support is not as developed as left ventricular assisting devices. The Impella RP (Abiomed, Danvers, Massachusetts) is a 22-F percutaneous microaxial constant flow pump that aspirates blood from the inferior vena cava and ejects it to the main pulmonary artery. A 36-year-old man with atrial septal defect surgically corrected in his childhood and Ebstein anomaly was evaluated by the heart team due to terminal right ventricular failure. After being on a heart transplantation waiting list for more than 4 months and despite ambulatory levosimendan and high diuretic doses, the patient presented with a persistent decline in his functional class and was admitted on 2 occasions due to acute heart failure. Therefore, it was decided to implant an Impella RP and progress to the urgent category of the heart transplantation waiting list. However, the patient presented with severe tricuspid regurgitation of congenital etiology as a relative contraindication and a massive dilation of the right ventricle (Figure 1) that might potentially hinder the feasibility of a correct implantation.
A 36-year-old man with severe nonischemic cardiomyopathy and left ventricular assist device (LVAD) HeartWare HVAD (Medtronic. Dublin, Ireland) presented after cutting his LVAD driveline during a psychotic episode. He had New York Heart Association functional grade III symptoms, and a transthoracic echocardiogram revealed diastolic flow reversal through the LVAD circuit and descending thoracic aorta (Figure 1, Video 1). After heart team discussion, he was deemed to not be a candidate for pump exchange or heart transplantation. Percutaneous closure of the LVAD conduit was proposed to avoid worsening of heart failure secondary to retrograde LVAD flow.
Growing clinical data support the use of transcatheter therapies for significant mitral valve disease. Currently, edge-to-edge repair is the transcatheter treatment of choice, but many anatomies are not suitable. Transcatheter mitral valve replacement offers several potential advantages over transcatheter repair, most notably a greater and more sustained reduction in mitral regurgitation post-implantation, but also potential disadvantages. To enable the successful treatment of mitral valve disease in a wide range of patients and anatomies, we require an armory of transcatheter devices, including transcatheter mitral valve replacement systems.
Objectives The purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes.
Objectives The REFLECT II (Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Implantation) trial was designed to investigate the safety and efficacy of the TriGUARD 3 (TG3) cerebral embolic protection in patients undergoing transcatheter aortic valve replacement.
Objectives The aim of this study was to investigate the online assessment feasibility of aortography using videodensitometry in the catheterization laboratory during transcatheter aortic valve replacement (TAVR).
Transcatheter aortic valve replacement (TAVR) is the standard of care for severe, symptomatic aortic stenosis. Real-world TAVR data collection contributes to benefit/risk assessment and safety evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, as well as clinical research and real-world implementation through appropriate use criteria. The essential minimum core dataset for these purposes has not previously been defined but is necessary to promote efficient, reusable real-world data collection supporting quality, regulatory, and clinical applications. The authors performed a systematic review of the published research for high-impact TAVR studies and U.S. multicenter, multidevice registries. Two expert task forces, one from the Predictable and Sustainable Implementation of National Cardiovascular Registries/Heart Valve Collaboratory and another from The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry convened separately and then met to reconcile a final list of essential data elements. From 276 unique data elements considered, unanimous consensus agreement was achieved on 132 “core” data elements, with the most common reasons for exclusion from the minimum core dataset being burden or difficulty in accurate assessment (36.9%), duplicative information (33.3%), and low likelihood of affecting outcomes (10.7%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established 132 interoperable, reusable essential core data elements essential to supporting more efficient, consistent, and informative TAVR device evidence for regulatory submissions, safety surveillance, best practice, and hospital quality assessments.
Objectives The aim of this study was to compare Doppler flow velocity and thermodilution-derived indexes and to determine the optimal thermodilution-based diagnostic thresholds for coronary flow reserve (CFR).
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