01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve Replacement. A Systematic Review

Paol Rojas, Ignacio J. Amat-Santos, Carlos Cortés, Javier Castrodeza, Javier Tobar, Rishi Puri, Teresa Sevilla, Silvio Vera, Luis H. Varela-Falcón, Jose Luis Zunzunegui, Itziar Gómez, Josep Rodés-Cabau, José A. San Román

Objectives: The aim of this study was to describe the incidence, mechanisms, features, and management of aseptic intracardiac shunts (AICS).

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Quality of Life After Transcatheter Aortic Valve Replacement. Prospective Data From GARY (German Aortic Valve Registry)

Rüdiger Lange, Andreas Beckmann, Till Neumann, Markus Krane, Marcus-André Deutsch, Sandra Landwehr, Joachim Kötting, Armin Welz, Ralf Zahn, Jochen Cremer, Hans R. Figulla, Gerhard Schuler, David M. Holzhey, Anne-Kathrin Funkat, Gerd Heusch, Stefan Sack, Miralem Pasic, Thomas Meinertz, Thomas Walther, Karl-Heinz Kuck, Friedhelm Beyersdorf, Michael Böhm, Helge Möllmann, Christian W. Hamm, Friedrich W. Mohr, GARY Executive Board

Objectives: This study sought to analyze health-related quality-of-life (HrQoL) outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) based on data from GARY (German Aortic Valve Registry).

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Impella 5.0 Fracture and Transcatheter Retrieval

Castigliano M. Bhamidipati, Moses Mathur, Ravi S. Hira, James M. McCabe, Jay D. Pal

A 35-year-old man with a history of Kawasaki disease presented in cardiogenic shock following ST-segment elevation myocardial infarction. He underwent percutaneous intervention of the culprit vessel. He subsequently sustained cardiac arrest, during which time an Impella 5.0 device (Abiomed, Danvers, Massachusetts) was placed percutaneously via the right common femoral artery. The patient continued to experience ventricular tachyarrhythmias, and venoarterial extracorporeal life support was initiated. The Impella was left in the left ventricle to aid in decompression.

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Malabsorption of a Bioresorbable Vascular Scaffold System Leading to Very Late In-Scaffold Restenosis More Than 3.5 Years After Implantation. Assessment by Optical Coherence Tomography

Michael Dommasch, Nikolas Langwieser, Karl-Ludwig Laugwitz, Tareq Ibrahim

A 47-year-old man was admitted because of unstable angina pectoris for the past 4 weeks and symptom progression within the past 2 h. Forty-four months previously, a non–ST-segment elevation myocardial infarction was revascularized using 2 bioresorbable vascular scaffolds (BVS) (3.0 × 18 mm and 2.5 × 28 mm Absorb, Abbott Vascular, Santa Clara, California) implanted into the left circumflex coronary artery and post-dilated with a 3.0-mm noncompliant balloon. Angiography and optical coherence tomography (OCT) (Ilumien, St. Jude Medical, St. Paul, Minnesota) performed directly after implantation showed an excellent early result, without any gap or overlap

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. A Marble in the Heart

Juan Caro-Codón, Guillermo Galeote, Carlos Álvarez-Ortega, Raul Moreno, Jose-Luis López-Sendón

An 83-year-old woman with chronic atrial fibrillation and hypertension underwent left atrial appendage occlusion at another center with a 22-mm Amplatzer cardiac plug (St. Jude Medical, Minneapolis, Minnesota) after embolic central retinal artery occlusion while receiving treatment with dabigatran. Dual antiplatelet therapy with aspirin and clopidogrel was initiated, but both drugs were stopped after 3 months of follow-up with transthoracic echocardiography.

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Stenting of a Left Ventricular Assist Device Outflow Kink

Abdallah El Sabbagh, Mohammed Al-Hijji, Rajiv Gulati, Charanjit S. Rihal, Peter M. Pollak, Atta Behfar

A 70-year old man with end-stage ischemic cardiomyopathy status post HeartMate II (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) implantation as destination therapy presented with recurrent gastrointestinal bleeding. He was seen by gastroenterology and had a work-up that revealed proximal jejunal angiodysplasia. Device parameters revealed a high velocity of his pump with evidence of poor decompression of the left ventricle on the transthoracic echocardiogram. Computed tomography angiography of the chest revealed a 90° angulation in the LVAD proximal outflow cannula with no cannula thrombosis (Figure 1). It was thought that this outflow obstruction is causing acquired von Willebrand’s disease, which was confirmed by a von Willebrand factor multimer analysis testing.

01 diciembre 2016

JACC: CARDIOVASCULAR INTERVENTIONS. Perforation of Anterior Mitral Leaflet Due to Mechanical Stimulation Late After Transcatheter Aortic Valve Replacement

Mizuki Miura, Akihiro Isotani, Kenichiro Murata, Tomohiro Kawaguchi, Masaomi Hayashi, Yoshio Arai, Shinichi Shirai, Michiya Hanyu, Kenji Ando

An 82-year-old man underwent transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis (AS) using a 23-mm balloon-expandable SAPIEN XT valve (Edwards Lifesciences, Irvine, California) deployed via a transapical approach (Figure 1A). He was referred to our center for dyspnea (New York Heart Association functional class IV) 6 months after TAVR. Transthoracic echocardiography revealed new mitral regurgitation from the middle of the anterior mitral leaflet (AML) to posterior wall.

30 agosto 2016

CIRCULATION. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Multicenter Randomized PRAGUE-18 Study

Zuzana Motovska, Ota Hlinomaz, Roman Miklik, Milan Hromadka, Ivo Varvarovsky, Jaroslav Dusek, Jiri Knot, Jiri Jarkovsky, Petr Kala, Richard Rokyta, Frantisek Tousek, Petra Kramarikova, Bohumil Majtan, Stanislav Simek, Marian Branny, Jan Mrozek, Pavel Cervinka, Jiri Ostransky, Petr Widimsky and For the PRAGUE-18 Study Group

Background: No randomized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y12 inhibitors were first demonstrated relative to clopidogrel.

01 enero 2017

AMERICAN HEART JOURNAL. Interventional left atrial appendage closure vs novel anticoagulation agents in patients with atrial fibrillation indicated for long-term anticoagulation (PRAGUE-17 study)

Pavel Osmancik, MD, PhD, Petr Tousek, MD, PhD, Dalibor Herman, MD, PhD, Petr Neuzil, MD, CSc, Pavel Hala, MD, Josef Stasek, MD, PhD, Ludek Haman, MD, PhD, Petr Kala, MD, PhD, Martin Poloczek, MD, Marian Branny, MD, PhD, Jan Chovancik, MD, Pavel Cervinka, MD, PhD, Jiri Holy, MD, Vlastimil Vancura, MD, PhD, Richard Rokyta, MD, PhD, Milos Taborsky, MD, CSc, Tomas Kovarnik, MD, PhD, David Zemanek, MD, PhD, Petr Peichl, MD, PhD, Sarka Haskova, Eng, Jiri Jarkovsky, Eng, Petr Widimsky, MD, DrSc on behalf of the PRAGUE-17 Investigators

Background: Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA.

01 enero 2017

AMERICAN HEART JOURNAL. Clinical value of post–percutaneous coronary intervention fractional flow reserve value: A systematic review and meta-analysis

Goran Rimac, MD, William F. Fearon, MD, Bernard De Bruyne, MD, PhD, Fumiaki Ikeno, MD, Hitoshi Matsuo, MD, Zsolt Piroth, MD, Olivier Costerousse, PhD, Olivier F. Bertrand, MD, PhD

Background: Fractional flow reserve (FFR) prior to percutaneous coronary intervention (PCI) is useful to guide treatment. Whether post-PCI FFR assessment might have clinical impact is controversial. The aim of this study is to evaluate the range of post-PCI FFR values and analyze the relationship between post-PCI FFR and clinical outcomes.

01 enero 2017

THE AMERICAN JOURNAL OF CARDIOLOGY. Prognostic Significance of Ischemic Mitral Regurgitation on Outcomes in Acute ST-Elevation Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention

Amgad Mentias, MD, Mohammad Q. Raza, MD, Amr F. Barakat, MD, Elizabeth Hill, DO, Dalia Youssef, MD, Amar Krishnaswamy, MD, Milind Y. Desai, MD, Brian Griffin, MD, Stephen Ellis, MD, Venu Menon, MD, E. Murat Tuzcu, MD, Samir R. Kapadia, MD

Ischemic mitral regurgitation (IMR) has been associated with worse outcome myocardial infarction. However, severity of mitral regurgitation (MR) and its impact on patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) remains unknown. We sought to determine impact of increasing severity of IMR on outcomes in patients with STEMI undergoing primary PCI. All patients presenting with STEMI who underwent primary PCI within 12 hours of symptoms from 1994 to 2014 were included. IMR was graded from 0 to 4+ within 3 days of index myocardial infarction by echocardiography. Overall, 4,005 patients with STEMI were included.

01 enero 2017

THE AMERICAN JOURNAL OF CARDIOLOGY. Percutaneous Coronary Intervention as a Trigger for Stroke

Torunn Varmdal, MPA, Imre Janszky, MD, PhD, Inger J. Bakken, PhD, Hanne Ellekjær, MD, PhD, Hild Fjærtoft, PhD, Siri E. Håberg, MD, PhD, Kaare H. Bønaa, MD, PhD

Percutaneous coronary intervention (PCI) is a plausible triggering factor for stroke, yet the magnitude of this excess risk remains unclear. This study aimed to quantify the transient change in risk of stroke for up to 12 weeks after PCI. We applied the case-crossover method, using data from the Norwegian Patient Register on all hospitalizations in Norway in the period of 2008 to 2014. The relative risk (RR) of ischemic stroke was highest during the first 2 days after PCI (RR 17.5, 95% confidence interval [CI] 4.2 to 72.8) and decreased gradually during the following weeks.

01 enero 2017

THE AMERICAN JOURNAL OF CARDIOLOGY. Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic Obstructive Pulmonary Disease Undergoing Percutaneous Coronary Intervention (from the BASKET-PROVE I and II Trials)

Tannas Jatene, MD, Tor Biering-Sørensen, MD, Kotaro Nochioka, MD, Fernanda Marinho Mangione, MD, Kim Wadt Hansen, MD, Rikke Sørensen, MD, Jan Skov Jensen, MD, Peter Godsk Jørgensen, MD, Raban Jeger, MD, Christoph Kaiser, MD, Matthias Pfisterer, MD, Søren Galatius, MD on behalf of the BASKET-PROVE Investigators

Chronic obstructive pulmonary disease (COPD) is associated with long-term all-cause death after percutaneous coronary intervention with bare-metal stents. Regarding other outcomes, previous studies have shown conflicting results and the impact of drug-eluting stent (DES) in this population is not well known. We analyzed 4,605 patients who underwent percutaneous coronary intervention with bare-metal stents (33.1%) or DES (66.9%) from the Basel Stent Kosten-Effektivitats Trial-Prospective Validation Examination trials I and II. COPD patients (n = 283, 6.1%), were older and had more frequently a smoking or cardiovascular event history. At 2-year follow-up, cumulative event rates for patients with versus without COPD were the following: major adverse cardiac events (MACE: composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization): 15.2% versus 8.1% (p <0.001); all-cause death: 11.7% versus 2.4% (p <0.001); cardiac death: 5.7% versus 1.2% (p <0.001); myocardial infarction: 3.5% versus 1.9% (p = 0.045); definite/probable/possible stent thrombosis: 2.5% versus 0.9% (p = 0.01); and major bleeding: 4.2% versus 2.1% (p = 0.014).

01 enero 2017

THE AMERICAN JOURNAL OF CARDIOLOGY. Meta-Analysis of Outcomes and Evolution of Pulmonary Hypertension Before and After Transcatheter Aortic Valve Implantation

Mengyao Tang, MD, Xianbao Liu, MD, Chiayu Lin, MD, Yuxin He, MD, Xianlei Cai, MD, Qiyuan Xu, MD, Po Hu, MD, Feng Gao, MD, Jubo Jiang, MD, Xiaoping Lin, MD, PhD, Qifeng Zhu, MS, Lihan Wang, MD, Huijia Kong, MD, Yunxian Yu, PhD, Jian´an Wang, MD, PhD

Pulmonary hypertension (PH) is a common entity in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI), but its role on clinical outcomes remains undetermined. We evaluated the impact of baseline and postprocedural PH on clinical outcomes and changes in pulmonary artery systolic pressure after TAVI by performing a meta-analysis of 16 studies enrolling 9,204 patients with AS who underwent TAVI. In patients with baseline PH, all-cause mortality was significantly increased, as shown by pooled odds ratio (ORs) for overall 30-day (OR 1.52, 95% confidence interval [CI] 1.28 to 1.80), 1-year (OR 1.39, 95% CI 1.27 to 1.51), and 2-year all-cause mortality (OR 2.00, 95% CI 1.49 to 2.69), compared with those without PH, independent of different methods of PH assessment. The presence of post-TAVI PH was associated with a significant increase in 2-year all-cause mortality (OR 2.32, 95% CI 1.43 to 3.74).

01 enero 2017

THE AMERICAN JOURNAL OF CARDIOLOGY. Relation Between Clinical Best Practices and 6-Month Outcomes After Transcatheter Aortic Valve Implantation With CoreValve (from the ADVANCE II Study)

Jan-Malte Sinning, MD, PhD, Anna Sonia Petronio, MD, Nicolas Van Mieghem, MD, PhD, Giulio Zucchelli, MD, PhD, Georg Nickenig, MD, PhD, Raffi Bekeredjian, MD, PhD, Johan Bosmans, MD, PhD, Francesco Bedogni, MD, Marian Branny, MD, Karl Stangl, MD, Jan Kovac, MD, Anna Nordell, MS, Molly Schiltgen, MS, Nicolo Piazza, MD, PhD, Peter de Jaegere, MD, PhD

Best practices for transcatheter aortic valve implantation with CoreValve include patient screening and valve size selection using multislice computed tomography, adherence to manufacturer recommendations for oversizing, control of implant depth to 6 mm or less, and management of conduction disturbances according to international guidelines. The ADVANCE II study implemented these strategies and demonstrated their relation to clinical outcomes. From October 2011 to April 2013, 200 patients with severe aortic stenosis were enrolled, and 194 were implanted. All imaging and electrocardiographic data were analyzed by an independent core laboratory, and adverse events were adjudicated to valve academic research consortium-2 definitions.