01 junio 2015

JACC. Strategies to Incorporate Left Atrial Appendage Occlusion Into Clinical Practice

Oluseun Alli, MD∗; Samuel Asirvatham, MD†; David R. Holmes, Jr., MD†

The left atrial appendage (LAA) has been identified as a predominant source of thrombus formation leading to significant thromboembolic events in patients with nonvalvular atrial fibrillation. Medical therapy to eliminate thrombus formation in the LAA has been the standard of care for several decades, but mechanical approaches designed to exclude the LAA from the circulation have recently been developed. The largest body of randomized and nonrandomized data to date has been for the Watchman device (Boston Scientific, Natick, Massachusetts), which was recently approved by the Food and Drug Administration for selected patients in the United States. There are no current guidelines or guidance for institutions and operators looking to become involved in this therapy. This perspective is aimed at exploring these issues and providing necessary information and guidance to these programs and operators to help ensure a successful launch of a LAA occlusion program and optimize patient selection, procedural performance, and outcome.

01 junio 2015

JACC. Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome

Shinobu Itagaki, MD∗; Joanna P. Chikwe, MD∗; Yuting P. Chiang, BA∗; Natalia N. Egorova, PhD†; David H. Adams, MD∗

Background: Bicuspid aortic valves are associated with valve dysfunction, ascending aortic aneurysm and dissection. Management of the ascending aorta at the time of aortic valve replacement (AVR) in these patients is controversial and has been extrapolated from experience with Marfan syndrome, despite the absence of comparative long-term outcome data.

01 mayo 2015

JACC. Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements. Prospective Data From the GARY Registry

Thomas Walther, MD∗; Christian W. Hamm, MD†; Gerhard Schuler, MD‡; Alexander Berkowitsch, MD†; Joachim Kötting, Dipl Stat§; Norman Mangner, MD‡; Harald Mudra, MD‖; Andreas Beckmann, MD¶; Jochen Cremer, MD#; Armin Welz, MD∗∗; Rüdiger Lange, MD††; Karl-Heinz Kuck, MD‡‡; Friedrich W. Mohr, MD§§; Helge Möllmann, MD†

Background: Transcatheter aortic valve replacement (TAVR) has evolved into a routine procedure with good outcomes in high-risk patients.

01 mayo 2015

JACC. Benefits and Risks of Extended Duration Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction

Robert W. Yeh, MD, MSc∗; Dean J. Kereiakes, MD§; Philippe Gabriel Steg, MD‖; Stephan Windecker, MD∗∗; Michael J. Rinaldi, MD††; Anthony H. Gershlick, MBBS‡‡; Donald E. Cutlip, MD†; David J. Cohen, MD, MSc‖‖; Jean-Francois Tanguay, MD¶¶; Alice Jacobs, MD##; Stephen D. Wiviott, MD‡; Joseph M. Massaro, PhD†; Adrian C. Iancu, MD‡‡‡; Laura Mauri, MD, MSc†

Background: The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction (MI) compared with more stable presentations.

01 mayo 2015

JACC. Bleeding Avoidance Strategies During Percutaneous Coronary Interventions

Mandeep Singh, MD, MPH

Bleeding avoidance strategies for percutaneous coronary interventions continue to evolve with the availability of newer antiplatelet and anticoagulation therapies. Advances in interventional practices have altered the balance between ischemic and bleeding complications. With the availability of rapidly-acting platelet adenosine diphosphate–receptor antagonists, the need for routine glycoprotein IIb/IIIa inhibitors has diminished. Recent meta-analyses and trials have advanced our knowledge of vascular access and different anticoagulation regimens. Vascular closure devices have long been used for early ambulation; however, more recent results demonstrating lower bleeding complications from observational registries are encouraging. This review synthesizes this information, taking into account changes in the landscape of interventional practice with respect to current bleeding avoidance strategies.

31 mayo 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Interventions. Everolimus-Eluting Stents in Patients With Bare-Metal and Drug-Eluting In-Stent Restenosis. Results From a Patient-Level Pooled Analysis of the RIBS IV and V Trials

Fernando Alfonso, MD, María José Pérez-Vizcayno, MD, Bruno García del Blanco,, MD, Arturo García-Touchard,, MD, José-Ramón López-Mínguez,, MD, Mónica Masotti,, MD, Javier Zueco,, MD, Rafael Melgares,, MD, Vicente Mainar,, MD, Raul Moreno,, MD, Antonio Domínguez,, MD, Juan Sanchís,, MD, Armando Bethencourt,, MD, José Moreu,, MD, Angel Cequier,, MD, Vicens Martí,, MD, Imanol Otaegui,, MD, Teresa Bastante,, MD, Nieves Gonzalo,, MD, Pilar Jiménez-Quevedo,, MD, Alberto Cárdenas,, MD and Cristina Fernández,, MD;; under the auspices of the Interventional Cardiology Working Group of the Spanish Society of Cardiology

Background: Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is more challenging than that of patients with bare-metal stent ISR. However, the results of everolimus-eluting stents (EES) in these distinct scenarios remain unsettled.

23 mayo 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Physiologic Assessment and Imaging. Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome. One-Year Results of the POST-IT Multicenter Registry

Sergio Bravo Baptista, MD, Luís Raposo, MD, Lino Santos, MD, Ruben Ramos, MD, Rita Calé, MD, Elisabete Jorge, MD, PhD, Carina Machado, MD, Marco Costa, MD, Eduardo Infante de Oliveira, MD, João Costa, MD, João Pipa, MD, Nuno Fonseca, MD, Jorge Guardado, MD, Bruno Silva, MD, Maria-João Sousa, MD, João Carlos Silva, MD, Alberto Rodrigues, MD, Luís Seca, MD and Renato Fernandes, MD

Background: Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome.

13 mayo 2015

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Structural Heart Disease. Transcatheter Aortic Valve Implantation With the New Balloon-Expandable Sapien 3 Versus Sapien XT Valve System. A Propensity Score–Matched Single-Center Comparison

Freek Nijhoff, MD, Masieh Abawi, BSc, Pierfrancesco Agostoni, MD, PhD, Faiz Z. Ramjankhan, MD, Pieter A. Doevendans, MD, PhD and Pieter R. Stella, MD, PhD

Background: The new balloon-expandable Sapien 3 transcatheter heart valve (S3-THV) incorporates new features to reduce aortic regurgitation (AR) and vascular complications in transcatheter aortic valve implantation. Aim of this study is to compare the outcomes of the S3-THV with the preceding Sapien XT THV (SXT-THV) in patients who underwent transcatheter aortic valve implantation for symptomatic severe native aortic stenosis.

15 junio 2015

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Pharmacology. Ticagrelor Versus Clopidogrel in Black Patients With Stable Coronary Artery Disease. Prospective, Randomized, Open-Label, Multiple-Dose, Crossover Pilot Study

Ron Waksman, MD, Juan Maya, MD, MS, Dominick J. Angiolillo, MD, PhD, Glenn F. Carlson, MD, Renli Teng, PhD, Richard J. Caplan, PhD and Keith C. Ferdinand,, MD

Background: The burden of coronary artery disease (CAD) is high in blacks, highlighting the need for clinical research of antiplatelet agents in this population. We sought to evaluate platelet reactivity during loading and maintenance dosing of ticagrelor versus clopidogrel, and the pharmacokinetic profile of ticagrelor and its metabolite AR-C124910XX, in black patients with stable CAD taking low-dose aspirin (acetylsalicylic acid).

30 marzo 2015

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Myocardial Infarction. Intracoronary Delivery of Self-Assembling Heart-Derived Microtissues (Cardiospheres) for Prevention of Adverse Remodeling in a Pig Model of Convalescent Myocardial Infarction

Romain Gallet, MD, Eleni Tseliou, MD*, James Dawkins, DVM*, Ryan Middleton, MS, Jackelyn Valle, BS, David Angert, MD, PhD, Heidi Reich, MD, Daniel Luthringer, MD, Michelle Kreke, PhD, Rachel Smith, PhD, Linda Marbán, PhD and Eduardo Marbán, MD, PhD

Background: Preclinical studies in rodents and pigs indicate that the self-assembling microtissues known as cardiospheres may be more effective than dispersed cardiosphere-derived cells. However, the more desirable intracoronary route has been assumed to be unsafe for cardiosphere delivery: Cardiospheres are large (30–150 μm), raising concerns about likely microembolization. We questioned these negative assumptions by evaluating the safety and efficacy of optimized intracoronary delivery of cardiospheres in a porcine model of convalescent myocardial infarction.

17 abril 2015

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Artery Disease. Impact of Intravenous Lysine Acetylsalicylate Versus Oral Aspirin on Prasugrel-Inhibited Platelets. Results of a Prospective, Randomized, Crossover Study (the ECCLIPSE Trial)

David Vivas, MD, PhD, Agustín Martín, MD, Esther Bernardo, BSc, María Aranzazu Ortega-Pozzi, Bsc, PhD, Gabriela Tirado, MD, Cristina Fernández, MD, PhD, Isidre Vilacosta, MD, PhD, Iván Núñez-Gil, MD, PhD, Carlos Macaya, MD, PhD and Antonio Fernández-Ortiz, MD, PhD

Background: Prasugrel and ticagrelor, new P2Y12-adenosine diphosphate receptor antagonists, are associated with greater pharmacodynamic inhibition and reduction of cardiovascular events compared with clopidogrel in patients with an acute coronary syndrome. However, evidence is lacking about the effects of achieving faster and stronger cyclooxygenase inhibition with intravenous lysine acetylsalicylate (LA) compared with oral aspirin on prasugrel-inhibited platelets.

26 febrero 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Cardiac Catheterization. Occupational Health Risks in Cardiac Catheterization Laboratory Workers

Maria Grazia Andreassi, MSc, PhD, Emanuela Piccaluga, MD, Giulio Guagliumi, MD, Maurizio Del Greco, MD, Fiorenzo Gaita, MD, PhD, Eugenio Picano, MD, PhD and ; on behalf of the Healthy Cath Lab Study Group*

Background: Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure.

15 marzo 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Interventions. Comparison of the Efficacy of Paclitaxel-Eluting Balloon Catheters and Everolimus-Eluting Stents in the Treatment of Coronary In-Stent Restenosis. The Treatment of In-Stent Restenosis Study

Leos Pleva, MD, Pavel Kukla, MD, Pavlina Kusnierova, RNDr, PhD, Jana Zapletalova, MSc, PhD and Ota Hlinomaz, MD, PhD

Background: The aim of this prospective randomized noninferiority study was to compare the efficacy of paclitaxel-eluting balloon (PEB) catheters and everolimus-eluting stents (EES) in the treatment of bare metal stent restenosis.

22 febrero 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Physiologic Assessment and Imaging. Quantification of the Effect of Pressure Wire Drift on the Diagnostic Performance of Fractional Flow Reserve, Instantaneous Wave-Free Ratio, and Whole-Cycle Pd/Pa

Christopher M. Cook, MBBS, Yousif Ahmad, MBBS, Matthew J. Shun-Shin, MBBS, Sukhjinder Nijjer, MB CHB, Ricardo Petraco, MD, Rasha Al-Lamee, MBBS, Jamil Mayet, MD, MBA, FESC, Darrel P. Francis, MA, MD, Sayan Sen, MBBS, PhD and Justin E. Davies, MBBS, PhD

Background: Small drifts in intracoronary pressure measurements (±2 mm Hg) can affect stenosis categorization using pressure indices. This has not previously been assessed for fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and whole-cycle distal pressure/proximal pressure (Pd/Pa) indices.

09 febrero 2016

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Interventions. Temporal Trends in the Risk Profile of Patients Undergoing Outpatient Percutaneous Coronary Intervention. A Report from the National Cardiovascular Data Registry’s CathPCI Registry

Amit N. Vora, MD, MPH, Dadi Dai, PhD, Hitinder Gurm, MD, Amit P. Amin, MD, MSc, John C. Messenger, MD, Ehtisham Mahmud, MD, Laura Mauri, MD, Tracy Y. Wang, MD, MHS, MSc, Matthew T. Roe, MD, MHS, Jeptha Curtis, MD, Manesh R. Patel, MD, Harold L. Dauerman, MD, Eric D. Peterson, MD, MPH and Sunil V. Rao, MD

Background: Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated.