01 febrero 2013

CANADIAN JOURNAL OF CARDIOLOGY. Risk of Bleeding on Triple Antithrombotic Therapy After Percutaneous Coronary Intervention/Stenting: A Systematic Review and Meta-analysis

Jason G. Andrade, MD, Marc W. Deyell, MD, Clarence Khoo, MD, May Lee, MSc, Karin Humphries, DSc, John A. Cairns, MD

Background: There are no reported randomized controlled trials of triple antithrombotic therapy (TT; aspirin plus a thienopyridine plus vitamin K antagonist) vs dual antiplatelet therapy (DAPT; aspirin plus a thienopyridine) among patients undergoing percutaneous coronary intervention with stenting (PCI-S). A systematic review and meta-analysis was undertaken to assess the risk of bleeding among patients receiving TT after PCI-S.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Bleeding Avoidance in Transcatheter Aortic Valve Replacement

Matthew I. Tomey, MD†; Roxana Mehran, MD†

Bleeding complications after transcatheter aortic valve replacement (TAVR) are common. Reported rates of major bleeding at 30 days include 9.3% and 16.8% in the high- and extreme-risk cohorts of the PARTNER (Placement of Aortic Transcatheter Valve) trial (1,), 24.1% in the extreme-risk cohort of the CoreValve U.S. Pivotal Trial (3), and 7.2% to 9.7% in large international registries (4). Major or life-threatening bleeding events, as classified by the Valve Academic Research Consortium (5), are potent predictors of mortality (6,7,8,9). To the extent that anticoagulation used during TAVR may influence periprocedural bleeding risk, there is a need to identify best anticoagulation strategies to minimize clinically important bleeding while maintaining antithrombotic efficacy.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Transapical Mitral Implantation of the Tiara Bioprosthesis. Pre-Clinical Results

Shmuel Banai, MD∗; Stefan Verheye, MD†; Anson Cheung, MD‡; Marc Schwartz, BSc§; Alexei Marko, MASc, PEng§; Randy Lane, BSc§; E. Marc Jolicoeur, MD‖; Patrick Garceau, MD‖; Simon Biner, MD∗; Jean-Francois Tanguay, MD‖; Elazer R. Edelman, MD, PhD¶; Christopher J. White, MD#

Objectives: This study sought to describe the pre-clinical evaluation of transapical mitral implantation of the Tiara (Neovasc Inc, Vancouver, British Columbia, Canada) valve in preparation for first-in-man implantation.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Predicting Outcome in the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). Coronary Anatomy Versus Ischemia

G.B. John Mancini, MD∗; Pamela M. Hartigan, PhD†; Leslee J. Shaw, PhD‡; Daniel S. Berman, MD§; Sean W. Hayes, MD§; Eric R. Bates, MD‖; David J. Maron, MD¶; Koon Teo, MD#; Steven P. Sedlis, MD∗∗; Bernard R. Chaitman, MD††; William S. Weintraub, MD‡‡; John A. Spertus, MD§§; William J. Kostuk, MD‖‖; Marcin Dada, MD¶¶; David C. Booth, MD##; William E. Boden, MD

Objectives: The aim of this study was to determine the relative utility of anatomic and ischemic burden of coronary artery disease for predicting outcomes.

01 marzo 2014

JACC. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes and Severe Aortic Stenosis at High Risk for Surgery. An Analysis of the PARTNER Trial (Placement of Aortic Transcatheter Valve)

Brian R. Lindman, MD, MSCI∗; Philippe Pibarot, DVM, PhD†; Suzanne V. Arnold, MD, MHA‡; Rakesh M. Suri, MD, DPhil§; Thomas C. McAndrew, MS‖; Hersh S. Maniar, MD∗; Alan Zajarias, MD∗; Susheel Kodali, MD‖; Ajay J. Kirtane, MD, SM‖; Vinod H. Thourani, MD#; E. Murat Tuzcu, MD∗∗; Lars G. Svensson, MD, PhD∗∗; Ron Waksman, MD††; Craig R. Smith, MD¶; Martin B. Leon, MD‖

Objectives: The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS).

01 marzo 2014

JACC. Bleeding Complications After Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement. Insights From the PARTNER I Trial (Placement of Aortic Transcatheter Valve)

Philippe Généreux, MD∗; David J. Cohen, MD, MSc§; Mathew R. Williams, MD∗; Michael Mack, MD‖; Susheel K. Kodali, MD∗; Lars G. Svensson, MD, PhD¶; Ajay J. Kirtane, MD, SM∗; Ke Xu, PhD†; Thomas C. McAndrew, MS†; Raj Makkar, MD#; Craig R. Smith, MD∗; Martin B. Leon, MD∗

Objectives: This study sought to identify the incidence, predictors, and prognostic impact of bleeding complications (BC) after surgical aortic valve replacement (SAVR) compared with transcatheter aortic valve replacement (TAVR).

01 marzo 2014

JACC. Who Comes Off Best With Closed Chest?. Aortic Valve Replacement in Patients With High Surgical Risk

Joachim Schofer, MD

Since its introduction, transcatheter aortic valve replacement (TAVR) has emerged as a new therapeutic option for patients with inoperable, severe aortic stenosis and as an alternative treatment modality to surgical aortic valve replacement (SAVR) in selected, high-risk patients (1,). Because it is less invasive, this novel treatment is highly attractive to both physicians and patients. Not surprisingly, the use of TAVR has been increasing exponentially in Europe and North America. The available data on TAVR versus SAVR for patients at a higher surgical risk show similar outcomes for both groups (3). Therefore, to identify individuals who benefit more from 1 therapy or the other, a discriminating look at this heterogeneous group of high-risk, but still operable, patients is mandatory.

01 marzo 2014

JACC. Procedural Volume and Outcomes With Radial or Femoral Access for Coronary Angiography and Intervention

Sanjit S. Jolly, MD, MSc∗; John Cairns, MD†; Salim Yusuf, MBBS, DPhil∗; Kari Niemela, MD, PhD‡; Philippe Gabriel Steg, MD§; Matthew Worthley, MD‖; Emile Ferrari, MD¶; Warren J. Cantor, MD#; Anthony Fung, MD†; Nicholas Valettas, MD, MSc∗; Michael Rokoss, MD∗; Goran K. Olivecrona, MD, PhD∗∗; Petr Widimsky, MD††; Asim N. Cheema, MD, PhD‡‡; Peggy Gao, MSc∗; Shamir R. Mehta, MD, MSc∗

Objectives: The study sought to evaluate the relationship between procedural volume and outcomes with radial and femoral approach.

01 marzo 2014

JACC. ST-Segment Elevation Myocardial Infarction Treated by Radial or Femoral Approach in a Multicenter Randomized Clinical Trial. The STEMI-RADIAL Trial

Ivo Bernat, MD, PhD∗; David Horak, MD†; Josef Stasek, MD, PhD‡; Martin Mates, MD, PhD§; Jan Pesek, MD∗; Petr Ostadal, MD, PhD§; Vlado Hrabos, MD†; Jaroslav Dusek, MD, PhD‡; Jiri Koza, MD∗; Zdenek Sembera, MD†; Miroslav Brtko, MD, PhD‡; Ondrej Aschermann, MD§; Michal Smid, MD, PhD∗; Pavel Polansky, MD‡; Abdul Al Mawiri, MD‡; Jan Vojacek, MD, PhD‡; Josef Bis, MD‡; Olivier Costerousse, PhD‖; Olivier F. Bertrand, MD, PhD‖; Richard Rokyta, MD, PhD∗

Objectives: This study sought to compare radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) by high-volume operators experienced in both access sites.

01 marzo 2014

JACC. Radial Access for Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Time for a Paradigm Shift?

Robert J. Applegate, MD

In the past 2 decades there has been tremendous evolution of both the effectiveness and safety of percutaneous coronary intervention (PCI). As coronary ischemic events have decreased dramatically in frequency during and after PCI, efforts to improve the safety of PCI have shifted to addressing other complications, especially bleeding, occurring in the periprocedural period. A growing body of literature has shown that periprocedural bleeding is an independent predictor of adverse events including death following PCI (1). The term “bleeding avoidance strategies” has emerged reflecting that multiple factors have been associated with an increase in bleeding, and may have additive effects on this outcome 2. Although multiple factors contribute to bleeding after PCI, the access site (i.e., femoral or radial artery) has recently come under intense scrutiny as a source of potential bleeding, and by extension, a potential modifiable factor in an effort to reduce bleeding complications.

01 marzo 2014

JACC. Underexpansion and Ad Hoc Post-Dilation in Selected Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement

Marco Barbanti, MD∗; Jonathon Leipsic, MD∗; Ronald Binder, MD∗; Danny Dvir, MD∗; John Tan, MD∗; Melanie Freeman, MBBS∗; Bjarne Norgaard, MD†; Nicolaj Hansson, MD†; Anson Cheung, MD∗; Jian Ye, MD∗; Tae-Hyun Yang, MD∗; Kasia Maryniak, MD∗; Rekha Raju, MD∗; Angus Thompson, MBBS, PhD∗; Philipp Blanke, MD∗; Sandra Lauck, PhD, RN∗; David Wood, MD∗; John Webb, MD

Objectives: This study sought to assess the clinical outcomes and hemodynamic performance associated with a strategy of underexpanding balloon-expandable transcatheter heart valves (THV) when excessive oversizing is a concern.

01 marzo 2014

JACC. Factors Associated With Major Bleeding Events. Insights From the ROCKET AF Trial (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation)

Shaun G. Goodman, MD, MSc∗; Daniel M. Wojdyla, MS†; Jonathan P. Piccini, MD†; Harvey D. White, MB, ChB, DSc‡; John F. Paolini, MD, PhD§; Christopher C. Nessel, MD‖; Scott D. Berkowitz, MD§; Kenneth W. Mahaffey, MD†; Manesh R. Patel, MD†; Matthew W. Sherwood, MD†; Richard C. Becker, MD†; Jonathan L. Halperin, MD¶; Werner Hacke, MD#; Daniel E. Singer, MD∗∗; Graeme J. Hankey, MD††; Gunter Breithardt, MD‡‡; Keith A.A. Fox, MB, ChB§§; Robert M. Califf, MD‖‖

Objectives: This study sought to report additional safety results from the ROCKET AF (Rivaroxaban Once-daily oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).

01 marzo 2014

JACC. Stratification of Outcomes After Transcatheter Aortic Valve Replacement According to Surgical Inoperability for Technical Versus Clinical Reasons

Raj R. Makkar, MD∗; Hasan Jilaihawi, MD∗; Michael Mack, MD†; Tarun Chakravarty, MD∗; David J. Cohen, MD, MSc‡; Wen Cheng, MD∗; Gregory P. Fontana, MD§; Joseph E. Bavaria, MD‖; Vinod H. Thourani, MD¶; Howard C. Herrmann, MD‖; Augusto Pichard, MD#; Samir Kapadia, MD∗∗; Vasilis Babaliaros, MD¶; Brian K. Whisenant, MD††; Susheel K. Kodali, MD‡‡; Mathew Williams, MD‡‡; Alfredo Trento, MD∗; Craig R. Smith, MD‡‡; Paul S. Teirstein, MD§§; Mauricio G. Cohen, MD‖‖; Ke Xu, PhD‡‡; E. Murat Tuzcu, MD#; John G. Webb, MD¶¶; Martin B. Leon, MD‡‡

Objectives: The goal of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).

01 marzo 2014

JACC. TAVI in Patients Unsuitable for Surgery. A Prognostic Benefit for All?

Olaf Wendler, MD, PhD†; Rafal Dworakowski, MD, PhD‡

Since Alain Cribier performed the first human transcatheter aortic valve implantation (TAVI) in 2002 (1), the procedure has evolved into a reproducible and safe technique with >100,000 procedures performed worldwide. Early experience with new devices and techniques in Europe led to advanced procedural techniques, and large commercial and national registries provided real-world outcome data (2,3,4). Nevertheless, despite excellent results, various studies also demonstrated that although TAVI is a promising alternative treatment option for patients at high risk for surgical aortic valve replacement (SAVR), there is a group of patients who, despite successful prosthetic valve implantation, do not benefit from the procedure. It became clear that for the benefit of these patients, as well as to improve the economic strength and future viability of TAVI, treatment of this futile cohort should be avoided. Therefore, major attempts have been made to develop a clear understanding of the characteristics of this patient group; so far, there has not been much success.

01 marzo 2014

JACC. Prospective Multicenter Evaluation of the Direct Flow Medical Transcatheter Aortic Valve

Joachim Schofer, MD∗; Antonio Colombo, MD†; Silvio Klugmann, MD‡; Jean Fajadet, MD§; Federico DeMarco, MD‡; Didier Tchétché, MD§; Francesco Maisano, MD†; Giuseppe Bruschi, MD‡; Azeem Latib, MD†; Klaudija Bijuklic, MD∗; Neil Weissman, MD‖; Reginald Low, MD¶; Martyn Thomas, MD∗∗; Christopher Young, MD∗∗; Simon Redwood, MD∗∗; Michael Mullen, MD††; John Yap, MD††; Eberhard Grube, MD‡‡; Georg Nickenig, MD‡‡; Jan-Malte Sinning, MD‡‡; Karl Eugen Hauptmann, MD§§; Ivar Friedrich, MD§§; Michael Lauterbach, MD§§; Michael Schmoeckel, MD‖‖; Charles Davidson, MD¶¶; Thierry Lefevre, MD∗∗∗

Objectives: The study sought a prospective multicenter nonrandomized evaluation of the Direct Flow Medical (DFM) system for the treatment of severe aortic stenosis.