01 noviembre 2014

JACC. Invasive Coronary Microcirculation Assessment During Myocardial Infarction. One Step Forward or Two Steps Back

Gilles Rioufol, MD, PhD; Gérard Finet, MD, PhD

In acute coronary occlusion, ST-segment elevation myocardial infarction (STEMI) has been experimentally and clinically correlated with ischemic myocardial mass (area at risk), coronary reperfusion delay, and collateral circulation 1. Rapid coronary reperfusion, usually by primary percutaneous coronary intervention (PPCI), provides the principal means of limiting infarct size and improving prognosis. It may, however, induce reperfusion lesions, accounting for up to 40% to 50% of final infarct size (2), making this a major research issue in therapeutic development 3. Much has been learned thanks to cardiac magnetic resonance (CMR) imaging, which notably enables noninvasive assessment of the area at risk and reperfusion lesions (microvascular obstruction [MVO]) that develop in the days after STEMI, and, later, specifics regarding infarct size

01 noviembre 2014

JACC. Second-Generation Drug-Eluting Stent Implantation Followed by 6- Versus 12-Month Dual Antiplatelet Therapy

Antonio Colombo, MD∗; Alaide Chieffo, MD∗; Arian Frasheri, MD†; Roberto Garbo, MD‡; Monica Masotti-Centol, MD§; Neus Salvatella, MD‖; Juan Francisco Oteo Dominguez, MD¶; Luigi Steffanon, MD#; Giuseppe Tarantini, MD∗∗; Patrizia Presbitero, MD††; Alberto Menozzi, MD‡‡; Edoardo Pucci, MD§§; Josepa Mauri, MD‖‖; Bruno Mario Cesana, MD¶¶; Gennaro Giustino, MD∗; Gennaro Sardella, MD##

Background: The optimal duration of dual antiplatelet therapy (DAPT) following second-generation drug-eluting stent (DES) implantation is still debated.

01 diciembre 2014

JACC. Multicenter Evaluation of a Next-Generation Balloon-Expandable Transcatheter Aortic Valve

John Webb, MD∗; Gino Gerosa, MD†; Thierry Lefèvre, MD‡; Jonathon Leipsic, MD∗; Mark Spence, MD§; Martyn Thomas, MD‖; Matthias Thielmann, MD¶; Hendrik Treede, MD#; Olaf Wendler, MD∗∗; Thomas Walther, MD††

Background: The SAPIEN 3 (Edwards Lifesciences Inc., Irvine, California) transcatheter valve incorporates features designed to address the well-known deficiencies of transcatheter aortic valve replacement (TAVR). An ultra–low-profile delivery system facilitates safe, controlled, and accurate implantation and an external seal minimizes paravalvular regurgitation.

01 diciembre 2014

JACC. New Transcatheter Aortic Valve Prosthesis Sets a New Standard

Howard C. Herrmann, MD

When Cribier et al. 1 first described transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) in 2002, few envisioned the current widespread utilization of this novel technique. Initial randomized studies provided evidence for efficacy in patients not suitable for open surgical aortic valve replacement (2,3). Subsequent studies demonstrated noninferiority (4) and then superiority 5 to surgery for high-risk patients. Nonetheless, limitations of TAVR, particularly vascular complications, stroke, and paravalvular leaks (PVL) resulting in aortic regurgitation (AR), have combined to restrict TAVR to patients with high or high-intermediate risk for surgery

01 diciembre 2014

JACC. Coronary Stent Thrombosis With Vorapaxar Versus Placebo

Marc P. Bonaca, MD, MPH; Benjamin M. Scirica, MD, MPH; Eugene Braunwald, MD; Stephen D. Wiviott, MD; Michelle L. O´Donoghue, MD, MPH; Sabina A. Murphy, MPH; David A. Morrow, MD, MPH

Background: Vorapaxar, a novel thrombin receptor antagonist, reduces cardiovascular death and recurrent thrombotic events when added to standard antiplatelet therapy in patients with stable atherosclerotic vascular disease.

01 diciembre 2014

JACC. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

Darren Mylotte, MB, MD∗; Thierry Lefevre, MD‡; Lars Søndergaard, MD§; Yusuke Watanabe, MD‡; Thomas Modine, MD‖; Danny Dvir, MD¶; Johan Bosmans, MD#; Didier Tchetche, MD∗∗; Ran Kornowski, MD††; Jan-Malte Sinning, MD†; Pascal Thériault-Lauzier, PhD†; Crochan J. O`Sullivan, MB, MD§§; Marco Barbanti, MD‖‖; Nicolas Debry, MD‖; Jean Buithieu, MD†; Pablo Codner, MD††; Magdalena Dorfmeister, MD¶¶; Giuseppe Martucci, MD†; Georg Nickenig, MD‡‡; Peter Wenaweser, MD§§; Corrado Tamburino, MD‖‖; Eberhard Grube, MD‡‡; John G. Webb, MD¶; Stephan Windecker, MD§§; Ruediger Lange, MD, PhD¶¶; Nicolo Piazza, MD, PhD†

Background: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV).

01 diciembre 2014

JACC. Bicuspid Aortic Valve. Any Room for TAVR?

Antonio Colombo, MD; Azeem Latib, MD

Bicuspid aortic valve (BAV) disease is the most common congenital cardiac defect, with a prevalence estimated between 0.5% and 2% (1,2). The earliest description of BAV is attributed to Leonardo da Vinci, who sketched the bicuspid variant of the aortic valve over 400 years ago (3). In the last 100 years, various authors have reported the clinical sequelae of this common congenital disease, namely aortic stenosis or incompetence, endocarditis, aortic aneurysm formation, and aortic dissection

01 diciembre 2014

JACC. OCT Assessment of the Long-Term Vascular Healing Response 5 Years After Everolimus-Eluting Bioresorbable Vascular Scaffold

Antonios Karanasos, MD∗; Cihan Simsek, MD∗; Muthukarrupan Gnanadesigan, MSc†; Nienke S. van Ditzhuijzen, MSc∗; Raphael Freire, MD∗; Jouke Dijkstra, PhD‡; Shengxian Tu, PhD‡; Nicolas Van Mieghem, MD∗; Gijs van Soest, PhD†; Peter de Jaegere, MD, PhD∗; Patrick W. Serruys, MD, PhD∗; Felix Zijlstra, MD, PhD∗; Robert-Jan van Geuns, MD, PhD∗; Evelyn Regar, MD, PhD∗

Background: Although recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response.

01 diciembre 2014

JACC. Long-Term Favorable Coronary Healing After Bioresorbable Scaffold Implantation

Nieves Gonzalo, MD, PhD†; George Dangas, MD, PhD‡; Borja Ibanez, MD, PhD†

Vascular response after coronary angioplasty varies according to the technique. Acute response after balloon angioplasty is characterized by luminal gain in most cases, although dissection can occur during the procedure, putting coronary artery patency at risk. Arterial “elastic recoil” sometimes follows this acute luminal gain, resulting in some degree of restenosis.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Left Atrial Appendage Closure

Jacqueline Saw, MD; Mathieu Lempereur, MD

Percutaneous left atrial appendage closure technology for stroke prevention in patients with atrial fibrillation has significantly advanced in the past 2 decades. Several devices are under clinical investigation, and a few have already received Conformité Européene (CE)-mark approval and are available in many countries. The WATCHMAN device (Boston Scientific, Natick, Massachusetts) has the most supportive data and is under evaluation by the U.S. Food and Drug Administration for warfarin-eligible patients. The Amplatzer Cardiac Plug (St. Jude Medical, Plymouth, Minnesota) has a large real-world experience over the past 5 years, and a randomized trial comparing Amplatzer Cardiac Plug with the WATCHMAN device is anticipated in the near future. The Lariat procedure (SentreHEART Inc., Redwood City, California) has also gained interest lately, but early studies were concerning for high rates of serious pericardial effusion and major bleeding. The current real-world experience predominantly involves patients who are not long-term anticoagulation candidates or who are perceived to have high bleeding risks. This pattern of practice is expected to change when the U.S. Food and Drug Administration approves the WATCHMAN device for warfarin-eligible patients. This paper reviews in depth the procedural techniques, safety, and outcomes of the current leading devices.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Risk of Cerebrovascular Events in Patients With Patent Foramen Ovale and Intracardiac Devices

Kanhaiya L. Poddar, MD∗; Vijaiganesh Nagarajan, MD†; Amar Krishnaswamy, MD∗; Navkaranbir S. Bajaj, MD†; Meera Kumari, MBBS∗; Hazem Bdair, MD∗; Dhruv Modi, MD∗; Shikhar Agarwal, MD, MPH, CPH∗; Sachin S. Goel, MD∗; Akhil Parashar, MD†; E. Murat Tuzcu, MD∗; Samir R. Kapadia, MD∗

Objectives: This study investigated whether patients with patent foramen ovale (PFO) have an increased risk of stroke due to permanent pacemaker (PPM)/implantable cardioverter-defibrillator (ICD) implantation.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Outcomes After Transfemoral Transcatheter Aortic Valve Replacement. A Comparison of the Randomized PARTNER (Placement of AoRTic TraNscathetER Valves) Trial With the NRCA (Nonrandomized Continued Access) Registry

William F. Fearon, MD∗; Susheel Kodali, MD†; Darshan Doshi, MD†; Michael P. Fischbein, MD, PhD∗; Alan C. Yeung, MD∗; E. Murat Tuzcu, MD‡; Charanjit S. Rihal, MD§; Vasilis Babaliaros, MD‖; Alan Zajarias, MD¶; Howard C. Herrmann, MD#; David L. Brown, MD∗∗; Michael Mack, MD††; Paul S. Teirstein, MD‡‡; Brian K. Whisenant, MD§§; Raj Makkar, MD‖‖; Samir Kapadia, MD‡; Martin B. Leon, MD∗

Objectives: This study sought to determine whether outcomes for transfemoral (TF) transcatheter aortic valve replacement (TAVR) differ between the randomized controlled trial (RCT) and the subsequent NRCA (Nonrandomized Continued Access) registry of the PARTNER (Placement of AoRTic TraNscathetER Valves) trial.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. One-Year Follow-Up of the Melody Transcatheter Pulmonary Valve Multicenter Post-Approval Study

Aimee K. Armstrong, MD∗; David T. Balzer, MD†; Allison K. Cabalka, MD‡; Robert G. Gray, MD§; Alexander J. Javois, MD‖; John W. Moore, MD¶; Jonathan J. Rome, MD#; Daniel R. Turner, MD∗∗; Thomas M. Zellers, MD††; Jacqueline Kreutzer, MD‡‡

Objectives: This study sought to confirm that the short-term hemodynamic effectiveness of the Melody transcatheter pulmonary valve (TPV) (Medtronic, Inc., Minneapolis, Minnesota) achieved by real-world providers is equivalent to the historical results established in the initial 5-center Investigational Device Exemption trial.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of the Complexity of Bifurcation Lesions Treated With Drug-Eluting Stents. The DEFINITION Study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts)

Shao-Liang Chen, MD∗; Imad Sheiban, MD†; Bo Xu, MBBS‡; Nigel Jepson, MD§; Chitprapai Paiboon, MD‖; Jun-Jie Zhang, PhD¶; Fei Ye, MD¶; Teugh Sansoto, MD#; Tak W. Kwan, MD∗∗; Michael Lee, MD††; Ya-Ling Han, MD‡‡; Shu-Zheng Lv, MD§§; Shang-Yu Wen, MD‖‖; Qi Zhang, MD¶¶; Hai-Chang Wang, MD##; Tie-Ming Jiang, MD∗∗∗; Yan Wang, MD†††; Liang-Long Chen, MD‡‡‡; Nai-Liang Tian, MD∗; Feng Cao, MD##; Chun-Guang Qiu, MD§§§; Yao-Jun Zhang, PhD¶; Martin B. Leon, MD‖‖‖

Objectives: The present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Hybrid Revascularization for Multivessel Coronary Artery Disease

Mariusz Gąsior, MD∗; Michael Oscar Zembala, MD, PhD†; Mateusz Tajstra, MD, PhD∗; Krzysztof Filipiak, MD, PhD†; Marek Gierlotka, MD∗; Tomasz Hrapkowicz, MD, PhD†; Michał Hawranek, MD, PhD∗; Lech Poloński, MD∗; Marian Zembala, MD†

Objectives: The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).