Cerebral Protection Devices in Transcatheter Aortic-Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a common procedure used in the treatment of severe aortic stenosis and other cardiac valve diseases. Although this procedure has been shown to be effective and safe in improving cardiac function and life expectancy in this population, there is an inherent risk of neurological complications such as stroke and cognitive impairment. In the last years, there has been a breakthrough in the development of brain protection devices that minimize the risk of brain embolism during the procedure. These devices are designed to capture clots and calcium debris that could become dislodged during the valve implant, therefore keeping the embolus from entering the nervous system via the supra-aortic vessels. Some studies indicate that using brain protection devices during an aortic valve replacement could substantially decrease the burden of stroke and other associated neurological complications. However, despite the promising expected results, further studies are required to sustain the benefit of using these devices, besides with the ongoing development in this area it would be fundamental a face-to-face interaction between the devices in the current development. Furthermore, although the experience with these devices is limited and the recent experience indicates they are safe, it would be fundamental to identify and take in consideration possible risks and complications related to these devices

Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Atypical Abdominal Pain in a Patient With Liver Cirrhosis

The causes of abdominal pain in patients with liver cirrhosis and ascites are well-known but occasionally, atypical causes arise. We report the case of a patient with a ruptured, confined abdominal aortic aneurysm

Aplicaciones del stent cubierto con membrana de politetrafluoroetileno en el intervencionismo coronario (Experiencia del Instituto Nacional de Cardiología "Ignacio Chávez")

El stent cubierto con membrana se ha reportado como un dispositivo útil para corregir lesiones angiográficas específicas, así como complicaciones potenciales secundarias a procedimientos de intervencionismo coronario. El stent cubierto con membrana de (Jostent-Jomed) está compuesto por una fina capa de politetrafluoroetileno (PTFE) que se localiza entre dos stents metálicos. En esta revisión retrospectiva el stent de PTFE se utilizó en varias lesiones y situaciones angiográficas tanto en arterias coronarias como en injertos venosos. Nuestra experiencia consistió de 17 pacientes que fueron tratados por diferentes indicaciones clínicas y angiográficas: perforación coronaria en dos pacientes (pts), injertos venosos con trombo y cambios degenerativos en ocho (pts), aneurismas coronarios en 4 (pts) y trombo grande refractario a tratamiento habitual en otros 3 casos. Nuestros resultados con el stent de PTFE mostraron una tasa de éxito clínico del 100% sin complicaciones durante la fase hospitalaria y en el seguimiento clínico a 10 ± 3 meses sólo tres pacientes tuvieron algún evento cardíaco adverso mayor. La indicación potencial para el implante del stent de PTFE en injertos venosos todavía no se ha puntualizado; sin embargo a la luz de varios estudios pareciera haber poco beneficio en esta circunstancia. Por otro lado la perforación y el aneurisma coronario parecen ser las indicaciones más recomendables para la aplicación de este dispositivo

The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty

Introduction: Patients with ST elevation acute myocardial infarction (STEMI) comprise a heterogeneous population with respect to the risk for adverse events. Primary percutaneous coronary intervention (PCI) has shown to be better, mainly in high-risk patients. Objective: The purpose of this study was to determine if the Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI applied to patients undergo primary PCI identifies a group of patients at high risk for adverse events. Methods: We identifed patients with STEMI without cardiogenic shock on admission, who were treated with primary PCI. The TIMI and CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) risk scores were calculated to determine their predictive value for in hospital mortality. Patients were divided into two groups according to their TIMI risk score, low risk being 0-4 points and high risk ≥5 points, and the frequency of adverse events was analyzed. Results: We analyzed 572 patients with STEMI. The c-statistics predictive value of the TIMI risk score for mortality was 0.80 (p=0.0001) and the CADILLAC risk score was 0.83, (p=0.0001). Thirty-two percent of patients classifed as high risk (TIMI ≥5) had a higher incidence of adverse events than the low-risk group: mortality 14.8% vs. 2.1%, (p=0.0001); heart failure 15.3% vs. 4.1%, (p=0.0001); development of cardiogenic shock 10.9% vs. 1.5%, (p=0.0001); ventricular arrhythmias 14.8% vs. 5.9%, (p=0.001); and no-refow phenomenon 22.4% vs. 13.6%, (p=0.01). Conclusions: The TIMI risk score for STEMI prior to primary PCI can predict in hospital mortality and identifes a group of high-risk patients who might develop adverse events

Long-term outcomes of saphenous vein graft stenting compared with native coronary artery stenting in patients with previous coronary artery bypass graft surgery

Objective: Our main objective was to compare the in-hospital and long-term outcomes of saphenous vein graft stenting and native coronary artery stenting in patients with previous coronary artery bypass grafting. Methods: We studied 127 patients who had prior coronary artery bypass; they were divided in two groups, according to the kind of percutaneous coronary intervention performed. The first group included 49 patients with saphenous vein graft stenting and the second group included 78 patients who underwent native coronary artery stenting. Results: There was no significant difference in age, incidence of diabetes, smoking, arterial hypertension, dyslipidemia, left ventricular ejection fraction or in the New York Heart Association functional class between both groups. The incidence of no reflow phenomenon was higher in group 1 (10.2% vs. 1.2%, p = 0.0001). The cumulative incidence of major adverse cardiac events was different between groups at 1 month (10.2% vs. 2.5%, p = 0.041). There was a lower MACE (major adverse cardiovascular events) free survival at 36 months in the saphenous vein graft stenting group (65.0% vs. 89.1%, p = 0.024). Conclusions: Major in-hospital complications occurred more frequently in the saphenous vein graft stented group. MACE-free survival at 3 years was higher in the native coronary artery stent patients

Coronary CT Angiography in Takayasu Arteritis

ObjectivesThe aim of this study was to use coronary computed tomographic (CT) angiography to characterize coronary artery involvement in patients with known Takayasu arteritis who present with anginal chest pain or shortness of breath.BackgroundTakayasu arteritis is a primary vasculitis of the large vessels, which mainly affects the aorta and its branches but can also involve the coronary arteries. Coronary CT angiography allows visualization of the coronary vessels and can be used to detect both stenotic and nonstenotic coronary artery lesions.MethodsEighteen consecutive patients with Takayasu arteritis and angina (typical or atypical) and/or dyspnea underwent contrast-enhanced 64-slice coronary CT angiography. The arterial injury was classified according to the Numano classification. Three patients had prior known coronary artery disease. Coronary arteries were evaluated concerning the presence of obstructive and nonobstructive lesions, and differences between the clinical presentations of patients with and without coronary artery involvement on CT angiography were analyzed.ResultsCoronary artery involvement was found in 8 patients (44.4%), 3 of them with clinical activity. A total of 19 coronary lesions were present (13 in ostial locations, 5 in proximal coronary artery segments, and 1 in a mid segment). Eight lesions exceeded 50% diameter reduction (2 in ostial locations and 6 in proximal coronary artery segments). Median disease duration was significantly different between patients with coronary artery involvement (176 months; range 13 to 282 months) compared with those without (21 months; range 1 to 142 months) (p = 0.013).ConclusionsCoronary CT angiography allows the assessment of coronary artery involvement in patients with Takayasu arteritis. These data confirm prior observations that most coronary lesions are in ostial or proximal coronary artery locations. Disease duration in patients with coronary artery involvement is longer than in patients without

Ensayo clínico de asignación aleatoria, para evaluar la eficacia de dos técnicas de compresión en la disminución de complicaciones en el sitio de acceso vascular femoral, posterior a cateterismo diagnóstico y terapéutico

Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La falla para lograr hemostasia se presentó en 48% del grupo uno vs 19.7% en el grupo dos (p<0.001). Existió una tendencia a presentar con más frecuencia hematomas &gt;4 cm durante el seguimiento con ultrasonido, en el grupo con compresor 11.4% vs el grupo manual 4.6% (p=0.062). En el análisis de regresión logística sólo se encontró que los factores independientes para falla en la hemostasia fueron: uso de compresor con OR 4.34 (IC 95%, 2.24-8.43, p<0.001) y edad mayor a 61 años con OR 2.44 (IC 95%, 1.3-4.7, p=0.008), el índice de masa corporal < 26 disminuyó el riesgo con OR 0.86 (IC 95%, 0.78-0.94, p=0.001). Conclusiones: Para el retiro de introductores, la compresión manual es superior al empleo del compresor mecánico para evitar la falla de hemostasia en el sitio de punción. Una limitación es que no se puede asegurar cuál de los dos métodos es superior para disminuir complicaciones vasculares, dado que no se completó el tamaño de muestra calculado