New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led toa paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascularsystem, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patientsremain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with newonset AF and coronavirus disease 2019 (COVID-19) infection.Methods: This observational study analyzed a sample of 160 consecutive patients hospitalized due toCOVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148,sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older andhypertensive, as well as presenting more frequently with a history of acute coronary syndrome andrenal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%;p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death(58.3% vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality.Results: In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrateda 14.26 odds ratio for thromboembolism (95% confidence interval 2.86–71.10, p < 0.001).Conclusions: New-onset AF in COVID-19 patients presumably has a notable impact on prognosis.The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19at high risk of developing “de novo” AF, provide early anticoagulation and minimize the embolic risk ofboth entities

Cierre percutáneo de fístula coronaria iatrogénica con stent recubierto de politetrafluoroetileno expandido

Las fístulas coronario-cavitarias adquiridas son una enfermedad poco común. Describimos el caso de un paciente de 50 años de edad sometido a una intervención urgente de remplazo valvular aórtico y mitral por endocarditis por Staphylococcus aureus. Precisó reintervenciones por sangrado y dehiscencia protésica e implantación de un tubo de tórax por neumotórax izquierdo. En el seguimiento postoperatorio se documentó un soplo continuo y el estudio ecocardiográfico estableció el diagnóstico de fístula coronaria de descendente anterior a ventrículo derecho. Se procedió al cierre del ostium de la fístula mediante la implantación de un stent recubierto de politetrafluoroetileno expandido de 3,5 mm de sección por 16 mm de longitud (Jostent Coronary System Graft®, Jomed, Alemania), con lo que se logró la oclusión completa de la fístul

Transcatheter treatment of native aortic valve regurgitation:Results from an international registry using the transfemoral ACURATE neo valve

Background: Transcatheter aortic valve replacement (TAVR) has been validated for the treatment of severe symptomatic aortic stenosis in patients at high and intermediate surgical risk. Recently, TAVR has been proposed as an alternative to medical therapy in inoperable patients with severe native aortic valve regurgitation (NAVR). This multicenter international registry sought to evaluate safety and efficacy of TAVR with the self-expandable ACURATE neo valve in a cohort of patients with NAVR.Methods: A total of 24 patients with severe NAVR treated by TAVR between September 2016 and October 2018 in 13 European centers were included. Clinical, procedural and follow up data were inserted in a dedicated database. Outcomes were codified according to Valve Academic Research Consortium-2 criteria.Results: Mean age was 79.4 years, 58.4% were female. Mean EuroSCORE II and STS score were 5% and 3.9%, respectively. Device success was 87.5%. Moderate paravalvular leak (PVL) was found in two (8.3%) of patients, both with a perimeter oversizing index <10%. Implantation of a second device was necessary in three cases (12.5%), one for severe PVL and two for device displacement. New pacemaker implantation rate was 21.1%. At 30 days, stroke and all-cause mortality rates were 0% and 4.1%, respectively.Conclusions: This multicenter study suggests good feasibility and early safety of transfemoral TAVR with the self-expandable ACURATE neo device in patients with severe NAVR refused for surgery. Rates of moderate PVL, new pacemaker implantation and need for a second valve were higher than those reported for TAVR in aortic stenosis. (C) 2020 The Authors. Published by Elsevier B.V

Unplanned Percutaneous Coronary Revascularization After TAVR: A Multicenter International Registry.

OBJECTIVES This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). BACKGROUND Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. METHODS Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. RESULTS Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). CONCLUSIONS Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501)