Length of hospital stay following temporary pacing post-transcatheter valve replacement

Transcatheter valve replacement (TVR) provides a minimally invasive method of valve replacement. During TVR, conduction abnormalities can develop, but only some will require permanent pacing, and use of temporary pacing provides immediate support until a decision of temporary pacing is made. Henry Ford Health System has two methods of pacing lead placement: balloon tipped leads and screw-in leads. Currently, the impact of different types of temporary pacing leads on recovery time is still unknown. This project investigated the differences in the length of hospital and ICU stay between patients who received the balloon tipped and screw-in leads. Data was collected from 144 patients who underwent TVR and was analyzed for differences between these two patient groups. We had 44 patients with a balloon tipped lead and 104 patients with a screw in lead. Of the patients who received balloon tipped leads, average length of stay was 10.4 days and number of ICU days was 4.3. For the patients who received Screw in leads, average length of stay was 6.7 days and average number of ICU days was 1.2. Both the length of hospital stay (

Transcatheter Mitral Valve Replacement: Evolution and Future Development

We will review transcatheter mitral valve replacement (TMVR) and discuss this evolving cutting edge procedure in terms of types (valve in valve, valve in ring and valve in mitral annular calcification MAC), clinical indications, pre-procedural planning and value of pre-procedural imaging including computed tomography role, technical challenges encountered in these procedures, potential complications for each type of TMVR, and potential strategies to mitigate and avoid such complications, We will review the currently available devices dedicated for mitral valve replacement, with a summary of their preliminary data and early outcome results. We will also discuss knowledge gaps and ideas for future research

Congenital Supravalvular Pulmonic Stenosis, Maybe or Maybe Not

Introduction: It is extremely rare for leiomyosarcomas to affect the cardiovascular system. High degree of suspicion is required to diagnose this tumor in patients presenting with symptoms suggestive of a cardiac etiology. Because of the high mortality associated with this malignancy, early and aggressive intervention is crucial. Furthermore, imaging modalities may not adequately identify this tumor, as will be presented in this case leading challenges in diagnosis. Case: We present a case of a 59 year old female with a history of hypothyroidism who presented with progressive exertional dyspnea and palpitations. She underwent a chest CT which excluded pulmonary embolism but revealed diffuse long tubular narrowing above pulmonary valve involving main pulmonary artery raising suspicion forsupravalvularpulmonic stenosis. A 2D echocardiogram revealed normal left and right ventricular function, elevated systolic velocities distal to the pulmonic valve suggestive of supra-valvularpulmonary artery stenosis. A cardiac MRI was performed conforming pulmonary artery narrowing of the main pulmonary artery 1 cm above the pulmonic valve, with the narrowest area measuring 9mm in diameter. The pulmonic valve appeared uninvolved. She underwent a cardiac catheterization which demonstrated a peak gradient of 67 mm Hg across the stenotic lesion in the main PA. She was then diagnosed as symptomatic congenital isolated supra-valvularpulmonic stenosis. She was referred for cardiac surgery for relief of supra-valvularstenosis and reconstruction of the main pulmonary artery. Intraoperatively, a segment of the pulmonary artery was circumferentially narrowed by an infiltrative process. Frozen section analysis confirmed sarcoma, possible spindle cell variant. The main pulmonary artery was resected to the level of the pulmonary artery bifurcation, and a 23 mm aortic homograft was sewed in place. Subsequent biopsy revealed high grade spindle cell sarcoma, with morphologic features suggestingleiomyosarcoma. Re-review of the CT and MRI failed to conclusively predict the presence of this encircling tumor around pulmonary artery. Following surgery and recovery, she underwent a PET scan which demonstrated a small lytic lesion at L1, with possible metastatic femoral neck lesion. She was seen by hematology/oncology with recommendations to undergo localized radiotherapy and chemotherapy. Patient delayed treatment for her sarcoma in anticipation of a second opinion, and she ultimately passed away. Discussion: Leiomyosarcoma involving the pulmonary artery is extremely rare and usually manifests as a filling defect involving the pulmonary artery, mimicking a pulmonary embolism. In this case, multiple imaging studies were performed including a CT, MR and TTE, all of which failed torevealedthe extrinsic circumferential compression of the main pulmonary artery. In patients that do not have a congenital cardiac history (iepulmonic stenosis), a high degree of suspicion is required to rule out extrinsic compression by a tumor, as was evident in our case.https://scholarlycommons.henryford.com/merf2019caserpt/1008/thumbnail.jp

Real world outcomes using 20 mm balloon expandable SAPIEN 3/ultra valves compared to larger valves (23, 26, and 29 mm)-a propensity matched analysis

OBJECTIVE/BACKGROUND: Small balloon expandable valves have higher echocardiographic transvalvular gradients and rates of prosthesis-patient mismatch (PPM) compared to larger valves. However, the impact of these echocardiographic findings on clinical outcomes is unknown. We sought to determine the clinical outcomes of 20 mm SAPIEN 3 (S3 BEV) compared to larger S3 BEV in relation to echocardiographic hemodynamics. METHODS: Using the STS/ACC transcatheter valve registry, we performed a propensity-matched comparison of patients undergoing treatment of native aortic valve stenosis using transfemoral, balloon-expandable implantation of 20 mm and ≥ 23 mm S3 BEVs. Baseline and procedure characteristics, echocardiographic variables and survival were analyzed. Multivariable logistic regression was used to identify predictors of 1-year mortality. RESULTS: After propensity matching of the 20 mm and ≥ 23 mm SAPIEN 3 valves, 3,931 pairs with comparable baseline characteristics were identified. Small valves were associated with significantly higher echocardiographic gradients at discharge (15.7 ± 7.1 mmHg vs. 11.7 ± 5.5 mmHg, p \u3c 0.0001) and severe PPM rates (21.5% vs. 9.7%, p \u3c 0.0001). There was no significant difference in 1-year all-cause mortality (20 mm: 13.0% vs. ≥23 mm: 12.7%, p = 0.72) or other major adverse event rates and outcomes between the two cohorts. Based on a multivariable analysis, elevated discharge mean gradient (\u3e20 mmHg), severe PPM and the use of 20 mm versus ≥23 mm were not independent predictors of 1-year mortality. CONCLUSION: SAPIEN 3 20 mm valves were associated with higher echocardiographic gradients, and severe PPM rates compared to larger valves but these factors were not associated with significant differences in 1-year all-cause mortality or rehospitalization

Patent foramen ovale closure with vena cava thrombus: You need an arm and a neck!

In patients with challenging femoral vein anatomy, transcatheter patent foramen ovale (PFO) closure can be safely and effectively be done through the jugular veins guided by ICE from the arm. This novel technique can potentially save resources (anesthesia and TEE) and provide an option for patients without a femoral option

Emergency Alcohol Septal Ablation for Shock After TAVR: One More Option in the Toolbox

We hereby report a case of severe shock from left ventricular outflow tract obstruction following transcatheter aortic valve replacement that did not respond to medical therapy and had to be treated with emergent alcohol septal ablation (ASA). Emergent ASA should be considered for bail-out treatment for these refractory cases. (Level of Difficulty: Advanced.

Mechanical Circulatory Support in Cardiogenic Shock due to Structural Heart Disease

Despite advances in cardiovascular care, managing cardiogenic shock caused by structural heart disease is challenging. Patients with cardiogenic shock are critically ill upon presentation and require early disease recognition and rapid escalation of care. Temporary mechanical circulatory support provides a higher level of care than current medical therapies such as vasopressors and inotropes. This review article focuses on the role of hemodynamic monitoring, mechanical circulatory support, and device selection in patients who present with cardiogenic shock due to structural heart disease. Early initiation of appropriate mechanical circulatory support may reduce morbidity and mortality