Search

Background: In March 2022, a COVID-19 outbreak disrupted the global supply of iodine contrast media (ICM). Healthcare systems implemented contrast-saving strategies to maintain their remaining ICM supplies. This study sought to determine the impact of contrast shortage on the incidence of contrast-associated acute kidney injury (CA-AKI)., Methods: This was a retrospective study of 265 patients undergoing 278 percutaneous coronary interventions (PCI) during 4-month periods prior to (9/1/2021 to 12/31/2021) and during (5/1/2022 to 8/31/2022) contrast shortage at a single center. The primary endpoint was the incidence of CA-AKI between study periods., Results: A total of 148 and 130 PCIs were performed before and during contrast shortage, respectively. The incidence of CA-AKI significantly decreased from 11.5% to 4.6% during contrast shortage ( P  = 0.04). During the shortage, average contrast volume per PCI was significantly lower (123 ± 62 mL vs 88 ± 46 mL, P  < 0.001), while coronary imaging was significantly higher (34.3% vs 50%, P  = 0.009) compared to preshortage. All-cause mortality at discharge was comparable between study periods (2.8% vs 3.3%, respectively; P  = 0.90)., Conclusion: The scarcity of ICM for PCI procedures in this single-center experience was associated with a significant increase in the utilization of intravascular imaging and a significant reduction in CA-AKI., Competing Interests: Karim Al-Azizi is a proctor and consultant for Edwards LifeSciences, a consultant and advisory board member for Medtronic, a consultant for Boston Scientific, and on a speaker’s bureau for Philips. Srinivasa Potluri is an advisory board member, proctor, and speaker for Medtronic, Boston Scientific, Abbott, and Cordis Proctor and a speaker for Edwards, Terumo, and AstraZeneca. Molly Szerlip is a proctor, speaker, and consultant for Edwards LifeSciences; an advisory board member, consultant, and proctor for Abbott Vascular; on the steering committee for Medtronic; and a speaker and consultant for Boston Scientific. Michael Mack is a trial co–principal investigator for Abbott and for Edwards Life Sciences and a trial study chair for Medtronic—all uncompensated. The other authors report no disclosures., (Copyright © 2024 Baylor University Medical Center.)

Transcatheter aortic valve replacement (TAVR) valve-in-valve (VIV) therapy has been approved for select patients with surgically inoperable bioprosthetic valves that need replacement. Bioprosthetic valve fracturing (BVF) used in conjunction with VIV TAVR can reduce transvalvular gradients and increase the aortic valve area. Twelve patients who underwent BVF VIV TAVR at a single center were retrospectively analyzed. Measurements of hemodynamics and aortic valve area were performed at baseline, after VIV TAVR, after BVF, and at 30-day follow-up. The mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.12 ± 3.5%, with 75% of patients deemed high risk by the heart team. Mean gradients decreased from 44 mm Hg to 15 mm Hg following VIV TAVR, and to 7 mm Hg following BVF. The mean aortic valve area increased from 0.6 cm 2 to 1 cm 2 following VIV TAVR, and to 1.3 cm 2 following BVF. There were no postoperative permanent pacemaker implantations or vascular complications, and at 30 days, only one patient had died. While we report intraoperative mortality, BVF with VIV TAVR can be performed to reduce transvalvular gradients and increase effective aortic valve area in high-surgical-risk patients with failed bioprosthetic valves., (Copyright © 2020 Baylor University Medical Center.)