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Objective: Surgical reoperation for aortic homograft structural valve degeneration (SVD) is a high‐risk procedure. Transcatheter aortic valve replacement (TAVR) for homograft‐SVD is an alternative to reoperation, but descriptions of implantation techniques are limited. This study compares outcome in patients undergoing into two groups by the type of previously implanted aortic valve prosthesis: TAVR for failed aortic homografts (TAVR‐H) or for stented aortic bioprostheses (TAVR‐BP). Methods: From 2015 to 2017, TAVR was performed in 41 patients with SVD. Thirty‐three patients in the TAVR‐BP group (six for SVD of valved conduits), and eight patients in the TAVR‐H group. The Valve Academic Research Consortium criteria were used for outcome reporting purposes. Results: The patients with TAVR‐BP had predominant prosthetic stenosis (94%, p =.002), whereas TAVR‐H individuals presented mostly with regurgitation (88%, p = <.001). Patients with TAVR‐H received: Sapien‐3 (6), Sapien‐XT (1), and CoreValve (1) devices. Low, 40% ventricular fixation in relation to homograft annulus was attempted to anchor the prosthesis on the homograft suture‐line. One patient with TAVR‐BP experienced intraoperative distal prosthesis migration and Type‐B aortic dissection, and two patients in the TAVR‐H group had late postoperative proximal device migration. In both groups, there was zero 30‐day mortality, stroke, or pacemaker implantation. Conclusions: TAVR for failing aortic homografts may be a feasible and safe alternative to high‐risk surgical reintervention. Precise, 40%‐ventricular device positioning appears crucial for prevention of late paravalvular leak/late prosthesis migration and minimizing the risk of repeat surgical intervention. [ABSTRACT FROM AUTHOR]

Tricuspid valve (TV) degeneration after surgical repair with an annuloplasty ring is problematic as redo operation carries high mortality. This can be addressed with transcatheter therapies to implant a valve within in prior ring (tricuspid valve‐in‐ring). When an incomplete ring is present, paravalvular leak is commonly encountered after tricuspid valve‐in‐ring (TViR) implant; however, this can be addressed with paravalvular leak closure devices. Multimodality imaging including cardiac computed tomography and three‐dimensional (3D) transesophageal echocardiography (TEE) are important for successful TViR implant. We report a case of tricuspid regurgitation after tricuspid repair with an incomplete annuloplasty ring and subsequent paravalvular leak closure. [ABSTRACT FROM AUTHOR]

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high‐grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long‐term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high‐grade or complete AV block after TAVR who remain dependent on the PPM in follow‐up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon‐expandable, 18.1% self‐expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow‐up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self‐expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow‐up (< 30 days). The use of self‐expanding valves and PBD are associated with a markedly increased risk of PPM dependency. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a 55‐year‐old woman with heart failure with preserved ejection fraction (HFpEF), who presented with hypertensive urgency and pulmonary oedema. The patient was medically optimized and underwent cardiac catheterization revealing pulmonary hypertension, elevated pulmonary capillary wedge pressure, normal cardiac index, and non‐obstructive coronary disease. Invasive evaluation of coronary flow revealed blunted coronary flow reserve and increased index of microvascular resistance. Cardiac magnetic resonance imaging demonstrated reduced global myocardial perfusion and diffuse interstitial fibrosis. This case exhibits a potential HFpEF phenotype associated with microvascular dysfunction, fibrosis, and elevated filling pressures. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the 'off-label' use of drug-eluting stents (DES) versus bare metal stents (BMS). MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled. Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen. Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients. (J Interven Cardiol 2010;23:528-545) [ABSTRACT FROM AUTHOR]

Abstract: Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS. Methods and results: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60–90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00–1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03–1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15–2.11). This association was similar in patients with left ventricular systolic dysfunction (EF <40%, adjusted HR 1.52, 95% CI 0.98–2.35) and preserved systolic function (EF ≥40%, adjusted HR1.58, 95% CI 1.05–2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62–1.80 for PSF, HR 1.13, 95% CI 0.71–1.80 for LVSD). Conclusions: In AHFS, patients with CAD have a higher 60–90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population. [Copyright &y& Elsevier]

Focuses on the approach of gas company Vastar Resources Inc. in Houston, Texas to the Gulf of Mexico deepwater drilling rig. Assemblage of deepwater technical staff; Creation of deepwater database; Obtainment of access to deepwater drilling rig.