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One of the major obstacles preventing successful percutaneous pulmonary valve implantation (PPVI) is related to the close proximity of coronary artery branches to the expected landing zone. The aim of this study was to assess the frequency of coronary artery anomalies (CAAs) especially those associated with major coronary branches crossing the right ventricular outflow tract (RVOT) and to describe their relevance for the feasibility of percutaneous pulmonary valve implantation (PPVI). In our retrospective single-center study 90 patients were evaluated who underwent invasive testing for PPVI in our institution from 1/2010 to 1/2020. CAAs were identified in seven patients (8%) associated with major branches crossing the RVOT due to origin of the left anterior descending (LAD) or a single coronary artery from the right aortic sinus. In 5/7 patients with CAAs balloon testing of the RVOT and selective coronary angiographies revealed a sufficiently large landing zone distal to the coronary artery branch. While unfavorable RVOT dimensions prevented PPVI in one, PPVI was performed successfully in the remaining four patients. The relatively short landing zone required application of the "folded" melody technique in two patients. All patients are doing well (mean follow-up 3 years). CAAs associated with major coronary branches crossing the RVOT can be expected in about 8% of patients who are potential candidates for PPVI. Since the LAD crossed the RVOT below the plane of the pulmonary valve successful distal implantation of the valve was possible in 4/7 patients. Therefore these coronary anomalies should not be considered as primary contraindications for PPVI. [ABSTRACT FROM AUTHOR]

Background: Clinical outcomes after transcatheter aortic valve implantation (TAVI) patients have not been reported in the Gulf region. Objectives: To define the baseline electrocardiographic (ECG), echocardiographic, and computed tomographic findings of patients undergoing TAVI and analyze the predictors of developing new-onset persistent left bundle branch block (LBBB). Methods: Patients with severe aortic stenosis who underwent TAVI between 2013 and 2021 at the Sabah Al-Ahmed Cardiac Centre in Al-Amiri Hospital in the state of Kuwait were included in this study. Baseline characteristics, electrocardiography (ECG), echocardiography, and preprocedural computed tomography data were extracted. The primary outcome was new-onset LBBB. Results: A total of 61 patients were included (65.6% females; mean age: 73.5 ± 9 years; baseline ejection fraction: 55.5% ± 9.7%). Of these, 18 developed new-onset LBBB. Those who developed LBBB tended to have lower ejection fraction (52.5 ± 9.6 vs. 56.8% ± 9.5%; P = 0.116). Those who developed LBBB were more likely to develop 1st degree atrioventricular block post-TAVI (P = 0.001). Conclusion: The incidence of new-onset LBBB post-TAVI was 29.5%. The new-onset LBBB group was more likely to develop conduction abnormalities requiring permanent pacemaker implantation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Radial artery access has become the standard of care in percutaneous coronary procedures due to demonstrated patient safety and comfort benefits; however, uptake of radial access for diagnostic cerebral angiography has been limited by practitioner concerns over the ability to achieve procedural success. We aimed to provide randomized clinical trial evidence for the non-inferiority of radial access to achieve procedural success. Material and Methods: Monocentric open label randomized controlled trial with a non-inferiority design and blinded primary outcome assessment. Adult patients referred in-hours for diagnostic cerebral angiography were eligible. Participants underwent permuted block randomization to radial or femoral artery access with an intention-to-treat analysis. The primary outcome was procedural success, defined as selective cannulation and/or diagnostic angiography of predetermined supra-aortic vessels of interest. The non-inferiority limit was 10.0%. Secondary outcomes included postprocedural complications, fluoroscopy and procedural times, radiation dose, contrast volume and rates of vertebral artery cannulation. Results: A total of 80 participants were enrolled (female 42, male 38, mean age 47.0 years, radial access group n = 43, femoral n = 37). One patient in the radial group was excluded after enrollment due to insufficient sonographic radial artery internal diameter. Procedural success was achieved in 41 of 42 participants in the radial group (97.6%) and 36 of 37 in the femoral group (97.3%). The difference between groups was −0.3% (one-sided 95% confidence interval, CI 6.7%) and the null hypothesis was rejected. Conclusion: Radial artery access is non-inferior to femoral artery access for procedural success in cerebral angiography. A large multicenter trial is recommended as the next step. [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine the prevalence of amyloid transthyretin (ATTR) cardiac amyloidosis in patients 1–2 years after trans‐catheter aortic valve replacement (TAVR) and to assess their clinical and echocardiographic outcome and long‐term survival. Methods and results: We enrolled 88 patients, mean age 81 years, 534 (390–711) days after TAVR. Patients underwent a Tc99m‐PYP scintigraphy for the diagnosis of ATTR cardiac amyloidosis. Eleven (12.5%) participants were diagnosed with ATTR cardiac amyloidosis. Eighty eight per cent of patients without amyloidosis were in New York Heart Association Classes 1–2 after TAVR, compared with 64% patients with ATTR cardiac amyloidosis (P = 0.022). There were no differences in left ventricular (LV) ejection fraction (P = 0.69) between patients with and without ATTR cardiac amyloidosis at enrolment. The LV mass index and pulmonary artery pressure were significantly higher in patients with ATTR cardiac amyloidosis (P = 0.046 and P = 0.002, respectively). Global longitudinal strain and myocardial work efficiency were significantly lower in patients with ATTR cardiac amyloidosis (P = 0.031 and P = 0.048, respectively). We assessed changes in echocardiographic data, from the time of TAVR to enrolment, and as expected, there was a significant decrease in aortic valve gradient in both groups. There was a significant reduction in LV mass and LV mass index and improvement in basal segment LV strain in the ATTR cardiac amyloidosis negative group (P = 0.045, P = 0.046 and 0.023, respectively). However, in the ATTR cardiac amyloidosis group the change in LV mass and LV mass index and LV basal strain values was not significant (P = 0.24, P = 0.13 and P = 0.35, respectively). The were no significant changes in other echocardiographic parameters in both groups. The patients were followed for 1150 (1086–1221) days after enrolment. Twenty seven patients had at least one cardiac hospitalization during of follow up, of them seven were with ATTR cardiac amyloidosis and 20 patients without amyloidosis (P = 0.017). Eighteen patients (20%) died during follow up; 12 (14%) patients died due to cardiac causes. There was no difference in all‐cause and cardiac mortality between patients with and without ATTR cardiac amyloidosis (P = 0.6 and P = 0.53, respectively). Conclusions: The long‐term survival after TAVR is not significantly affected by the presence of ATTR cardiac amyloidosis. However, the clinical course of these patients and the LV hemodynamic improvement is less favourable. This hypothesis‐generating study suggests screening for ATTR cardiac amyloidosis in patients who underwent TAVR and have limited clinical or echocardiographic improvement, because they may potentially improve with new therapies for ATTR cardiac amyolidosis. [ABSTRACT FROM AUTHOR]

Transcatheter pulmonary valve replacement (TPVR) is a staple in the pediatric cardiac catheterization lab. Despite the ubiquitous use of this procedure, guidelines for antithrombosis post pulmonary valve replacement are non-existent. A survey was sent out via email to the members of the Congenital Cardiovascular Interventional Study Consortium (CCISC) and the Pediatric and Adult Interventional Cardiac Symposium (PICS-AICS). Responses were received from 109 cardiologists who perform this procedure. Following TPVR 76.5% of respondents use only Aspirin, while the remainder prescribe a second antithrombotic agent at discharge. The majority (78%) of respondents do not educate patients about avoiding enteric formulations of aspirin, and another 86% do not educate patients about the need to avoid proton pump inhibitors (PPI). In addition, 67% do not advise against concomitant use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Lastly, the survey showed a wide discrepancy in prescribed dose with 56% choosing to always prescribe 70–100 mg regardless of weight, 28% choosing to do weight-based dosing, and 7.5% choosing 325 mg regardless of weight. In a survey sent out to pediatric cardiac interventionalists worldwide, a significant discrepancy was noted in antithrombotic regimens used following TPVR. We hypothesize that these discrepancies may contribute to early valve failure and suggest the need for further study and the development of unified antithrombosis guidelines following TPVR. [ABSTRACT FROM AUTHOR]

Aims: A review was conducted on the composition, advantages and limitations of available aortic valve prototypes to create an ideal valve for percutaneous implantation. Patients Patients with multiple comorbidities who cannot withstand the risks of open cardiac surgery.Methodology: The search was performed using online databases and textbooks. Articles were excluded based on specific criterion.Results: Ten prototypes created between 2006 and 2019 were found and reviewed. The prototypes had a set of advantages and limitations with their characteristics coinciding at times.Conclusions: The ideal percutaneously implantable aortic valve should have minimum coaptation height, zero folds in the leaflets, minimum valve height, minimum leaflet flexion and three leaflets. It can be composed of biological or synthetic material, as long as it provides minimal risk of thrombosis. However, more studies are needed to ensure other ideal parameters. [ABSTRACT FROM AUTHOR]

In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post‐procedural outcomes right after PTA, without stent implantation. Clinically‐used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self‐defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (−11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) patients are at increased risk of cardiovascular disease (CVD). Cell adhesion molecules (CAM) are increased in OSA and CAM are also implicated in the development of CVD. Research question: Do CAM (ICAM-1, VCAM-1 and E-selectin) have prognostic value in identifying risk of cardiovascular events in OSA? Study design and methods: Patients with suspected OSA referred for a polysomnogram provided a fasting blood sample. Plasma levels of ICAM-1, VCAM-1 and E-selectin were determined by multiplex Luminex Assay (Milliporesigma ON, Canada). Cardiovascular events were determined by deterministic linkage to provincial health databases. Results: 418 patients were included in the analysis. Mostly male (68.2%), mean age of 50.7 yrs, median AHI 16.5 events/hour, and mean BMI of 31.7 kg/m2. 36 cardiovascular events occurred in 8-yrs of follow up. Higher levels of ICAM-1 were associated with developing CVD (HR = 3.65 95% CI 1.40–9.53, 2nd and 3rd tertiles vs. 1st tertile), including in patients with OSA (HR = 3.1 95% CI 1.16–8.25). E-selectin was significantly associated with cardiovascular events in patients with moderate to severe OSA (HR = 3.31 95% CI 0.94–11.72, 2nd and 3rd tertiles vs. 1st tertile) but not in patients without moderate to severe OSA (HR = 0.67 95% CI 0.19–2.38), p-value for interaction = 0.07. Interpretation: In a suspected OSA cohort, patients with higher levels of ICAM-1 (>816 ng/ml) were significantly more likely to experience a cardiovascular event within 8 years after PSG. In moderate to severe OSA patients, a higher E-selectin (>36.4 ng/ml) was significantly associated with cardiovascular events. [ABSTRACT FROM AUTHOR]

This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low‐risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low‐risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high‐sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non‐obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high‐sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits. [ABSTRACT FROM AUTHOR]

Introduction: Transcatheter aortic valve implantation (TAVI) although minimally invasive is still accompanied by changes in blood morphological parameters, some of them linked to unfavorable outcomes. Aim: To find any association between changes in blood morphology reflecting an inflammatory response and acute kidney injury (AKI). Material and methods: This study involved 176 consecutive transfemoral TAVI patients with a mean age of 78.4 ±7.0 years. Serum creatinine concentration (CREA) and blood morphology were analyzed in the blood samples taken before the procedure, then approximately 1, 24, 48 and 72 hours after the procedure, and lastly at the time of discharge. Post-procedural maximal or minimal values (max/min) and max/min-to-bs ratio of the laboratory parameters were also calculated. Results: Leucocyte (WBC) and neutrophil (NEUT) counts increased significantly after the procedure whereas lymphocyte (LYMPH) counts declined markedly, reaching the highest or lowest values 24 hours after the procedure. A significant increase in neutrophil-to-lymphocyte ratio (NLR) was observed. Platelet count (PLT) dropped to a minimum at 72 hours after TAVI but at discharge did not return to the admission level. TAVI was associated with a marked increase in CREA with a peak at 48 hours after the procedure (135.7 ±75.9 µM/l). Patients with AKI (n = 65; 36.9%) presented more pronounced variations in relative changes in counts of all blood morphological parameters. A positive moderate (r = 0.412) correlation between maximal NLR and relative CREA changes was noted. Conclusions: TAVI is associated with significant changes in blood morphological parameters that reflect an inflammatory response. They are more pronounced among subjects with post-procedural AKI. [ABSTRACT FROM AUTHOR]

Purpose: This prospective observational study aimed to explore the influence of physical inactivity during initial chemotherapy on the risk of disability and hospitalization in later life among older patients with advanced non-small-cell lung cancer (NSCLC). Patients and Methods: Patients aged 70 or above who were scheduled to receive first-line chemotherapy for newly diagnosed advanced NSCLC were recruited for the study. An electronic pedometer was used to measure daily steps; based on the change rate (cutoff: − 12.5%) from pretreatment to 12 ± 4 weeks after enrolment, patients were classified as active or inactive. The Barthel Index estimated activities of daily living. We compared disability-free survival time, mean cumulative functions of hospital stays, and medical costs, between the active and inactive groups. Results: Among the 29 patients enrolled, 21 were evaluable. Compared with active patients (n = 11), inactive patients (n = 10) showed shorter disability-free survival (6.4 vs 19.9 months, p < 0.05) and tended to have longer hospital stays (23.7 vs 6.3 days/person) and higher inpatient care cost (¥ 1.6 vs ¥ 0.3 million/person [US$16,000 vs US$3000/person]) during the first year. Conclusion: Physical inactivity during initial chemotherapy may be a risk factor for developing disability and requiring hospitalization in later life for older patients with advanced NSCLC. Our findings may indicate the need for lifestyle interventions with multidisciplinary teams, which include physicians, nurses, and physiotherapists, for older patients with advanced lung cancer during an active cancer treatment. A large-sample-sized study is needed to validate our findings. [ABSTRACT FROM AUTHOR]

The article discusses the 2020 guidelines presented by the European Society of Cardiology (ESC) for acute coronary syndrome (ACS) management in patients without persistent ST-segment elevation. Topics explored include the clinical characteristics and diagnosis of myocardial infarction, the administration of electrocardiogram to assess patients with suspected ACS, and the patients which may not be considered for invasive coronary angiography.

In this state-of-the-art review, we present the findings and a critical analysis of the Leaders Free trial program, evaluating outcomes of a new stent-generation based on polymer-free technology, in this case the BioFreedom™ (Biosensors Europe, Switzerland), in patients at high bleeding risk (HBR). Polymer-free drug-coated stents were designed to obtain a device with the antirestenotic benefits of drug-eluting stents but without the polymer coating as potential trigger for delayed arterial wall healing and subsequent late ischemic adverse events, causing a prolonged dependence on dual antiplatelet therapy after stenting. This offers therefore the potential of a promising device-based strategy in a complex growing population of patients with combined HBR and high thrombosis risk, due to the possible reduction of antithrombotic duration. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous pulmonary valve implantation (PPVI) into right ventricle-to-pulmonary artery conduits is increasingly being performed, but a few options are available for patients with a dilated native right ventricular outflow tract (RVOT), among which is the off-label use of Edwards SAPIEN® valves. This study reviews the results of the SAPIEN XT and SAPIEN 3 (S3) valve implantations in the pulmonary position in patients with a dilated native RVOT. Methods: Between January 2015 and March 2020, PPVI procedures were performed on 129 patients. Among them, 103 (80%) had dilated native RVOT, 86 of whom were eligible for PPVI prestenting and valve implantation. Retrospective analysis was performed on 84 patients who have undergone successful PPVI implantation using the SAPIEN XT or S3 valves with dilated native RVOT. Results: The procedural success rate was 84/86 (98%). The median age was 18.7 years (8-46 years), and the median weight was 57 kg (22-102 kg). The primary underlying diagnosis was tetralogy of Fallot (n=77/84). Stenting was performed simultaneously with valve implantation in 50/84 (60%) cases-six of which were hybrid procedures-whereas prestenting was performed 3 to 14 weeks earlier in 34/84 cases. Before valve implantation, the median right anterior oblique and lateral diameters of the stents were 26 mm (20-32 mm) and 28 mm (21-32 mm). Valve sizes were 26 mm (n=13) and 29 mm (n=64) for XT and 29 mm (n=7) for S3. In 59 patients, an additional 1-5 ml (median 2 ml) volume was added to the valves' balloons for stabilization. In all hybrid procedures, the stent and valve were implanted in the same session. During follow-ups of 1 to 59 months (median 14 months), no deaths were reported, 3 patients developed tricuspid regurgitation secondary to the procedure, and valves continued to function in all patients. Conclusion: The Edwards SAPIEN XT and S3 valves may be an alternative to PPVI in patients with dilated native RVOT. [ABSTRACT FROM AUTHOR]

Purpose of the review: Compared with femoral access, transradial access for percutaneous vascular intervention has demonstrated several advantages, including lower risks of access site complications, faster patient recovery time, and lower health care costs. This has led to a growing interest in utilization of transradial access as the primary access site for certain peripheral vascular interventions (PVIs). This review outlines the rationale for transradial access for PVI, offers tips on equipment selection and special procedure-specific considerations, discusses challenges and barriers to widespread utilization, and highlights the latest developments in the field. Recent findings: Recent development of longer balloon and stent shafts and guiding catheters have made transradial access feasible for a larger number of PVIs, including internal carotid, vertebral, subclavian, and innominate; renal, celiac, and mesenteric; and aorto-iliac and superficial femoral artery disease. Despite these advances, there remain limitations with transradial access for PVI mainly due to the small size of the radial arteries and the distance from the radial arteries to the target vessels. In addition to new devices, there has been the development of newer approaches to limit radiation exposure, prevent radial artery spasm, and avoid radial artery occlusion. Summary: The benefits of radial access for vascular interventions have been well established. With ongoing innovation and studies demonstrating effectiveness and safety of this approach, "radial first" for peripheral interventions has a bright future and may someday become the standard of care for certain peripheral interventions. [ABSTRACT FROM AUTHOR]

Purpose of review: Multivessel coronary artery disease is usually present in up to 50% of patients presenting with ST-elevation myocardial infarction (STEMI). The optimal revascularization approach for non-infarct related lesions has been a topic of recent debate. Various observational studies and clinical trials have been conducted to assess the impact of multivessel revascularization. In this review, we aim to present the currently available evidence behind the different revascularization strategies. Recent findings: Early observational studies, registry-based analyses, and meta-analyses had suggested a benefit of culprit only revascularization over complete revascularization. However, in several recent randomized clinical trials, a complete revascularization approach for non-infarct-related lesions, either during the index hospitalization or as a staged approach, has been associated with improved outcomes. These findings exclude patients with cardiogenic shock and chronic total occlusions. Summary: Clinical decisions regarding the extent and timing of revascularization in STEMI patients necessitate an individualized, patient-oriented approach. Based on the evidence from recent clinical trials, complete revascularization of non-culprit lesions in STEMI should be considered. [ABSTRACT FROM AUTHOR]

Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD. [ABSTRACT FROM AUTHOR]

Background: Low prosthesis position after transcatheter aortic valve implantation (TAVI) is associated with higher rates of new onset conduction disturbances and permanent pacemaker implantations. Purpose of this study was to investigate possible predictors of a low prosthesis position of the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) valve type using fusion imaging of pre- and post-procedural computed tomography angiography (CTA). Methods: CTA fusion imaging was performed in 120 TAVI-patients with 3D-reconstruction of the transcatheter heart valve (THV) position within the device landing zone. A low implantation position was defined according to the manufacturer's recommendations as > 30% of the prosthesis below the native annulus plane. Results: A low THV position was found in 17 patients (14%). Patients with low THV position had less calcification of the annulus region and a smaller annulus size compared to patients with a normal or high THV position (P = 0.003 and 0.041, respectively). The only independent predictor of a low THV position in multivariate logistic regression analysis was the extent of calcification of the cusp region (odds ratio [CI] 0.842 [0.727–0.976], P = 0.022). Conclusions: Fusion imaging of pre-and post-procedural CTA identified reduced calcification of the cusp region as an independent predictor of a low THV position of the SAPIEN 3. This should be considered when planning the TAVI procedure. Correlation of cusp region calcification and prosthesis position after TAVI [ABSTRACT FROM AUTHOR]

BACKGROUND: The relationship between cardiac enzyme release following coronary endarterectomy (CE) and morbidity and mortality is unclear. Therefore, the present study aimed to investigate the association of cardiac enzymes with morbidity and mortality of patients undergoing CE surgery. METHODS: This was a single-center retrospective cohort study of 475 patients who had undergone off-pump coronary artery bypass graft (OPCABG). The patients were followed up for a mean of 72.99 ± 14.60 months. RESULTS: Among 475 patients undergoing OPCABG, 39 (8.2%) were non-survivors. Non-survivors were younger and had a fewer ejection fraction (EF). Comorbidities were similar in survivors and non-survivors. The crude Cox regression analysis showed that creatine kinase-myocardial band (CK-MB) had a protective effect against mortality, but when adjusted with age, sex, diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, smoking, family history, body mass index (BMI), left main disease (LMD), and EF, this effect disappeared. Troponin in crude and adjusted analysis did not have any significant effect. CONCLUSION: There is no association between CK-MB and troponin and mortality in patients undergoing coronary artery bypass graft (CABG). [ABSTRACT FROM AUTHOR]

Background Transcatheter aortic valve replacement (TAVR) in combination with a valve-in-valve (V-i-V) transcatheter mitral valve replacement (TMVR) is a rare procedure in comparison to surgical therapy especially in young patients. We report on a young patient at high surgical risk, receiving a double valve implantation with two S3 transcatheter heart valves. Case summary A 59-year-old female patient with two previous mitral valve replacements due to endocarditis and re-endocarditis experienced a new onset of severe mitral valve stenosis in combination with progredient aortic stenosis. She was admitted to the hospital with severe dyspnoea and intermittent non-invasive ventilation [New York Heart Association (NYHA) III–IV]. An interventional transapical transcatheter double valve implantation was planned and carried out due to cardiac decompensation and high comorbidity preoperatively (STS score of 6.92). At 6-month follow-up, the patient presented herself in an improved condition with reduced symptoms (NYHA I–II), a good functional status of both valves and an advanced right and left ventricular function in the echocardiogram. Discussion Even in younger patients at high risk, a combined native TAVR and V-i-V TMVR procedure can be performed. In this case, a transcatheter SAPIEN 3 valve was transapically implanted with good clinical mid-term outcome at 6 months. [ABSTRACT FROM AUTHOR]

Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. The definition of what constitutes large bore access is subject to discussion, however within the field it is generally accepted to reflect a catheter diameter exceeding 8-French. We sought in this review to explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure. [ABSTRACT FROM AUTHOR]

Introduction: Contrast medium Pd/Pa ratio (cFFR) was introduced as an alternative to fractional flow reserve (FFR). Aim: To assess the accuracy of cFFR in predicting of FFR, quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR). Material and methods: Resting Pd/Pa, cFFR, FFR, QFR, and iFR were measured in 110 intermediate coronary lesions. cFFR was obtained after intracoronary injection of contrast medium. FFR was measured after the intravenous administration of adenosine. QFR was derived from fixed empiric hyperemic flow velocity based on coronary angiography. iFR was calculated by measuring the resting pressure gradient across a coronary lesion during diastole. Results: Forty-four patients with 110 intermediate coronary lesions were enrolled. Mean baseline Pd/Pa was 0.93 ±0.05. Mean cFFR value was similar to FFR value (0.83 ±0.09 vs. 0.81 ±0.09; p = 0.13) and QFR (0.81 ±0.1; p = 0.69) and iFR (0.90 ±0.07; p = 0.1). A total of 46 vessels (41.8%) had FFR ≤ 0.80, 50 (45.5%) vessels had cFFR ≤ 0.83, 44 (40.0%) vessels had QFR ≤ 0.80, and 38 (34.5%) vessels had iFR ≤ 0.89. An excellent agreement between cFFR and resting Pd/Pa, FFR, QFR, and iFR was confirmed (intraclass correlation coefficients of 0.83, 0.99, 0.98, and 0.88, respectively). The optimal cutoff value of cFFR was 0.83 for prediction of FFR ≤ 0.80 with sensitivity, specificity, and accuracy of 96.9%, 97.8%, and 97.3%, respectively. 100% sensitivity was observed for a cutoff value of 0.82 and 100% specificity for a cutoff value of 0.84; AUC = 0.998 (0.995-1.00); p < 0.001. Conclusions: Contrast medium Pd/Pa ratio seems to be accurate in predicting the functional significance of borderline coronary lesions assessed with FFR, iFR, and QFR. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a risk for increased incidence of adverse clinical events after percutaneous coronary intervention. However, the difference in the incidence of adverse clinical events according to stent type in patients with diabetes remains to be elucidated. In the present study, we aimed to compare the clinical outcomes between patients treated with the biodegradable polymer sirolimus-eluting stents (BP-SES) and the durable polymer everolimus-eluting stents (DP-EES) among patients with diabetes. Methods: Among 631 lesions in 510 consecutive patients treated with either BP-SES or DP-EES, 165 lesions in 141 patients with diabetes mellitus and stable angina pectoris were identified and classified into the BP-SES group (48 lesions in 44 patients) and the DP-EES group (117 lesions in 100 patients). The incidence of adverse clinical events after stent implantation was compared between the 2 groups. Results: There was no significant difference in the prevalence of conventional risk factors, lesion characteristics, and procedural characteristics between the 2 groups. During median 386 [334–472] days follow-up, the incidence of target lesion revascularization (11.4 vs. 2.0%, p = 0.003) and device-oriented clinical endpoint (13.6 vs. 6.0%, p = 0.035) in the BP-SES group was significantly greater than that in the DP-EES group. A univariate model demonstrated that the BP-SES usage was significantly associated with the higher incidence of target lesion revascularization (odds ratio, 6.686; 95% confidence interval, 1.234–36.217; p = 0.028). Conclusion: BP-SES was associated with the greater incidence of TLR than the DP-EES in patients with diabetes mellitus. Further studies with larger cohorts and longer follow-up are required to confirm the present results. [ABSTRACT FROM AUTHOR]

Calcific aortic stenosis (AS) is the most prevalent cardiac valve disorder among urban populations. It is distinguished by an obstinate progressive fibro-calcific remodeling and thickening of the aortic valves in the heart which in due course of time causes severe impediment to cardiac outflow. If such is the situation patient feels difficulty in performing day to day activities. In economically developed countries, AS is the second-most frequent cardiovascular disease after coronary artery disease. Mostly in some situations congenital cardiac deformities especially in bicuspid valve and older age are the powerful risk factors for calcific AS and again many other idiopathic factors may also contribute for the same clinical condition. Here we have presented a case of patient with severe calcific aortic stenosis admitted in a government headquarters hospital, Virudhunagar district, Tamilnadu, India. A 57 years old male patient was admitted with complaints of dyspnoea for the past four days; he also had a co-morbidity of right diabetic foot ulcer since the previous week. He was a known type 2 diabetic mellitus and systemic hypertensive patient under medication from the past time. In his diagnostic report it was written after observation that his lungs were showing bilateral pleural effusion. Lab report of swab culture taken from his diabetic foot ulcer by a sterile cotton swab shows gram negative microorganisms Klebseilla pneumoniae was found present. The key aspect of this case report is to draw attention towards Pharmacist interventions in relation to the drugs prescribed and administered to this patient. [ABSTRACT FROM AUTHOR]

The clinical benefits of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still controversial. The purpose of this study is to assess the quantitative therapeutic benefits of successful PCI for CTO from the clinical data acquired by myocardial perfusion imaging (MPI). Consecutive 42 patients, who were successfully revascularized of CTO between August 2013 and March 2018, were examined. A stress MPI was performed before CTO PCI and at follow-up, and the changes in quantitative gated and perfusion single photon emission computed tomography parameters were examined. The follow-up interval was 18 ± 9 (median 14) months, during which 36 patients were maintained patency (patent CTO), while 6 were re-occluded (R/O CTO). The reduction in the % myocardial ischemia and the improvement in the ejection fraction were significantly higher in the patent CTO group than those in the R/O CTO group (67.5 ± 37.0% vs. − 56.4 ± 84.9%, p < 0.0001, 20.7 ± 49.8% vs. − 9.2 ± 20.6%, p = 0.0247, respectively). Interestingly, the improvements we observed were predominantly in the patients with LAD CTO rather than those with RCA or LCx CTO. Successful CTO PCI was able to reduce myocardial ischemia and improve the cardiac function when the patency after CTO PCI was maintained, with the most notable significance in the patients with LAD CTO. [ABSTRACT FROM AUTHOR]

Objectives: The study was conducted to evaluate the outcomes of different onset stage of cardiogenic shock (CS) in the patients with ST-segment elevation myocardial infarction (STEMI).Methods: Total 675 STEMI patients who had undergone primary percutaneous coronary intervention (pPCI) from November 2010 to December 2017 in Nanjing Drum Tower Hospital were enrolled. According to the onset time of CS, the cohort was divided into three groups: Non-CS group, CS on admission group and Developed CS group. The short-term (30 days), middle-term (12 months) and long-term (80 months) outcomes were analyzed. COX proportional hazard models were established for identification of the predictors.Results: The all cause death, cardiac death and major adverse cardiac events (MACE) at 30 days were similar among the three groups. The incidence of MACE in the CS on admission group was significantly higher than the other two groups at 12 months. As to the long-term outcomes, the CS on admission group had lower survival rate than the other two groups. The Develop CS group had lower survival rate than Non-CS group numerically with a trend towards statistical significance. The incidence of cardiac death in the Non-CS group was the lowest. The incidence of MACE in the CS on admission group was much higher compared with the other two groups. After multivariate analysis, the independent predictors of all cause death included age, male sex, prior stroke and LVEF. The independent predictors of cardiac death included age, male sex, prior stroke, LVEF, CS on admission and developed CS. The independent predictors of MACE included age, prior stroke, LVEF, multivessel lesions, post-PCI TIMI grade 1 and CS on admission.Conclusions: The long-term outcomes of CS on admission group were the worst of all. The outcomes of Developed CS group laid between the other two groups. The consequences highlighted the importance of prevention for CS developing in the STEMI patients during hospitalization. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. Methods and results: We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) Conclusions: The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes. [ABSTRACT FROM AUTHOR]