Search

Reverse cardiac remodeling may occur in some left ventricular assist device (LVAD) recipients. Although considered the standard therapy, surgical device explantation with repeat sternotomy might be undesirable or very high risk. On the other hand, there are few data reporting minimally invasive percutaneous LVAD deactivation. We describe a case of a man with LVAD malfunction due to driveline fracture and left ventricular (LV) function recovery who had a Heart Mate II deactivated with a percutaneous technique using a left atrial appendage occluder (LAAO) positioned inside the outflow cannula. To the best of our knowledge, this the first report of LVAD deactivation with the fully recapturable LAAO device. We propose that the use of a LAA occluder to obstruct HM II outflow cannula is feasible and safe.

The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial catheterization.RAO is an infrequent complication of transradial procedures. One of the strategies used to reduce this complication is the patent hemostasis technique. Use of minimum pressure in hemostatic wristband, without monitoring patency, might have the same efficacy for preventing RAO.This is a multicenter study encompassing patients submitted to transradial catheterization. After pneumatic wristband application, the band was deflated to the lowest allowable volume while preserving hemostasis. Radial artery patency was subsequently evaluated. The group with no return of plethysmographic curve was labeled "minimum pressure," and the group in which the signal returned was labeled "patent hemostasis." RAO was verified by Doppler evaluation within the first 24 hours of the procedure.A total of 1082 patients were enrolled, with mean age of 61.4 ± 10.4 years. The majority (61.0%) were male and 34.5% had diabetes. Patent hemostasis was achieved in only 213 cases (20%). Early RAO occurred in 16 patients (1.8%) in the minimum pressure group and in 4 patients (1.9%) in the patent hemostasis group (P=.97). No major bleeding was observed among the entire cohort. EASY scale for hematoma grade was similar between the cohorts (EASY grades 1-3: 7.0% in the minimum pressure group vs 7.5% in the patent hemostasis group; P=.96).Checking radial patency during hemostatic compression may not be necessary after the procedure when adopting a mild and short hemostatic compression.

Introduction: The presence of acute renal injury (AKI) enhances morbimortality after surgical aortic valve. Hypothesis: This prospective observational study aims to determine the incidence of AKI after transcatheter aortic valve replacement (TAVR), its predictors and impact on 30-days and 1-year mortality. Methods: We assessed data from 224 consecutive patients with severe symptomatic aortic stenosis submitted to TAVR between January 2009 and February 2015 on two tertiary cardiologic centers, conducted by the same heart team. All patients used an ionic, low-osmolar, low-viscosity contrast. Kidney injury was defined according to VARC criteria, following AKIN system, and data collected until the seventh day post-procedure. Three patients were excluded due to death during the procedure, considering those deaths not related to renal dysfunction, remaining 221 patients analysed separated in two groups: AKI group and non-AKI group. Follow-up was performed on 30 days and after one year. Results: Fifty two patients (23.5%) developed AKI until seventh day of procedure. Groups 1 and 2 were similar, except for EuroSCORE II (8.66% ± 5.64% vs 7.34% ± 8.58%, p = 0.02) and glomerular filtration rate (GFR) (39.59 ml/min.1.73m2 ± 13.62 vs. 48.49 ± 19.6, p = 0.002). Overall 30 days-mortality and 1-year mortality was 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs 1.2%, p < 0.001) and 1-year mortality (44.2% vs 4.7%, p< 0.001) were higher in group 1. In multivariable-adjusted models, the only independent predictor for AKI after TAVR was baseline GFR [hazard ratio (HR) 1.37, CI 95% 1.08-1.77, p = 0.01]. Regarding long term follow-up, AKI (HR 19.86, CI 95% 7.31-53.98, p Conclusion: In this TAVR sample, baseline GFR was the only independent predictor of AKI, and patients who developed it had significantly higher mortality at 30 days and 1 year. Acute renal impairment was the strongest risk factor for mortality and adverse cardiovascular events that provided risk information beyond the traditional scores, as EuroSCORE II and STS.

C-reactive protein (CRP) is an inflammatory marker that predicts cardiac events in patients with coronary syndromes. However, data on the relationship between the CRP level and in-stent restenosis are contradictory. The objective of this study was to investigate the relationship between the basal CRP level and the neointimal hyperplasia volume measured by intracoronary ultrasound 4 months after implantation of a zotarolimus-eluting stent.The study included 40 consecutive patients who underwent zotarolimus-eluting stent implantation. Patients were divided into quartiles according to their preprocedural CRP level. Intracoronary ultrasound was performed after stent implantation and at 4 months, and the neointimal hyperplasia volume was determined using Simpson's rule. Correlation and linear regression analyses were used to evaluate the relationships between variables. Multivariate analysis was used to identify variables that were independently related to neointimal hyperplasia volume.The patients' mean age was 58 (8) years, 55% were male, and 40% had diabetes mellitus. There was no difference in baseline characteristics between the quartiles. The hyperplasia volumes were 4.8 (4.2) microl and 15.8 (10.0) microl in the first and fourth quartiles, respectively (P.001). There was a significant positive correlation between the CRP level and neointimal hyperplasia volume (r = 0.64, P=.0001). The CRP level, the postimplantation lumen volume, and the final deployment pressure were all independent predictors of neointimal hyperplasia.In this study, an independent correlation was observed between the CRP level before zotarolimus-eluting stent implantation and the neointimal hyperplasia volume at 4-month follow-up.