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Background: Catheter-directed interventions (CDIs) for pulmonary embolism (PE) continue to evolve. However, due to the paucity of data, their use has been limited in patients with underlying kidney disease., Methods: The National Readmission Database (2016-2020) was utilized to identify intermediate to high-risk PE (IHR-PE) patients requiring CDI (thrombectomy, thrombolysis, and ultrasound-assisted thrombolysis). Cohorts were stratified based on the presence of CKD stage ≥3, including ESRD. A Propensity Score Matching (PSM) model was applied to compare outcomes., Results: From 2016-2020, 20795 patients with IHR-PE underwent CDIs. Most were done in the non-CKD/ESRD population (N:18438, 88.7 %), while only 2357 (11.3 %) were done in the CKD/ESRD population. After propensity matching, the CKD/ESRD population had higher adverse events, including mortality (7.3 % vs. 5.1 %, p: 0.036), need for transfusions (52.6 % vs. 44.7 %, p < 0.001), and acute bleeding (15.4 % vs. 10.6 %, p < 0.001). CKD/ESRD population had a higher median LOS (5 vs. 4 days, p < 0.001) and total cost ($32935 vs. $29805, p < 0.001) in the index admission. Over the study period, total cost decreased in the CKD/ESRD population ($37829 to $31436, p-trend: 0.024) but remained the same in the non-CKD/ESRD population (p-trend>0.05). 180-day readmission rates were higher in the CKD/ESRD population (24.7 % vs. 17.5 %, p: 0.006). Our subgroup analysis, excluding ESRD patients, showed no significant difference in in-hospital mortality (6.5 % vs. 7.3 %, p > 0.05), but the rates of thoracic or respiratory bleeding (4.5 % vs. 2.6 %, p:0.012), need for transfusions (52.4 % vs.. 43.5 %, p < 0.001), and AKI (57.1 % vs. 23.2 %, p < 0.001) were higher in patients with CKD undergoing CDIs for IHF-PE., Conclusion: CKD/ESRD patients requiring catheter-directed interventions for IHR-PE had higher periprocedural mortality and acute bleeding. The presence of ESRD mainly drove periprocedural mortality in our study, while the presence of non-dialyzed CKD was associated with higher rates of non-fatal localized hemorrhage., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Transcatheter aortic valve replacement (TAVR) continues to grow in the United States. There are limited data on recipients of solid organ transplant (SOT) and patients with liver cirrhosis who undergo aortic valve replacement (AVR). Our study aims to evaluate outcomes in these populations. Using the national readmission database (2016 to 2020), we identified recipients of SOT and patients with liver cirrhosis without previous liver transplants who were admitted for severe aortic stenosis and underwent either TAVR or surgical AVR (SAVR). We used multivariable regression for adjusted analysis and the propensity score matching model, implementing complete Mahalanobis distance matching within the Propensity Score Caliper (0.2) to match TAVR and SAVR cohorts for outcomes. Of 3,394 hospitalizations for AVR in recipients of SOT, 2,181 underwent TAVR, and 1,213 underwent SAVR. On propensity-matched analysis, SAVR was associated with more adverse events than was TAVR, including in-hospital mortality (5.2% vs 1.1%, adjusted odds ratio [aOR] 4.49, p <0.001), acute kidney injury (43.7% vs 10.2%, p <0.001), cardiogenic shock (9.0% vs 1.6%, p <0.001), sudden cardiac arrest (15.9 vs 6.0%, p <0.001), major adverse cardiac and cerebrovascular events (28% vs 10.4%, p <0.001), and net adverse events (72.8 vs 37.6%, p <0.001). A greater median length of stay (10 vs 2 days, p <0.001) and adjusted cost ($80,842 vs $57,014, p <0.001) were also observed. The readmission rates were the same for both cohorts after a 6-month follow-up. Similarly, in 14,763 hospitalizations for AVR in liver cirrhosis, 7,109 patients underwent TAVR, and 7,654 underwent SAVR. In propensity-matched cohorts (n = 2,341), SAVR was found to be associated with greater adverse events, including in-hospital mortality (19.8% vs 10%), stroke (6.7% vs 2%), acute kidney injury (67.7% vs 30.3%), cardiogenic shock (41.9% vs 19.9%), sudden cardiac arrest (31.8% vs 13.2%, aOR 2.89), major adverse cardiac and cerebrovascular events (66.2% vs 35.7%), and net adverse events (86% vs 59.5%) (p <0.001). A greater median length of stay (16 vs 3 days) and cost ($500,218 vs $263,383) were also observed (p <0.001). However, the rate of readmissions at 30-day (9% vs 11.1%) and 180-day intervals (33.4% vs 39.8%) was lower for the SAVR cohort (p <0.05). In recipients of SOT and patients with liver cirrhosis, SAVR is associated with greater short-term mortality, adverse events, and healthcare burden than is TAVR. TAVR is a relatively safer alternative to SAVR in these patient populations, although further studies are warranted to compare the long-term outcomes., Competing Interests: Declaration of competing interest The authors have no competing interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Takotsubo cardiomyopathy (TTC) has a preponderance for females, particularly postmenopausal. However, recent data from multicenter registries identified a worse prognosis in male patients, particularly with cardiogenic shock. We aim to investigate gender disparities in outcomes of TTC-associated cardiogenic shock (TTC-CS)., Methods: The National Readmission Database (2016-2020) was utilized to identify TTC-CS hospitalizations. Cohorts were stratified by gender. A Propensity Score Matching (PSM) model, which utilized complete Mahalanobis Distance Matching within the Propensity Score Caliper following multivariate regression, successfully matched males and females. Pearson's χ 2 test was applied to the propensity-matched cohorts to compare outcomes., Results: Among 12,803 TTC-CS hospitalizations, the majority (74.1 %) were females (N: 9490), and 25.9 % were males (N: 3313). On propensity-matched cohorts (2609), males were found to have higher in-hospital mortality (31 % vs. 26 %, p  < 0.001), higher incidence of sudden cardiac arrest (14 % vs. 10.8 %, p  < 0.001), endotracheal intubation (52.1 % vs. 48.8 %, p: 0.001), acute liver injury (18 % vs. 15.9 %, p: 0.004), acute stroke (7.2 % vs. 5.8 %, p: 0.004), cardiac arrhythmias (55.1 % vs. 49.3 %, p  < 0.001) and acute kidney injury (63.1 % vs. 49 %, p < 0.001); while female patients were found to have higher utilization of mechanical circulatory support (MCS) modalities (16.1 % vs 13.2 %, p  < 0.001).Males had a higher adjusted cost of hospitalization ($54,537 vs. $42,805, p < 0.001) with a higher median length of hospital stay (10 vs. 9 days, p < 0.001). The two groups had no significant difference in 30, 90, and 180-day readmission rates ( p  > 0.05). From 2016 to 2020; mortality has not changed significantly for TTC-CS, while the use of percutaneous coronary angiogram (PCA) and MCS has down-trended (p-trend < 0.05)., Conclusion: For TTC-CS hospitalization, males have higher in-hospital mortality and complication rates, along with higher LOS and cost of hospitalization. Despite advances in the management of CS, there was no significant difference in mortality from 2016 to 2020., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results., Methods: PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I 2 test., Results: Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75)., Conclusions: This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations., Competing Interests: Declaration of competing interest Authors have no conflicts to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A 73-year-old man with history significant for paroxysmal atrial fibrillation on apixaban underwent percutaneous coronary intervention (PCI) of the left anterior descending artery via transradial access. The patient was discharged on clopidogrel, atorvastatin, carvedilol, isosorbide mononitrate, losartan, and apixaban.

We report a case of recurrent ST-segment elevation myocardial infarction (STEMI) due to a previously implanted under-expanded stent with in-stent thrombosis refractory to traditional interventional techniques. We underscore the utility of bail-out shockwave intravascular lithotripsy to tackle previously under-expanded stents in this acute setting., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

The transfemoral approach for transcatheter aortic valve replacement (TAVR) is superior to alternative access strategies. Only transfemoral access has been shown to have better clinical outcomes than surgical aortic valve replacement. In our patient, severe calcification of the distal abdominal aorta posed difficulty in using transfemoral access for TAVR. We applied intravascular lithotripsy (IVL) to the distal abdominal aorta to achieve necessary luminal gain facilitating bioprosthetic aortic valve deployment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Post-flu-vaccination optic neuritis is an extremely rare condition with an incidence ranging from 0.003 cases to 0.89 per 100 000 population. The exact pathophysiology is not clearly defined. Most of the patients with post-flu-vaccination optic neuritis tend to present with progressive worsening of vision in 2-3 weeks post-vaccine administration. A prompt fundus examination supplemented with MRI imaging of the orbit is required to establish the diagnosis. On diagnosis, early initiation of high-dose oral or IV steroids is recommended to prevent optic atrophy or worsening of vision. Most patients tend to have complete recovery of vision when started on steroids. However, if the patient continues to have worsening symptoms while being treated with a high dose of steroids, plasmapheresis (PLEX) is an effective intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bouchette et al.)

The prevalence of tricuspid regurgitation (TR) increases with age, affecting 65%-85% of adults. Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus (leaflets, chordae, papillary muscles, or annulus). Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle (RV) or right atrium (RA) remodeling and increased RV pressures. Isolated TR is without increased RV pressures and is associated with atrial fibrillation. Mild TR is a benign disease. Moderate to severe tricuspid regurgitation has independently been associated with increased mortality. Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR. The in-hospital mortality rate is 8.8%, and the median length of stay in hospital is 11 days resulting in higher healthcare costs. Even if the patients undergo surgical repair or replacement, available data do not show improvement in survival. With a more detailed understanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricuspid valve disease, the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention. In the past decade, transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been developed, contributing to decreased mortality from surgical repair. Transcatheter tricuspid valve intervention techniques have improved survival, quality of life, and reduced heart failure rehospitalization. This review summarizes normal anatomy, types of TR, etiology and different mechanisms of TR, echocardiographic assessment of the severe TR, and highlights various percutaneous transcatheter techniques for tricuspid valve repair., (© 2022 JGC All rights reserved; www.jgc301.com.)

We report a case of coronary artery fistula arising from the left main coronary artery in a 62-year-old patient presenting with atrial fibrillation. He underwent a transthoracic echocardiogram which suggested a possible coronary artery fistula. Cardiac computed tomographic angiography and cardiac catheterization confirmed the diagnosis. Coronary artery fistula originated from the left main coronary artery, which is rare and terminated in the coronary sinus. Multi-modality imaging helps to delineate anatomy and decide treatment options. Small asymptomatic fistulas do not require treatment, and large or symptomatic fistulas need closure. Our patient was asymptomatic, and we opted for conservative management with close outpatient echocardiographic monitoring., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)

Lemierre's syndrome is a rare disease that generally occurs in young, healthy individuals, where an index of suspicion for something so serious is often low. There is no standardized definition of Lemierre's syndrome, which has led to a dilemma if Lemierre's can be diagnosed without internal jugular vein (IJV) thrombophlebitis. We highlight a complex case of Lemierre's syndrome that deviates from the classical presentation of the disease. A 31-year-old male presented to the hospital with "throat swelling" and difficulty swallowing. He was in severe sepsis with end-organ damage. The patient developed severe pneumonia with pleural/pericardial effusions and bilateral nodular necrosed lesions during hospitalization. A facial vein thrombus was diagnosed, but the absence of internal jugular vein involvement initially delayed Lemierre's diagnosis. However, blood culture speciation revealed  Fusobacterium necrophorum,  which supported the suspected diagnosis. Persistent fevers and leukocytosis complicated the hospital course despite appropriate antibiotic coverage. The patient ultimately required bilateral thoracotomy and a pericardial window. He made a full recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Cloutet et al.)

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Competing Interests: Competing interests: None declared.