Transcatheter Aortic Valve Replacement
Interaction Between Self-Expanding Transcatheter Heart Valves and Coronary Ostia: An Angiographically Based Analysis of the Evolut R/Pro Valve System
Thomas Couture, MS*; Laurent Faroux, MD, MSc*; Lucia Junquera, MD; David del Val, MD; Guillem Muntané-Carol, MD; Jerôme Wintzer-Wehekind, MD; Alberto Alperi, MD; Siamak Mohammadi, MD; Jean-Michel Paradis, MD; Robert Delarochellière, MD; Dimitri Kalavrouziotis, MD; Eric Dumont, MD; Josep Rodés-Cabau, MD *Joint first authors
We assessed the position of the CoreValve Evolut R/Pro (Medtronic) with respect to the left coronary artery (LCA) ostium and evaluated the impact of implantation depth on this relationship. Angiographic measurements included valve implantation depth, position of the Evolut R/Pro with respect to the LCA, and distance between the neo-valve cusp and the LCA ostium. Coronary access issues post transcatheter aortic valve replacement (TAVR) were also recorded.
Transcatheter Aortic Valve Replacement
Does Resting Cardiac Power Index Affect Survival Post Transcatheter Aortic Valve Replacement?
Pradyumna Agasthi, MD*; Reza Arsanjani, MD*; Farouk Mookadam, MBBCh; Panwen Wang, PhD: Nithin R. Venepally, MBBS; John Sweeney, MD; Mackram Eleid, MD; David R. Holmes Jr, MD; Peter Pollak, MD; Floyd David Fortuin, MD *Joint first authors
Cardiac power index is an integrative hemodynamic measure of cardiac pumping capability and is the product of the simultaneously measured mean arterial pressure and the cardiac output. We assessed the association between baseline resting cardiac power index and survival post TAVR by retrospectively abstracting information from patients who underwent TAVR at the Mayo Clinic Foundation with follow-up data available at 1 year.
Transcatheter Aortic Valve Replacement
Incidence and Predictors of Acute Kidney Injury Following Transcatheter Aortic Valve Replacement: Role of Changing Definitions of Renal Function and Injury
Ruben Rodriguez, MD; Mohammed Hasoon, MD; Marvin Eng, MD; Joel Michalek, PhD; Qianqian Liu, BS; Brian Hernandez, BS; Shweta Bansal, MD; Steven R. Bailey, MD; Anand Prasad, MD
Acute kidney injury (AKI) is a known complication of TAVR. The prospective validation of various AKI definitions and estimated baseline renal function equations in the context of TAVR remains an ongoing area of research. This study examined the VARC 1 and 2 criteria for AKI, and impact of three eGFR equations on AKI incidence in TAVR patients.
Coronary Artery Disease
Novel Mechanical Thrombectomy Device for the Treatment of Acute Myocardial Infarction: A Retrospective Report of Initial Results
George L. Adams, MD, MHS, MBA; Nick Cavros, MD; Zaheed Tai, MD
The objective of this study was to assess the effectiveness of mechanical thrombectomy using the Aspire mechanical thrombectomy device (Control Medical) for the treatment of acute myocardial infarction as measured by Thrombolysis in Myocardial Infarction (TIMI) flow post procedure compared with baseline.
Radial Access Approach
Comparison of Minimum Pressure and Patent Hemostasis on Radial Artery Occlusion After Transradial Catheterization
Roberto L. da Silva, MD; Pedro B. de Andrade, MD, PhD; Alexandre A.C. Abizaid, MD, PhD; Paulo F.R. Britto, MD; Filippe B. Filippini, MD; Renata M.M. Viana, MD; Amanda G.M. Sousa, MD, PhD; Fausto Feres, MD, PhD; José R. Costa Jr, MD, PhD
Radial artery occlusion (RAO) is an infrequent complication of transradial procedures. Our study compared two hemostatic techniques, minimum pressure technique and patent hemostasis, on RAO after transradial catheterization.
Chronic Total Occlusion
Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry
Iosif Xenogiannis, MD; Fotios Gkargkoulas, MD; Dimitri Karmpaliotis, MD, PhD; Khaldoon Alaswad, MD; Farouc A. Jaffer, MD, PhD; Robert W. Yeh, MD; Mitul Patel, MD; Ehtisham Mahmud, MD; James W. Choi, MD; M. Nicholas Burke, MD; Santiago Garcia, MD; Anthony H. Doing, MD; Phil Dattilo, MD; Catalin Toma, MD; Barry Uretsky, MD; Oleg Krestyaninov, MD; Dmitrii Khelimskii, MD; Jeffrey W. Moses, MD; Nicholas J. Lembo, MD; Manish Parikh, MD; Ajay J. Kirtane, MD; Ziad A. Ali, MD; Juan J. Russo, MD; Emad Hakemi, MD; Allison B. Hall, MD; Ilias Nikolakopoulos, MD; Evangelia Vemmou, MD; Aris Karatasakis, MD; Barbara Danek, MD; Bavana V. Rangan, BDS, MPH; Shuaib Abdullah, MD; Subhash Banerjee, MD; Emmanouil S. Brilakis, MD, PhD
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved in recent years. Our aim was to compare the clinical, angiographic, and technical characteristics of CTO-PCIs between the “early era” (2012-2016) and the “current era” (2017-2019).
COVID-19: An Unintended Force for Medical Revolution?
Xiaowen Wang MD and Deepak L. Bhatt MD, MPH
Our healthcare systems are facing unprecedented pressure to come up with innovative solutions to help combat coronavirus disease 2019. The SCAI should be applauded for their prompt effort in providing guidance to frontline clinicians especially in regard to the activation of the cardiac cath lab for STEMI patients confirmed or suspected to have COVID-19. It is our hope that the innovations implemented during the crisis of COVID-19 will serve as an unintended force to modernize and revolutionize medical care more broadly.
Failed ISCHEMIA Trial or Failed Ischemia Testing?
Suraj Dahal, MD and Matthew J. Budoff, MD
After an almost decade-long endeavor and $100 million in funding, the eagerly awaited results of the ISCHEMIA trial were presented at the American Heart Association’s annual meeting in November, 2019. The trial failed to show that routine invasive therapy reduces the major adverse cardiac event rate compared with optimal medical therapy among patients with stable ischemic heart disease and moderate-to-severe ischemia on non-invasive stress testing. We believe there was a fundamental problem in the algorithm used to detect ischemia with initial non-invasive stress testing. In this editorial, we discuss some of the limitations involved with the trial design and methodology.
Cardiogenic Shock: A Systematic Review of Clinical Trials Registered With ClinicalTrials.gov
Alexander Shaffer, BS; Omar Sheikh, MD; Anand Prasad, MD
Despite a range of devices, medical interventions, and revascularization techniques utilized in cardiogenic shock, there is a lack of evidence guiding management. We sought to characterize the contemporary trials through utilization of the ClinicalTrials.gov database.
Role of Intravascular Ultrasound in Managing a Rare Case of Delayed Stent Deformity
Pallavi Satuluri, MBBS; Kasaiah Makam, MD; Peyman Naji, MD; Najam Wasty, MD; Khalil Kaid, MD
Delayed stent deformity is a very rare complication. We attempted to dilate the lumen within the crushed stent, but were unsuccessful even after laser atherectomy. At this point, we opted to place a new stent within the deformed old stent. In this case, intravascular ultrasound was extremely useful in guiding its diagnosis and management.
Alpha-Loop for Permanent Pacemaker Implantation in Restrictive Cardiomyopathy
Yash Paul Sharma, MD; Kewal Kanabar, MD; Sagar Makode, MD; Krishna Prasad, MD
High-grade and complete heart block commonly occurs in adult patients with restrictive cardiomyopathy, and requires aggressive monitoring and prophylactic pacemaker/defibrillator. There are limited data on the procedural details of pacemaker implantation in this group of patients, and as reported, special maneuvers may be required for ventricular lead placement.
Adjunctive Rotational Atherectomy and Intravascular Lithotripsy for Heavily Calcified
Left Main Disease Via Radial Access
Fernando Macaya, MD; Julian Yeoh, MBBS, FRACP; Jonathan Hill, MA, FRCP; Rafal Dworakowski, PhD, FRCP
Coronary angiography demonstrated severe distal left main disease in a patient with heavy concentric calcification extending into the left anterior descending and left circumflex arteries. Rotational atherectomy and lithotripsy were used to debulk plaque so that stenting could be performed.
A 67-Year-Old Man With a Mass Shadow in His Heart Chamber During Coronary Angiography
Zhiqiang Han, MS; Xiangdong Xu, BS; Yangyi Lin, MS
A 67-year-old man was admitted to our hospital due to chest tightness induced by activity that had started about 2 months earlier. To clarify the causes of chest pain in this patient, cardiac magnetic resonance imaging was performed, resulting in a diagnosis of ventricular apical hypertrophic cardiomyopathy with intramyocardial calcification.
Impella-Induced Left Ventricular Microbubbles, A Potential Sign for Hemolysis
Henry C. Quevedo, MD and Nidal Abi Rafeh, MD
We observed left ventricular microbubbles associated with Impella support in the setting of a high-risk coronary intervention. Left ventricular microbubbles may indicate exaggerated shear stress and cavitation phenomenon, potentially leading to hemolysis.
Radial Artery Spiral Dissection Confirmed by Optical Coherence Tomography Without Guidewire Shadow
Zijing Liu, MD; Dan Niu, MD; Jincheng Guo, MD
A novel technique was used to eliminate the guidewire shadow artifact by removing the guidewire in frequent domain optical coherence tomography interpretation in vivo. This technique allowed us to observe a rare iatrogenic spiral dissection of the radial artery caused by transradial coronary intervention.