February 2019 Table of Contents

Original Contributions

Coronary Artery Disease

The Incidence of Non-Cardiac Surgery in Patients Treated With Drug-Eluting Stents According to Age

Oh-Hyun Lee, MD;  Sung-Jin Hong, MD;  Chul-Min Ahn, MD;  Jung-Sun Kim, MD;  Byeong-Keuk Kim, MD;  Young-Guk Ko, MD;  Donghoon Choi, MD;  Yangsoo Jang, MD;  Myeong-Ki Hong, MD

The impact of age on the incidence and timing of non-cardiac surgery after coronary stent implantation is unknown. We evaluated the incidence and timing of non-cardiac surgery after drug-eluting stent (DES) implantation according to patient age. We included a total of 37,915 consecutive patients treated by DES implantation between February 2003 and April 2014 and divided them into groups depending on age and when they underwent non-cardiac surgery (within 1 year, 2 years, or 3 years of DES implantation). Elderly patients underwent non-cardiac surgery more often than younger patients, and 62 years was deemed the age that best predicted an increase in the number of non-cardiac surgeries within 1 year of DES implantation. Physicians are advised to carefully select the type of DES used to treat patients ages ≥62 years old while considering the possibility of cessation of dual-antiplatelet therapy.

J INVASIVE CARDIOL 2019;31(2):E9-E14.

Transcatheter Aortic Valve Replacement

Prognostic Impact of Permanent Pacemaker Implantation in Patients With Low Left Ventricular Ejection Fraction Following Transcatheter Aortic Valve Replacement

Yoshio Maeno, MD, PhD;  Yigal Abramowitz, MD;  Sharjeel Israr, MD;  Sung-Han Yoon, MD;  Shunsuke Kubo, MD;   Takahiro Nomura, MD, PhD;  Masaki Miyasaka, MD;  Hiroyuki Kawamori, MD, PhD;  Yoshio Kazuno, MD;   Nobuyuki Takahashi, MD;  Tarun Chakravarty, MD;  Mamoo Nakamura, MD;  Rahul P. Sharma, MD;  Hasan Jilaihawi, MD;  Raj R. Makkar, MD

Data are limited regarding the clinical impact of permanent pacemaker implantation in patients with low left ventricular ejection fraction after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the impact of new permanent pacemaker implantation in patients with baseline low left ventricular ejection fraction at 2-year follow-up after TAVR. A total of 659 patients undergoing TAVR between January 2013 and December 2015 were included in the study. Patients were divided into two groups according to the need for permanent pacemaker implantation after TAVR (104 patients receiving new permanent pacemaker implantation compared with 555 patients receiving no permanent pacemaker) and further divided by their baseline left ventricular ejection fraction.

J INVASIVE CARDIOL 2019;31(2):E15-E22.

High-Risk PCI

Outcomes of Hemodynamic Support With Impella for Acute Myocardial Infarction Complicated by     Cardiogenic Shock at a Rural Community Hospital Without On-Site Surgical Back-up

Charles Everett Wilkins, MD;  Tammie Lynn Herrera, RT(R), RCIS;  Monica Kwai Nagahiro, RN, RCIS;  Luther Basil Weathers, MD;  Sudhakar Virendra Girotra, MD;  Faraz Sandhu, MD

Impella 2.5 and Impella CP (Abiomed) are percutaneous left ventricular assist devices that can be easily deployed in the cardiac catheterization laboratory without need for surgery and provide effective hemodynamic support. The utility of Impella devices for management of acute myocardial infarction complicated by cardiogenic shock at a rural community hospital without on-site surgical back-up has not been reported. Our study retrospectively reviewed all consecutive patients who underwent percutaneous coronary intervention with Impella support between 2012 and 2017 for acute myocardial infarction complicated by cardiogenic shock at our institution. Survival, in-hospital complications, and recovery of native heart function at follow-up were assessed in 90 patients at discharge, 30 days, and 180 days, and in 89 patients at 365 days.

J INVASIVE CARDIOL 2019;31(2):E23-E29.

Transcatheter Aortic Valve Replacement

Short-Term and Long-Term Outcomes of Patients Undergoing Urgent Transcatheter Aortic Valve Replacement Under a Minimalist Strategy

Yasuhiro Ichibori, MD, PhD;  Jun Li, MD;  Toral Patel, MD;  Jerry Lipinski, BS;  Thomas Ladas, MD, PhD;  Petar Saric, MD;  Daniel Kobe, MD;  Takahiro Tsushima, MD;  Matthew Peters, MD;  Sandeep Patel, MD; Angela Davis, RN;  Alan H. Markowitz, MD;  Hiram G. Bezerra, MD, PhD;  Marco A. Costa, MD, PhD;  Ankur Kalra, MD;  Guilherme F. Attizzani, MD

Urgent TAVR is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral approach with conscious sedation and no transesophageal echocardiography guidance).

J INVASIVE CARDIOL 2019;31(2):E30-E36.

Cardiac Imaging

Angio-Guidewire-Ultrasound (AGU) Guidance for Femoral Access in Procedures Requiring Large Sheaths

Francesco Burzotta, MD, PhD;  Osama Shoeib, MD;  Cristina Aurigemma, MD, PhD;  Carlo Trani, MD

Many techniques are based on fluoroscopic, angiographic, and echocardiographic guidance to achieve the ideal femoral artery puncture, which is important to decrease vascular-related complications. We report an original technique for femoral access integrating angiographic, guidewire, and ultrasound (AGU) guidance, working together to obtain the best femoral artery stick according to the individual patient’s anatomy. This technique is designed to facilitate large-sheath femoral access in procedures requiring ancillary arterial access.

J INVASIVE CARDIOL 2019;31(2):E37-E39.

Clinical Images

Cardiac Arrest in a 31-Year-Old Man With Noonan Syndrome

Simone Grotti, MD;  Gianni Dall’Ara, MD, PhD;  Fabio Tarantino, MD;  Cristina Bachetti, MD;  Filippo Ottani, MD;  Marcello Galvani, MD

A 31-year-old man with Noonan syndrome who suffered an out-of-hospital cardiac arrest presented at our institution with severe postanoxic coma (Glasgow coma scale 3), but normalized electrocardiogram and stable hemodynamics. Coronary angiography documented a giant right coronary artery supplying collateral flow to the left coronary artery, which presented a left main functional occlusion.

J INVASIVE CARDIOL 2019;31(2):E40.

Clinical Images

Occlusion of a Multilobed Shallow Left Atrial Appendage Using a Special LAmbre Device After Failed Watchman Implantation

Chak-yu So, MBChB;  Yat-yin Lam, MBBS, MD;  Gary Shing-him Cheung, MBBS;  Kevin Ka-ho Kam, MBChB;  Anna Kin-yin Chan, MBChB;  Alex Pui-wai Lee, MBChB;  Bryan P. Yan, MBBS

Although reported failure rates of the Watchman device are low, the ball-shaped device is not suitable for shallow and multilobed left atrial appendages (LAAs). The LAmbre device is available in two configurations – standard (cover 4-6 mm larger in diameter than the umbrella) and special (cover 12-14 mm larger than the umbrella) – which allows the closure of a wide range of LAA anatomies. This case illustrates that the LAmbre device can be used for complex LAA anatomies that are not suitable for the Watchman device.

J INVASIVE CARDIOL 2019;31(2):E41-E42.

Clinical Images

Successful Stent Delivery Through a Slaloming Coronary Path

Konstantinos Aznaouridis, MD, PhD;  Maria Bonou, MD, PhD;  Konstantina Masoura, MD, PhD;  Sophia Vaina, MD, PhD;  Charalambos Vlachopoulos, MD, PhD;  Dimitris Tousoulis, MD, PhD

A 66-year-old man with refractory angina was admitted for percutaneous coronary intervention (PCI) through a tortuous saphenous vein graft sequentially anastomosed with a diagonal and a first marginal branch. Our target was a critical stenosis at the retrograde limb of the first marginal proximal to saphenous vein graft anastomosis. Stent delivery to our target lesion mandated tracking through sequential angulations. In this case, we enhanced the support of the guide catheter and delivered a stent on the retrograde limb of the first marginal branch with very deep intubation of the guide catheter into the saphenous vein graft and use of a buddy wire, which is a cheaper and relatively safer maneuver than complex techniques such as the double guide-catheter extension technique. Proper selection of the type and size of the guide catheter and meticulous attention to the pressure waveform in order to avoid ischemia or dissection of the graft is mandatory during this technique.

J INVASIVE CARDIOL 2019;31(2):E43.

Clinical Images

Endothelialization of an Amplatzer Septal Occluder Device 6 Months Post Implantation: Is This Enough Time? An In Vivo Angioscopic Assessment

Yasuhiro Tanabe, MD, PhD;  Yukio Sato, MD, PhD;  Masaki Izumo, MD, PhD;  Yuki Ishibashi, MD, PhD;  Takumi Higuma, MD, PhD;  Tomoo Harada, MD, PhD;  Yoshihiro J. Akashi, MD, PhD

The current guidelines recommend a minimum of 6 months of antithrombotic and antibiotic prophylaxis following septal occluding device placement for transcatheter closure of atrial septal defect. Full neoendothelialization is thought to be completed within 6 months of device implantation; however, there is no method available that can assess the level of neoendothelialization in vivo. This report therefore evaluates endothelialization in vivo and demonstrates that 6 months of postimplantation prophylactic therapy may not provide sufficient time for adequate endothelialization. Further investigations are warranted to determine the optimal duration of these treatments after atrial septal defect closure.

J INVASIVE CARDIOL 2019;31(2):E44.

Clinical Images

Superdominant Circumflex Thrombosis With Occluded LAD and Absent RCA Ostium

Bruno da Silva Matte, MD, MSc;  Felipe Pereira Lima Marques, MD;  Gustavo Neves de Araujo, MD, PhD;  Sandro Cadaval Gonçalves, MD, PhD

To our knowledge, this is the first report of primary percutaneous coronary intervention in a patient with a superdominant left circumflex artery, in which the entire right coronary artery myocardium territory is provided by the left circumflex. Coronary angiographic images of our 80-year-old male patient illustrate this anomaly. Single coronary arteries are among the most rare anatomic coronary anomalies, and the absence of right coronary artery ostium has been described as the rarest of these anomalies. Coronary events in such cases can be catastrophic due to the large amount of myocardium at risk.

J INVASIVE CARDIOL 2019;31(2):E45.

Clinical Images

Percutaneous Biventricular Mechanical Circulatory Support With Impella CP and Protek Duo Plus     TandemHeart

Nachiket J. Patel, MD;  Divya R. Verma, MD;  Radha Gopalan, MD;  Richard R. Heuser, MD;  Ashish Pershad, MD

This is the first reported case of full biventricular mechanical circulatory support with the combination of Impella and Protek Duo, which is a dual-lumen cannula inserted via the right internal jugular vein, with its proximal inflow lumen positioned in the right atrium and distal lumen positioned in the main pulmonary artery. These lumens are connected with the paracorporeal TandemHeart pump allowing flows up to 5 L/min. The alternative percutaneous option for right ventricular support is the Impella RP (Abiomed), which has to be placed in the femoral vein, preventing ambulation. The axillary and internal jugular vein positions for devices are probably less prone to infection compared to the femoral area. The combination of an Impella inserted via the axillary artery with the Protek Duo is a viable option, allowing ambulation while providing biventricular support.

J INVASIVE CARDIOL 2019;31(2):E46.