Coronary Artery Disease
Outcomes and Characteristics of Myocardial Infarction in Patients With Cirrhosis
Dustin Hillerson, MD; Gbolahan O. Ogunbayo, MBChB; Mohsin Salih, MD, MS; Naoki Misumida, MD; Ahmed Abdel-Latif, MD, PhD; Susan S. Smyth, MD, PhD; Adrian W. Messerli, MD
Patients with cirrhosis have increased bleeding risk due to coagulopathy and platelet sequestration, as well as inherent cardiovascular risk. We assessed the impact of cirrhosis on the revascularization rates and in-hospital outcomes in patients with acute myocardial infarction by comparing them with a propensity-score matched cohort without cirrhosis.
Advances in Venous Access
Real-Time Ultrasound-Guided Venous Access of the Arm for Right Heart Catheterization
Jonathan S. Roberts, MD; Jianli Niu, MD, PhD; Christopher Alexander, MSc; Juan A. Pastor-Cervantes, MD
Arterial access from the wrist for cardiac catheterization is increasingly being used. Right heart catheterization (RHC) is an integral part of many of these procedures. Reliable venous access from the arm allows avoidance of femoral or jugular venous access for RHC. It is uncertain if ultrasound guidance offers a benefit for venous access of the arm for RHC; thus, we sought to assess the efficacy of ultrasound-guided venous access of the arm for RHC.
Transcatheter Aortic Valve Replacement
Detection of Atrial Fibrillation and Atrial Flutter by Pacemaker Device Interrogation After Transcatheter Aortic Valve Replacement (TAVR): Implications for Management
Michael Megaly, MD, MS; Santiago Garcia, MD; Lucille Anzia; Pamela Morley, RN; Ross Garberich, MS; Charles C. Gornick, MD; John Lesser, MD; Paul Sorajja, MD; Mario Gössl, MD, PhD; Jay Sengupta, MD
Understanding the incidence and consequences of new-onset atrial fibrillation/atrial flutter (NOAF) post TAVR is important to provide optimal clinical care. We aimed to identify the actual cumulative incidence of NOAF in patients who required pacemaker insertion after TAVR using pacemaker device interrogation.
Transcatheter Aortic Valve Replacement
Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement
Andrés M. Pineda, MD; Jennifer Rymer, MD; Alice Wang, MD; Lynne H. Koweek, MD; Adam Williams, MD; Todd Kiefer, MD; Andrew Wang, MD; Jeffrey Gaca, MD; G. Chad Hughes, MD; J. Kevin Harrison, MD
Alternative access is still required for a significant proportion of patients undergoing TAVR. We sought to compare the clinical outcomes of patients undergoing alternative access versus transfemoral access TAVR in a total of 600 patients, of which 78 (13%) had alternative access and 522 (87%) had transfemoral access. Alternative-access TAVR was associated with an increased incidence of postoperative adverse events, including mortality, when compared with those undergoing transfemoral access.
Ultrasound Guidance in Femoral Artery Catheterization: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials
Mohammed K. Rashid, MD; Nazanin Sahami, MD; Kuljit Singh, MD, PhD; Jose Winter, MD; Tej Sheth, MD; Sanjit S. Jolly, MD, MSc, FRCP
During percutaneous cardiac procedures, the use of radial access is growing, but femoral access remains needed for large-bore, high-risk procedures. Methods are needed to make femoral access safer. In this systematic review and meta-analysis of randomized-controlled trials, we assessed whether ultrasound guidance was associated with a decreased risk of vascular complications during femoral artery catheterization.
Transcatheter Aortic Valve Replacement
A Direct Comparison of Self-Expandable Portico Versus Balloon-Expandable Sapien 3 Devices for Transcatheter Aortic Valve Replacement: A Case-Matched Cohort Study
Silvia Mas-Peiro, MD, MSc; Philipp Christian Seppelt, MD; Helge Weiler, MD; Gina-Lisa Mohr, MD; Nestoras Papadopoulos, MD; Thomas Walther, MD; Andreas M. Zeiher, MD; Stephan Fichtlscherer, MD; Mariuca Vasa-Nicotera, MD
New-generation devices for TAVR have been developed to overcome limitations of first-generation devices and to reduce complications after TAVR. This is the first study to directly compare the Portico valve with the Sapien 3 valve; we compared 104 Portico valves and 73 Sapien 3 valves at a high-volume center in a real-world setting and found similar short-term clinical and hemodynamic outcomes.
Orbital Atherectomy for Calcific Coronary Artery Disease in Patients With Severe Aortic Stenosis: A Safety and Feasibility Study
Ibrahim Kassas, MD; Ahmed Nagy, MD; Alvaro Alonso, MD; Mohammed Waseem Akhter, MD; Craig S. Smith, MD; Mohamed Ahmed, MD; Abdul Moiz Hafiz, MD; Jennifer Walker, MD; Nikolaos Kakouros, BSc, MBBS, MD(Res), PhD, FRCP
Percutaneous revascularization followed by TAVR has been increasingly utilized as an alternative to surgery in patients with severe aortic stenosis and coronary artery disease. We assessed the safety and feasibility of coronary orbital atherectomy in elderly patients with calcific coronary artery disease and severe aortic stenosis who were under consideration for TAVR.
Optimal Technique for Performing Invasive Pulmonary Angiography for Chronic Thromboembolic Pulmonary Disease
Lawrence Ang, MD; Anna McDivit Mizzell, MD; Lori B. Daniels, MD, MAS; Ori Ben-Yehuda, MD; Ehtisham Mahmud, MD
This article provides detailed guidance in performing hemodynamic assessment and invasive pulmonary angiography for the evaluation of chronic thromboembolic pulmonary disease.
Chronic Total Occlusion
Left Main Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Series
Iosif Xenogiannis, MD; Dimitri Karmpaliotis, MD; Khaldoon Alaswad, MD; Mir B. Basir,, MD; Robert W. Yeh, MD; Hector Tamez, MD; Mitul Patel, MD; Ehtisham Mahmud, MD; James W. Choi, MD; M. Nicholas Burke, MD; Anthony H. Doing, MD; Phil Dattilo, MD; Jaikirshan J. Khatri, MD; Abdul M. Sheikh, MD; Bilal A. Malik, MD; Mary E. Greene, MD; Nidal Abi Rafeh, MD; Asaad Maallouf, MD; Fadi Abou Jaoudeh, MD; Jeffrey W. Moses, MD; Nicholas J. Lembo, MD; Manish Parikh, MD; Ajay J. Kirtane, MD; Ziad A. Ali, MD; Fotis Gkargkoulas, MD; Juan Russo, MD; Emad Hakemi, MD; Peter Tajti, MD; Allison B. Hall, MD; Evangelia Vemmou, MD; Ilias Nikolakopoulos, MD; Bavana V. Rangan, BDS, MPH; Shuaib Abdullah, MD; Subhash Banerjee, MD; Emmanouil S. Brilakis, MD, PhD
Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Review of 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites produced 20 LMCA cases; we examined the clinical and angiographic characteristics and procedural outcomes of each case and determined that LMCA-CTO-PCI was associated with good procedural outcomes.
Magmaris Resorbable Magnesium Scaffold Implantation Assisted by Optical Coherence Tomography to Treat an Acute Coronary Dissection After a Blunt Chest Trauma
José Abellán-Huerta, MD, PhD; Alfonso Jurado-Román, MD, PhD; Fernando Lozano-Ruiz-Poveda, MD, PhD; María Thiscal López Lluva, MD; Ignacio Sánchez-Pérez, MD
The treatment of coronary lesions caused by blunt chest trauma is controversial. To our knowledge, this is the first report of a coronary dissection related to blunt chest trauma evaluated with OCT and treated with a magnesium resorbable scaffold.
Multimodality Imaging and Percutaneous Closure of Right Sinus of Valsalva to Right Ventricular Outflow Tract Fistula After Transcatheter Aortic Valve Replacement
Sanjay S. Mehta, MD; Naveed Adoni, MD; Ahmad Shihabi, MD; Christopher Bodine, MD; Issam Moussa, MD; Matthew Gibb, MD
We present the diagnosis and treatment of a 90-year-old male with critical aortic stenosis and multiple medical comorbidities who underwent TAVR that was complicated by annular rupture.
Iliac Artery Rupture During Transfemoral Transcatheter Aortic Valve Implantation
Amir Aker, MD; Khader Nader, MD; Ronen Jaffe, MD
An 82-year-old male with severe symptomatic aortic stenosis underwent elective TAVR complicated by rupture of the proximal iliac artery. This case illustrates the feasibility of percutaneous vascular repair following severe vascular injury during TAVR.
Location of Dissections Post Balloon Angioplasty in Patients With Femoropopliteal Arterial Disease as Seen on Intravascular Ultrasound
Nicolas W. Shammas, MD, MS; W. John Shammas, BS; James T. Torey, PA; Andrew N. Shammas, BS, OMS
We reviewed images from our intravascular ultrasound core lab to define the various locations of dissections in femoropopliteal arteries post balloon angioplasty in relation to plaque morphology.
Aim For the Bubbles: Agitated Saline Injection as an Adjunct Technique to Ultrasound-Guided Subclavian Vein Cannulation
Faris G. Araj, MD; Jose Pena, BSN, RN; Julie Cox, BSN, RN, BS
Agitated saline during central line placement is described for the purpose of identifying the subclavian vein during ultrasound-guided procedures.
Chronic Dissection of Left Sinus of Valsalva Obscuring Left Main Coronary Artery
Korakoth Towashiraporn, MD and Vithaya Chaithiraphan, MD
Coronary angiography in a 44-year-old woman shows chronic dissection of the left sinus of Valsalva, totally obscuring the LMCA, with good collaterals supplying the left coronary system from the right coronary artery.