Chronic Total Occlusions
Use of Polymer-Jacketed, Tapered-Tip, Low-Force Guidewires With Composite-Core, Dual-Coil Design as Part of the Antegrade Approach to Coronary Chronic Total Occlusions
Jeffrey E. Rossi, MD; Ravi Nair, MD; Stephen G. Ellis, MD; Samir R. Kapadia, MD; Jaikirshan J. Khatri, MD
Our aim was to investigate the impact of novel, polymer-jacketed, tapered-tip, low-force guidewires with composite-core, dual-coil design (Fielder XT-R and Fielder XT-A; Asahi Intecc) on antegrade wire escalation (AWE) crossing of coronary chronic total occlusion (CTO) lesions. A total of 164 consecutive CTO lesions at a single institution were treated with a primary AWE strategy using either Fielder XT-R or XT-A as the starting wire regardless of lesion characteristics. Success rates, wiring times, and complications were analyzed.
Radial Access Technique
Randomized Trial of Radial Hemostasis Using Focused vs Balloon Compression Devices
Jordan G. Safirstein, MD; Ali Elfandi, MD; Nicole Reid, MD; Timothy W.I. Clark, MD
Radial artery hemostasis devices differ in compression mechanisms, which may influence time to hemostasis and hand perfusion. We randomized 52 patients undergoing transradial diagnostic coronary catheterization or percutaneous coronary intervention to either focused compression (VasoStat; Forge Medical) or balloon compression device (TR Band; Terumo Medical) for radial artery hemostasis. Time to complete hemostasis enabling device removal was measured in each subject. Hand perfusion was quantitated using the perfusion index (PI) with oximetry (1) before; (2) during device use; (3) during device use with ulnar artery compression; and (4) following device removal.
Plaque Composition and Dynamics
Instantaneous Wave-Free Ratio (iFR) Correlates With Fractional Flow Reserve (FFR) Assessment of Coronary Artery Stenoses and Myocardial Bridges in Children
Tam T. Doan, MD, MS; James C. Wilkinson, MD; Hitesh Agrawal, MD; Silvana Molossi, MD, PhD; Mahboob Alam, MD; Carlos M. Mery, MD, MPH; Athar M. Qureshi, MD
Instantaneous wave-free ratio (iFR) has been proven to correlate with coronary flow reserve better than fractional flow reserve (FFR) and is non-inferior to FFR in guiding coronary revascularization in ischemic heart disease. There has been no study validating the utility of iFR in children. We performed a retrospective review of clinically indicated cases in which both FFR and iFR were obtained at Texas Children’s Hospital from July 2016 to March 2019. FFR and iFR were obtained at baseline. iFR correlated with FFR in the assessment of CA stenoses in children, and does not require administration of pharmacological agents.
Transcatheter Aortic Valve Replacement
Impact of Left Ventricular Outflow Tract Calcification on Pacemaker Implantation After Transcatheter Aortic Valve Implantation With Second-Generation Devices
Marco B. Ancona, MD; Francesco Moroni, MD; Matteo Pagnesi, MD; Paolo Del Sole, MD; Ozan Demir, MD; Saud Khawaja, MD; Barbara Bellini, MD; Luca Ferri, MD; Alessandro Beneduce, MD; Emanuele Visco, MD; Cristina Capogrosso, MD; Eustachio Agricola, MD; Antonio Esposito, MD; Anna Palmisano, MD; Alaide Chieffo, MD; Matteo Montorfano, MD
The objective of this single-center retrospective study was to evaluate the impact of left ventricular outflow tract (LVOT) calcification localization and extension on permanent pacemaker implantation rates after transcatheter aortic valve implantation (TAVI) with second-generation devices. We included all consecutive patients (n = 377) who underwent transfemoral TAVI with second-generation devices at San Raffaele Hospital in Milan, Italy from January 2014 to June 2017. The localization and extension of LVOT calcification were evaluated using computed tomography imaging; LVOT regions were categorized according to the overlying coronary cusps.
Transcatheter Aortic Valve Replacement
Transcatheter Valve Implantation for Failed Surgical Aortic and Mitral Bioprostheses: A Single-Center Experience
Jerry Lipinski, MD*; Sandeep M. Patel, MD*; Toral R. Patel, MD; Daniel Kobe, MD, Petar Saric, MD, PharmD; Muhammad Panhwar, MD; Fahd Nadeem, MD; Jun Li, MD; Joshua R. Clevenger, MD; Yasuhiro Ichibori, MD; Anas Fares, MD; Katherine Lang, BA; Hiram G. Bezerra, MD, PhD; Basar Sareyyupoglu, MD; Benjamin Medalion, MD; Salil Deo, MD; Yakov Elgudin, MD, PhD; Alan Markowitz, MD; Daniel I. Simon, MD; Marco A. Costa, MD, PhD; Ankur Kalra, MD; Guilherme F. Attizzani, MD *Joint first authors
As medicine continues to advance, the lifespan of individuals continues to increase, and current surgical valvular therapies begin to degrade prior to a person’s end of life. It is important to evaluate the efficacy and durability of transcatheter valves within failed surgical bioprostheses. We share our center’s experience with the use of transcatheter valvular therapies in the setting of failed bioprostheses. Baseline characteristics, periprocedural complications, and long-term outcomes were collected and assessed.
Peripheral Vascular Disease
Safety and Long-Term Patency of Endovascular Therapy for Infrarenal Aortic Disease: Single-Center Experience and Review of the Literature
Muhammad Asif Mangi, MD; Chandramohan Meenakshisundaram, MD; Mubbasher Ameer Syed, MD; Khalid Hamid Changal, MD; Mohammed Alyosif, MD; Mark W. Burket, MD; Mujeeb A. Sheikh, MD
Endovascular therapy (EVT) has emerged as an alternative to surgery for the treatment of symptomatic infrarenal aortic stenosis. However, long-term outcomes with EVT are unknown. We performed a retrospective review of infrarenal aortic stenosis patients treated with EVT at the University of Toledo Medical Center in Toledo, Ohio. We compared our single-center study with a review of published studies regarding complications, patency rate, and repeat intervention rate.
Resource Allocation and Decision Making for Pediatric and Congenital Cardiac Catheterization During the Novel Coronavirus SARS-CoV-2 (COVID-19) Pandemic: A U.S. Multi-Institutional Perspective
Brian H. Morray, MD; Brent M. Gordon, MD; Matthew A. Crystal, MD; Bryan H. Goldstein, MD; Athar M. Qureshi, MD; Alejandro J. Torres, MD; Shilpi M. Epstein, MD; Ivory Crittendon, MD; Frank F. Ing, MD; Shyam K. Sathanandam, MD
The novel coronavirus (COVID-19) pandemic has placed severe stress on healthcare systems around the world. There is limited information on current practices in pediatric cardiac catheterization laboratories in the United States. Our objective was to describe current practice patterns and make recommendations regarding potential resource allocation for congenital cardiac catheterization during the COVID-19 pandemic.
Temporal Trends and Outcomes of Percutaneous Coronary Atherectomy in the United States
Ayman Elbadawi, MD; Mohammed Elzeneini, MD; Islam Y. Elgendy, MD; Karim Mahmoud, MD; Mohmed A. Omer, MD; Gbolahan O. Ogunbayo, MD; Waleed Kayani, MD; Ali Denktas, MD; David Paniagua, MD; Hani Jneid, MD
There is paucity of data regarding the temporal trends and outcomes of coronary atherectomy (CA) in the United States. We queried the National Inpatient Sample database (2011-2016) for hospitalizations of CA patients. We also compared outcomes of non-orbital vs orbital CA in a more contemporary cohort.
Machine Learning on High-Dimensional Data to Predict Bleeding Post Percutaneous Coronary Intervention
Corbin Rayfield, MD*; Pradyumna Agasthi, MD*; Farouk Mookadam, MBBCh; Eric H. Yang, MD; Nithin R. Venepally, MBBS; Harish Ramakrishna, MD; Piotr Slomka, PhD; David R. Holmes Jr, MD; Reza Arsanjani, MD *Joint first authors
This study examined the accuracy of machine learning in predicting bleeding outcomes post percutaneous coronary intervention (PCI) in comparison with the American College of Cardiology CathPCI bleeding risk model. Mayo Clinic CathPCI registry data were retrospectively analyzed from 15,603 PCI patients.
The First 4 Years of Postmarketing Safety Surveillance Related to the MitraClip Device: A United States Food and Drug Administration MAUDE Experience
Chetaj A. Mahabir, MBBS*; Ersilia M. DeFilippis, MD*; Sourabh Aggarwal, MD; Anandbir Bath, MD; Arman Qamar, MD; Nilay K. Patel, MD; Andrew M. Goldsweig, MD; Muthiah Vaduganathan, MD, MPH *Joint first authors
The MitraClip (Abbott) is a commercially available device to perform percutaneous transcatheter mitral valve repair for patients with symptomatic mitral regurgitation. We queried all available adverse event reports regarding the device from the MAUDE database from October 2013 to September 2017.
Letter to the Editor
Down the Memory Lane of Tamponade During Balloon Mitral Valvotomy
Sourabh Agstam, MD, DM
Digital Hand Embolization as a Complication of Substance Abuse
Francis Kiernan, MD; Amged Abdelaziz, MD, MS; Brett Hiendlmayr, MD; Saqib A. Gowani, MD
Intra-arterial injection of recreational substances and drugs is less well described in the literature. It carries a risk for hand ischemia and embolization to the hand digits and ultimately amputation.
Footprint of a Bioresorbable Vascular Scaffold in Computed Tomography Coronary Angiogram at 5-Year Follow-up
Rajesh Vijayvergiya, MD; Kewal Kanabar, MD; Rajan Palanivel, MD; Anupam Lal, MD; Ankush Gupta, MD
The Absorb bioresorbable vascular scaffold (Abbott Vascular) does not have an artifact on computed tomography coronary angiography (CTCA); the extent/location of the stent in situ can only be assessed by localizing its radiopaque platinum markers in a non-contrast CTCA. The characteristic appearance of BVS on CTCA should be interpreted as the footprint of a resorbed BVS, instead of a calcified plaque.
Infected Thrombus on a TAVI Aortic Valve
Ilan Merdler, MD, MHA; Aviram Hochstadt, MD; Amir Kramer, MD, PhD; Haim Shmilovich, MD; Assaf Halavy, MD; Merav Ingbir, MD; Yacov Shacham, MD
After a series of tests, an 86-year-old patient was shown to have an infected thrombus on a TAVI valve and was referred to urgent surgery. The valve with the infected thrombus was removed and a biological prosthetic valve was implanted in its place.
Rakesh Agarwal, MD, DM and Dhurjati Prasad Sinha, MD, DM
Accordion effect or concertina effect — also known as “crumpled coronary” — is an uncommon occurrence during coronary angioplasty. It usually has no major clinical sequelae and should be differentiated from spasm, dissection, and thrombosis, which require special management.
A Unique Case Report of Complete Left Main Coronary Artery Occlusion in a 24-Year-Old Male
Paul B. Heyworth, MBBS; Nasser Essack, FRACP; Atifur Rahman, FRACP
A 24-year-old male presented to hospital following syncope with electrocardiographic changes and was found to have left main coronary artery occlusion requiring emergent coronary artery bypass grafting.
Chronic Total Occlusion 5 Years After Bioresorbable Vascular Scaffold Implantation: A Serial Optical Coherence Tomography Assessment
Dorota Ochijewicz, MD; Mariusz Tomaniak, MD, PhD; Lukasz Kołtowski, MD, PhD; Janusz Kochman, MD, PhD
Angiography at 60 months post implantation of an Absorb 1.0 bioresorbable vascular scaffold (Abbott Vascular) revealed a total occlusion at the distal scaffold. Within the proximal edge, optical coherence tomography showed complete absorption of stent struts with a decreased mean scaffold area and diameter.
Pulmonary Arteriography in Pulmonary Vein Stenosis
Laura Duque, MD; María José Orrego, MD; Álvaro Escobar, MD; Sebastián Isaza, MD; Mauricio Duque, MD
A 43-year-old woman underwent radiofrequency pulmonary vein ablation for symptomatic paroxysmal atrial fibrillation. At 3 months, she developed worsening dyspnea and exercise intolerance; tests revealed severe stenosis in her right pulmonary veins at the venoatrial junction and an abnormally small left atrium.