Coronary Artery Disease
Four-Year Outcomes of Multivessel Percutaneous Coronary Intervention With Xience V Everolimus-Eluting Stents
Michael S. Lee, MD; Richard Shlofmitz, MD; Ehtisham Mahmud, MD; Kyung Woo Park, MD; PhD; Seung-Woon Rha, MD, PhD; Anna Gaborro, MD; Jin Wang, PhD; Weiying Zhao, MD, PhD; Krishnankutty Sudhir, MD, PhD
We evaluated the long-term outcomes of multivessel compared with single-vessel percutaneous coronary intervention (PCI) with Xience V everolimus-eluting stents in real-world patients. Treatment options for multivessel disease include PCI, coronary artery bypass grafting, and medical therapy. Patients with multivessel disease are at a higher risk for ischemic complications than those with single-vessel disease. The XIENCE V USA study was a condition-of-approval, single-arm, prospective study in unselected real-world patients. Patients who underwent multivessel PCI (n = 655) were compared with those who underwent single-vessel PCI (n = 4079). Major clinical outcomes, including mortality, stent thrombosis, and target-lesion failure, were evaluated at 4 years.
Percutaneous Transapical Left Ventricular Access to Treat Paravalvular Leak and Ventricular Septal Defect
Joseph M. Venturini, MD; Isla McClelland, MD; John E.A. Blair, MD; Akhil Narang, MD; Rohan Kalathiya, MD; Roberto M. Lang, MD; Karima Addetia, MD; Jonathan Paul, MD; Sandeep Nathan, MD; Atman P. Shah, MD
Surgical transapical access is an established technique for structural heart procedures, but is associated with considerable morbidity. Percutaneous transapical puncture provides direct access for structural heart procedures and may overcome the disadvantages of surgical access. This study sought to evaluate the safety of percutaneous transapical left ventricular access for structural heart interventions.
Use of the DyeVert System in Chronic Total Occlusion Percutaneous Coronary Intervention
Peter Tajti, MD; Iosif Xenogiannis, MD; Allison Hall, MD; M. Nicholas Burke, MD; Ivan Chavez, MD; Santiago Garcia, MD; Mario Gössl, MD, PhD; Michael Mooney, MD; Anil Poulose, MD; Paul Sorajja, MD; Yale Wang, MD; Evangelia Vemmou, MD; Ilias Nikolakopoulos, MD; Pamela Morley, RN; Bavana V. Rangan, BDS, MPH; Imre Ungi, MD, PhD; Emmanouil S. Brilakis, MD, PhD
Chronic total occlusion PCI often requires administration of large contrast volume. The DyeVert system (Osprey Medical, Inc) is a disposable device that interfaces with standard manifold systems to reduce the amount of contrast used. We compared the procedural outcomes of 39 patients in whom the DyeVert system was used vs 91 patients in whom it was not used during chronic total occlusion PCI at a single center.
Transcatheter Aortic Valve Replacement
Transcatheter Aortic Valve Implantation in Patients With Pre-Existing Mechanical Mitral Valve Prostheses
Smita Scholtz, MD; Cornelia Piper, MD, PhD; Dieter Horstkotte, MD, PhD; Nobuyuki Furukawa, MD; Jochen Börgermann, MD, PhD; Jan Gummert, MD, PhD; Tanja K. Rudolph, MD, PhD; Volker Rudolph, MD, PhD; Werner Scholtz, MD
Transcatheter aortic valve implantation (TAVI) has become standard therapy for aortic stenosis patients with intermediate or high operative risk. Treatment of patients with pre-existing mechanical mitral valve replacement is challenging due to possible interference between the TAVI prosthesis and the mechanical valve. We present our single-center experience with 16 patients in this special patient cohort. Repositionable and retrievable devices seem to be a safer option.
Coronary Artery Disease
The Dose and Timing of Fentanyl Impacts on Ticagrelor Absorption and Platelet Inhibition During Percutaneous Coronary Intervention: The PACIFY Randomized Clinical Trial
Rakesh R. Goli, BA; Khalil Ibrahim, MD; Rohan Shah, MD; Thomas S. Kickler, MD; William A. Clarke, PhD; Jon R. Resar, MD; Steven P. Schulman, MD; John W. McEvoy, MBBCh, MHS
In this secondary analysis of the PACIFY randomized trial, we assessed whether dose and timing of fentanyl have implications for the pharmacokinetics and pharmacodynamics of ticagrelor loading during PCI. We have previously shown that fentanyl slows absorption of oral ticagrelor, attenuating its effect on platelet inhibition. We now demonstrate that this mechanism appears to be dose- and time-dependent.
Coronary Artery Disease
Intact and Isolated Human Cadaveric Coronary Artery Perfusion Models to Facilitate Research and Education Regarding Coronary Anatomy and Pathology
John L. Petersen, MD, MHS; Dmitry B. Levin, BS; Vivian W. Hou, MS; Carol V. Hagen, CDT; Grant Anderson, BS; Joanie Block, BS, MA; Mark Reisman, MD
Cadaveric tissue-perfusion models are well established in the fields of structural heart and peripheral vascular disease; however, less consideration has been given toward coronary artery disease despite comparable prevalence and morbidity. Two tissue-perfusion models were developed to address this need. The first, an intact heart model, allows simulation of PCI procedures. The second focuses upon isolated arteries, allowing quantification of simulated procedures.
High-Risk PCI / Original Contribution
Secular Trend in the Use and Implementation of Impella in
High-Risk Percutaneous Coronary Intervention and Cardiogenic Shock: A Real-World Experience
Abdul Wahab Hritani, MD; Adil S. Wani, MD; Susan Olet, PhD; Claire J. Lauterbach; Suhail Q. Allaqaband, MD; Tanvir Bajwa, MD; M. Fuad Jan, MBBS, MD
Cardiogenic shock carries high mortality despite advancements in therapeutic interventions. Impella (Abiomed) is a mechanical circulatory support device that is being increasingly used in cardiogenic shock patients. Impella is also utilized in high-risk patients undergoing percutaneous coronary intervention (PCI). This a retrospective, observational study of Impella use for two indications, cardiogenic shock and high-risk PCI, at a tertiary-care center. We review the trend of Impella use at a single tertiary-care center, retrospectively analyze the outcomes, and discuss the increasing use of this device in the United States.
Coronary Artery Disease / Brief Communication
A Polymeric Bioresorbable Vascular Scaffold Versus an Everolimus-Eluting Stent in ST-Segment Elevation Myocardial Infarction
Bernhard Wernly, MD; Azeem Latib, MD; Alfonso Ielasi, MD; Christian Jung, MD, PhD
Bioresorbable vascular scaffold (BRS) devices deliver both short-term coronary artery support and drugs. This could potentially be advantageous in patients suffering from STEMI featuring large and necrotic thrombus-rich lesions, which are often associated with stent-related complications. We performed a meta-analysis comparing polymeric BRS vs everolimus-eluting stent in STEMI patients.
Severe, Reversible Pulmonary Hypertension From Giant Pedunculated Left Atrial Myxoma
Paul Bamford, MBChB and George Tat-Ming Lau, MBBS, PhD
A 77-year-old woman with obstructive sleep apnea presented with a 3-week history of leg swelling and dyspnea on exertion. She had a dry cough and lost 10 kg over the past 2 years. Examination revealed elevated jugular venous pressure, reduced air entry in the left lower-lung field, and pedal edema.
Loss of Leaflet Insertion After Percutaneous Mitral Valve Repair Requiring Left Ventricular Assist Device Implantation: Usefulness of 3D Multiplanar Reconstruction
Francesco Melillo, MD; Francesco Ancona, MD; Francesco Calvo, MD; Andrea Fisicaro, MD; Stefano Stella, MD; Cristina Capogrosso, MD; Roberto Spoladore, MD; Paolo Denti, MD; Giulio Melisurgo, MD; Elisabetta Lapenna, MD; Federico Pappalardo, MD; Alessandro Castiglioni, MD; Alberto Margonato, MD; Eustachio Agricola, MD
Recurrence of mitral regurgitation after MitraClip implantation is challenging; mitral valve surgery is high risk, and repeat MitraClip intervention could be feasible but is technically challenging. This case demonstrates that LVAD implantation may be a solution to address MitraClip failure.
Can Lightning Strike Twice? Tackling Complications From Transcatheter Aortic Valve Implantation
Jonathan Yap, MBBS, MRCP, MPH; See Hooi Ewe, MBBS, MRCP, PhD; Victor Chao, MBBS, FRCS; Kay Woon Ho, MBBS, MRCP
A 79-year-old woman with known severe degenerative calcified aortic stenosis underwent transfemoral TAVI; prior to groin closure, she became hypotensive. TAVI complications may occur in the peri- and postprocedural periods; operators must be aware of the differentials for such complications and well-versed in their management.
3D Optical Coherence Tomography Reveals Fractured Coronary Stent as Cause of Acute Myocardial Infarction
Daniel R. Obaid, PhD, MA(Cantab), MRCP(UK); Alexander J. Chase, MBBS, PhD; Dave Smith, BM, MD
3D-OCT revealed extensive fracture and distortion of the struts in the distal portion of a stent, presumably caused by aggressive postdilation at the time of implantation. This was managed successfully with the insertion of a new coronary stent inside the damaged stent segment.
Anomalous Origin of Right Coronary Artery From Left Sinus of Valsalva
Giovanni Lorenzoni, MD; Pierluigi Merella, MD; Graziana Viola, MD; Stefano Bandino, MD; Gavino Casu, MD
Anomalous origination of coronary artery from the opposite sinus (ACAOS) is an uncommon coronary anomaly; the incidence is about 1.07% in general, and only 0.12%-0.9% in the case of right ACAOS. The clinical consequences can be relevant if the ectopic artery has intramural intussusception or courses between the aorta and pulmonary artery.
Rendered OCT Imaging of an Impressive Stent Malapposition in the Left Main Coronary Artery
Pierluigi Merella, MD; Giovanni Lorenzoni, MD; Graziana Viola, MD; Paola Berne, MD; Gavino Casu, MD
Our case emphasizes the need to use intravascular imaging to optimize stent implantation in the left main coronary artery. Despite recommendations, intravascular imaging is still widely under-utilized. The recently developed stent apposition OCT software (OPTIS Stent Optimization Software; Abbott Vascular) confirmed its usefulness in optimizing stent implantation in unprotected left main PCI.