Atypical complications of aortic intramural hematoma: Paraplegia resulting from spinal cord infarction.
(AAS) acute aortic syndromes; (ACS) acute coronary syndrome; (CSFD) cerebrospinal fluid drainage; (CTA) computed tomography angiogram; (ECG) electrocardiogram; (ER) emergency room; (IMH) intramural hematoma; (MRI) magnetic resonance imaging; (SCI) spinal cord infarction; (TEVAR) thoracic endovascular aortic repair
Tsushima T; Al-Kindi SG; Patel T; Kalra A
International journal of cardiology. Heart & vasculature
2019
2019-03
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.ijcha.2019.01.006" target="_blank" rel="noreferrer noopener">10.1016/j.ijcha.2019.01.006</a>
PMID: 30788412
Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement.
Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Risk Factors; Time Factors; Aged 80 and over; Patient Readmission; Risk Assessment; Cause of Death; Coronary Artery Disease/diagnostic imaging/mortality/therapy; AVD - aortic valve disease; CAD - coronary artery disease; Catheterization Peripheral/adverse effects/mortality; Femoral Artery; PCI - percutaneous coronary intervention (PCI); Percutaneous Coronary Intervention/adverse effects/mortality; percutaneous intervention; Transcatheter Aortic Valve Replacement/adverse effects/mortality; Aortic Valve Stenosis/diagnostic imaging/mortality/physiopathology/surgery; Aortic Valve/diagnostic imaging/physiopathology/surgery; Punctures
OBJECTIVES: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. METHODS: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan-Meier method. RESULTS: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. CONCLUSIONS: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.
Li Jun; Patel SM; Nadeem F; Thakker P; Al-Kindi SG; Thomas R; Makani A; Hornick JM; Patel T; Lipinski J; Ichibori Y; Davis A; Markowitz AH; Bezerra HG; Simon DI; Costa MA; Kalra A; Attizzani GF
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-02-15
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27894" target="_blank" rel="noreferrer noopener">10.1002/ccd.27894</a>
PMID: 30312990
Short-term and long-term outcomes of patients undergoing urgent transcatheter aortic valve replacement under a minimalist strategy.
Female; Humans; Male; Retrospective Studies; Treatment Outcome; Risk Factors; United States/epidemiology; Follow-Up Studies; Severity of Illness Index; Time Factors; Aged 80 and over; Length of Stay; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement/methods; minimalist approach; Hospital Mortality/trends; severe aortic stenosis; urgent procedure; Aortic Valve Stenosis/diagnosis/mortality/surgery; Aortic Valve/diagnostic imaging/surgery; Cardiac Catheterization/methods; Echocardiography Transesophageal; Elective Surgical Procedures/methods; Femoral Artery
OBJECTIVES: Urgent transcatheter aortic valve replacement (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 [TF] approach with conscious sedation and no transesophageal echocardiography guidance). METHODS: After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent
Ichibori Y; Li J; Patel T; Lipinski J; Ladas T; Saric P; Kobe D; Tsushima T; Peters M; Patel S; Davis A; Markowitz AH; Bezerra HG; Costa MA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30700628