Publications by authors named "Alejandro Lemor"
Article Synopsis
- In a study analyzing patients during high-risk percutaneous coronary intervention (HR-PCI), nearly half (49%) experienced loss of pulse pressure (LOPP), defined as a mean pulse pressure below 20 mm Hg for 5 seconds or more.
- Patients with LOPP demonstrated significantly lower baseline systolic and mean arterial blood pressures and a higher heart rate compared to those without LOPP.
- The occurrence of LOPP was linked to a higher incidence of serious complications including major adverse cardiac events, acute kidney injury, and death within 90 days, with low systolic blood pressure and cardiomyopathy identified as strong predictors of LOPP.
Article Synopsis
- Right ventricular dysfunction (RVD) affects 30-40% of patients experiencing acute myocardial infarction and cardiogenic shock, leading to concerns about their survival outcomes when treated with left ventricular mechanical support.
- A study conducted across 80 sites analyzed 361 patients, finding that 28% had RVD, which correlated with lower survival rates to discharge (61.8% vs. 73.4%) and higher instances of severe shock and active CPR during treatment.
- Despite initial lower survival for RVD patients, hemodynamic parameters measured within 24 hours showed no significant differences between those with and without RVD, indicating that early left ventricular support may not immediately affect RV function.
Article Synopsis
- TAVR (transcatheter aortic valve replacement) offers treatment for severely ill patients, but outcomes for those with cardiogenic shock (CS) are not well understood.
- A meta-analysis of five studies showed that 30-day mortality and major vascular complications were significantly higher in patients with CS compared to those without, but there were no significant differences in longer-term outcomes at one year.
- The study suggests that while short-term risks are elevated for TAVR patients with CS, their long-term prognosis may be similar to those without CS; further research is needed to explore the timing and management strategies of TAVR for this group.
Use of percutaneous mechanical circulatory support for right ventricular failure.
Catheter Cardiovasc Interv
May 2024
Background: Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS.
Aims: We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes.
Methods: This was a single-center retrospective cohort study.
Background: There are limited data on the clinical characteristics and outcomes of patients who require prolonged mechanical circulatory support (MCS) after Impella-supported high-risk percutaneous coronary intervention (HR-PCI).
Aims: The aim of this study is to describe the contemporary clinical characteristics, outcomes, and predictors associated with prolonged MCS support after assisted HR-PCI.
Methods: Patients enrolled in the prospective, multicentre, clinical endpoint-adjudicated PROTECT III study who had undergone HR-PCI using Impella were evaluated.
Article Synopsis
- - Out-of-hospital cardiac arrest accounts for about 50% of cardiovascular deaths, with less than 10% of victims surviving long enough to leave the hospital.
- - Higher survival rates with good neurological outcomes occur in cases where there’s a witnessed shockable rhythm, bystander CPR, return of spontaneous circulation within 15 minutes, and ST-segment elevation on initial ECG.
- - The cardiac catheterization lab is crucial for diagnosing and treating cardiac arrests, especially those caused by coronary artery disease, and recent trials have expanded our understanding of its role in patient management post-rescue.
Background: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) devices increase systemic blood pressure and end organ perfusion while reducing cardiac filling pressures.
Methods And Results: The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, multicenter study.
The use of Impella assist device for high-risk percutaneous coronary interventions and cardiogenic shock has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Herein, we describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal.
View Article and Find Full Text PDFMechanical circulatory support for cardiogenic shock complicated by acute severe aortic regurgitation poses a unique challenge for traditional veno arterial extracorporeal membrane oxygenation (ECMO) because of rapidly rising left ventricular pressures accentuated by the increased afterload from retrograde flow in femoral cannulation. This process necessitates rapid left ventricular unloading while also allowing for adequate native left ventricular function. Herein, we describe a case of cardiogenic and septic shock secondary to methicillin-resistant Staphylococcus aureus complicated by acute severe aortic regurgitation temporized by left atrial-veno arterial (LA-VA) ECMO via the Livanova TandemHeart system.
View Article and Find Full Text PDFVeno-arterial extracorporeal membrane oxygenation is used in patients requiring biventricular support; however, its use increases the afterload. In patients with severe aortic insufficiency or severe left ventricular disfunction, it will increase left-side filling pressures, hence the need for left ventricle unloading with an additional mechanical circulatory support device. We present a case of a patient with cardiogenic shock and severe aortic insufficiency who underwent left atrial veno-arterial extracorporeal membrane oxygenation and provide a step-by-step explanation of the technique.
View Article and Find Full Text PDFBackground: Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating peri-procedural complications is unknown.
Methods: Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials.
Left ventricular (LV) unloading has been associated with improved survival in patients treated with venoarterial extracorporeal membrane oxygenation. This case describes a patient with a COVID-19 infection who subsequently developed non-ischemic cardiomyopathy with an LV ejection fraction of 10% to 15% (baseline echocardiography). He did poorly in the outpatient setting and was admitted to an outside hospital with heart failure symptoms and was subsequently transferred to our hospital for escalation of care and consideration of advanced heart failure therapies.
View Article and Find Full Text PDFObjective: We aim to report on the efficacy and safety of large bore venous access (LBVA) preclosure with Perclose™ (Abbott Vascular Devices) suture-mediated device use following transcatheter edge-to-edge (TEER) and replacement (TMVR).
Background: Patients requiring TEER and TMVR require LBVA. Clinical outcome data on the use of suture-mediated devices for LBVA site closure are limited.
Rates and impact of vascular complications in mechanical circulatory support.
Catheter Cardiovasc Interv
April 2022
Background: Mechanical circulatory support (MCS) devices are increasingly used for hemodynamic support in cardiogenic shock or high-risk percutaneous coronary interventions. Vascular complications remain a major source of morbidity and mortality despite technological advances with percutaneous techniques. Little is known about the rates and predictors of vascular complications with large-bore access MCS in the contemporary era.
View Article and Find Full Text PDFBackground: Patients presenting with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) are at high risk for impaired antiplatelet activity secondary to malabsorption, systemic hypoperfusion, hypothermia, need for mechanical ventilation, and high use of analgesics. The use of antiplatelet therapy in these high-risk patients is not well studied.
Methods: Using the National Cardiogenic Shock Initiative database, we analyzed patients who presented with AMI-CS at 60 hospitals from March 2018 to December 2020.
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication, and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of CS in those with ischemic and nonischemic CS etiologies.
View Article and Find Full Text PDFArticle Synopsis
- Women experience higher adverse events after mitral valve surgery, prompting a study to compare outcomes of transcatheter edge-to-edge repair by sex.
- The study analyzed data from 5,295 patients who underwent the procedure, finding that women were less likely to have multiple clips implanted and had lower device success rates.
- At one year, there was no difference in major adverse events between sexes, but females had a lower risk of all-cause mortality compared to males.
Previous reports have described non-ischaemic cardiomyopathy related to a variety of autoimmune diseases. However, very few case reports describe Sjögren disease as a contributing factor to cardiomyopathy. We report the case of a 69-year-old woman with a history of Sjögren disease who presented with cardiogenic shock.
View Article and Find Full Text PDFIn this review, recent key publications related to acute coronary syndrome (ACS) are summarized and placed into context of contemporary practice. Landmark trials examining vascular access in ST-elevation myocardial infarction, the management of multivessel disease, acute myocardial infarction and cardiac arrest are discussed. An update in pharmacology for ACS provides updates in major trials relating to P2Y12 inhibitor initiation, deescalation, and use in special populations.
View Article and Find Full Text PDFPercutaneous ventricular assist devices (pVAD) are frequently utilized in high-risk percutaneous coronary intervention (HR-PCI) to provide hemodynamic support in patients with complex cardiovascular disease and/or multiple comorbidities who are poor candidates for surgical revascularization. Using the National Inpatient Sample we identified pVAD-assisted PCI (excluding intra-aortic balloon pump) in patients without cardiogenic shock from January 2008 to December 2018. We evaluated the trends in patient and procedural characteristics, and complication rates across the 11-year study period.
View Article and Find Full Text PDFObjective: To determine the rate and clinical outcomes of post-TAVR VSD.
Background: Transcatheter aortic valve replacement (TAVR) is a safe and established procedure for patients with severe symptomatic aortic stenosis. Ventricular septal defect (VSD) is a rare complication of TAVR.