CT-Overlay Hybrid Imaging to Facilitate Sentinel Cerebral Protection System Deployment in the Presence of an Anomalous Vertebral Artery Originating From the Aortic Arch During Transcatheter Aortic Valve Implantation.

Stroke remains an important risk during transcatheter aortic valve implantation (TAVI). Though the use of the double-filter Sentinel cerebral protection system (Boston Scientific, Marlborough, MA, USA) may lower the stroke risk, the deployment of this device requires manipulation within the aortic arch and cranial arch vessels potentially causing dislodgment of atherosclerotic debris in the process thereby possibly offsetting its benefit with regards to reducing cerebral embolization. Apart from patient selection, minimizing maneuvering during deployment may improve the safety of device deployment.

Transcatheter Mitral Valve-in-Ring Implantation in the Flexible Adjustable Attune Annuloplasty Ring.

Transcatheter mitral valve-in-ring implantation (TMViR) poses unique challenges when compared to valve-in-valve implantation due to the large variation in the different annuloplasty rings used. Annuloplasty rings are often classified according to whether they are complete or incomplete, rigid, semi-rigid, or flexible, and whether their three-dimensional geometry is saddle-shaped or flat. A limited number of annuloplasty rings are available which are adjustable allowing the surgeon to increase or decrease the size of the ring once it has been sutured in place.

Transcatheter aortic valve implantation in the presence of an anomalous left circumflex coronary artery: a case report.

This is a case of an anomalous left circumflex coronary artery (LCX) originating from the right coronary cusp with a retroaortic course in a patient with severe aortic valve stenosis requiring transcatheter aortic valve implantation (TAVI). In the context of TAVI, an anomalous LCX has been described only in a few case reports. In some, the LCX remains unaffected.

Exposure to glucocorticoids prior to transcatheter aortic valve replacement is associated with reduced incidence of high-degree AV block and pacemaker.

Background: Tissue edema and inflammation, which occur at the device landing zone during valve deployment, may contribute to the pathophysiology of conduction abnormalities after transcatheter aortic valve replacement (TAVR). We hypothesized that exposure to glucocorticoids prior to TAVR will reduce the incidence of conduction abnormalities requiring PPM implantation after TAVR.

Methods: We included 167 consecutive patients treated with TAVR at the Minneapolis VA Medical Center and University of Minnesota.

Computed tomography (CT) assessment of the membranous septal anatomy prior to transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 valve.

Objectives: The lower limit of the membranous septum (MS) is considered an anatomic landmark for the emergence of the Bundle of His into the left ventricle. Computed tomography (CT) assessment of MS anatomy may provide useful information about the risk of conduction abnormalities following transcatheter aortic valve replacement (TAVR).

Methods And Results: The study included 102 consecutive patients undergoing TAVR with the Edwards Sapien 3 (S3) valve.

Outcomes of intermediate-risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20-year experience.

Background: Transfemoral transcatheter aortic valve replacement (TAVR) was superior to surgical aortic valve replacement (SAVR) in the placement of aortic transcatheter valves (PARTNER) 2A trial (P2). The generalizability of the trial results to the broader population of patients with intermediate surgical risk remains unknown.

Objective: To compare the outcomes of SAVR and TAVR among patients with intermediate surgical risk treated in the VA Healthcare System.

Routine use of anticoagulation after transcatheter aortic valve replacement: Initial safety outcomes from a single-center experience.

Background: Subclinical leaflet thrombosis (SCLT) can be seen in up to 12% of patients after transcatheter aortic valve replacement (TAVR). Anticoagulation appears to prevent and reverse SCLT but concerns exist about bleeding risk.

Methods: Our program adopted a strategy of routine anticoagulation after TAVR, starting warfarin on post-procedure day 0 and continuing for 3months in 10/2015.

Role of epinephrine and extracorporeal membrane oxygenation in the management of ischemic refractory ventricular fibrillation: a randomized trial in pigs.

xtracorporeal membrane oxygenation (ECMO) is used in cardiopulmonary resuscitation (CPR) of refractory cardiac arrest. We used a 2×2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF). Pigs underwent 5 minutes of untreated VF, 10 minutes of CPR, and were randomized to receive epinephrine versus placebo for another 35 minutes.

Outcomes of transcatheter aortic valve replacement using a minimalist approach.

Background: Transcatheter Aortic Valve Replacement (TAVR) is increasingly performed using a minimalist approach under monitored anesthesia care (MAC). The safety of this approach remains controversial and adoption has been low in the US.

Methods: The study cohort was comprised of 130 patients (98% male) who underwent TAVR between 4/2015 and 4/2017 at the Minneapolis VA.

Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement.

To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency. There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures. A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012, = 219) 1 year prior to launching the new program.

Sodium nitroprusside enhanced cardiopulmonary resuscitation improves short term survival in a porcine model of ischemic refractory ventricular fibrillation.

Introduction: Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms.

Hypothesis: SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model.

Coronary artery embolism from infectious endocarditis treated with catheter thrombectomy using a GuideLiner catheter.

A 27-year-old male with history of IV drug use and recurrent endocarditis necessitating bioprosthetic mitral and tricuspid valve replacements presented with 2 weeks of fevers and chest pain. ECG revealed inferior ST-elevation myocardial infarction and he was taken urgently to the cardiac catheterization laboratory. Coronary angiography revealed thrombotic occlusion of the distal right coronary artery (RCA) with no angiographic evidence of atherosclerotic disease.

Use of Transesophageal Echocardiography to Improve the Safety of Transvenous Lead Extraction.

Objectives: The aim of this study was to evaluate the utility of transesophageal echocardiography (TEE) during transvenous lead extraction (TLE) involving both conventional and laser lead removal.

Background: TLE carries a small but measurable risk of serious adverse events. Few studies have examined the potential benefit of continuous monitoring with TEE during this procedure.