Risk of infective endocarditis after surgical and transcatheter aortic valve replacement.

Objective: To define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).

Methods: All patients who underwent first SAVR or TAVI in England between 2007 and 2016 were identified from the NICOR databases. Hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics database.

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation.

Objective: Performing transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia (GA) has been increasingly adopted. We sought to study the impact of GA and non-GA approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.

Methods: The UK TAVI registry holds information for every TAVI procedure in the UK.

Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention.

Objectives: Prasugrel and ticagrelor both reduce ischaemic endpoints in high-risk acute coronary syndromes, compared with clopidogrel. However, comparative outcomes of these two newer drugs in the context of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains unclear. We sought to examine this question using the British Cardiovascular Interventional Society national database in patients undergoing primary PCI for STEMI.

Inferior ST-segment elevation following transseptal puncture for balloon mitral valvuloplasty is atropine-responsive.

ST-segment elevation in the inferior leads has been previously described following transseptal puncture for balloon mitral valvuloplasty. The mechanism, however, is obscure, and immediate left and right coronary angiography has not suggested that embolism or vascular spasm is the cause. We hypothesized that a neurally-mediated mechanism was responsible and have since treated 3 further patients with inferior ST-segment elevation following transseptal puncture for balloon valvuloplasty with intravenous atropine, with rapid resolution of ST-segment elevation in each case.

Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases.

The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route.

Permanent pacemakers: should straightened atrial leads be repositioned?

The aim of this study was to assess if atrial leads whose "J" configuration has straightened significantly on the postprocedural chest X ray should be repositioned. Between January 1996 and December 1997, 445 patients underwent dual chamber pacemaker implantation at the Papworth Hospital. Postprocedural chest X rays were available in 410 of these.

Coronary angiography in the fully anticoagulated patient: the transradial route is successful and safe.

The radial approach to coronary angiography is intuitively attractive for fully anticoagulated patients (INR > 2) but no data exist concerning efficacy or safety of this procedure. The consensus view is that the femoral approach is contraindicated in fully anticoagulated patients, and though some operators undertake femoral catheterization in such patients and use closure devices, there are no data to suggest that it is safe to do so. At our institution, the radial approach for coronary angiography is reserved for patients in whom there is a relative contraindication to the femoral route.

Occasional-operator percutaneous brachial coronary angiography: first, do no arm.

The percutaneous brachial approach to coronary angiography is perceived, rightly or wrongly, to be the easiest of the arm approaches. Predominantly femoral operators may therefore be encouraged to use the percutaneous brachial approach as an occasional procedure. We decided to investigate prospectively whether this was a reasonable strategy by examining outcome in patients who underwent percutaneous brachial cardiac catheterization by occasional brachial operators.

Assessment of coronary flow reserve by adenosine transthoracic echocardiography: validation with intracoronary Doppler.

Objective: Data on the accuracy of transthoracic echocardiographic (TTE) analysis of coronary flow reserve are scarce. We compared coronary flow reserve measurements assessed using TTE with those achieved using the gold standard of intracoronary Doppler.

Methods: Twenty-one patients admitted for elective coronary angioplasty to the circumflex or left anterior descending (LAD) coronary artery underwent TTE immediately before angioplasty, both at rest and during intravenous administration of adenosine 140 microg/kg/min.