Publications by authors named "Delewi R"
Background: Transcatheter aortic valve replacement (TAVR) harbors the risk of periprocedural complications that require emergent cardiac surgery, or "surgical bailout." Surgical bailout intends to be lifesaving but is associated with high mortality. This has given rise to discussion on the necessity of surgical backup during TAVR.
View Article and Find Full Text PDFBackground: Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI.
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- - The study evaluated the safety and efficacy of using an upper-extremity approach for secondary access during transfemoral transcatheter aortic valve implantation (TAVI) compared to the traditional lower-extremity method, as it may reduce significant bleeding risks.
- - Conducted between November 2022 and November 2023 in the Netherlands, the TAVI XS trial involved 238 patients with severe aortic stenosis, who were randomly assigned to either the upper or lower access groups.
- - Results showed that the upper-extremity approach had a lower incidence of clinically relevant bleeding (4.2% vs. 13.4% for the lower extremity), suggesting it could be a safer option for patients undergoing
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- Lipoprotein(a) [Lp(a)] is associated with increased risk for atherosclerotic cardiovascular disease (ASCVD), but there are gaps in its measurement among cardiologists according to current guidelines.
- The review presents four clinical cases showing the link between elevated Lp(a) levels and coronary artery disease (CAD), supported by consensus statements from leading heart organizations.
- Emphasizing routine Lp(a) measurement can help identify high-risk patients, guiding more aggressive treatment and tailored care in catheterization settings, while ongoing clinical trials explore Lp(a)-lowering therapies.
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- * In a trial with 858 patients, results showed no significant difference in major complications between those who continued anticoagulation (16.5% experienced primary outcomes) and those who interrupted it (14.8%).
- * Continuation of anticoagulation led to higher incidences of major bleeding (31.1% vs. 21.3%), suggesting that interrupting anticoagulation is safer in this patient population undergoing TAVI.
Background: Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real-world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI.
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- Accurate diagnosis of sarcopenia involves assessing muscle quality, specifically how much fat is infiltrated in muscle tissue, which is crucial for predicting mortality in TAVI patients.
- The study analyzed CT scans from 1199 patients who underwent TAVI between 2010 and 2020, employing deep learning algorithms to measure skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT).
- Results indicated that low muscle quality, identified through both low SMD and high IMAT, significantly correlates with increased mortality risk, suggesting that muscle quality metrics are valuable predictors of health outcomes post-TAVI.
Background: During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking.
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- This study investigates whether crushed prasugrel loading doses administered before hospital arrival can benefit patients with large myocardial infarctions and ST-segment elevation myocardial infarction (STEMI).
- It includes data from the CompareCrush trial, focusing on 532 patients, of which 331 had a large myocardial area confirmed by prehospital ECG.
- Results show that crushed prasugrel significantly improved postprocedural blood flow in STEMI patients with a large area at risk, suggesting it could be a safe and effective strategy for enhancing myocardial reperfusion in this high-risk group.
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- Major bleeding is a common complication after transcatheter aortic valve replacement (TAVR) and is linked to worse clinical outcomes, making its study crucial.
- A comprehensive analysis of 23,562 patients showed a decrease in major bleeding incidents from 11.5% to 5.5% over a decade (2007-2022) and identified female sex and peripheral vascular disease as key predictors.
- Patients experiencing major bleeding faced significantly higher mortality within 30 days and up to a year compared to those without major bleeding, highlighting the serious risks associated with this complication.
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- International guidelines recommend assessing frailty before Transcatheter Aortic Valve Implantation (TAVI), but there's no standard method to do so; this study used the Edmonton Frail Scale (EFS) to evaluate frailty status in patients.
- In a study of 357 TAVI patients, higher EFS scores (indicating greater frailty) were linked to longer hospital stays and increased mortality rates within 30 days to 4 years post-procedure.
- The findings suggest that the EFS is an effective tool for identifying frailty in TAVI patients and could guide clinical decisions to improve patient outcomes and reduce the risk of complications.
Objective: The importance of revascularisation of significant coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is unclear. Despite the lack of randomised controlled trials comparing different revascularisation strategies, guidelines currently recommend percutaneous coronary intervention (PCI) in patients with significant proximal CAD undergoing TAVI.
Methods: In this systematic review and meta-analysis, a systematic search was conducted to identify studies comparing TAVI with and without PCI in patients with significant CAD on pre-TAVI coronary angiography.
Background: Approximately one-third of patients with symptomatic severe aortic valve stenosis who are scheduled for transcatheter aortic valve implantation (TAVI) have some degree of cognitive impairment. TAVI may have negative cognitive effects due to periprocedural micro-emboli inducing cerebral infarction. On the contrary, TAVI may also have positive cognitive effects due to increases in cardiac output and cerebral blood flow (CBF).
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- Direct stenting (DS) may reduce complications during heart procedures but could increase the risk of stent issues compared to conventional stenting (CS).
- In a study involving 446 STEMI patients, both stenting methods showed similar effectiveness in terms of stent size, blood flow post-procedure, and ST-segment resolution.
- The findings concluded that, for pretreated STEMI patients, DS and CS had comparable outcomes for early recovery and vessel health after one year.
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- Patients with non-obstructive lipid-rich plaques (LRPs) are at a high risk for future health issues, prompting the exploration of a new treatment strategy involving a paclitaxel-eluting drug-coated balloon (PE-DCB).
- This pilot study focuses on assessing the safety and effectiveness of PE-DCB treatment on non-culprit LRPs, aiming to reduce the lipid core burden over a 9-month follow-up period through advanced imaging techniques (IVUS and NIRS).
- Outcomes will be measured based on changes in lipid core burden, clinical events, and various cardiac parameters, with ongoing follow-up extending to one year to evaluate long-term safety and effectiveness.
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- The study compares transaxillary (TAx) access and transfemoral (TF) access in transcatheter aortic valve implantation (TAVI) to assess their safety and efficacy.
- A total of 6,334 patients were evaluated, with 322 from each group after reducing selection bias.
- Results showed that both access methods had similar mortality rates at 30 days and one year, but TAx had a higher rate of myocardial infarction and a lower rate of permanent pacemaker implantations compared to TF access.
Background: Standard modifiable cardiovascular risk factors (SMuRFs) are well-established players in the pathogenesis of ST-elevation myocardial infarction (STEMI). However, in a significant proportion of STEMI patients, no SMuRFs can be identified, and the outcomes of this subgroup are not well described.
Objectives: To assess the infarct characteristics at myocardial-tissue level and subsequent clinical outcomes in SMuRF-less STEMIs.
About one-third of patients undergoing transcatheter aortic valve implantation (TAVI) use oral anticoagulants (OAC), mainly due to atrial fibrillation. General guidelines advise interrupting OAC in patients with a high risk of bleeding undergoing interventions. However, preliminary observational data suggest that the continuation of OAC during TAVI is safe and may reduce the risk of periprocedural thromboembolic events.
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