Publications by authors named "Ignacio Cruz Gonzalez"
Background: Procedural success following tricuspid transcatheter edge-to-edge repair (TEER) has been defined variably over time; however, the consequences of achieving a tricuspid regurgitation (TR) grade of 0/1+ are still unclear.
Objectives: This study aimed to assess the predictors and prognostic impact of achieving TR 0/1+ after TEER and its role in clinical events.
Methods: This multicenter registry included patients undergoing tricuspid TEER in 15 Spanish centers from June 2020 and May 2023.
: Mitral regurgitation (MR) is the second most common valve disease in Europe, and differences between men and women have been described in relation to aetiology or management, which might impact the decision for intervention and patients' clinical and economic outcomes. Thus, the objective was to analyse the burden of MR in Spain by aetiology and sex, and the management of all patients suffering from MR being admitted to hospital between 2016-2021. : An analysis was carried out with the Ministry of Health's database, including all patients in public and subsidised hospitals and defining two groups, general MR and those patients undergoing Transcatheter Edge-to-Edge repair (TEER), using a descriptive analysis of patients' characteristics, use of resources, and outcomes; standardised rates were calculated and observed outcomes were described.
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- A study evaluated the effectiveness of closing a patent foramen ovale (PFO) after a cryptogenic stroke, comparing those who had it done within 9 months (early closure) to those who had it done after 9 months (delayed closure).
- The research found no significant differences in recurrence rates of cerebrovascular events or systemic embolisms between the early and delayed closure groups, indicating similar outcomes regardless of when the procedure was performed.
- The results suggest that PFO closure might be beneficial even in patients with a cryptogenic event that occurred more than 9 months ago, challenging the notion that the timing of the closure is critical.
Article Synopsis
- The article reviews the 2023 activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology, highlighting key trends in interventional cardiology practices in Spain.
- A survey involving 119 hospitals revealed a slight decrease in diagnostic studies but an increase in percutaneous coronary interventions (PCI), with a notable rise in the use of drug-coated balloons and techniques for plaque modification.
- The findings indicate a stabilization in coronary interventions while showcasing a growth in complex procedures, particularly for valvular and nonvalvular structural heart diseases, with primary PCI becoming the leading treatment for myocardial infarction.
We describe a case of aortic rupture following transcatheter aortic valve implantation that was managed percutaneously.
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- A study assessed the procedural and early outcomes of transjugular transcatheter tricuspid valve replacement (TTVR) for patients with symptomatic tricuspid regurgitation using the LuX-Valve Plus system across 15 centers from January 2022 to February 2024.
- Among 76 patients with a median age of 78, the procedure significantly reduced tricuspid regurgitation, with 95% of patients showing improvement at one month.
- While there were some adverse events including 4 in-hospital deaths and some bleeding, overall survival at one month was high at 94.4%, and patients reported better functional status.
Article Synopsis
- Antithrombotic treatment (ATT) after left atrial appendage occlusion (LAAO) is debated, especially for patients at high bleeding risk.
- This study compared simplified ATT, which involves single antiplatelet or no treatment, to conventional ATT, including dual antiplatelet or anticoagulation therapy, in very high bleeding risk patients.
- Results showed no significant differences in major adverse outcomes between the two treatment groups; however, patients with a history of major bleeding had a lower incidence of major bleeding with the simplified ATT.
Article Synopsis
- The study aimed to explore outcomes of transcatheter patent foramen ovale (PFO) closure in patients over 60 years old, particularly looking at recurrent cerebrovascular events (CVE) and atrial fibrillation (AF).
- Involving 689 patients, the procedural success rate was high at 99.4%, but there were notable risks: 9.6% of patients died during follow-up, and diabetes and atrial septal aneurysm were linked to increased CVE events.
- The findings suggest that while most older patients experience low rates of CVE and AF post-procedure, factors like diabetes, atrial septal aneurysms, and increasing age are important in guiding clinical decisions regarding PFO closure.
Article Synopsis
- Left atrial appendage occlusion (LAAO) is becoming an important method for preventing strokes in patients with atrial fibrillation, with cardiac imaging being crucial for planning and follow-up.
- Recent advancements in cardiac computed tomography (CCT) have made it a preferred option over transesophageal echocardiography for assessing LAAO procedures, particularly in identifying device-related complications.
- This paper aims to standardize how to acquire and interpret CCT images after LAAO, addressing current inconsistencies and providing guidance based on expert consensus from specialists in Europe and North America.
Early and late hospital readmissions after percutaneous left atrial appendage closure.
Rev Esp Cardiol (Engl Ed)
August 2024
Article Synopsis
- Percutaneous left atrial appendage closure (LAAC) is a procedure to prevent blood clots in patients with nonvalvular atrial fibrillation, but there is limited information on readmission rates following the procedure.
- A study of 1419 patients found that 18.1% were readmitted within a year, primarily due to bleeding and heart failure, with specific health conditions increasing the likelihood of readmission.
- Both early and late readmissions were linked to a higher risk of mortality within two years, highlighting the importance of managing patient health before and after LAAC.
Article Synopsis
- The study aimed to determine the effectiveness and safety of low-dose direct oral anticoagulation (DOAC) compared to dual antiplatelet therapy (DAPT) in patients who underwent left atrial appendage occlusion (LAAO) for three months post-procedure.
- Conducted across three European sites, the ADALA trial faced challenges with participant recruitment due to the COVID-19 pandemic and was halted prematurely, involving only 90 patients.
- The main outcomes assessed included the rates of major bleeding and thromboembolic events, with the study analyzing patients who had a history of bleeding and various health profiles.
Background: Device-related thrombosis (DRT) is a common finding after left atrial appendage closure (LAAC) and is associated with worse outcomes. As women are underrepresented in clinical studies, further understanding of sex differences in DRT patients is warranted.
Methods And Results: This sub-analysis from the EUROC-DRT-registry compromises 176 patients with diagnosis of DRT after LAAC.
Early Nonprocedural Bleeding After Left Atrial Appendage Occlusion.
JACC Cardiovasc Interv
August 2024
Article Synopsis
- The study examined early nonprocedural bleeding in patients who underwent left atrial appendage occlusion (LAAO), finding that about 7% experienced bleeding unrelated to the procedure within three months, with more than half categorized as major bleeding.
- Key predictors for early bleeding included receiving dual antiplatelet therapy at discharge, a history of gastrointestinal bleeding, and multiple previous bleeding episodes.
- Furthermore, early nonprocedural bleeding was linked to a higher risk of all-cause mortality, emphasizing the serious implications of such events, regardless of their severity.
Article Synopsis
- Left atrial appendage (LAA) occluder embolization is a rare but critical complication occurring mostly within the first 24 hours after the procedure, with data collected from 67 centers on 108 patients.
- The management strategies included attempting percutaneous retrieval in 75% of cases, while 21.3% of patients underwent surgery without prior attempts, highlighting significant mortality rates associated with multiple retrieval attempts.
- Overall, a major adverse event rate of 43.5% was observed, underscoring the serious risks, including death, particularly following unsuccessful retrievals.
Article Synopsis
- - A new technique for aligning the valves during transcatheter aortic valve replacement with the Allegra valve is introduced, ensuring consistency in the procedure.
- - Slight rotation of the valve system is required before insertion, which helps in achieving proper alignment.
- - The Allegra valve features a permaflow system and radiopaque markings, allowing for small adjustments to be made before deploying the valve, enhancing accuracy.
Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study.
JACC Cardiovasc Interv
February 2024
Article Synopsis
- The COVID-19 pandemic led to significant treatment delays for patients needing transcatheter aortic valve replacement (TAVR), with a marked decrease in procedure volumes during the first two waves of the pandemic.
- The study analyzed TAVR case data from 130 centers in 61 countries, finding a 15% drop in cases during the first wave and 7% in the second, particularly affecting regions like Africa, Central-South America, and Asia.
- Factors such as hospital type (private vs public), urban vs rural location, low procedure volumes, a country's socioeconomic status, and stringent public health measures contributed to these reductions, highlighting the need for improved public health policies for future health crises.
Introduction And Objectives: Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD.
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- * In trials involving 44 patients, mostly older women, 95.5% showed clinical improvement, with significant gains in quality of life scores, functional class, and walking distance, while serious complications were rare.
- * After one year, the treatment led to a sustained reduction in symptoms and improved heart function, with 63.8% of patients experiencing complete relief from caval backflow, which is linked to lower levels of heart failure-related biomarkers.
Article Synopsis
- Left atrial appendage occlusion (LAAO) is a successful alternative to oral anticoagulants for patients with nonvalvular atrial fibrillation, and advancements in technology have made the procedure safer and more efficient.* -
- This study aimed to compare the safety and efficacy of an outpatient LAAO program versus a conventional hospital stay approach by analyzing 262 patients and measuring their outcomes after 30 days.* -
- Results showed a 99.6% success rate and similar safety profiles between the outpatient and conventional groups, with the outpatient group benefiting from a shorter hospital stay, indicating potential clinical and economic advantages.*
Article Synopsis
- This article reports on the annual activities of the Interventional Cardiology Association of the Spanish Society of Cardiology for 2022.
- A total of 111 centers participated, revealing a 4.8% increase in diagnostic studies and a significant 22% rise in PCIs on the left main coronary artery, while the overall PCI numbers remained stable.
- Key trends included a preference for the radial approach in 94.9% of cases, increased use of drug-eluting balloons and intracoronary imaging, and a continuous rise in noncoronary procedures, especially those related to heart valve and structural heart issues.