Publications by authors named "Juan C Rama-Merchan"

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.
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Article Synopsis
  • This study investigates the agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in patients with intermediate stenosis in the left main coronary artery (LMCA), finding an 80% concordance between the two methods.
  • The research involved 300 patients and emphasized the role of intravascular ultrasound (IVUS) for assessing cases where FFR and iFR results disagreed, identifying minimal lumen areas as a factor in decision-making.
  • Over a 20-month follow-up, deferral of revascularization based on iFR and IVUS showed a lower incidence of major adverse cardiac events compared to those who underwent revascularization, suggesting that deferring treatment
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  • Paravalvular leaks (PVL) occur in 5-17% of patients after surgical valve replacement, especially in the mitral position, and if untreated, can lead to poor outcomes.
  • This study assessed the effectiveness and safety of percutaneous closure for mitral PVLs over a median follow-up of about 42 months, analyzing 128 procedures from 2010 to 2020.
  • Results showed a high success rate (89.8%) for the procedure, with significant improvements in patient outcomes and long-term survival, especially for those without complications like chronic kidney disease.
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Article Synopsis
  • The study aimed to evaluate the outcomes of elderly patients (over 75 years) undergoing percutaneous transluminal coronary intervention (PCI) using an antithrombotic strategy that considers their individual risks for bleeding and ischemic events.
  • The research included 1,064 patients and found that the incidence of major adverse cardiovascular events and bleeding was lower in this tailored treatment group compared to a control group, with no cases of stent thrombosis in those receiving shorter dual antiplatelet therapy.
  • The conclusion indicates that a risk-adjusted antithrombotic protocol for elderly patients after revascularization with the latest stent technology may lead to better health outcomes regarding both bleeding and ischemic events.
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Iodinated contrast media (CM) are the leading cause of acute renal failure of toxic origin. Between 21% and 50% of patients that receive them develop contrast-induced nephropathy (CIN). All prophylactic measures used so far have failed to provide effective prevention.

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Objectives: The aims of this registry were to determine the incidence, predictors, and prognostic value of periprocedural acute kidney injury (AKI) after left atrial appendage closure (LAAC).

Background: No data exist on the occurrence of AKI after LAAC.

Methods: A total of 355 patients undergoing LAAC were included in the study.

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Introduction And Objectives: Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality.

Methods: Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015.

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Purpose: We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation.

Methods: Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included.

Results: A total of 101 patients (median age 76 [IQR 69-80] years, 48% women, mean CHADS-VASc 5 ± 2; HAS-BLED 4 ± 1) were included.

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We present the case of a patient with a high-output fistula between the right superficial femoral artery and femoral vein after left atrial appendage closure successfully treated with a PK-Papyrus covered coronary stent using a 6F guiding catheter. To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting.

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Paravalvular leak (PVL) is an uncommon yet serious complication associated with the implantation of mechanical or bioprosthetic surgical valves and more recently recognized with transcatheter aortic valves implantation (TAVI). A significant number of patients will present with symptoms of congestive heart failure or haemolytic anaemia due to PVL and need further surgical or percutaneous treatment. Until recently, surgery has been the only available therapy for the treatment of clinically significant PVLs despite the significant morbidity and mortality associated with re-operation.

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Background: Mitral paravalvular leak (PVL) is a potential complication of surgical valve replacement procedures. Real-time 3D transesophageal echocardiography (RT-3DTEE) has emerged as an efficient tool for providing essential information about the anatomy of mitral PVLs compared with 2DTEE findings. The purpose of this study was to evaluate the utility of RT-3DTEE in the assessment of mitral PVLs.

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Pulmonary vein (PV) stenosis (PVS) is a known complication of PV isolation procedures for AF (atrial fibrillation). PV angioplasty and stenting have been used as an effective therapy for PVS, yet high rates of restenosis are common. Experience with intravascular ultrasound (IVUS) in evaluating the PVS morphological characteristics and appropriate stent deployment is very limited.

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The most common etiology of tricuspid stenosis is rheumatic, and in most cases it is associated with valvular regurgitation. Interestingly, there have been reports of tricuspid stenosis without associated valvular regurgitation, mostly related to pacemaker leads. Percutaneous tricuspid valvuloplasty may be a therapeutic alternative to surgery in cases of pure tricuspid stenosis without other concomitant valvulopathies.

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Fully bioresorbable vascular scaffolds (BVS) are a new approach to the percutaneous treatment of coronary artery disease. The BVS have not yet been fully tested in complex lesions, including chronic total occlusion (CTO). We report a CTO case successfully treated with a second-generation bioabsorbable drug-eluting scaffold.

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Objectives: The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions.

Background: Thick polymer-based BVS have different mechanical properties than thin second-generation DES. Data on the acute performance of BVS are limited to simple coronary lesions treated in trials with strict inclusion criteria.

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Introduction And Objectives: Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device.

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