Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage.

Objective: To evaluate the safety and feasibility of percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) and previous intracranial hemorrhage (ICH).

Methods: In an explorative, prospective, single-center, observational study, LAAO was performed in patients with previous ICH and AF using the Amplatzer Cardiac Plug device. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2Vasc score and the HAS-BLED score.

Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis.

Background: Elevated concentrations of troponin T have prognostic impact in patients with various cardiovascular diseases including those with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) has improved prognosis for patients without a surgical option. Whether this affects the prognostic value of preinterventional troponin T remains unclear.

Percutaneous edge-to-edge repair of mitral regurgitation as a bail-out strategy in critically ill patients.

Percutaneous edge-to-edge mitral valve repair using the MitraClip device has evolved as a new tool for the treatment of severe mitral valve regurgitation. This technique has been evaluated in both surgical low- and high-risk patients. The aim of this study was to assess the feasibility and efficacy of MitraClip implantation in critically ill, unstable patients with severe mitral regurgitation who would persistently need inotropes or who could not be weaned from a ventilator.

Objective quantification of aortic valvular structures by cardiac computed tomography angiography in patients considered for transcatheter aortic valve implantation.

Purpose: To test the ability of a model-based segmentation of the aortic root for consistent assessment of aortic valve structures in patients considered for transcatheter aortic valve implantation (TAVI) who underwent 256-slice cardiac computed tomography (CT).

Methods: Consecutive patients (n = 49) with symptomatic severe aortic stenosis considered for TAVI and patients without aortic stenosis (n = 17) underwent cardiac CT. Images were evaluated by two independent observers who measured the diameter of the aortic annulus and its distance to both coronary ostia (1) manually and (2) software-assisted.

The groin first approach for transcatheter aortic valve implantation: are we pushing the limits for transapical implantation?

Objective: Transcatheter aortic valve implantation (TAVI) is a therapeutic option for old and multimorbid patients with severe aortic stenosis. When applying the groin first approach by transfemoral implantation, patients in the transapical group are highly selected with even higher morbidity. We report outcome of the transapical group.

Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients?

Background And Purpose: Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population.

C-reactive protein kinetics and its prognostic value after transfemoral aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option in high-risk patients with severe aortic valve stenosis. The potential threat of a postinterventional infection is one of several life-threatening complications. We have analyzed C-reactive protein levels in all patients who underwent successful transfemoral aortic valve implantation between July 2009 and January 2011.

Improved procedural results after CoreValve implantation with the new AccuTrak delivery system.

Aims Of The Study: Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis in patients with unacceptable high-surgical risk. Recently, the new AccuTrak delivery system for improved deliverability of the CoreValve aortic bioprosthesis was launched. It has not yet been shown if the new delivery catheter leads to optimized positioning and improved procedural outcomes.

Percutaneous and surgical treatment of mitral valve regurgitation.

Background: Mitral valve regurgitation is the second most common clinically relevant valvular heart disease in adults, with an incidence of about 2% to 3% per year. Surgical mitral valve repair is the treatment of choice. Recent years have seen major advances in minimally invasive mitral valve surgery.

Incidence of late occurring bradyarrhythmias after TAVI with the self-expanding CoreValve(®) aortic bioprosthesis.

Objectives: Analysis of timing, type, electrocardiographic and patient characteristics of postinterventional bradyarrhythmias after CoreValve implantation.

Background: Transcatheter aortic valve implantation (TAVI) has become an accepted alternative to surgical therapy in patients with high risk. Among the major drawbacks of this procedure is the need for postprocedural permanent pacemaker implantation (PPM).

Continuous monitoring versus HOLTER ECG for detection of atrial fibrillation in patients with stroke.

Background And Purpose: Detection of atrial fibrillation is of vital importance because oral anticoagulation decreases the risk of a stroke by 64%. Current standards for stroke unit treatment require continuous electrocardiogram (ECG) monitoring for at least 24 h. Additionally, a 24-h HOLTER ECG (HOLTER) should be performed in selected patients.

Acute safety and 30-day outcome after percutaneous edge-to-edge repair of mitral regurgitation in very high-risk patients.

Percutaneous edge-to-edge mitral valve repair using the MitraClip device has evolved as a new tool for the treatment of severe mitral valve regurgitation. This technique has been evaluated in surgical low- and high-risk patients. Patients with advanced age, multiple morbidities, and heart failure will be the first to be considered for a nonsurgical approach.

Transcatheter aortic valve implantation after previous mechanical mitral valve replacement: expanding indications?

Background: Cardiac operation for severe aortic stenosis after previous mitral valve replacement is a surgical challenge in older patients with multiple morbidities. Transcatheter aortic valve implantation (TAVI) after previous mechanical mitral valve replacement has been considered a high-risk procedure, owing to possible interference with the mitral valve prosthesis.

Methods: Since August 2008, 5 female high-risk patients with severe aortic stenosis and previous mitral valve replacement (mean ± SD age, 80 ± 5.

Large atrial thrombus formation after MitraClip implantation: is anticoagulation mandatory?

Percutaneous mitral valve repair with the MitraClip system has evolved as a promising new technique for the non-surgical treatment of mitral regurgitation (MR). To date, few major adverse events have been reported in initial studies with this technique. The case is reported of a 70-year-old patient who underwent successful MitraClip implantation.

Usefulness of percutaneous aortic valve implantation to improve quality of life in patients >80 years of age.

Older patients with aortic stenosis cannot always be offered conventional surgical aortic valve replacement at an acceptable risk. Transcatheter aortic valve implantation (TAVI) is currently considered an alternative treatment option with lower periprocedural risks. However, its effect on post-TAVI quality of life and clinical improvement has not been systematically and prospectively evaluated in those of advanced age.

Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins.

Background: Transradial access for diagnostic and therapeutic coronary angiography gains more and more popularity because of its advantages over the femoral approach, enhancing patient comfort, reducing bleeding complications and duration of hospital stay. However, these benefits are overshadowed by an increased rate of radial artery (RA) occlusion. There are little data regarding the exact incidence, potential predictors and outcome of post-procedural RA occlusions.

Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease.

Background: Peripheral artery disease (PAD) is associated with high cardiovascular mortality and a poor quality of life. The AT1-receptor blocker telmisartan has been shown to have pleiotropic effects and it may also improve endothelial function. The aim of this study was to analyze the effects of telmisartan on absolute walking distance (WD) and endothelial function in patients with PAD.

Transcatheter closure of patent foramen ovale with radiofrequency: acute and intermediate term results in 144 patients.

Aims: Currently available devices for transcatheter closure of patent foramen ovale (PFO) which rely on a permanent implant have limitations, including late complications. The study objective was to evaluate the safety, feasibility, and effectiveness of the PFx Closure System, the first transcatheter technique for PFO closure without an implantable device.

Methods And Results: A prospective study of 144 patients was conducted at nine clinical sites from October 2005 through August 2007.

Significance of close surveillance of patients with peripheral arterial disease.

Background: Peripheral arterial disease (PAD) indicates generalized atherosclerosis but is still underdiagnosed and undertreated.

Methods: Data were collected from patients with PAD from the Department of Cardiology and Angiology, University of Heidelberg, Germany. The prevalence of cardiovascular risk factors and medication were documented.

Nitinol stent implantation in TASC A and B superficial femoral artery lesions: the Femoral Artery Conformexx Trial (FACT).

Purpose: To investigate the impact of nitinol stenting of superficial femoral artery (SFA) lesions with a maximum length of 10 cm (TASC-II A or B) on 1-year outcomes compared to a historical study cohort from the Femoral Artery Stent Trial (FAST).

Methods: Between January 2004 and August 2005, 6 study sites enrolled 110 symptomatic patients (75 men; mean age 68+/-9 years) with a single de novo >70% SFA lesion <10 cm long treated with the self-expanding nitinol Conformexx stent. The primary study endpoint was binary restenosis determined by duplex ultrasound at 12 months.

Treatment of iatrogenic femoral pseudoaneurysm by ultrasound-guided compression therapy and thrombin injection.

Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6,300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography.