Outcomes and Complications of Mitral and Tricuspid Transcatheter Edge-to-edge Repair.

In the realm of innovative medical procedures, TEER (transcatheter edge-to-edge repair) has emerged as a promising field, showcasing significant growth and advancements. Mitral TEER has been performed for the last two decades; in contrast, tricuspid TEER is newer, with long-term outcomes pending. This article aims to provide a comprehensive review of the current literature, with a primary focus on outcomes and potential complications associated with both procedures.

Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta-analysis.

Background: Transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic approach among patients with symptomatic severe aortic stenosis irrespective of surgical risk. Data regarding sex-specific differences in the outcomes with newer generation valves are limited.

Methods: Electronic databases were searched for studies assessing sex differences in the outcomes of patients undergoing TAVR with newer generation valves (SAPIEN 3 or Evolut).

Antithrombotic Management for Transcatheter Aortic Valve Implantation.

Background: There have been significant changes in the optimal antithrombotic regimen post transcatheter aortic valve implantation (TAVI) after the results of major clinical trials in the past few years. Given the clinical importance of the optimal antithrombotic therapy post TAVI, we performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes, as well the current guideline recommendations and knowledge gaps.

Methods: We performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes.

Coronary steal syndrome caused by a large saphenous venous graft aneurysm with a fistula communicating to the right atrium managed by transcatheter closure.

A 71-year-old man with history of coronary artery disease status post coronary artery bypass grafting (CABG) in 1999 (left internal mammary artery-left anterior descending, saphenous venous graft [SVG]-diagonal, and SVG-right coronary artery [RCA], ascending aorta aneurysm [4.8 cm], infrarenal aorta aortic aneurysm status post endovascular aortic repair, heart failure with reduced ejection fraction of 25% status post cardiac resynchronization therapy-defibrillator) presented with decompensated heart failure. He was in monomorphic ventricular tachycardia; he was cardioverted and started on amiodarone and lidocaine.

Thrombectomy using AlphaVac for left atrial thrombus causing mechanical mitral valve obstruction and cardiogenic shock.

We present a 73-year-old female with history of rheumatic heart disease status post-mechanical mitral valve on warfarin, valvular atrial fibrillation, and alpha thalassemia who was admitted to an outside hospital with anterior ST-segment myocardial infarction. Coronary angiogram showed occluded left anterior descending artery (LAD) with acute thrombus status post-thrombectomy and balloon angioplasty.

Treatment of left main coronary artery compression in the setting of unpalliated congenital heart disease: a case series.

Background: Left main coronary artery compression syndrome (LMCS) is a well-characterized phenomenon resulting from compression of the left main coronary artery (LMCA) between the aorta and an enlarged pulmonary arterial trunk. The development of LMCS is usually described in the context of severe pulmonary arterial hypertension. Cases of LMCS, in the context of unpalliated congenital heart disease (CHD), are complex clinical scenarios that challenge traditional treatment paradigms.

Cardiogenic shock in a young woman with SCAD: The importance of early access to VA-ECMO in the community.

Spontaneous coronary artery dissection (SCAD) is a common cause of myocardial infarction in young and middle-aged women. Patients with SCAD present rarely with hemodynamic collapse and cardiogenic shock, requiring immediate resuscitation and mechanical circulatory support. Percutaneous mechanical circulatory support may serve as a bridge to recovery, decision or heart transplantation.

Intracoronary Imaging and Physiology to Guide PCI: Are We Ready for a Class I Guideline Recommendation?

Purpose Of Review: Over the last decade, there has been a plethora of evidence to support the utilization of intravascular coronary imaging and physiological assessment to guide percutaneous coronary interventions (PCI). While there is a class I recommendation for the use of coronary physiology to guide PCI, the use of intravascular coronary imaging remains a class IIa recommendation. Herein, we aimed to review the recent scientific evidence from major trials highlighting the consideration for a future class I guideline recommendation for the use of intracoronary imaging.

A Visual Depiction of Left Ventricular Unloading in Veno-Arterial ExtraCorporeal Membrane Oxygenation With Impella.

Left ventricular (LV) unloading has been associated with improved survival in patients treated with venoarterial extracorporeal membrane oxygenation. This case describes a patient with a COVID-19 infection who subsequently developed non-ischemic cardiomyopathy with an LV ejection fraction of 10% to 15% (baseline echocardiography). He did poorly in the outpatient setting and was admitted to an outside hospital with heart failure symptoms and was subsequently transferred to our hospital for escalation of care and consideration of advanced heart failure therapies.

Non-obstructive Plaque and Treatment of INOCA: More to Be Learned.

Purpose Of Review: A significant proportion of patients evaluated for chest pain have ischemia with non-obstructive coronary artery disease (INOCA). Studies have shown INOCA is associated with increased risk of major adverse cardiac events and significant burden on the health care system.

Recent Findings: While there is scarce scientific evidence on management of INOCA, the CorMicA trial showed that stratified medical therapy based on the type of INOCA improved patients' symptoms and quality of life.

Impact of COVID-19 on Management Strategies for Coronary and Structural Heart Disease Interventions.

Purpose Of Review: The COVID-19 pandemic has created unprecedented challenges globally, with significant strain on the healthcare system in the United States and worldwide. In this article, we review the impact of COVID-19 on percutaneous coronary interventions and structural heart disease practices, as well as the impact of the pandemic on related clinical research and trials. We also discuss the consensus recommendations from the scientific societies and suggest potential solutions and strategies to overcome some of these challenges.

Sex differences in outcomes of transcatheter edge-to-edge repair with MitraClip: A meta-analysis.

Background: Transcatheter edge-to-edge repair (TEER) with MitraClip improves outcomes among select patients with moderate-to-severe and severe mitral regurgitation; however, data regarding sex-specific differences in the outcomes among patients undergoing TEER are limited.

Methods: An electronic search of the PubMed, Embase, Central, and Web of Science databases for studies comparing sex differences in outcomes among patients undergoing TEER was performed. Summary estimates were primarily conducted using a random-effects model.

Coronary Microvascular Dysfunction in Patients with Non-Obstructive Coronary Arteries: Current Gaps and Future Directions.

There has been increasing interest in open artery syndrome, also known as ischemia with non-obstructive coronary arteries (INOCA). INOCA has been increasingly recognized as a heterogeneous clinical entity. Diagnostic evaluation of this heterogeneous entity, including invasive assessment, remains key to diagnose this clinical condition and provide the appropriate treatment.

Trends and differences in management and outcomes of cardiac arrest in underweight and obese acute myocardial infarction hospitalizations.

The influence of weight on in-hospital events of acute myocardial infarction complicated with cardiac arrest (AMI-CA) is understudied. To address this, we utilized the National Inpatient Sample database (2008-2017) to identify adult AMI-CA admissions and categorized them by BMI into underweight, normal weight, and overweight/obese groups. The outcomes of interest included differences in in-hospital mortality, use of invasive therapies, hospitalization costs, and hospital length of stay across the three weight categories.

Syndrome of Nonobstructive Coronary Artery Diseases: A Comprehensive Overview of Open Artery Ischemia.

Syndromes of cardiac ischemia with nonobstructive coronary arteries have been increasingly recognized as a clinical entity with heterogeneous clinical presentations, commonly encountered in women. Knowledge of pathophysiology and clinical risk factors is key to ensuring appropriate diagnostic evaluation and management for these often-neglected patients. In this review, we discuss the epidemiology, risk factors, and clinical presentations of these syndromes.