Association Between Sarcopenia and Adverse Events Following Transcatheter Aortic Valve Implantation.

Background: Sarcopenia, the age-related loss of skeletal muscle mass/function, has been identified as a marker of frailty. We examined the association between sarcopenia and adverse events following transcatheter aortic valve implantation (TAVI).

Methods: A retrospective cohort study was conducted at Toronto General Hospital.

Periprocedural Outcomes of Fluoroscopy-Guided Patent Foramen Ovale Closure With Selective Use of Intracardiac Echocardiography.

Background: Recent randomized trials have confirmed the role of patent foramen ovale (PFO) closure in the secondary prevention of cryptogenic stroke. Guidelines have suggested a central role for intraprocedural imaging using intracardiac echocardiography (ICE). However, this modality may not be required to achieve safe and effective closure.

Clinical Outcomes After Percutaneous Patent Ductus Arteriosus Closure in Adults.

Background: There is little published data regarding percutaneous patent ductus arteriosus (PDA) closure in adults. We aim to describe the outcomes of adult patients undergoing PDA closure at a single tertiary referral centre.

Methods: All adults who underwent device PDA closure at our centre from 2001 to 2017 were identified and enrolled in the study.

Three-Year Outcomes From the Harmony Native Outflow Tract Early Feasibility Study.

Background: The Harmony transcatheter pulmonary valve (TPV) was designed for treatment of postoperative pulmonary valve regurgitation in patients with repaired right ventricular outflow tracts.

Methods: The Native TPV EFS (Early Feasibility Study) is a prospective, multicenter, nonrandomized feasibility study. Three-year outcomes are reported.

Cor Triatriatum Sinister with Secundum Atrial Septal Defect.

• Multimodality imaging identifies cor triatriatum sinister and its consequences. • Echocardiography is useful in defining a cor triatriatum sinister membrane. • Cor triatriatum sinister can have a variable clinical presentation.

Harmony Feasibility Trial: Acute and Short-Term Outcomes With a Self-Expanding Transcatheter Pulmonary Valve.

Objectives: This study sought to obtain in vivo data to confirm assumptions on device loading conditions and assess procedural feasibility, safety, and valve performance.

Background: The Harmony transcatheter pulmonary valve (Medtronic, Minneapolis, Minnesota) was designed for patients with severe pulmonary regurgitation who require pulmonary valve replacement.

Methods: Three sites participated in this first Food and Drug Administration-approved early feasibility study using an innovative device design to accommodate the complex anatomy of the right ventricular outflow tract.

Patient Selection Process for the Harmony Transcatheter Pulmonary Valve Early Feasibility Study.

This early feasibility study was designed to obtain in vivo data to confirm assumptions on device loading conditions of the Medtronic Harmony transcatheter pulmonary valve (TPV). Secondary objectives included procedural feasibility, safety, and valve performance. The Harmony TPV was developed for nonsurgical pulmonary valve replacement in non-right ventricle-pulmonary artery conduit patients.

Left Atrial Phasic Function and Its Association With Atrial Fibrillation in Patients After Transcatheter Aortic Valve Implantation.

Background: Left atrial (LA) size is a marker of prognosis in severe aortic stenosis (AS). The aims of this retrospective study were to assess the impact of transcatheter aortic valve implantation (TAVI) on the recovery of LA phasic function and to assess the relationship between LA function and new-onset atrial fibrillation (NAF) after TAVI.

Methods: In this retrospective cohort study, LA function was measured using biplane volumes and 2-dimensional (2D) speckle tracking echocardiography (STE) in 52 patients (median age, 81 years) with severe AS before TAVI and at midterm follow-up.

Initial clinical experience with the GORE CARDIOFORM ASD occluder for transcatheter atrial septal defect closure.

Objectives: To report the initial clinical experience with a novel atrial septal defect (ASD) closure device, the GORE CARDIOFORM ASD Occluder (GCO).

Background: Transcatheter closure has become the treatment of choice for secundum ASD. A wide range of occluder devices are available, but concern has been raised about the risk of cardiac erosion associated with rigid devices and future access to the left atrium METHODS: Retrospective chart review of patients treated with the GCO at three Canadian centers.

Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement.

Background: The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM).

Methods And Results: In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.

Transcatheter Pulmonary Valve Replacement With the Edwards Sapien System: The Toronto Experience.

Objectives: This study sought to review the outcomes for the Sapien and Sapien XT valves (Edwards Lifesciences, Irvine, California) for percutaneous pulmonary valve implantation (PPVI).

Background: PPVI has emerged as a viable alternative to surgery in patients with right ventricular (RV) outflow tract dysfunction. Limited data are available for the Sapien and Sapien XT valves in this setting.

Long-term outcome of unprotected left main stenting: a Canadian tertiary care experience.

Background: Coronary stenting is increasingly used to treat unprotected left main disease in selected patients. However, there is a paucity of data on the long-term outcome of these patients in a Canadian context outside of clinical trials.

Methods: We retrospectively reviewed all provincially-insured patients undergoing left main coronary stenting at a large tertiary referral centre from 2000-2011.

Association between drug-eluting stent type and clinical outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention.

Background: The comparative efficacy of first- vs second-generation drug-eluting stents (DESs) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) is unknown.

Methods: A retrospective analysis of consecutive patients undergoing PCI at a tertiary PCI center from 2007-2011 was performed, with linkage to administrative databases for long-term outcomes. CKD was defined as creatinine clearance (CrCl) < 60 mL/min.

Recovery of left ventricular mechanics after transcatheter aortic valve implantation: effects of baseline ventricular function and postprocedural aortic regurgitation.

Background: Impaired left ventricular (LV) myocardial deformation is associated with adverse outcome in patients with severe aortic stenosis (AS). The aim of this retrospective study was to assess the impact of transcatheter aortic valve implantation (TAVI) on the recovery of myocardial mechanics and the influence of postprocedural aortic regurgitation (AR).

Methods: Speckle-tracking echocardiography was used to assess multidirectional myocardial deformation (longitudinal and circumferential strain) and rotational mechanics (apical rotation and twist) before and at midterm follow-up after TAVI.

Experience with the Atrium Advanta covered stent for aortic obstruction.

Introduction: We sought to assess the efficacy, safety and clinical outcomes of the Advanta V12™ covered stent in management of coarctation of the aorta (CoA).

Materials And Methods: Stent functionality was assessed by review of angiographic imaging, clinical data at admission, discharge and at the last clinic visit, stent configuration on chest roentgenogram, radiation exposure, and complications.

Results: Between October 2009 and February 2012, 17 patients underwent stent implantation.

Complex Interventions in the Adult with Congenital Heart Disease: Percutaneous Solutions for Venous Baffles, Coronary Artery Fistulas, and Ruptured Sinus of Valsalva Aneurysms.

We describe 3 distinct ACHD lesions amenable to percutaneous repair: (1) venous baffle obstruction in transposition of the great arteries, (2) coronary artery fistulas, and (3) ruptured sinus of Valsalva aneurysms. For each entity, we chronicle the typical clinical scenario and indications for intervention to supplement the technical approach and potential pitfalls with treatment.

Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations.

Background: The crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry.

Antithrombotic therapy after coronary stenting in patients with nonvalvular atrial fibrillation.

Background: The safety and efficacy of triple therapy (TT; warfarin with dual antiplatelet therapy [DAPT]) in post-percutaneous coronary intervention (PCI) patients with atrial fibrillation (AF) are unclear. We aimed to determine whether TT is associated with a decreased stroke rate and an acceptable bleeding rate in this population.

Methods: This was a single-centre, retrospective study.

Long-term outcomes after percutaneous intervention of the internal thoracic artery anastomosis: the use of drug-eluting stents is associated with a higher need of repeat revascularization.

Background: There is a lack of data and absence of clear recommendations regarding the optimal treatment of lesions located at the anastomosis of internal thoracic artery (ITA) grafts and native coronary arteries (CAs). The objective of this study was to assess the long-term outcomes of percutaneous coronary intervention (PCI) at the ITA anastomosis according to delivered treatment, namely deployment of a drug-eluting stent (DES), bare-metal stent (BMS), or balloon angioplasty only (POBA).

Methods: We used a prospective PCI registry at a large Canadian teaching hospital to identify all patients who underwent PCI at the ITA-CA anastomosis between June 2000 and June 2010.

Inhibition of sPLA2 and endothelial function: a substudy of the SPIDER-PCI trial.

Background: Inflammation plays an important role in the pathophysiology of atherosclerosis and endothelial dysfunction, and occurs after percutaneous coronary intervention (PCI). We evaluated whether endothelial function is attenuated after PCI and if inhibition of secretory phospholipase A2 (sPLA2) activity augments endothelial function and coronary flow reserve (CFR) in these patients.

Methods: In the sPLA2 Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) study, patients undergoing elective PCI were randomized to receive Varespladib (Anthera Pharmaceuticals Inc, San Mateo, CA), an inhibitor of sPLA2, or placebo 3-5 days prior to PCI and for 5 days after PCI.

Clinical characteristics of coronary artery disease in adults with congenital heart defects.

Background: There are now more adults with congenital heart disease than children. This aging cohort is at risk for acquired heart diseases such as coronary artery disease (CAD). The purpose of the study was to examine the clinical features of the CAD in adults with congenital heart disease.

The sPLA2 Inhibition to Decrease Enzyme Release after Percutaneous Coronary Intervention (SPIDER-PCI) trial.

Background: Secretory phospholipase A(2) (sPLA(2)) may play a role in myonecrosis after elective percutaneous coronary intervention (PCI). Inhibition of this enzyme may have a beneficial effect. The central hypothesis of this study was that treatment with varespladib, a small-molecule inhibitor of sPLA(2) would reduce postprocedural release of cardiac biomarkers after elective percutaneous coronary intervention.

Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries.

Background: Conventional coronary angiography (CCA) may be inaccurate to distinguish between interarterial and septal subtypes of anomalous left coronary arteries (CAs).

Objective: We compared the classification of anomalous left CA arising from the right sinus of Valsalva (RSV) or right CA on the basis of multidetector computed tomography coronary angiography (MDCTCA) with the classification derived from CCA.

Methods: A retrospective review of 6000 consecutive electrocardiographic-gated MDCTCAs identified 15 cases of anomalous left main or left anterior descending CA arising from the RSV or right CA coursing between the aorta and the main pulmonary artery.

Transcatheter aortic valve implantation for high risk patients with severe aortic stenosis using the Edwards Sapien balloon-expandable bioprosthesis: a single centre study with immediate and medium-term outcomes.

Background: Transcatheter aortic valve implantation (TCAVI) is an emerging alternative therapy to open-heart surgery in high-risk patients with symptomatic aortic stenosis.

Methods: Between January 2007 and May 2009, 46 patients underwent TCAVI with the 23 mm or 26 mm Edwards Sapien bioprosthesis via either the transapical (TA-AVI) or transfemoral (TF-AVI) approach. All patients had an estimated operative mortality risk of >15%.

The ultimate proof of paradoxical embolism and a percutaneous solution.

Central venous catheters (CVCs) and ports are frequently used for the administration of total parenteral nutrition, antibiotics, and chemotherapeutic agents. Their use may be associated with serious complications, such as venous thrombosis, embolization, and catheter rupture. Catheter fragments most commonly embolize to the right atrium, right ventricle, and pulmonary artery (Surov et al.