Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries.

Background: Preoperative management of patients with aortic stenosis (AS) who need noncardiac surgery (NCS) remains controversial. We sought to determine the impact of AS on the postoperative outcomes after NCS.

Methods And Results: Patients undergoing NCS with moderate AS (valve area: 1.

A comprehensive review of the PARTNER trial.

Objective: Percutaneous transcatheter aortic valve replacement was introduced in 2002, but its effectiveness remained to be assessed.

Methods: A prospective, randomized trial (the Placement of Aortic Transcatheter Valves, or PARTNER) was designed with 2 arms: PARTNER A (n = 699) for high-risk surgical patients (Society of Thoracic Surgeons score >10%, surgeon assessed risk of mortality >15%) and PARTNER B (n = 358, patients inoperable by assessment of 2 surgeons). PARTNER A patients were divided into femoral artery access transcatheter aortic valve replacement or none (n = 207), and then randomized to open aortic valve replacement (n = 351) or device (n = 348).

Left main coronary atherosclerosis progression, constrictive remodeling, and clinical events.

Objectives: The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies.

Background: Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor modification, little is known about the natural history and clinical sequelae of atherosclerosis progression within the LMCA.

Methods: In 340 patients with angiographic coronary artery disease who underwent serial intravascular ultrasound imaging to evaluate the effects of anti atherosclerotic therapies across 7 clinical trials, LMCA and epicardial disease progression was characterized.

Aortic valve and ascending aorta guidelines for management and quality measures: executive summary.

The Society of Thoracic Surgeons Clinical Practice Guidelines are intended to assist physicians and other health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. Moreover, these guidelines are subject to change over time, without notice.

Percutaneous paravalvular leak closure- imaging, techniques and outcomes.

Paravalvular leak (PVL) is a known complication of surgical and transcatheter valve replacement procedures. Patients most commonly present with congestive heart failure and/or hemolysis, and repeat surgical procedures to correct the PVL carries increased risk with reduced likelihood of success. As a result, percutaneous approaches to PVL closure have been developed, with a considerable emphasis on multimodality imaging for both diagnosis and procedural guidance in the cardiac catheterization laboratory.

Prospective ECG-triggered, axial 4-D imaging of the aortic root, valvular, and left ventricular structures: a lower radiation dose option for preprocedural TAVR imaging.

Background: Transcatheter valve interventions rely on imaging for patient selection, preprocedural planning, and intraprocedural guidance.

Objective: We explored the use of prospective electrocardiogram (ECG)-triggered 4-dimensional (4-D) CT imaging in patients evaluated for transcatheter aortic valve replacement (TAVR).

Methods: A total of 47 consecutive patients underwent 128-slice dual-source CT with wide-window dose-modulated prospective ECG-triggered, axial acquisition of the aortic root, reconstructed during diastolic and systolic cardiac phases.

Off-label closure during CLOSURE study.

Background: The role of percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke or transient ischemic attack remains controversial. Registry data have suggested considerable benefit of closure over medical therapy, but the prospective, randomized CLOSURE I trial found no benefit for device closure.

Methods: We compared patients enrolled into CLOSURE I to off-label closures performed during the study recruitment period at a single large institution and prospectively enrolled into an institutional registry of PFO closure.

Predictive value of renal resistive index in percutaneous renal interventions for atherosclerotic renal artery stenosis.

Background: The clinical benefit of percutaneous interventional therapies for atherosclerotic renal artery stenosis (ARAS) is still obscure. Randomized trials conducted on general patient populations provided unsatisfactory results in justifying the interventional treatment. In this study, the predictive value of renal resistive index (RRI) was retrospectively analyzed in identifying the patients who may benefit from renal angioplasty and stenting.

Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism.

Objectives: In this study, a meta-analysis of observational studies was performed to compare the rate of recurrent neurological events (RNE) between transcatheter closure and medical management of patients with cryptogenic stroke/transient ischemic attack (TIA) and concomitant patent foramen ovale (PFO).

Background: A significant controversy surrounds the optimal strategy for treatment of cryptogenic stroke/TIA and coexistent PFO.

Methods: We conducted a MEDLINE search with standard search terms to determine eligible studies.

Optimizing outcomes during left main percutaneous coronary intervention with intravascular ultrasound and fractional flow reserve: the current state of evidence.

Percutaneous coronary intervention (PCI) is an evolving indication for the treatment of unprotected left main coronary arterial (UMLCA) stenoses in selected individuals. Intravascular ultrasound (IVUS)-guided PCI within the epicardial coronary tree has been shown to improve acute procedural results and subsequent clinical outcomes. Similarly, fractional flow reserve (FFR) is rapidly gaining popularity as a means to guide the coronary interventionalist to embark upon a "physiological-based" revascularization strategy.

Role of echocardiography in percutaneous mitral valve interventions.

Intraprocedural imaging continues to evolve in parallel with advances in percutaneous mitral valve interventions. This didactic review uses several illustrations and rich intraprocedural videos to further describe and demonstrate the role of the most up-to-date echocardiographic and advanced imaging technologies in the patient selection and intraprocedural guidance of percutaneous mitral valve interventions. We will focus on 3 interventions: 1) percutaneous balloon mitral valvuloplasty for mitral stenosis; 2) transcatheter edge-to-edge repair of mitral valve regurgitation; and 3) transcatheter closure of periprosthetic mitral regurgitation.

Optimization of acquisition and contrast injection protocol for C-arm CT imaging in transcatheter aortic valve implantation: initial experience in a swine model.

To determine the optimal C-arm computed tomography (CT) protocol for transcatheter aortic valve implantation (TAVI) in swine. In 6 swine, C-arm CT was performed using 5-s ungated acquisition during sinus rhythm with aortic root (Method 1) or peripheral (Method 2) injection, and during rapid ventricular pacing with root injection (Method 3). Additionally, 24-s ECG-gated acquisitions were performed during sinus rhythm with root (Method 4) or peripheral (Method 5) injection.

Impact of diabetes on long-term mortality following multivessel percutaneous interventions: an insight into optimal statistical analysis.

Background: Several studies have demonstrated better long-term outcomes with drug eluting stents (DES) as compared to bare metal stents (BMS) among diabetics with coronary artery disease (CAD). A significant heterogeneity exists with respect to the optimal statistical strategy to analyze stent related data.

Methods: We used our percutaneous intervention (PCI) registry to identify all diabetics with CAD, who underwent PCI on two or more vessel territories between 2003 and 2009.

Transcatheter valve-in-valve implantation for failed balloon-expandable transcatheter aortic valves.

Objectives: This study sought to evaluate outcomes after implantation of a second transcatheter heart valve (THV-in-THV) for acute THV failure.

Background: Aortic regurgitation after transcatheter aortic valve replacement (TAVR) may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing.

Methods: Patients undergoing aortic balloon-expandable TAVR at 3 centers were prospectively evaluated at baseline, intraprocedurally, at hospital discharge, and annually.

Spotty calcification as a marker of accelerated progression of coronary atherosclerosis: insights from serial intravascular ultrasound.

Objectives: The purpose of this study was to determine atheroma progression in patients with spotty calcification.

Background: Although extensively calcified atherosclerotic lesions have been proposed to be clinically quiescent, the presence of spotty calcification within plaque has been reported to be associated with an increased incidence of ischemic cardiovascular events. The relationship between spotty calcification and disease progression has not been investigated.

Percutaneous coronary revascularization in coronary artery disease: lessons from a single center experience.

Objectives: To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD).

Background: It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment.

A practical guide to multimodality imaging of transcatheter aortic valve replacement.

The advent of transcatheter aortic valve replacement (TAVR) is one of the most widely anticipated advances in the care of patients with severe aortic stenosis. This procedure is unique in many ways, one of which is the need for a multimodality imaging team-based approach throughout the continuum of the care of TAVR patients. Pre-procedural planning, intra-procedural implantation optimization, and long-term follow-up of patients undergoing TAVR require the expert use of various imaging modalities, each of which has its own strengths and limitations.

Do bisphosphonates slow the progression of aortic stenosis?

Objectives: The aim of this study was to investigate the impact of bisphosphonates on the progression of aortic stenosis.

Background: Valvular calcification is associated with the development and progression of aortic stenosis. Bisphosphonates have been suggested to slow this progression.