Publications by authors named "Pedro Cepas-Guillen"
Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in aortic stenosis patients. However, the factors associated with poorer outcomes among AF patients in contemporary TAVR practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.
Methods: Multicenter study including consecutive patients with a history of AF, evaluating the clinical outcomes and predictors of mortality, and HF-related hospitalization, who underwent TAVR with newer-generation devices using balloon or self-expandable valves.
Article Synopsis
Background: Procedural success following tricuspid transcatheter edge-to-edge repair (TEER) has been defined variably over time; however, the consequences of achieving a tricuspid regurgitation (TR) grade of 0/1+ are still unclear.
Objectives: This study aimed to assess the predictors and prognostic impact of achieving TR 0/1+ after TEER and its role in clinical events.
Methods: This multicenter registry included patients undergoing tricuspid TEER in 15 Spanish centers from June 2020 and May 2023.
The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk (HBR) in patients undergoing transcatheter aortic valve replacement (TAVR). The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale TAVR population. Multicenter study including 10,449 patients undergoing TAVR.
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- A study evaluated the effectiveness of closing a patent foramen ovale (PFO) after a cryptogenic stroke, comparing those who had it done within 9 months (early closure) to those who had it done after 9 months (delayed closure).
- The research found no significant differences in recurrence rates of cerebrovascular events or systemic embolisms between the early and delayed closure groups, indicating similar outcomes regardless of when the procedure was performed.
- The results suggest that PFO closure might be beneficial even in patients with a cryptogenic event that occurred more than 9 months ago, challenging the notion that the timing of the closure is critical.
Article Synopsis
- The study investigates the effectiveness and safety of using a 3D computational model fused with real-time fluoroscopy to guide left atrial appendage closure (LAAC) for patients with non-valvular atrial fibrillation.
- The research included 106 patients who underwent the procedure, achieving a 100% success rate for device implantation and meeting primary efficacy criteria in 89% of cases.
- The approach was deemed safe, with only 1.9% of patients experiencing major complications, suggesting that this technique could enhance LAAC outcomes.
Article Synopsis
- Patients with a heart condition called atrial fibrillation (AF) who have strokes can still be at very high risk of having more strokes, even when taking medication to prevent them.
- Left atrial appendage occlusion (LAAO) is a special procedure aimed at helping these patients avoid future strokes.
- A study compared two groups – one that had LAAO and one that only continued their usual medication – and found that there was still a risk of strokes in both groups over a two-year period.
Article Synopsis
- The study focused on monitoring electrocardiogram (ECG) changes during transcatheter aortic valve replacement (TAVR) using the CARA system, as conduction disturbances (CDs) are common complications.
- It involved 196 patients without prior CDs, measuring variations in PQ and QRS intervals throughout different phases of the TAVR procedure, including wire insertion and valve deployment.
- Results showed significant increases in PQ and QRS intervals and revealed that a majority of patients (82.4%) experienced at least one episode of conduction disturbance, particularly during critical steps like pre-dilatation and valve implantation.
Thrombocytopenia after transcatheter aortic valve implantation.
Rev Esp Cardiol (Engl Ed)
September 2024
Introduction And Objectives: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.
Methods: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *10/L.
Article Synopsis
- * Effective management of NSTE-ACS requires personalized treatment plans, including specific diagnosis, antithrombotic therapies, and timely invasive interventions, particularly for vulnerable groups like the elderly and those with chronic kidney disease.
- * Emphasizing a multidisciplinary approach, the review underscores the importance of cardiac rehabilitation and managing cardiovascular risk factors as key components for improving outcomes and preventing future issues in NSTE-ACS patients.
Article Synopsis
- Antithrombotic treatment (ATT) after left atrial appendage occlusion (LAAO) is debated, especially for patients at high bleeding risk.
- This study compared simplified ATT, which involves single antiplatelet or no treatment, to conventional ATT, including dual antiplatelet or anticoagulation therapy, in very high bleeding risk patients.
- Results showed no significant differences in major adverse outcomes between the two treatment groups; however, patients with a history of major bleeding had a lower incidence of major bleeding with the simplified ATT.
Article Synopsis
- The study aimed to validate the VARC-3 definition of neurologic events following transcatheter aortic valve replacement (TAVR) by analyzing their incidence, predictors, and clinical impact in a large sample of 2,924 patients.
- Out of the participants, 16.1% experienced neurologic events, predominantly periprocedural (58.6%), with strokes (NeuroARC type 1) being the most common type.
- Neurologic events were found to significantly increase the risk of mortality within one year, especially in cases of ischemic and hemorrhagic strokes, while transient ischemic attacks and delirium had no impact on survival.
Early and late hospital readmissions after percutaneous left atrial appendage closure.
Rev Esp Cardiol (Engl Ed)
August 2024
Article Synopsis
- Percutaneous left atrial appendage closure (LAAC) is a procedure to prevent blood clots in patients with nonvalvular atrial fibrillation, but there is limited information on readmission rates following the procedure.
- A study of 1419 patients found that 18.1% were readmitted within a year, primarily due to bleeding and heart failure, with specific health conditions increasing the likelihood of readmission.
- Both early and late readmissions were linked to a higher risk of mortality within two years, highlighting the importance of managing patient health before and after LAAC.
Article Synopsis
- Patients with cardiogenic shock (CS) and mitral regurgitation (MR) face high surgical risks, but the study investigates the effectiveness of transcatheter edge-to-edge therapy (TEER) combined with mechanical circulatory support (MCS) for these patients.
- The MITRA-ASSIST study looked at 24 patients with CS and MR treated with TEER and MCS across nine Spanish centers, revealing a procedural success rate of 95.8% and 87.5% in-hospital survival.
- At 12 months, 25% of patients died, and 33.3% experienced either death or hospitalization for heart failure, suggesting that TEER combined with MCS could be a viable treatment
Article Synopsis
- The study aimed to determine the effectiveness and safety of low-dose direct oral anticoagulation (DOAC) compared to dual antiplatelet therapy (DAPT) in patients who underwent left atrial appendage occlusion (LAAO) for three months post-procedure.
- Conducted across three European sites, the ADALA trial faced challenges with participant recruitment due to the COVID-19 pandemic and was halted prematurely, involving only 90 patients.
- The main outcomes assessed included the rates of major bleeding and thromboembolic events, with the study analyzing patients who had a history of bleeding and various health profiles.
Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent type of acute coronary syndrome in the elderly. Antithrombotic therapy is the cornerstone of pharmacological therapy in the setting of an acute ischemic event, a clinical scenario in which thrombotic and bleeding risks ought to be considered, particularly in older patients. In this article, specific aspects of antithrombotic therapy in elderly patients with NSTEMI are reviewed, including pharmacokinetic and pharmacodynamic characteristics and different clinical situations.
View Article and Find Full Text PDFEarly Nonprocedural Bleeding After Left Atrial Appendage Occlusion.
JACC Cardiovasc Interv
August 2024
Article Synopsis
- The study examined early nonprocedural bleeding in patients who underwent left atrial appendage occlusion (LAAO), finding that about 7% experienced bleeding unrelated to the procedure within three months, with more than half categorized as major bleeding.
- Key predictors for early bleeding included receiving dual antiplatelet therapy at discharge, a history of gastrointestinal bleeding, and multiple previous bleeding episodes.
- Furthermore, early nonprocedural bleeding was linked to a higher risk of all-cause mortality, emphasizing the serious implications of such events, regardless of their severity.
Article Synopsis
- Patients who underwent left atrial appendage occlusion (LAAO) have an increased risk of bleeding and thromboembolic events, leading researchers to investigate the role of hematological markers in predicting these risks.
- Data from 1,315 patients revealed that while the platelet count was somewhat associated with thromboembolic events, none of the hematological markers were linked to major bleeding events.
- Key factors influencing thromboembolism included age and previous thromboembolic history, while major bleeding risks were tied to prior events, renal disease, and dual antiplatelet therapy upon discharge.
Article Synopsis
- * Fixing PVL in TAVI patients is harder than in those with traditional heart surgery.
- * Using a special method called the arterial-arterial (A-A) rail technique helps doctors close PVL successfully by making it easier to use smaller tools.
Article Synopsis
- Transcarotid transcatheter aortic valve replacement (TC-TAVR) is being studied for its long-term outcomes, with a focus on 5-year clinical results in patients.
- A total of 110 patients were evaluated, revealing that 54.5% experienced adverse events, with notable rates of all-cause mortality (45.6%) and rehospitalization (27.2%).
- The study found persistent improvements in heart function, quality of life, and low rates of stroke, indicating TC-TAVR is a viable alternative for high-risk patients not suitable for traditional surgery.