Publications by authors named "Rafael Vera-Urquiza"
Despite guideline-based recommendation of the interchangeable use of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) to guide revascularization decision-making, iFR/FFR could demonstrate different physiological or clinical outcomes in some specific patient or lesion subsets. Therefore, we sought to investigate the impact of difference between iFR and FFR-guided revascularization decision-making on clinical outcomes in patients with left main disease (LMD). In this international multicenter registry of LMD with physiological interrogation, we identified 275 patients in whom physiological assessment was performed with both iFR/FFR.
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- Paravalvular leak (PVL), conduction disturbances, and vascular complications are key issues following Transcatheter Aortic Valve Replacement (TAVR), leading to the development of third-generation heart valves like SAPIEN 3 and EVOLUT PRO to reduce these problems.
- A study involving 1,481 patients from six European centers found that SAPIEN 3 showed lower rates of PVL compared to EVOLUT PRO at various follow-up points, especially for low-grade PVL.
- However, no significant difference in severe PVL or 1-year survival rates was observed between the two devices, indicating that while PVL detection is high, both devices have similar outcomes in terms of serious complications and survival.
Background: The majority of randomized controlled trials of revascularization decision-making excludes left main coronary artery disease (LMD). Therefore, contemporary clinical outcomes of patients with stable coronary artery disease and LMD with proven ischemia remain poorly understood. The aim of this study was to assess the long-term clinical outcomes of physiologically significant LMD according to the treatment strategies of revascularization versus revascularization deferral.
View Article and Find Full Text PDFThere have been no studies comparing clinical outcomes of physiology-guided revascularization in patients with unprotected left main coronary disease (ULMD) between percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). The aim of this study was to assess the long-term clinical outcomes between PCI and CABG of patients with physiologically significant ULMD.
View Article and Find Full Text PDFTranscatheter aortic valve replacement (TAVR) is an established treatment for patients with symptomatic severe aortic stenosis. In recent years, an emphasis has been placed on simplification of the procedure. Balloon predilation was initially considered a mandatory step to cross and prepare the stenotic aortic valve, but several studies demonstrated the feasibility of performing TAVR without balloon valvuloplasty.
View Article and Find Full Text PDFBackground: Vascular and bleeding complications related to secondary femoral access site are frequent in patients undergoing transcatheter aortic valve replacement (TAVR), and their occurrence is associated to poorer outcomes. We aimed to evaluate the clinical impact of vascular closure devices (VCDs) for secondary femoral access hemostasis in TAVR procedures.
Methods: This was a multicenter study including 4031 patients who underwent TAVR (mean age, 81 ± 8 years; mean Society of Thoracic Surgeons [STS] score, 4.
Background: There is great degree of interobserver variability in the visual angiographic assessment of left main coronary disease (LMCD). Fractional flow reserve and intravascular ultrasound are often used in this setting. The use of instantaneous wave-free ratio (iFR) for evaluation of LMCD has not been well studied.
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- The study aimed to assess vascular complications (VCs) after transfemoral transcatheter aortic valve replacement (TAVR) using a crossover technique (COT) with new-generation devices.
- *The multicenter research involved 2,214 patients, comparing outcomes between those using COT and those who did not, revealing that while major VCs and mortality rates were similar, minor VCs and acute renal failure were more common in the COT group.
- *Ultimately, while COT did not show a significant advantage in reducing major complications, it may benefit high-risk patients, particularly those with obesity, suggesting a need for personalized treatment strategies.
Planning of percutaneous coronary interventions (PCI) is largely based on anatomical information obtained with invasive coronary angiography. Over the last decade, intracoronary information obtained from both imaging and physiological techniques has gradually gained recognition for this purpose. Yet, coronary computed tomography angiography (CCTA) is still ignored by most interventionalists as a tool in the planning of PCI strategies.
View Article and Find Full Text PDFObjectives: The aim of this study was to assess the long-term clinical outcomes of patients with left main coronary artery (LM) stenosis in whom treatment strategy was based on the instantaneous wave-free ratio (iFR).
Background: The overall safety of iFR to guide revascularization decision making in patients with stable coronary artery disease has been established. However, no study has examined the safety of deferral of revascularization of LM disease on the basis of iFR.
Background: Transfemoral approach has been commonly used as secondary access in transcatheter aortic valve replacement (TAVR). Scarce data exist on the use and potential clinical benefits of the transradial approach as secondary access during TAVR procedures. The objective of the study is to determine the occurrence of vascular complications (VC) and clinical outcomes according to secondary access (transfemoral versus transradial) in patients undergoing TAVR.
View Article and Find Full Text PDFIntroducciÓn: En estudios de medicina nuclear se ha observado que la disminución de la fracción de expulsión del ventrículo izquierdo (FEVI) se asocia con enfermedad coronaria trivascular; en resonancia magnética cardiaca (RMC) no se ha estudiado el papel que desempeña la disminución de la FEVI.
Objetivo: Evaluar la asociación entre la disminución de la FEVI y la isquemia cardiaca en pacientes con estudios de RMC con adenosina.
MÉtodo: Estudio transversal comparativo.
Objective: Identify risk factors that determine pneumonia development in patients who have undergone cardiac surgery.
Methods: Prospective study of a single cohort in a postoperative intensive care unit at a tertiary care center, encompassing all patients undergoing cardiac surgery from January to July 2014.
Results: 31 postoperative pneumonia cases were enrolled out of 211 patients (14.