Prognostic Value of 6-Minute Walk Distance in Patients Undergoing Percutaneous Coronary Intervention: a Veterans Affairs Prospective Study.

The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown. In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention.

Axillary Artery Hemostasis Post-Intra-Aortic Balloon Pump Failure.

Intra-aortic balloon pump via the axillary approach has been increasingly utilized to facilitate physical rehabilitation prior to definitive heart failure therapy. There is a high risk of device fracture with loss of arterial accessibility. Three cases are presented that demonstrate innovative arteriotomy hemostasis techniques for malfunctioning axillary intra-aortic balloon pumps.

Transcatheter aortic valve replacement 24 years after cardiac transplantation.

As patient survival after cardiac transplantation has improved over the course of the last several decades, clinicians are now faced with late complications. This includes aortic stenosis which, traditionally, has been treated with reoperative sternotomy and aortic valve replacement. Transcather aortic valve replacement (TAVR) offers a minimally invasive alternative in this high-risk population.

Impact of Valve Size on Prosthesis-Patient Mismatch and Aortic Valve Gradient After Transcatheter versus Surgical Aortic Valve Replacement.

Objective: Limited data is available about the effect of implanted valve size on prosthesis-patient mismatch (PPM) incidence and aortic gradient (AG) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We compared PPM incidence and postprocedural AG between TAVR and SAVR patients considering the impact of implanted valve size.

Methods: From March 20, 2012, to September 30, 2015, 563 consecutive patients underwent TAVR ( = 419) or isolated SAVR ( = 144).

Length of Stay After Transfemoral Transcatheter Aortic Valve Replacement: An Analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

Objectives: The goal of this study was to investigate the trends, predictors, and outcomes of delayed discharge (>72 h) after transcatheter aortic valve replacement.

Background: Length of stay post-transcatheter aortic valve replacement may have significant clinical and administrative implications.

Methods: Data from the Transcatheter Valve Therapy Registry were used to identify patients undergoing nonaborted transfemoral transcatheter aortic valve replacement who survived to discharge, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events.

Outcomes of Direct Transcatheter Aortic Valve Replacement Without Balloon Aortic Valvuloplasty Using a New Generation Valve.

Purpose: We investigated the outcomes of patients who underwent Transcatheter Aortic Valve Replacement (TAVR) with and without Balloon Aortic Valvuloplasty (BAV) using the SAPIEN 3 (S3) valve.

Methods: All patients who underwent TAVR using S3 valve were included. The primary outcomes were the incidence of stroke and significant paravalvular leak (PVL).

Drug-Eluting Balloons Versus Everolimus-Eluting Stents for In-Stent Restenosis: A Meta-Analysis of Randomized Trials.

Objectives: Individual randomized trials comparing drug-eluting balloons (DEB) versus everolimus-eluting stents (EES) for in-stent restenosis (ISR) were underpowered for clinical end-points. The objective of this study was to compare the clinical outcomes of DEB versus EES for any ISR.

Materials & Methods: Electronic databases were searched for randomized trials which compared DEB versus EES for any ISR (i.

Transcatheter Aortic Valve Replacement: Efficiency and Safety Improvements With Progressive Experience and Improved Technology.

Objective: Transcatheter aortic valve replacement is now commercially available for intermediate-risk, high-risk, or inoperable patients with severe aortic stenosis. In this study, we investigated change in the safety and efficiency of the transcatheter aortic valve replacement procedure at our institution and patient outcomes comparing our first 100, second 100, and last 100 patients.

Methods: From March 2012 to June 2016, 544 patients underwent transcatheter aortic valve replacement at our center.

Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database.

Background: Prior studies have shown that survivors of acute myocardial infarction (AMI) complicated by cardiogenic shock are likely to have increased risk of readmissions in the early post-discharge period. However, the contemporary prevalence, reasons, and predictors of 30-day readmissions are not well known.

Methods And Results: Hospitalizations for a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive, were identified in the 2013 and 2014 Nationwide Readmissions Databases.

Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention.

Background: Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians.

Methods: We performed a meta-analysis of observational studies and randomized, controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome.

Two-Decade Trends in the Prevalence of Atherosclerotic Risk Factors, Coronary Plaque Morphology, and Outcomes in Adults Aged ≤45 Years Undergoing Percutaneous Coronary Intervention.

Data are limited about the prevalence trends of risk factors, lesion morphology, and clinical outcomes of coronary artery disease in patients, aged ≤45 years, undergoing percutaneous coronary intervention (PCI), between the bare-metal stent (BMS; 1994 to 2002) and drug-eluting stent (DES; 2003 to 2012) eras. From the PCI database at the Cleveland Clinic, we identified 1,640 patients aged ≤45 years and without a history of coronary artery bypass grafting who underwent PCI from 1994 to 2012. There were 883 patients in the BMS era cohort with a mean follow-up period of 13.

Prescription of Guideline-Based Medical Therapies at Discharge After Carotid Artery Stenting and Endarterectomy: An NCDR Analysis.

Background And Purpose: Carotid artery revascularization was previously found to incrementally reduce stroke risk among patients with carotid stenosis treated with medical therapy. However, the frequency with which optimal medical therapies are used at discharge after carotid endarterectomy (CEA) and carotid artery stenting (CAS) is not known, and the influence of patient, operator, and hospital characteristics on the likelihood of prescription is poorly understood.

Methods: In a retrospective cohort study of 23 112 patients undergoing CAS or CEA between January 2007 and June 2012 at US hospitals participating in the CARE registry (Carotid Artery Revascularization and Endarterectomy), we examined antiplatelet therapy and statin utilization at discharge.

Bleeding complications of triple antithrombotic therapy after percutaneous coronary interventions.

Background: 5% of patients undergoing coronary stenting have an indication for anticoagulation. The aim of our study was to determine the bleeding rates and complications in patients on triple oral antithrombotic therapy (TOAT) after coronary stenting.

Methods: We studied patients who underwent coronary stenting in our institution between 2003-2013 and were started on TOAT.

Thyrotoxic Periodic Paralysis: A Concise Review of the Literature.

Background: Thyrotoxic periodic paralysis (TPP) is a rare disease entity highlighted by hypokalemia, flaccid paralysis, and thyrotoxicosis. It usually presents as sudden profound muscle weakness manifested as almost complete immobility and can affect proximal and distal limb muscles, respiratory musculature as well as the cardiac conduction system.

Methods: A comprehensive review of Thyrotoxic periodic paralysis from 1885 to date was carried out by an extensive and thorough literature research including but not limited to Pubmed, Medline and EMBASE.

Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry.

Objectives: The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013).

Background: The authors examined contemporary use and outcomes of PCI in patients with CS-AMI.

Methods: The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI.

SCAI/SVM expert consensus statement on carotid stenting: Training and credentialing for carotid stenting.

Carotid artery stenting (CAS) has become an integral part of the therapeutic armamentarium offered by cardiovascular medicine programs for the prevention of stroke. The purpose of this expert consensus statement is to provide physician training and credentialing guidance to facilitate the safe and effective incorporation of CAS into clinical practice within these programs. Since publication of the 2005 Clinical Competence Statement on Carotid Stenting, there has been substantial device innovation, publication of numerous clinical trials and observational studies, accumulation of extensive real-world clinical experience and widespread participation in robust national quality improvement initiatives [5].

Bioresorbable Stents: Is This Where We Are Headed?

Current drug-eluting stents (DES) have shown excellent safety and efficacy in various clinical settings. However, the presence of a permanent metallic scaffold remains an Achilles heel, with concerns for late stent thrombosis and the need for prolonged dual anti-platelet therapy. The bioresorbable vascular scaffold (BRS) has been termed the fourth revolution in interventional cardiology, with an ability to not only treat the coronary lesion, but also restore endothelial function after complete absorption.

Racial/Ethnic variation in carotid artery revascularization utilization and outcomes: analysis from the National Cardiovascular Data Registry.

Background And Purpose: It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA).

Methods: We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012.

Results: Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.

Pulmonary arteriovenous malformations presenting as platypnea-orthodeoxia in graft-versus-host disease.

This case highlights the utility of agitated saline studies during transesophageal echocardiography (TEE) for detection of pulmonary arteriovenous malformations (PAVM) as a viable alternative to contrast-enhanced imaging studies. By carefully studying each pulmonary vein individually during saline contrast studies, TEE is able to demonstrate and localize PAVM. In addition, this report represents the first documentation of PAVM arising as a complication of graft-versus-host disease after allogeneic hematopoietic stem cell transplant.

Carotid Artery Stenting: Operator and Institutional Learning Curves.

Despite rapid growth in the frequency that carotid artery stenting (CAS) is performed, there remain concerns regarding the steep learning curve associated with this procedure. This article reviews the evidence base supporting operator and institutional CAS learning curves and discusses their implications for the establishment and maintenance of competencies. Attempts are made to delineate minimum volume thresholds to attain these goals and means to enhance procedural safety without compromising patient access.