Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial).

OBJECTIVES: Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of 'Pre-close technique' to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. METHODS: A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. RESULTS: The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group (P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. CONCLUSIONS: Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.

Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial).

AIM: Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in-hospital and long-term mortality in patients undergoing surgical aortic valve replacement (SAVR). METHODS: PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66-74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes. RESULTS: During the 50 ± 31 months follow-up period, a total of 36 (24%) patients died. 30-day mortality, 1-year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0-2] vs. 2 [0.2-3]; p < .001) was significantly higher. CONCLUSION: Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.

Relationship between systemic immune-inflammation index and no-reflow in percutaneous coronary intervention for saphenous grafts.

Objective: In this study, we investigated the occurrence of no-reflow (NR) in percutaneous coronary intervention (PCI) for saphenous vein grafts (SVGs) and its relationship with a new systemic immune-inflammation index (SII) that determines inflammation. Methods: We studied 303 patients with acute coronary syndrome without ST elevation who underwent PCI for SVG disease. Results: NR formation during SVG PCI was significantly higher in patients with high SII (p < 0.001). NR occurrence was 12.8% when SII was ≤548 and 41.9% when SII was >548. Conclusion: Our study is the first to investigate SII as the state of inflammation and its effect on the SVG PCI. Patients with higher SII have a higher risk of NR during an SVG for PCI.

This study is about a type of surgery called bypass surgery, which is done to help when the heart is not working properly. During this surgery, doctors sometimes use veins in the leg to create new pathways for blood to flow around the heart. However, after a while these vessels can narrow or become blocked, so another procedure, stenting, is done to open them. Even after the stent is placed, the blood flow through the vein is sometimes not as good as it should be. This is called 'no reflow'. We wanted to investigate how often this problem occurs and whether it is related to a marker called the systemic immune-inflammation index (SII), which is a measure of inflammation in the body. We analyzed 303 patients who underwent stenting after a heart attack. We divided them into two groups according to their SII scores and investigated whether there was a difference in no-reflow occurrence between the two groups. We found that patients with a higher SII score were more likely to have no reflow during the stenting procedure, and an increased risk of no reflow if the SII score was above 548. This study was the first to look at SII and how it affects the stenting procedure for vessels used in bypass surgery.

The Association between the Extent of Late Gadolinium Enhancement and Diastolic Dysfunction in Hypertrophic Cardiomyopathy.

Background Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) patients is a frequent, yet poorly understood phenomenon. Purpose The purpose of this study is to assess the relationship between the myocardial fibrosis and diastolic dysfunction in patients with HCM. Materials and Methods We retrospectively investigated the impact of the myocardial fibrosis, as assessed by the extent of late gadolinium enhancement (LGE-%) on cardiac magnetic resonance imaging (CMRI), on diastolic dysfunction in 110 patients with HCM. The diastolic dysfunction was evaluated by the left atrial (LA) volume index measured on CMRI and lateral septal E/E' ratio calculated on echocardiography. Results : There was a moderate correlation between the LGE-% and LA volume ( r = 0.59, p < 0.0001). The logistic regression model of LGE-%, mitral regurgitation, and total left ventricular mass that investigated the independent predictors of LA volume identified LGE-% as the only independent parameter associated with the LA volume index ( ß = 0.30, p = 0.003). No correlation was observed between the LGE-% and E/E'( r = 0.24, p = 0.009). Conclusions Myocardial fibrosis in HCM patients is associated with a chronic diastolic burden as represented by increased LA volume. However, the fibrosis does not influence the E/E' ratio, which is a well-known parameter of ventricular relaxation, restoring forces, and filling pressure.

CHA2DS2-VASc score as a predictor of no-reflow phenomenon after saphenous vein graft percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes.

BACKGROUND: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) is associated with an increased risk of complications, particularly no­reflow phenomenon and distal embolization due to low patency rates. The CHA2DS2­VASc score is a clinical risk stratification tool used to predict thromboembolism events especially in patients with nonvalvular atrial fibrillation. AIM: The aim of this study was to investigate the relationship between the CHA2DS2­VASc score and no­reflow phenomenon after SVG PCI in patients with non-ST­segment elevation acute coronary syndromes (NSTE­ACS). METHODS: In this study, we included 268 patients diagnosed with NSTE­ACS who underwent PCI for SVG disease in our tertiary cardiovascular center. Patients were divided into 2 groups: group 1 without no­­reflow phenomenon (n = 190) and group 2 with no­reflow phenomenon (n = 78) following the intervention, and then compared based on CHA2DS2­VASc scores. RESULTS: The CHA2DS2­VASc score (P <0.001) was significantly higher in group 2, even though no significant difference regarding atrial fibrillation was observed between the study groups. The CHA2DS2­VASc score (P <0.001), degenerated saphenous vein graft (P = 0.006), and intraluminal thrombus (P <0.001) were found to be independent predictors of no­reflow phenomenon. Receiver operating characteristics analysis showed that a CHA2DS2­VASc score of 4 predicted no­reflow phenomenon with 67.9% sensitivity and 69.3% specificity. CONCLUSIONS: Our findings suggest that the CHA2DS2­VASc score can be an independent predictor of no­reflow phenomenon in patients undergoing SVG interventions. As a simple and easy­to­calculate score, it might be a useful assessment tool to predict no­reflow phenomenon before SVG interventions in patients with NSTE­ACS.