Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin Prophylaxis: A Retrospective Single-Center Study.

BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.

The Cone Flare Crush Modified-T (CFCT) stenting technique for coronary artery bifurcation lesions.

BACKGROUND: The present study is a prospective observational single arm clinical investigation, with parallel bench test interrogation, aimed at investigating the technical feasibility, safety and clinical outcomes with the cone flare crush modified-T (CFCT) bifurcation stenting technique. Bifurcation percutaneous coronary intervention (PCI) remains an area of ongoing procedural evolution. More widely applicable and reproducible techniques are required. METHODS: From April 2018 until March 2019, 20 consecutive patients underwent bifurcation PCI using the CFCT technique with a Pt-Cr everolimus drug-eluting stent with a bioresorbable polymer. Exercise stress echocardiography was performed at 12-month follow-up. The primary outcome was a composite of cardiac related mortality, myocardial infarction, target lesion/vessel revascularization and stroke. Safety secondary endpoints included bleeding, all-cause mortality and stent thrombosis. RESULTS: All patients underwent a successful CFCT bifurcation procedure with no complications to 30-day follow-up. One patient met the primary endpoint requiring target lesion revascularization at 9 months for stable angina. There were no other primary or secondary outcome events in the cohort. There were no strokes, deaths, stent thrombosis or myocardial infarction during the follow-up period. The mean CCS score improved from 2.25 to 0.25 (p < 0.0001). Optical coherence tomography (OCT) and bench test findings indicated optimal side branch ostial coverage and minimal redundant strut material crowding the neo-carina. CONCLUSIONS: The CFCT technique appears to be a safe, efficacious and feasible strategy for managing coronary artery bifurcation disease. Expanded and randomized datasets with longer term follow-up are required to further explore confirm this feasibility data. (ANZCTR ID: ACTRN12618001145291).

Dual visualization: a technique to simplify native vessel intervention in patients with bypass grafts.

We describe a case of stenting to a distal left anterior descending artery stenosis via the native vessel aided by contrast injection via a left internal mammary artery graft. This dual visualization technique allows good distal vessel opacification whilst minimising instrumentation of the internal mammary artery and its associated risks.

Treatment strategies for peripheral artery disease.

Peripheral arterial disease is an underecognized manifestation of systemic atherosclerosis associated with high rates of cardiovascular morbidity and mortality. The rationale of therapy is to reduce cardiovascular risk, improve symptoms of intermittent claudication, and prevent the development of critical limb ischemia and amputation. Exercise therapy and several pharmacologic agents have been shown to improve walking distance in patients with intermittent claudication. Patients with lifestyle-interfering symptoms despite exercise, or those who progress to critical limb ischemia, frequently undergo revascularization. Endovascular techniques are commonly used in these patients. Combined pharmacological and endovascular strategies will play an increasing role in management of these patients in the future.

Spontaneous coronary artery dissection: a review of the etiology and available treatment options.

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction and sudden cardiac death. We present a case of a 36-year-old female runner who was successfully thrombolysed for acute anterior ST elevation myocardial infarction. Coronary angiography revealed spontaneous dissection of the left anterior descending and diagonal arteries. The patient was treated medically with warfarin and dual antiplatelet therapy. Repeat angiography at 8 weeks showed significant angiographic improvement. Exercise stress testing at 10 months was normal and allowed a return to exercise. At 28 months the patient is asymptomatic and fully active. A review of the etiology and available treatment options is presented.

Percutaneous balloon mitral commissurotomy in indigenous versus non-indigenous Australians.

BACKGROUND: Rheumatic heart disease remains a serious health issue amongst the Australian indigenous population. Percutaneous balloon mitral commissurotomy (PBMC) has become the treatment of choice in patients with symptomatic pure mitral stenosis with favourable valve morphology. There is little published data on the efficacy of PBMC in indigenous Australians. AIMS: We sought to document differences between indigenous Australians (IA) and non-indigenous Australians (NIA) undergoing percutaneous balloon mitral commissurotomy (PBMC) at The Prince Charles Hospital and Holy Spirit Northside Hospital from 1990 to 2006. METHODS: PBMC was performed in 327 patients using the Inoue-balloon technique (271 female, 56 male, age +/-15 years (mean+/-S.D.), (range 13-89) between March 1990 and March 2006. RESULTS: The IA population was over represented in this cohort (11% versus an estimated 3.4% of the Queensland population) and comprised the largest non-Caucasian group. Compared with the NIA population they were younger (mean age 36 years (+/-13) versus mean 52(+/-14) years (P<0.05)). Baseline mitral valve area (MVA) was similar in the IA and NIA groups (0.96 cm(2) versus 1.08 cm(2)P=0.9). Mitral valve Echo-score was also similar between the two groups (mean score 7.36 versus 7.52 P=0.8). The IA population had higher pre-procedural mitral valve gradients (14.3 mmHg versus 11.1 mmHg, P<0.05), but less mitral valve calcification. Procedural success was achieved in 91% of both groups. Post procedural MVA (planimetry) was similar (1.98 cm(2) versus 1.84 cm(2)P=0.6), as was percent reduction in mitral valve gradient. Inadequate dilatation was seen in 1 (3%) IA and in 10 (3.6%) of the NIA group. Significant MR was seen in 2 (6%) IA patients and 11 (4%) NIA patients. There were no deaths or strokes or pericardiocenteses in either group. CONCLUSION: The indigenous population makes up a significant proportion of patients requiring PBMC in Queensland. They present younger and with higher mitral valve gradients. The procedure is safe in both the indigenous and non-indigenous Australian population. Further research is required to establish the long-term efficacy of this procedure in indigenous Australians.