SUOH 03 Guidewire for the Management of Coronary Artery Dissection: Insights from a Multicenter Registry.

Background: In the setting of coronary artery dissection, both spontaneous and iatrogenic, fixing the intimal tear, usually with stent implantation, can be extremely challenging if the distal wire position has been lost. Common complications are mainly related to the inadvertent subintimal tracking of the guidewire while attempting to gain the distal true lumen. Aims: To report the registry results of using the SUOH 0.3 guidewire for managing coronary artery dissection in a real-world multicenter setting. Methods: The study population in this retrospective, multicenter, international registry included 75 consecutive patients who underwent PCI and required an antegrade wiring of a dissected coronary artery. Results: Successful use of SUOH 0.3 was achieved in 69 (92%) patients. The use of a microcatheter was associated with a significantly higher rate of TIMI 3 flow at the end of the procedure (no microcatheter: n = 17, 81%; microcatheter: n = 52, 96.3%; p = 0.017). The first recanalization attempt was made with the SUOH 03 guidewire in 48 (64%) cases, and it was successful in 42 (87%). The overall PCI success rate was reported in 72 (96%) patients, with no significant differences among patients with different origins, mechanisms, and locations of dissection. Conclusions: In this setting, the SUOH 0.3 guidewire provides high procedural success without additional complex techniques.

Edge-to-edge percutaneous mitral repair for functional ischaemic and non-ischaemic mitral regurgitation: a systematic review and meta-analysis.

AIM: Randomized controlled trials comparing the use of the MitraClip device in addition to guideline directed medical therapy (GDMT) to GDMT alone in patients with secondary mitral regurgitation (MR) have shown conflicting results. However, if these differences could be due to the underlying MR aetiology is still unknown. Therefore, we aimed to evaluate if the effects of percutaneous edge-to-edge repair with MitraClip implantation could differ in patients with ischaemic (I-MR) and non-ischaemic mitral regurgitation (NI-MR). METHODS AND RESULTS: PubMed, Embase, BioMed Central, and the Cochrane Central Register of Controlled Trials were searched for all studies including patients with secondary MR treated with the MitraClip device. Data were pooled using a random-effects model. Primary endpoint was the composite of all-cause death and heart failure-related hospitalization. Secondary endpoints were the single components of the primary endpoint, New York Heart Association functional Classes III and IV, and mitral valve re-intervention. Seven studies enrolling 2501 patients were included. Patients with I-MR compared with patients with NI-MR had a similar risk of the primary endpoint (odds ratio: 1.17; 95% confidence interval: 0.93 to 1.46; I2 : 0%). The risk of all-cause death was increased in patients with I-MR (odds ratio: 1.31; 95% confidence interval: 1.07 to 1.62; I2 : 0%), while no differences were observed between the two groups in terms of the other secondary endpoints. CONCLUSIONS: The risk of mortality after MitraClip implantation is lower in patients with NI-MR than in those with I-MR. No absolute differences in the risk of heart failure related hospitalization were observed between groups.

[Feasibility and safety of same-day discharge after elective transcatheter interventions: experience of a high-volume center]. / Fattibilità e sicurezza della dimissione in giornata per procedure elettive di cardiologia interventistica in un centro ad alto volume.

BACKGROUND: Safety of same-day discharge (SSD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD is rarely adopted in Italy, with a potential waste of resources and decrease of patient satisfaction. METHODS: In 2019 we implemented a strategy of SDD for all elective coronary procedures admitted to our Radial Unit. Patients were excluded from SDD in case of contraindications for radial access, known contrast allergy, known left main disease based on previous angiogram or coronary computed tomography scan, chronic total occlusions considered as target of revascularization. We assessed the feasibility and safety of this approach in consecutive patients treated at Humanitas Research Center. RESULTS: Out of 366 patients who were admitted electively to our Radial Unit, 152 (41.5%) underwent only diagnostic coronary angiography, while 214 underwent PCI. As expected, radial access was used in the vast majority of cases (361; 98.6%). Patients were mostly discharged in the same day (268; 73%), both after diagnostic (96.7%) and interventional (56.5%) procedures. Patients that were hospitalized at least for one night were older, had a higher cardiovascular risk profile and had a more complex coronary anatomy (left main or proximal left anterior descending artery disease, bifurcations, total occlusions). There were no significant differences between patients discharged and those who were admitted overnight with regards to 7- and 30-day hospital readmission. CONCLUSIONS: SSD is safe and feasible in the majority of patients after elective coronary procedures (both diagnostic angiography and PCI), and is not associated with increased hospital readmission at 7 and 30 days. On the basis of the current study, a wider SDD program will be implemented in 2020.

Dual antiplatelet therapy duration after percutaneous coronary intervention with drug-eluting stents: how short can we go?

Current guidelines recommend a duration of dual antiplatelet therapy (DAPT) with aspirin and oral P2Y12 receptor inhibitors following percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) of 6 months for most patients with stable coronary disease and of 12 months for most patients with acute coronary syndromes. Large evidence from randomised clinical trials of shorter DAPT regimens after PCI with newer-generation DES is now emerging in heterogenous patient population not selected on the basis of high bleeding risk as well as in patients at high bleeding risk. The scope of this review is to provide an update on the benefits and harms of these short DAPT regimens and to discuss future directions in DAPT strategies after PCI with newer generation DES.

[Ultralow-contrast transcatheter aortic valve implantation with an Acurate neo prosthesis in a patient with severe chronic kidney disease]. / Impianto transcatetere di valvola aortica Acurate neo con minimo utilizzo di mezzo di contrasto in un paziente con insufficienza renale cronica severa.

Chronic kidney disease patients undergoing transcatheter aortic valve implantation are at high risk of post-procedural acute kidney injury. In order to minimize this risk, a meticulous procedural planning is needed, as well as a multidisciplinary team of interventionalists and imaging specialists.We present the case of an ultralow contrast transcatheter aortic valve implantation with an Acurate neo self-expandable prosthesis in a patient with advanced chronic kidney disease.