RESUMEN
Concomitant mitral stenosis (MS) is present in 10% to 15% of all patients who underwent transcatheter aortic valve replacement (TAVR). Our aim is to assess outcomes of TAVR in patients with MS using a national database. The Nationwide Inpatient Sample database was used to identify patients who underwent TAVR from 2015 to 2020. We created 2 groups, patients with and those without MS. We then compared baseline characteristics, demographics, and in-hospital outcomes of the groups. Primary outcomes were in-hospital mortality, acute respiratory failure, and pacemaker placement. Secondary outcomes were length of stay and in-hospital costs. Our study indicates that patients with MS had greater incidence of acute respiratory failure (8.8% vs 4.89%, p = 0.001), complete heart block (13.54% vs 9.36%, p = 0.01), and permanent pacemaker placement (8.03% vs 6.03%, p = 0.05). In-hospital mortality was greater in the MS group; however, it was not statistically significant (1.32% vs 1.53%, p = 0.679).
Asunto(s)
Estenosis de la Válvula Aórtica , Estenosis de la Válvula Mitral , Insuficiencia Respiratoria , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/cirugía , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/epidemiología , Estenosis de la Válvula Mitral/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/cirugía , Factores de Riesgo , Resultado del Tratamiento , Mortalidad Hospitalaria , Insuficiencia Respiratoria/etiologíaRESUMEN
BACKGROUND: Clopidogrel is the most frequently used P2Y12 inhibitor as a component of the dual antiplatelet regimen in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Prior studies have shown the variable efficacy of clopidogrel due to genotypic differences in the CYP2C19 enzyme function, which converts clopidogrel to its active metabolite. The aim of this meta-analysis is to evaluate the effectiveness of genotype testing-guided P2Y12 inhibitor prescription therapy to patients after PCI for ACS compared to non-genotype guided conventional treatment. METHODS: A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. RESULTS: Seven studies with 9617 patients were included. Genotype-guided strategy arm included prasugrel or ticagrelor prescription to patients with loss of function (LOF) of CYP219 alleles (most commonly alleles being *2 and *3) and clopidogrel prescription to those without the LOF allele. The conventional arm included patients treated with clopidogrel without genotype testing. Comparison of genotype arm with conventional arm showed decreased major adverse cardiovascular events (MACE), improved cardiovascular (CV) mortality, and reduced incidence of myocardial infarction (MI) in the genotype arm, and a similar stroke incidence in the two arms. Regarding adverse events, the incidence of stent thrombosis was lower in the genotype arm than the conventional arm. CONCLUSION: Our analysis illustrates the possible advantages of genotype-guided P2Y12 inhibitor prescription strategy compared to non-genotype-guided strategy with reductions in MACE, CV mortality, MI, and stent thrombosis. This analysis can be used as a stepping stone to conducting further trials determining the efficacy of this treatment strategy in various ACS subtypes.
Asunto(s)
Síndrome Coronario Agudo , Infarto del Miocardio , Intervención Coronaria Percutánea , Antagonistas del Receptor Purinérgico P2Y , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/terapia , Clopidogrel/uso terapéutico , Humanos , Infarto del Miocardio/etiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Clorhidrato de Prasugrel/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Ticagrelor/uso terapéutico , Resultado del TratamientoRESUMEN
Cardiovascular disease is the leading cause of maternal mortality worldwide and has been increasing in prevalence over the last several decades. Pregnancy is associated with significant hemodynamic changes that can overwhelm the maternal cardiovascular reserve, and may exacerbate previously asymptomatic cardiovascular disease. Complications associated with these may cause substantial harm to both the mother and the fetus, and the management of these conditions is often challenging. Numerous novel treatments and interventions have demonstrated the safety and efficacy of managing these conditions outside of pregnancy. However, there are little data regarding their use in the pregnant population. In this review, we describe the common cardiovascular diseases encountered during pregnancy and discuss their management strategies, with a particular focus on the role of percutaneous, catheter-based therapeutic interventions.
Asunto(s)
Complicaciones Cardiovasculares del Embarazo , Cateterismo Cardíaco , Cardiología , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/terapiaRESUMEN
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, Pâ¯=â¯0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, Pâ¯=â¯0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica , Humanos , Alta del Paciente , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). BACKGROUND: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications. METHODS: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. RESULTS: Thirty-seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation. CONCLUSION: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
Asunto(s)
Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Marcapaso Artificial , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Humanos , Masculino , Factores de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
We present the diagnosis and treatment of a 90-year-old male with critical aortic stenosis and multiple medical comorbidities who underwent TAVR that was complicated by annular rupture.
Asunto(s)
Cardiopatías/cirugía , Ventrículos Cardíacos , Imagen Multimodal , Seno Aórtico , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Fístula Vascular/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/métodos , Ecocardiografía Transesofágica/métodos , Fístula/complicaciones , Fístula/diagnóstico , Fístula/cirugía , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Humanos , Masculino , Tomografía Computarizada Multidetector/métodos , Fístula Vascular/complicaciones , Fístula Vascular/diagnósticoRESUMEN
Atherosclerotic disease of the shaft of the internal mammary artery (IMA) is rare. This imaging series demonstrates that angiography or arterial duplex ultrasound before bypass surgery of the IMA should be performed even when considering the patient for an emergent bypass surgery.
Asunto(s)
Aterosclerosis/diagnóstico por imagen , Estenosis Coronaria/diagnóstico , Anastomosis Interna Mamario-Coronaria/efectos adversos , Arterias Mamarias/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico , Infarto del Miocardio con Elevación del ST/cirugía , Ultrasonografía Intervencional/métodos , Aterosclerosis/etiología , Aterosclerosis/cirugía , Angiografía Coronaria , Estenosis Coronaria/etiología , Estenosis Coronaria/cirugía , Electrocardiografía , Humanos , Masculino , Arterias Mamarias/trasplante , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Infarto del Miocardio con Elevación del ST/diagnóstico , StentsRESUMEN
Images illustrate 3D reconstruction CT showing fistula arising from the left main coronary artery draining into the superior vena cava. Additional angiographic images show the fistula before and after percutaneous closure with Amplatzer Vascular plugs.
Asunto(s)
Fístula Arteriovenosa , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Vena Cava Superior , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/fisiopatología , Fístula Arteriovenosa/cirugía , Femenino , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava Superior/anomalías , Vena Cava Superior/diagnóstico por imagenRESUMEN
Computed tomography angiogram confirmed the anomalous right coronary artery from pulmonary artery (ARCAPA) in a patient who presented with altered mental status and hypoxia due to opiate drug abuse. ARCAPA is exceedingly rare, with reported incidence of 0.002% in the literature. We present clinical images and describe the case management.