High risk of coronary artery obstruction during TAVR, how to avoid it?

BACKGROUND: Coronary artery obstruction after percutaneous aortic replacement is a complication with high short-term mortality secondary to the lack of timely treatment. There are various predictors of coronary obstruction prior to valve placement such as the distance from the ostia, the degree of calcification, the distance from the sinuses; In such a situation some measures must be taken to prevent and treat coronary obstruction. CASE PRESENTATION: An 84-year-old male, with severe aortic stenosis and high surgical risk, who was treated with TAVR. However, during the deployment of the valve he presented hemodynamic instability secondary to LMCA obstruction. The intravascular image showed obstruction of the ostium secondary to the displacement of calcium that he was successfully treated with a chimney stent technique. CONCLUSIONS: The high degree of calcification and the left ostium near the annulus are conditions for obstruction of the ostium at the time of valve release; In this context, provisional stenting prior to TAVR in patients at high risk of obstruction should be considered as a safe prevention strategy to achieve the success of the procedure.

Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis.

Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional "20 de Noviembre"-ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01-1.53] vs. +0.90 [OR = 1.90, CI95% 1.56-2.32] vs. 0.73 [OR = 1.73, CI95% 1.36-2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11-1.87] vs. +0.35 [OR = 1.35, CI95% 1.00-1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22-1.94] vs. +0.41 [OR = 1.41, CI95% 1.13-1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics.

Neurological Manifestations and Outcomes in a Retrospective Cohort of Mexican Inpatients with SARS-CoV-2 Pneumonia: Design of a Risk Profile.

We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.

TAVI in Intermediate-risk patients: a review in purpose of a case / TAVI en pacientes de riesgo intermedio: una revisión a propósito de un caso

Abstract: Background: Aortic stenosis is the most common valvular heart disease worldwide. The prognosis is adverse without a valve replacement. Transcatheter aortic valve implantation (TAVI) has proven to be an effective treatment in high-surgical risk patients. Recent trials have highlighted the non-inferiority of TAVI compared with open surgery in patients with intermediate surgical risk. Case report: A 76-year-old man with severe aortic stenosis and intermediate surgical risk (STS-PROM 4.8%) who underwent TAVI with no complications. Results: Hospital discharge was decided five days after the procedure and continued outpatient follow-up. After two years remains in NYHA functional class I with a normofunctional percutaneous prosthesis. Conclusion: As this clinical case shows, TAVI has proven to be an effective treatment in patients with aortic stenosis and intermediate surgical risk. This is the first experience in this type of patients reported in our country.(AU)

Resumen: Antecedentes: La estenosis aórtica es la valvulopatía más común en todo el mundo. El pronóstico es sombrío sin reemplazo valvular. La implantación valvular aórtica transcatéter (TAVI) ha demostrado ser un tratamiento eficaz en pacientes de alto riesgo quirúrgico. Ensayos muy recientes destacaron la no-inferioridad de TAVI en comparación con la cirugía abierta en pacientes con riesgo quirúrgico intermedio. Caso clínico: Se presenta un hombre de 76 años de edad con estenosis aórtica severa y riesgo quirúrgico intermedio (STS-PROM 4.8%), al que se realiza TAVI sin complicaciones. Resultados: El alta hospitalaria se decide cinco días después del procedimiento para continuar el seguimiento ambulatorio. Después de dos años, el seguimiento permanece en la clase funcional I de la NYHA con una prótesis percutánea normofuncional. Conclusión: Como muestra este caso clínico, TAVI ha demostrado ser un tratamiento eficaz en pacientes de riesgo quirúrgico intermedio. Ésta es la primera experiencia en el uso de esta tecnología en este tipo de pacientes reportada en nuestro país.(AU)

Transcatheter transapical mitral valve-in-valve implantation: case report / Implantación transapical transcatéter de válvula protésica mitral (valve-in-valve): reporte de caso

Abstract: Introduction: The transcatheter mitral valve replacement has recently emerged as a new therapeutic tool in the field of structural interventionism, the experience is in an early stage of development and previously was nonexistent in our country. Case report: Woman of 85 years old, with mitral and aortic valve replacement with biological prosthesis 9 years ago, progresive deterioration of functional class, mitral dysfunction by pannus, with very high surgical risk, transcatheter transapical mitral "valve-in-valve" implantation is performed, being successful, with total remission of symptoms. Conclusions: This procedure can be performed with minimal morbidity and low mortality, clinical and hemodynamic results are favorable in the short and medium term, this is the first case reported in Mexico.

Resumen: Introducción: La sustitución de la válvula mitral percutánea ha surgido recientemente como una nueva herramienta terapéutica en el campo del intervencionismo estructural, la experiencia está en una etapa temprana de desarrollo y anteriormente era inexistente en nuestro país. Caso clínico: Mujer de 85 años de edad, con reemplazo valvular aórtico y mitral, con prótesis biológica hace nueve años, con deterioro progresivo de clase funcional. La mitral con disfunción de pannus, con muy alto riesgo quirúrgico. Se lleva a cabo la implantación mitral transapical transcatéter (valve-in-valve), exitosamente, con remisión total de síntomas. Conclusiones: Este procedimiento se puede realizar con una mínima morbilidad y baja mortalidad, los resultados clínicos y hemodinámicos son favorables en el corto y mediano plazos, este es el primer caso reportado en México.