The Aortic Prosthesis and Aortic Valve Bioprosthesis Trombosis as a Late Complication in Patients after the Bentall Procedure Followed by a Valve-in-Valve Transcatheter Aortic Valve Implantation.

Background: Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limited. Case presentation: We present the case of a 69-year-old male with a history of ViV-TAVI, who presented with symptoms of non-ST elevation myocardial infarction (NSTEMI) and transient ischemic attack (TIA). Computed tomography (CT) revealed thrombosis of the ascending aortic graft and aortic valve prosthesis. Transthoracic echocardiography (TTE) further confirmed new valve dysfunction, indicated by an increase in the aortic valve mean gradient. Treatment with low-molecular-weight heparin (LMWH) resulted in partial thrombus resolution. The multidisciplinary Heart Team opted against coronary angiography and recommended the long-term administration of vitamin K antagonists (VKAs). Follow-up CT showed the complete resolution of the thrombus. Conclusions: Thrombosis of the aortic graft and aortic valve following ViV-TAVI may be attributed to alterations in blood flow or mechanical manipulations during the TAVI procedure, yet it can be effectively managed with VKA therapy. CT is a valuable tool in coronary assessment in patients with NSTEMI and aortic valve and/or aortic graft thrombosis.

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.

Percutaneous Coronary Intervention for Chronic Total Occlusion-Contemporary Approach and Future Directions.

In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.

Growth Differentiation Factor 15 as a Predictor of the No-Reflow Phenomenon in Patients with ST-Segment Elevation Myocardial Infarction.

Growth differentiation factor 15 (GDF-15) and the no-reflow phenomenon are predictors of mortality after ST-segment elevation myocardial infarction (STEMI). We aimed to assess the relation between GDF-15 concentration on admission and the no-reflow phenomenon. The study was conducted prospectively among 80 consecutive STEMI patients who underwent primary PCI. No-reflow was defined as a corrected TIMI frame count > 27 and myocardial blush grade < 3 after PCI. GDF-15 was measured on admission. We assessed long-term (1.3 years) total mortality and the risk factors of no-reflow. The mean age was 65 (SD 12) years. Mortality rates were 2.5% and 7.5% for in-hospital and long-term observations, respectively. No-reflow occurred in 24% of patients. A negative correlation between TIMI flow after PCI and GDF-15 concentration (R = −0.2540, p = 0.023) was found. Receiver operating characteristic (ROC) analysis revealed GDF-15 as a predictor of no-reflow (AUC-0.698, 95%CI-0.552−0.843, p < 0.05). The multivariate logistic regression analysis revealed that the risk factors for no-reflow occurrence were higher age, a concentration of GDF-15 > 1503 pg/mL, lower systolic blood pressure, and higher troponin I concentration on admission. A higher concentration of GDF-15 can be used as an additional marker of ischemia/reoxygenation injury, subsequent no-reflow phenomenon, and worse long-term outcomes in patients with STEMI.

Serum Chemerin Concentration Is Associated with Proinflammatory Status in Chronic Coronary Syndrome.

BACKGROUND: Chemerin is an adipokine and a chemoattractant for leukocytes. Increased chemerin levels were observed in patients with coronary artery disease (CAD). We investigated associations between chemerin and biochemical measurements or body composition in CAD patients. METHODS: In the study, we included patients with stable CAD who had undergone percutaneous coronary intervention (PCI) in the past. All patients had routine blood tests, and their insulin and chemerin serum levels were routinely measured. Body composition was assessed with the DEXA method. RESULTS: The study group comprised 163 patients (mean age 59.8 ± years, 26% of females, n = 43). There was no significant difference in serum chemerin concentrations between patients with diabetes and the remaining ones: 306.8 ± 121 vs. 274.15 ± 109 pg/mL, p = 0.1. Chemerin correlated positively with the white blood cell (WBC) count, the neutrophil to lymphocyte ratio, hsCRP, all fractions of cholesterol, triglycerides, platelet count, fasting insulin, and c-peptide. Chemerin levels were also correlated with total fat mass but only in a subgroup with normal glucose metabolism. CONCLUSION: In patients with CAD, serum chemerin levels are correlated with inflammation markers, insulin resistance, and an unfavorable lipid profile. Correlation with fat mass is dependent on glucose metabolism status. Depending on the presence of diabetes/prediabetes, the mechanisms regulating chemerin secretion may be different.