Transcatheter aortic valve implantation amid the COVID-19 pandemic: a nationwide analysis of the first COVID-19 wave in the Netherlands.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. METHODS: We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. RESULTS: We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively). CONCLUSIONS: During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.

Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography.

AIMS: The consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as 'study cine', compared with conventional angiography. METHODS: Fifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81-0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm(2)/frame (53 % reduction, p < 0.001). CONCLUSION: This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.

Outcome and quality of life one year after percutaneous coronary interventions in octogenarians.

BACKGROUND: While percutaneous coronary intervention (PCI) is increasingly being performed in octogenarians, little is known about the quality of life (QOL) one year after PCI. We assessed the one-year outcome and QOL after PCI. METHODS: Outcome and QOL at one year were assessed in patients of 80 years and older who underwent PCI at our institution. We used the RAND-36 Health Survey to assess health-related QOL at follow-up. The EuroSCORE was used for reference risk assessment. RESULTS: Ninety-eight patients (mean age 82.7+/-2.9 years; 60% female) underwent PCI. Acute PCI was performed in 36% of the patients. Canadian Cardiovascular Society (CCS) angina class before the procedure was class III for 28% and class IV for 64%. Of the patients, 98% were in the highest-risk group (additive EuroSCORE 6+). The overall PCI success rate was 94%. Mortality at one year was 19% (38% acute vs. 12% elective PCI). At followup, general health was rated as fairly good and better then before PCI (CCS I and II: 77%). RAND-36 scores for the mental component were better than scores for the physical component. Physical functioning (41+/-28) and role limitations caused by physical health problems (32+/-37) had the worst scores. The mental component vitality had the lowest (55+/-20) and mental health the highest (70+/-21) score. Social functioning was in general good (67+/-26). CONCLUSION: Octogenarians have a high mortality risk following PCI, especially in acute PCI. In survivors QOL is acceptable with a better mental than physical score. In general, PCI in octogenarians has a positive effect on health perception, with less symptoms of angina pectoris. (Neth Heart J 2008;16:117-22.).

Acute myocardial infarction due to an acute type A aortic dissection involving the left main coronary artery.

We report a case of anterior myocardial infarction due to a Stanford type A aortic dissection involving the left main trunk of the coronary artery. Acute myocardial infarction due to extension of an acute Stanford type A aortic dissection is an infrequent but devastating situation. In our case a spontaneous aortocoronary dissection involving the Valsalva sinus and the ascending aorta with a history of hypertension is the most plausible cause. Emergent aortic replacement and revascularisation was performed. (Neth Heart J 2007;15:263-4.).

[Percutaneous closure of a perimembraneous ventricular septal defect: the first 4 patients in The Netherlands]. / Percutane sluiting van een perimembraneus ventrikelseptumdefect; de eerste 4 Nederlandse patiënten.

In four female patients, aged 30, 10, 8 and 2 years and 9 months (the latter with Down's syndrome), all with a perimembranous ventricular septal defect (VSD), percutaneous closure of the VSD was carried out using an Amplatzer endoprosthesis. These were the first 4 patients to undergo this procedure in The Netherlands. In 3 of the patients the procedure was without complications and complete occlusion of the defects was achieved. The last patient developed a left anterior hemiblock after implantation of the device and one week later an intermittent second degree atrioventricular block was detected, for which a pacemaker was implanted. A few days later the atrioventricular conduction time returned to normal. There was complete occlusion of the defect. Percutaneous closure of a perimembranous VSD using an Amplatzer prosthesis is a promising technique with good short-term results. In a selected group of patients this new technique can replace surgical treatment.

Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass.

Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right pneumonectomy through a right lateral thoracotomy in one operative session. To our knowledge, this is the first case in which this operative strategy was employed. CABG operations without the use of CPB might put concomitant lung surgery in a new perspective.

[Diagnostic image (175). A man with fast and irregular palpitations. Atrial fibrillation and Wolff-Parkinson-White syndrome]. / Diagnose in beeld (175). Een man met snelle, onregelmatige hartkloppingen. Atriumfibrilleren, met ook prikkelgeleiding over een anterograad geleidende accessoire verbinding.

A 51-year-old man with palpitations had fast, broad and irregular QRS complexes on his ECG, due to atrial fibrillation and Wolff-Parkinson-White syndrome.

Symptomatic congenital complete absence of the left pericardium. Case report and review of the literature.

A fully documented case of complete absence of the left pericardium in a 44-year-old male is presented. Complaints of acute chest pain were caused by strangulation of the heart between the pulmonary ligament and the diaphragm. Preoperative electrocardiogram, chest X-ray and echocardiography showed 'classic' signs as described in the literature. A CAT scan suggested absence of the left pericardium, the definitive diagnosis was made with the aid of thoracoscopy. This case of total absence of the left pericardium is the first documented one requiring thoracic surgery. The defect was closed through a left-lateral thoracotomy using an allograft of pig pericardium.