AngioVac for Minimally Invasive Removal of Intravascular and Intracardiac Masses: a Systematic Review.

PURPOSE OF REVIEW: Management of intracardiac masses, such as right heart thrombi and catheter-related vegetations, can be challenging. Many patients are high-risk candidates for surgical extraction due to multiple comorbidities and risk of distal embolization. In this review, we highlight the advancements in percutaneous approaches for treatment of intracardiac masses utilizing AngioVac (AngioDynamic, Latham, NY). RECENT FINDINGS: With the Food and Drug Administration (FDA) approval of the AngioVac System in 2009, a growing body of evidence has proven it to be a feasible and effective tool to extract thrombi and masses from the iliocaval system and the right heart. In this review, we highlight the feasibility of AngioVac System (AngioDynamic, Latham, NY) based on the published cases series and registries. Future randomized controlled trials are needed to establish an algorithmic approach in treating intracardiac masses.

Drug-eluting versus nondrug peripheral vascular interventions.

Introduction: Drug-eluting (DRUG) peripheral vascular interventions (PVIs) are associated with higher patency rates than nondrug (NONDRUG) PVIs. Recent data raised safety concerns with using DRUG devices in PVIs. Material and methods: The study population was extracted from the 2016 Nationwide Readmissions Database using the International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for PVI, DRUG and NONDRUG devices, and in-hospital procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospitalization, acute kidney injury (AKI), amputation, compartment syndrome, vascular complications, bleeding, and blood transfusion. Propensity matching was used to adjust for baseline characteristics. Results: 49,883 discharged patients who underwent lower extremity arterial PVI were identified, 25.3% DRUG and 74.7% NONDRUG PVI. Mean age was 68.3 years and 40.6% were female. Critical limb ischemia was reported in 33.2%, claudication in 7.6%, and acute limb ischemia in 0.1%. In comparison to the NONDRUG group, the DRUG group was associated with lower in-hospital all-cause mortality (2.2 vs. 2.9%, p < 0.001), shorter length of index hospitalization (8.3 vs. 8.6 days, p = 0.001), bleeding (12.0% vs. 13.5%, p < 0.001), and need for blood transfusion (10.1% vs. 11.0%, p = 0.004). There was no significant difference in terms of AKI (17.3% vs. 18.0%, p = 0.10), amputation (15.3% vs. 15.4%, p = 0.63), compartment syndrome (0.5% vs. 0.6%, p = 0.07), or vascular complications (0.8% vs. 0.8%, p = 0.50). After propensity matching, the mortality benefit was no longer present. Conclusions: DRUG PVI was associated with lower in-hospital all-cause mortality, bleeding events and shorter length of index hospitalization and comparable vascular-related complications. However, this mortality benefit was no longer present after propensity matching.

Correlation Between Aortic Angulation and Outcomes of Transcatheter Aortic Valve Replacement With New-Generation Valves.

The aim of this study was to assess the correlation of aortic angulation (AA) on immediate postprocedural and long-term outcomes following transcatheter aortic valve replacement (TAVR) with new-generation valves. There is limited and conflicting data on the impact of AA on short- and long-term outcomes in patients undergoing TAVR. Available studies to date were done with first-generation valves. We assessed 179 patients who underwent TAVR with either a balloon-expandable or self-expandable valve at our institute from May 2014 to June 2017 and had multislice computed tomography scans available for AA evaluation. All included patients received a second- or third-generation valve. TAVR endpoints, device success, and adverse events were defined according to the Valve Academic Research Consortium-2 criteria. The mean AA of the study population was 49.05 ± 10.07. Patients were divided into 2 groups: AA <49 and AA ≥49, and then further subdivided by valve type. There were no difference in mean age, The Society for Thoracic Surgery (STS) score, or race distribution between the AA <49 and AA ≥49 groups. The preimplantation balloon valvuloplasty rate was higher in patients with AA ≥ 49 compared to patients with AA <49, (70% vs 55.1%, P = 0.04). There was no difference in re-hospitalization, pacemaker implantation, postprocedural aortic regurgitation or mortality between patients with AA <49 and AA ≥49 irrespective of valve type (P < 0.05). AA does not significantly affect short- or long-term outcomes in patients who undergo TAVR with new-generation balloon-expandable or self-expandable valves.

Misunderstood or Mistrusted? The Under-Utilization of the Wearable Cardioverter Defibrillator in Clinical Practice.

Annually in the United States, sudden cardiac death (including out-of-hospital cardiac arrests) is responsible for over 300,000 deaths, comprising 40%-50% of total mortality rates from cardiovascular disease. Among the highest-risk patients are those with ischemic and nonischemic cardiomyopathy who have a reduced left ventricular ejection fraction (≤ 35%-40%). However, not everyone is a candidate for an implantable cardioverter defibrillator. In 2002, the wearable cardioverter defibrillator (WCD) gained Food and Drug Administration approval for its efficacy in the prevention of sudden cardiac arrest or death in certain at-risk populations and has been making its way into national guidelines with Class IIa to IIb strength of evidence. Despite the prevalence of sudden cardiac death and the demonstrated efficacy of the WCD, this technology remains under-prescribed. This study seeks to explicate the potential causes for under-utilization of WCDs and offer means of overcoming barriers to its use. Among these reasons include confusion about the guidelines and when to prescribe, who can prescribe the device, and debate about whether the WCD is efficacious based on recent studies. Other social barriers to prescription include cost and adherence to therapy by the patient. This study sets the stage for further research on the improvement of education about the device and opens discourse about its prescription in clinical practice.

Atrial Fibrillation and Deterioration in Cognitive Function.

The link between atrial fibrillation and cognitive decline and dementia has gained interest of the medical community lately. More research is being conducted to prevent and or delay this morbidity as no curative therapy is available for cognitive decline and dementia. The exact mechanism of causation is unclear. Multiple pathophysiological mechanisms have been implicated. Lately, treatment for atrial fibrillation including anticoagulation and catheter ablation therapies have shown to decrease the risk of deterioration of cognitive function. In this review we summarize epidemiologic studies linking the association, potential mechanisms, and impact of various modalities of therapy of atrial fibrillation on cognitive function outcomes.

Aortic Stenosis in African Americans: Focus On Disparities in Treatment and Outcomes.

Aortic stenosis (AS) is the third most common type of cardiovascular disease after hypertension and coronary artery disease, and it carries a high mortality rate when left untreated. Risk factors include male sex, hypertension, tobacco use, advanced age, elevated LDL cholesterol, and coronary atherosclerosis. Definitive treatment for AS includes valve repair, either percutaneously or surgically; however, in aging populations corrective surgery carries increased risk. While research suggests that patients of some non-White ethnic groups, including African-Americans, are less likely than their Caucasian counterparts to have AS, these minority patients may experience may experience differences in the way they receive and accept care. This paper seeks to explicate the mechanisms of racial disparities among the African-Americans affected by aortic stenosis as they pertain to healthcare utilization, referral for valve replacement, acceptance of therapy, and overall treatment outcomes.

Cardiac hydatidosis presenting as an acute coronary syndrome.

A 56-year-old man presented as an acute coronary syndrome. A transthoracic echocardiography (TTE) performed to assess left ventricular (LV) function revealed multiple hydatid cysts in the right ventricular cavity compressing the interventricular septum. CT scan for chest and abdomen revealed similar cysts in right-lung apex and left lobe of liver. A polyvisceral involvement in the setting of multiple cardiac cysts suggested cardiac hydatidosis as the most probable diagnosis. CT coronary angiography was normal. A preoperative oral albendazole therapy was initiated. Later the patient underwent elective surgery, 'Evaculation of RV Hydatid Cysts and Obliteration of Cavity with Bovine Pericardium'. His postoperative recovery was good. Regular exercise, chest physiotherapy, a life-long anticoagulation therapy and antibiotic prophylaxis for invasive procedures were recommended. Patient was scheduled for regular follow-up, to check for any recurrences or late complications.