The American journal of cardiology
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Multicenter Study Clinical Trial
Predictors of Paravalvular Regurgitation After Implantation of the Fully Repositionable and Retrievable Lotus Transcatheter Aortic Valve (from the REPRISE II Trial Extended Cohort).
Paravalvular leak (PVL) after transcatheter aortic valve replacement is associated with worse long-term outcomes. The Lotus Valve incorporates an innovative Adaptive Seal designed to minimize PVL. This analysis evaluated the incidence and predictors of PVL after implantation of the Lotus transcatheter aortic valve. ⋯ Significant independent predictors of PVL included device:annulus area ratio and left ventricular outflow tract calcium volume. When the prosthetic valve was oversized by ≥5%, the rate of mild or greater PVL was only 3%. In conclusion, the overall rates of PVL with the Lotus Valve are low and predominantly related to device/annulus areas and calcium; these findings have implications for optimal device sizing.
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Multicenter Study Comparative Study
Comparison of the Incidences of Complications After Second-Generation Cryoballoon Ablation of Atrial Fibrillation Using Vitamin K Antagonists Versus Novel Oral Anticoagulants.
Data evaluating the impact of the periprocedural administration of novel oral anticoagulants (NOACs) on complications in the setting of pulmonary vein (PV) isolation using cryoballoon (CB) is limited. In the present study, our aim was to analyze procedural characteristics and incidence of complications in those patients who underwent CB ablation for atrial fibrillation and the impact of NOACs on adverse events compared with vitamin K antagonists (VKAs). Consecutive patients with drug resistant atrial fibrillation who underwent PV isolation by CB as index procedure were retrospectively included in our analysis. ⋯ In both groups, the incidence of major complications was similar (group I [VKAs]: 7 patients [2.4%] vs group II [NOACs]: 2 patients [1.2%]; p = 0.5). In conclusion, CB ablation is a safe procedure for PV isolation and is associated with low complication rates. The incidence of adverse events in PV isolation using the second-generation CB with the periprocedural administration of NOACs is not significantly different than VKA treatment.
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Multicenter Study
Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Transcatheter Aortic Valve Replacement.
The main objective of this study was to investigate the incidence and magnitude of impact of heparin-induced thrombocytopenia (HIT) on outcomes of patients undergoing transcatheter aortic valve placement (TAVR). The impact of HIT on procedural outcomes after cardiac surgery has been described. We sought to investigate the incidence and outcomes of HIT after TAVR using the Nationwide Inpatient Sample (NIS) database. ⋯ Venous thrombosis/pulmonary embolism (OR 6.3, 95% CI 1.4 to 28.8, p = 0.01) and acute kidney injury (OR 6.1, 95% CI 2.8 to 13.1, p <0.001) were significantly associated with HIT. Patients who developed HIT also had a longer hospital stay (p <0.001) with the median hospital cost of 68,168 USD versus 50, 494 USD for the group without HIT (p <0.001). In conclusion, among patient who underwent TAVR, HIT was associated with higher risk of in-hospital mortality, venous thrombosis/pulmonary embolism, acute kidney injury, prolonged hospital stay, and increased cost.