Circulation. Cardiovascular interventions
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Circ Cardiovasc Interv · Dec 2012
Multicenter StudyPredictors of clinical outcomes in patients with severe aortic stenosis undergoing TAVI: a multistate analysis.
Patients with severe aortic stenosis at increased surgical risk continue to experience compromised long-term survival despite successful transcatheter aortic valve implantation. We used time-related pathways in a multistate analysis to identify predictors of adverse long-term outcome in patients who underwent transcatheter aortic valve implantation. ⋯ A body mass index ≤20 kg/m(2) was identified as a primary predictor of stroke and death after transcatheter aortic valve implantation during long-term follow-up, whereas transapical access emerged as a predictor of kidney injury and ABC. Age >80 years, body mass index ≤20 kg/m(2), prior stroke, and presence of atrial fibrillation at baseline increased the risk of stroke and death after an intercurrent event of ABC.
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Circ Cardiovasc Interv · Dec 2012
Multicenter StudyMelody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience.
Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure. ⋯ Transcatheter pulmonary valve implantation using the Melody valve within BPVs can be accomplished with a high rate of success, low procedure-related morbidity and mortality, and excellent short-term results. The findings of this preliminary multicenter experience suggest that the Melody valve is an effective transcatheter treatment option for failed BPVs.
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Circ Cardiovasc Interv · Dec 2012
Comparative StudyBivalirudin for primary percutaneous coronary interventions: outcome assessment in the Ottawa STEMI registry.
Data from randomized trials has demonstrated the superiority of bivalirudin to glycoprotein IIb/IIIa inhibitors plus heparin in patients undergoing primary percutaneous coronary intervention. Real-world performance of bivalirudin in primary percutaneous coronary intervention and the benefit of bivalirudin over heparin remain unknown in an era of routine dual antiplatelet therapy. ⋯ Bivalirudin use compared with glycoprotein IIb/IIIa inhibitors plus heparin as an antithrombotic strategy in primary percutaneous coronary intervention results in less major bleeding in contemporary practice. A benefit of bivalirudin over heparin could not be established with this registry and requires additional investigations to either confirm or refute.
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Circ Cardiovasc Interv · Dec 2012
Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.
Although balloon pulmonary angioplasty (BPA) for inoperable patients with chronic thromboembolic pulmonary hypertension was first reported over a decade ago, its clinical application has been restricted because of limited efficacy and complications. We have refined the procedure of BPA to maximize its clinical efficacy. ⋯ Our refined BPA procedure improves clinical status and hemodynamics of inoperable patients with chronic thromboembolic pulmonary hypertension, with a low mortality. A refined BPA procedure could be considered as a therapeutic approach for patients with inoperable chronic thromboembolic pulmonary hypertension.