The Journal of invasive cardiology
-
Case Reports
Bail-Out Use of Impella CP as a Bridge to TAVI in a Cardiogenic Shock Patient: The "Pump-Rewiring" Technique.
The optimal management of cardiogenic shock (CS) occurring in the presence of acute coronary syndromes, severe aortic stenosis, and poor left ventricular function has not been established. Recently, the availability of new assistance devices and techniques has provided novel management opportunities. In particular, when compared with surgical approaches, percutaneous procedures have the advantage of allowing "staged" interventions, in which different steps are planned according to the patient's evolving clinical conditions. ⋯ This case example demonstrates how a tailored step-by-step strategy including PCI, BAV, peripheral angioplasty, percutaneous ventricular assistance, and transcatheter aortic valve implantation (TAVI) allowed the successful treatment of a critical patient with CS. Impella CP could be considered an effective bridge to TAVI in patients developing aortic regurgitation after BAV, since maintaining arterial access can be achieved using the pump-rewiring technique.
-
To evaluate the safety and feasibility of transcatheter aortic valve implantation (TAVI) via femoral access under local anesthesia only (without concomitant sedation) as the initial strategy. ⋯ Our study suggests that TAVI with LA only as the initial strategy is a feasible alternative to GA, with potential benefit of this strategy over using routine concomitant sedation. LA only may be considered a primary option in many patients.
-
Review Meta Analysis
Ultrasound-Guided Catheterization of the Femoral Artery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
The goal of this meta-analysis was to determine the utility of real-time two-dimensional (2D) ultrasound guidance for femoral artery catheterization. ⋯ The use of real-time 2D ultrasound guidance for femoral artery catheterization decreases life-threatening vascular complications and improves first-pass success rate.
-
The purpose of the study was to examine survival in the implantable defibrillator subset of implanted leads at a large-volume implanting hospital. ⋯ This study demonstrated a significantly improved lead performance in the Boston Scientific and St. Jude leads as compared with Medtronic leads. Some lead construction variables (insulation and number of coils) also had a significant impact on lead failure, which was independent of the manufacturer. Recalled St. Jude leads performed better than recalled Medtronic leads in our study. Recalled St. Jude leads had no significant difference in lead failure when compared with the other manufacturer's non-recalled leads. Defibrillator recalled lead status was associated with an increased mortality as compared with non-recalled leads. This correlation was independent of the lead manufacturer and clinically significant even when considering known mortality risk factors. These results must be tempered by the largely unknown mechanism of death in these patients.
-
Acute kidney injury (AKI) stage II-III has been associated with a higher short-term and long-term mortality after transcatheter aortic valve replacement (TAVR). We present a patient with AKI where fluoroscopic landmarks and TEE imaging were used exclusively, sparing the patient a contrast load, and describe patient-tailored modifications.