Journal of Clinical Medicine

Editorial

Jump to: Research, Review

4 pages, 180 KiB

Open AccessEditorial

TAVR, SAVR and MI-AVR. Good Things Come to Those Who Wait

by Antonio Piperata, Marco Gemelli, Vjola Jorgji, Gino Gerosa and Tomaso Bottio

J. Clin. Med. 2020, 9(11), 3392; https://doi.org/10.3390/jcm9113392 - 23 Oct 2020

Cited by 3 | Viewed by 2384

Abstract

Modern medicine uses a combination of advanced technology and established knowledge to reach its ultimate goal: healing patients while limiting risks and preventing disease [...] Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

Research

Jump to: Editorial, Review

10 pages, 1087 KiB

Open AccessArticle

Rota-Lithotripsy—A Novel Bail-Out Strategy for Calcified Coronary Lesions in Acute Coronary Syndrome. The First-in-Man Experience

by Adrian Włodarczak, Piotr Rola, Mateusz Barycki, Jan Jakub Kulczycki, Marek Szudrowicz, Maciej Lesiak and Adrian Doroszko

J. Clin. Med. 2021, 10(9), 1872; https://doi.org/10.3390/jcm10091872 - 26 Apr 2021

Cited by 12 | Viewed by 2037

Abstract

Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed [...] Read more.

Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed a rota-lithotripsy—a combination of rotational atherectomy with subsequent intravascular lithotripsy—as a novel bail-out strategy to facilitate stent delivery in a tortuous calcified coronary artery. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

12 pages, 2630 KiB

Open AccessArticle

Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion

by Peter Tajti, Mohamed Ayoub, Thomas Nuehrenberg, Miroslaw Ferenc, Michael Behnes, Heinz Joachim Buettner, Franz-Josef Neumann and Kambis Mashayekhi

J. Clin. Med. 2021, 10(7), 1486; https://doi.org/10.3390/jcm10071486 - 3 Apr 2021

Cited by 2 | Viewed by 1723

Abstract

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, [...] Read more.

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), p < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), p < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), p < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), p < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

9 pages, 611 KiB

Open AccessArticle

Clinical Outcomes after Additional Dynamic Renal^® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

by Bachir Abdulrahman, Kambis Mashayekhi, Péter Tajti, Miroslaw Ferenc, Christian Marc Valina, Willibald Hochholzer, Franz-Josef Neumann and Thomas Georg Nührenberg

J. Clin. Med. 2020, 9(12), 3964; https://doi.org/10.3390/jcm9123964 - 7 Dec 2020

Cited by 2 | Viewed by 1899

Abstract

Background: Interventional treatment of aorto-ostial coronary stenoses is limited by stent recoil and suboptimal angiographic results, leading to restenosis and frequent re-interventions. As a potential bail-out strategy for stent recoil, implantation of an additional stent to increase radial force has been reported. Thus, [...] Read more.

Background: Interventional treatment of aorto-ostial coronary stenoses is limited by stent recoil and suboptimal angiographic results, leading to restenosis and frequent re-interventions. As a potential bail-out strategy for stent recoil, implantation of an additional stent to increase radial force has been reported. Thus, we sought to investigate clinical outcomes after additional implantation of a Dynamic Renal^® stent (DRS), a non-coronary; bare-metal stent with very high radial force, in aorto-ostial coronary stenoses. Methods: Patients treated by implantation of DRSs for stent recoil in the ostial right coronary artery or the left main stem were identified from the hospital database. Baseline clinical and procedural characteristics were compared to patients who underwent re-intervention for in-stent-restenosis in similar segments by either implantation of conventional drug-eluting stents (DES) or paclitaxel-coated balloons (PCB). Clinical follow-ups were performed up to three years following re-intervention with the assessment of death, target lesion reintervention (TLR), and major adverse cardiac events (MACE) as a combination death, myocardial infarction and target vessel revascularization. Kaplan–Meier analyses were performed for event-free survival between the three groups. Results: Between 05/2013 and 07/2019, 28 patients underwent DRS implantation of aorto-ostial coronary lesions. In comparison with 49 patients with DES implantation and 29 patients undergoing PCB treatment, no relevant differences in baseline parameters were identified. Median follow-up was 714 days, with an available follow-up of >1 year after intervention in 82.1% of patients. In the entire study cohort at two years after re-intervention, the TLR rate was 16% (17 patients), the MACE rate 37% (39 patients), and all-cause mortality 9% (10 patients), with no significant differences between the three groups. Conclusions: DRS implantation for treating stent recoil of aorto-ostial coronary lesions resulted in a high rate of TLR, and was associated with similar risk for death and MACE compared to treatment of in-stent-restenosis with DES or PCB. Randomized, larger comparisons of contemporary DES in patients exclusively presenting with stent recoil are necessary to further define the efficacy and safety of this approach. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

11 pages, 463 KiB

Open AccessArticle

The Impact of Valvuloarterial Impedance on Left Ventricular Geometrical Change after Transcatheter Aortic Valve Replacement: A Comparison between Valvuloarterial Impedance and Mean Pressure Gradient

by Satoshi Yamaguchi, Yuka Otaki, Balaji K. Tamarappoo, Tetsuya Ohira, Hiroki Ikenaga, Jun Yoshida, Tarun Chakravarty, John Friedman, Daniel Berman, Florian Rader, Robert J. Siegel, Raj Makkar and Takahiro Shiota

J. Clin. Med. 2020, 9(10), 3143; https://doi.org/10.3390/jcm9103143 - 29 Sep 2020

Viewed by 2121

Abstract

Increase in left ventricular (LV) mass develops as a compensatory mechanism against pressure overload in aortic valve stenosis. However, long-standing LV geometrical changes are related to poor prognosis. The LV geometrical change occurs after transcatheter aortic valve replacement (TAVR). The present study aimed [...] Read more.

Increase in left ventricular (LV) mass develops as a compensatory mechanism against pressure overload in aortic valve stenosis. However, long-standing LV geometrical changes are related to poor prognosis. The LV geometrical change occurs after transcatheter aortic valve replacement (TAVR). The present study aimed to investigate the relationship between improvement in valvuloarterial impedance (Zva) and change in LV mass index (LVMI) and the ratio of LVMI to LV end-diastolic volume index (LVMI/LVEDVI). We compared these relationships to that between Zva and mean pressure gradient (MPG). Baseline and follow-up transthoracic echocardiograms of 301 patients who underwent TAVR from November 2011 to December 2015 were reviewed. Spearman correlation coefficient (ρ) was used to compare ΔLVMI and ΔLVMI/LVEDVI with Zva or MPG. The correlation between ΔZva and ΔLVMI (ρ = 0.47, p < 0.001) was superior to that between ΔMPG and ΔLVMI (ρ = 0.15, p = 0.009) (p for comparison < 0.001). The correlation between ΔZva and ΔLVMI/LVEDVI was statistically significant (ρ = 0.54, p < 0.001); in contrast, that of ΔMPG and ΔLVMI/LVEDVI was not. The improvement in Zva after TAVR was more closely related to LVMI and LVMI/LVEDVI reduction than MPG reduction. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Graphical abstract

11 pages, 2070 KiB

Open AccessArticle

Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

by Daniel Hernandez-Vaquero, Carlota Vigil-Escalera, Yvan Persia, Carlos Morales, Isaac Pascual, Alberto Domínguez-Rodríguez, Emiliano Rodríguez-Caulo, Manuel Carnero, Rocío Díaz, Pablo Avanzas, Cesar Moris and Jacobo Silva

J. Clin. Med. 2020, 9(9), 2964; https://doi.org/10.3390/jcm9092964 - 14 Sep 2020

Cited by 6 | Viewed by 2125

Abstract

The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient–prosthesis mismatch. Our aim was to compare the prevalence of this complication between [...] Read more.

The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient–prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient–prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient–prosthesis mismatch: OR = 0.5 (95% CI 0.3–0.9, p = 0.02). Both prostheses led to a similar risk of severe patient–prosthesis mismatch: OR = 0.9 (95% CI 0.3–2.8, p = 0.79). Both prostheses provide a very low risk of severe patient–prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Graphical abstract

14 pages, 2341 KiB

Open AccessArticle

Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study

by Isaac Pascual, Fernando Carrasco-Chinchilla, Tomas Benito-Gonzalez, Chi Hion Li, Pablo Avanzas, Luis Nombela-Franco, Manuel Pan, Ana Serrador Frutos, Xavier Freixa, Ramiro Trillo-Nouche, Rosa A. Hernández-Antolín, Leire Andraka Ikazuriaga, Ignacio Cruz-Gonzalez, Jose R. López-Mínguez, Jose L. Diez, Alberto Berenguer-Jofresa, Juan Sanchis, Valeriano Ruiz-Quevedo, Cristobal Urbano-Carrillo, Juan F. Oteo Dominguez, Maria R. Ortas-Nadal, Eduardo Molina Navarro, Xavier Carrillo, Juan H. Alonso-Briales, Felipe Fernández-Vázquez, Luis Asmarats Serra, Daniel Hernandez-Vaquero, Pilar Jimenez-Quevedo, Dolores Mesa, Tania Rodríguez-Gabella, Ander Regueiro, Amparo Martinez Monzonís, Luisa Salido Tahoces, Lara Ruiz Gomez, Blanca Trejo-Velasco, Victor M. Becerra-Muñoz, Carmen Garrote-Coloma, Estafanía Fernández Peregrina, Rebeca Lorca, Jose A. De Agustín, Miguel Romero, Ignacio J. Amat-Santos, Manel Sabaté, Ana B. Cid Alvarez, Jose M. Hernandez-Garcia, Javier Gualis, Dabit Arzamendi, Cesar Moris, Gabriela Tirado-Conte, Angel Sánchez-Recalde and Rodrigo Estevez-Loureiro Show full author list Hide full author list

J. Clin. Med. 2020, 9(6), 1792; https://doi.org/10.3390/jcm9061792 - 9 Jun 2020

Cited by 4 | Viewed by 2435

Abstract

Background: Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip^® between two groups according to [...] Read more.

Background: Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip^® between two groups according to LVEF. Methods: In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. Results: Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. Conclusion: FMR patients with LVEF <30% treated with MitraClip^® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

10 pages, 1299 KiB

Open AccessArticle

Safety and Efficacy of Embolic Protection Devices in Saphenous Vein Graft Interventions: A Propensity Score Analysis—Multicenter SVG PCI PROTECTA Study

by Wojciech Wańha, Maksymilian Mielczarek, Natasza Gilis-Malinowska, Tomasz Roleder, Marek Milewski, Szymon Ładziński, Dariusz Ciećwierz, Paweł Gąsior, Tomasz Pawłowski, Rafał Januszek, Adam Kowalówka, Michalina Kolodziejczak, Stanisław Bartuś, Marcin Gruchała, Grzegorz Smolka, Eliano Pio Navarese, Dariusz Dudek, Andrzej Ochała, Elvin Kedhi, Miłosz Jaguszewski and Wojciech Wojakowski Show full author list Hide full author list

J. Clin. Med. 2020, 9(4), 1198; https://doi.org/10.3390/jcm9041198 - 22 Apr 2020

Cited by 3 | Viewed by 2421

Abstract

Background: Evidence concerning the efficacy of the embolic protection devices (EPDs) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI) is sparse. The study was designed to compare major cardiovascular events of all-comer population of SVG PCI with and without EPDs at [...] Read more.

Background: Evidence concerning the efficacy of the embolic protection devices (EPDs) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI) is sparse. The study was designed to compare major cardiovascular events of all-comer population of SVG PCI with and without EPDs at one year of follow-up. Methods and results: A multi-center registry comparing PCI with and without EPDs in consecutive patients undergoing PCI of SVG. The group comprised 792 patients, among which 266 (33.6%) had myocardial infarction (MI). The primary composite endpoint was major adverse cardiac and cerebrovascular event (MACCE) defined as death, MI, target vessel revascularization (TVR), and stroke assessed at one year. After propensity score analysis, there were no differences in MACCE (21.9% vs. 23.9%; HR 0.91, 95% CI 0.57–1.45, p = 0.681, respectively) nor in secondary endpoints of death, MI, TVR, target lesion revascularization (TLR) and stroke at one year in EPDs PCI group vs. no-EPDs PCI group. Similarly, there were no differences between groups in the study endpoints at 30 days follow-up. Conclusions: There were no clinical benefit for routine use of EPDs during SVG PCI in short and long-term follow-up. Further studies are warranted to explore the effect of individual types of EPDs on clinical outcomes. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research

11 pages, 863 KiB

Open AccessReview

Reticulated Platelets in Medicine: Current Evidence and Further Perspectives

by Noé Corpataux, Kilian Franke, Alexander Kille, Christian Marc Valina, Franz-Josef Neumann, Thomas Nührenberg and Willibald Hochholzer

J. Clin. Med. 2020, 9(11), 3737; https://doi.org/10.3390/jcm9113737 - 20 Nov 2020

Cited by 10 | Viewed by 4189

Abstract

Reticulated platelets (RPs) are young thrombocytes, newly released from the bone marrow. The identification and quantification of these cells remained difficult for decades due to a lack of standardized preanalytical and analytical methods. With the introduction of automated hematology analyzers in clinical routine, [...] Read more.

Reticulated platelets (RPs) are young thrombocytes, newly released from the bone marrow. The identification and quantification of these cells remained difficult for decades due to a lack of standardized preanalytical and analytical methods. With the introduction of automated hematology analyzers in clinical routine, the determination of RPs, either as a total count or as a fraction, became more reliable, faster and more affordable. Currently, RPs are the focus of research in multiple clinical settings. In cardiovascular medicine, recent studies have focused on the relationship between RPs, coronary artery disease (CAD) and clinical outcomes, as well as the impact of RPs on the effects of antiplatelet therapy. Cohort studies showed increased levels of RPs in patients with acute coronary syndrome (ACS) or cardioembolic stroke. In patients with ACS, increased levels of RPs were also associated with an increased incidence of major ischemic cardiovascular events during follow-up. Further studies showed an association of levels of RPs with the antiplatelet response to less-potent P2Y12 inhibitors. In patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation, levels of RPs differed significantly depending on the achieved rhythm (sinus rhythm vs. recurrent atrial fibrillation). Levels of RPs appear to also be predictive for bleeding events in patients with various hematological diagnoses. Although no causal relationship has so far been proven, RP values have been associated with a large number of pathologies and clinical scenarios. This review summarizes the current evidence with regard to RPs and their potential diagnostic and prognostic value for noncardiovascular patients and for cardiovascular patients in particular. It describes further perspectives on how the testing of these cells might improve the treatment of cardiovascular patients. Full article

(This article belongs to the Special Issue New Frontiers in Cardiovascular Intervention)

► Show Figures

Figure 1

Journal Menu

Journal Browser

New Frontiers in Cardiovascular Intervention

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (9 papers)

Editorial

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI