Journal of Invasive Cardiology最新文献

Objectives. Anesthetic agents (general anesthesia [GA]) used during transcatheter aortic valve replacement (TAVR) have been observed to affect intracardiac pressures when measured by catheter and echocardiography. The authors hypothesized that, during GA-employed TAVR, there is significant reduction in the invasively measured aortic valve gradients (AVG) as a result of the GA.Methods. The authors performed a retrospective analysis of 298 patients undergoing TAVR. All patients had preoperative TTE and procedural AVG. Preprocedural AVG measured by TTE were compared to the AVG measured invasively after GA induction. The authors investigated the relationship between AVG discrepancy and the types of GA agents used and compared various hemodynamic parameters before and after GA induction.Results. There were statistically significant reductions in both the maximum (mean reduction: 16.99 mm Hg; P<.001; 95% CI, 14.70-19.27 mm Hg) and mean AVG (mean reduction: 7.084 mm Hg; P <.001; 95% CI, 5.672-8.496 mm Hg) when measured invasively under anesthesia compared with awake pre-anesthesia AVG by TTE. There were statistically significant reductions in blood pressure (mean reduction: 16.41 mm Hg; P <.001; 95% CI, 12.26-20.56 mm Hg) and heart rate (mean reduction: 6.299 bpm; P < .001; 95% CI, 3.735-8.863 bpm), and a statistically significant increase in stroke volume (mean increase: 8.212 mL; P < .001; 95% CI, 3.559-12.86 mL). Further linear regression analysis proved that the aforementioned AVG discrepancy is directly related to AS severity.Conclusions. In patients undergoing TAVR with GA, there is a significant reduction in AVG when compared with the preprocedural TTE measurements. This phenomenon is directly related to AS severity.

Objectives. The use of a microaxial flow pump (mAFP) to support high-risk percutaneous coronary intervention (HRPCI) in patients with cardiogenic shock (CS) is well established. A high-flow, surgically implanted mAFP (Impella 5.5, Abiomed/Johnson & Johnson MedTech) is increasingly used in patients with CS, yet little is known about the outcomes in HRPCI. The authors aimed to describe the outcomes, patient and procedural characteristics of Impella 5.5-supported HRPCI in a high-volume center.Methods. The authors identified all adult patients who underwent Impella 5.5-supported percutaneous coronary intervention (PCI) at Providence St. Vincent Medical Center from January 1, 2021, to December 31, 2024. Patient demographics and clinical data were abstracted from the medical record. Categorical data were reported as frequency and percentage. Continuous variables represented by intervals were summarized using mean and SD or median and IQR.Results. Of the 34 patients identified, 31 were male, and the mean age was 62.9 (± 9.7) years. All patients had a maximal CS stage of C-E. The mean left ventricular ejection fraction was 24.3%. Unprotected left main was treated in 50% of the study cohort, and 94% of the patients required multivessel PCI. The mean SYNTAX score was 35.9 (± 10.8) and the residual SYNTAX score was 7.4 (± 5.9). Major adverse cardiac and cerebrovascular events occurred in 41% of the patients. The 90-day all-cause mortality was 38%.Conclusions. Impella 5.5 is feasible to support HRPCI in patients with severe multivessel coronary artery disease, severe heart failure, and CS with acceptable short- and intermediate-term patient outcomes.

Objectives: Systematic reviews and meta-analyses have highlighted the benefits of distal over proximal transradial access, including lower rates of radial artery occlusion and faster hemostasis. Despite the increasing adoption of distal transradial access by interventionalists, there is a lack of data addressing gender-specific differences. This study aimed to assess those differences in routine coronary procedures via distal transradial access.

Methods: The authors conducted a retrospective analysis of a large, real-world sample of 6871 consecutive all-comers who underwent coronary procedures via distal transradial access using data from the DISTRACTION registry.

Results: The mean patient ages were 63.8 ± 15.7 years, 63.5 ± 17.7, and 64.4 ± 11.1 years for total, male, and female groups, respectively; 65% of the patients were male. In the female group, there was statistically significant predominance of hypertension (82.2% vs 74%), diabetes (46.8% vs 37%), obesity (29.3% vs 22.2%), severe mitral valve disease (3.1% vs 1.1%), coronary angiography-only (48.7% vs 36%), and access-site crossovers (3.1% vs 1.5%). In the male group, there were more rates of former or current smoking (54.2% vs 40.8%), previous percutaneous coronary intervention (PCI) (29.8% vs 19.7%), previous coronary artery bypass grafting (4.5% vs 1.9%), ST-segment elevation myocardial infarction (24.2% vs 18.5%), PCI (66.1% vs 52.5%), left main PCI (2.6% vs 1.7%), redo right distal transradial access (15.3% vs 9.9%), and 7F sheath size (2.6% vs 0.9%). No major adverse cerebrovascular and cardiac events directly related to distal transradial access, no hand/thumb dysfunction or ischemia after any procedure, and no relevant access-site-related bleeding were recorded.

Conclusions: The adoption of distal transradial access by proficient operators as the default approach for routine coronary procedures appears to be safe and feasible in both male and female patients, with very low rates of access site crossovers and complications.