This case series highlights the successful application of robotic-assisted percutaneous coronary intervention using the R-One+ system in two acute coronary syndrome patients with significant coronary lesions. The procedures demonstrated the technology's safety, performance, and benefits such as minimal contrast use, reduced operator radiation exposure, and optimal procedural times.
This case shows the combination of two percutaneous techniques to treat an aortic root rupture during transcatheter aortic valve implantation. The patient was discharged at home and no cardiovascular events occurred at 12 months of follow up.
Ventricular arrhythmias (VA) are a major cause of morbidity and mortality in patients with coronary artery disease (CAD). Current guidelines recommend revascularization of significant CAD to improve survival in patients with ventricular fibrillation (VF), polymorphic ventricular tachycardia (VT), or those who are post-cardiac arrest. However, revascularization is not recommended for CAD patients with suspected scar-mediated monomorphic VT. There is a paucity of data detailing the utility of revascularization in reducing VA in CAD patients who do not present with acute coronary syndrome (ACS) and are not immediately post-cardiac arrest, which is the focus of this review. Medline, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies addressing this question. Studies that included patients presenting with ACS or those who were immediately post-cardiac arrest at the time of revascularization were excluded. In total, five studies comprising 2663 patients were reviewed.
Predicting coronary artery occlusion after transcatheter aortic valve replacement (TAVR) is usually based on computed tomography angiography (CTA). The primary risk factors seem to be a low coronary artery take-off and a small aortic root. However, CTA sometimes provides ambiguous risk assessment, and even if a potentially risky coronary artery is secured with a guidewire, the need for coronary stenting after valve implantation often remains uncertain. To reduce uncertainty, intravascular ultrasound (IVUS) can be used. The following two cases highlight the utility of IVUS in addressing these issues.
We report the use of the ŌNŌ retrieval system to remove a fully inflated 3.9 cm length by 24 mm diameter NuDEL CP Stent from the left pulmonary artery. There was no damage to any cardiac structures or venous anatomy following stent removal. To our knowledge, this is the first case of removal of a large caliber covered CP stent with the ŌNŌ system.
Infective endocarditis (IE) poses significant risks following percutaneous pulmonary valve implantation (PPVI) or surgical replacement (PVR).
This study evaluates the effectiveness of emergency percutaneous treatment in stabilizing patients with severe right ventricular dysfunction or obstructive cardiac shock, allowing for delayed surgical or percutaneous valve replacement.
This retrospective study examines 16 patients (age 19.9 [15.1–43.3] years) with right-sided IE treated with primary percutaneous intervention. Data collected included cardiac diagnosis, valve types, pathogens identified, procedural details, and outcomes.
Underlying diagnoses included aortic valve stenosis post-Ross surgery (43%), repaired tetralogy of Fallot (25%), common arterial trunk (18%), and repaired double outlet right ventricle (14%). Valve types varied, with Contegra Ven-Pro (56%) and Melody-valve (25%) being the most common. Diagnosis of IE occurred 66.5 (28.3–87.4) months postlast intervention/surgery, with emergency percutaneous treatment performed 2 (1–17) days postdiagnosis. Clinical presentations included obstructive cardiac shock (50%) and septic shock (25%). Preintervention RVOT velocity was 4.4 (4.2–5) m/s, with severely reduced RV function in 68%. Interventions included balloon dilatation, uncovered or covered stent implantation, and Melody valve implantation. Immediate resolution of RVOT obstruction was achieved in all patients, with significant reductions in RV systolic pressures (mean reduction 42.0 (30.2–50.0) mmHg) and improved RV function. No periprocedural deaths occurred, but one complication was noted. Follow-up included surgical repair (68%) and PPVI (18%). Mortality included one IE relapse and one surgical death.
Emergency percutaneous interventions can stabilize patients with RVOT obstruction due to IE, enabling delayed surgical or percutaneous interventions.
The self-expanding, supra-annular Evolut valve is an established platform for Transcatheter Aortic Valve Implantation (TAVI). Evolut PRO introduced an outer sealing wrap to mitigate paravalvular leakage. We evaluated the 3-year clinical outcomes and valve performance of the Evolut PRO in standard clinical practice for severe aortic stenosis (AS) patients at intermediate or higher risk for surgery.
The FORWARD PRO prospective, single-arm, multicentre, post-market clinical study enrolled 638 patients with native aortic valve stenosis or failed surgical bioprosthetic aortic valve undergoing TAVI, at intermediate or high risk, with the Evolut PRO valve. Clinical and serial echocardiographic outcomes were followed-up for 3 years.
TAVI using Evolut PRO was attempted in 629 AS patients (implanted in 97%) (mean age 81.7 years; STS PROM score, 4.7%). At 3 years all-cause mortality was 25.0%, disabling stroke 6.5% (all-cause mortality or disabling stroke, 28.5%) and rate of new permanent pacemaker implantation 24.7%. Excellent valve haemodynamics were maintained (mean gradient 8.8 ± 4.7 mm Hg; mean effective orifice area 2.0 ± 0.5 cm2) at 3 years. In a paired analysis of patients with ≥ mild paravalvular leakage (PVL) at discharge, more than two-thirds demonstrated improved PVL at 3 years. Patients with ≥ mild PVL at discharge had higher median total calcium volume than those with no/trace PVL (p < 0.001).
In clinical practice TAVI with the Evolut PRO valve is associated with favorable clinical outcomes and excellent haemodynamic performance out to 3 years. The observation of improvements in PVL over time warrants further research.
Right ventricular-to-pulmonary artery (RV-PA) coupling is an important predictor of long-term survival following transcatheter edge-to-edge repair. However, its impact on survival in patients undergoing indirect mitral annuloplasty is unknown. The study aimed to assess the impact of baseline RV-PA coupling on survival following indirect mitral annuloplasty in heart failure patients.
Patients were classified according to baseline RV-PA coupling: TAPSE (tricuspid annular plane systolic excursion)/PASP (pulmonary artery systolic pressure) > 0.55 (group 1), ≤ 0.55 ≥ 0.32 (group 2) and ≤ 0.32 (group 3). Clinical follow-up and RV function were assessed 3 and 12 months following indirect annuloplasty.
A TAPSE/PASP > 0.55 was found in 19 patients, while 47 patients showed a TAPSE/PASP ≤ 0.55 > 0.32 and 26 a TAPSE/PASP ≤ 0.32. A significant reduction in vena contracta and regurgitant volume compared to baseline was found in all groups at 3-months and 12-months follow-up. One-year mortality was significantly increased in group 3 compared to the other groups (group 1: 0.95, group 2: 0.91, group 3: 0.77; Log-Rank test p = 0.018). In groups 2 and 3 the TAPSE/PASP significantly improved during the 12-months follow-up, while it remained unchanged in group 1 (group 1: baseline = 0.71 ± 0.03, 12-months = 0.67 ± 0.01; group 2: baseline = 0.43 ± 0.06, 12-months: 0.56 ± 0.04; group 3: baseline = 0.25 ± 0.06, 12-months: 0.4 ± 0.03; p < 0.001).
RV-PA uncoupling before indirect mitral annuloplasty is associated with poor survival. However, Carillon device implantation improved right heart function and RV-PA coupling in patients with severe RV dysfunction at baseline. Therefore, Carillon device implantation can be a valuable option for transcatheter treatment of patients with FMR and right heart failure.
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