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Direct Oral Anticoagulants in Emergency Trauma Admissions.
CONCLUSION: DOACs in the setting of hemorrhage are a clinical challenge in the traumatological emergency room because of the inadequate validity of the relevant laboratory tests. An emergency antidote is now available only for dabigatran. PMID: 27658470 [PubMed - in process]
Source: Deutsches Arzteblatt International - September 24, 2016 Category: Journals (General) Tags: Dtsch Arztebl Int Source Type: research

Transfemoral transcatheter aortic-valve replacement should be preferred over surgery in most intermediate-risk patients
Commentary on: Leon MB, Smith CR, Mack MJ, et al.., PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–20 . Context Evidence derived from randomised clinical trials support transcatheter aortic valve replacement (TAVR) as a choice for patients with aortic stenosis with a prohibitive surgical risk and as a valid alternative therapy for those at high-risk of surgical mortality. Owing to increases in operator experience as well as improvements with transcatheter techniques and devices associated with reduction in procedural complications,...
Source: Evidence-Based Medicine - September 23, 2016 Category: Internal Medicine Authors: Tamburino, C., Capranzano, P. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research

Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50-69 years
Conclusion Patients aged 50–69 years who received mechanical valves had better long-term survival after AVR than those with bioprostheses. The risk of stroke was similar; however, patients with bioprostheses had a higher risk of aortic valve reoperation and a lower risk of major bleeding. Clinical Trial Registration http://clinicaltrials.gov/show/NCT02276950. ClinicalTrials.gov Identifier NCT02276950.
Source: European Heart Journal - September 21, 2016 Category: Cardiology Authors: Glaser, N., Jackson, V., Holzmann, M. J., Franco-Cereceda, A., Sartipy, U. Tags: Cardiovascular surgery Source Type: research

Claret Medical files for FDA clearance for Sentinel cerebral protection device
Claret Medical said today that it filed an application with the FDA seeking 510(k) clearance for its Sentinel cerebral protection system designed for use during transcatheter aortic valve replacements. The Santa Rosa, Calif.-based company’s Sentinel device is designed to capture and remove embolic debris dislodged during TAVR procedures, which can enter cerebral circulation and can potentially lead to strokes. “Our contribution in building significant new science will help the rapidly growing TAVR field embrace the critical role of cerebral protection in all left heart and endovascular procedures. These studi...
Source: Mass Device - September 20, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Food & Drug Administration (FDA) Regulatory/Compliance Replacement Heart Valves Vascular Claret Medical Inc. Stroke Source Type: news

Effect of New Cerebral Ischemic Lesions on the Delirium Occurrence After Transcatheter Aortic Valve Replacement
Although only 2% to 5% of patients develop symptomatic stroke following transcatheter aortic valve replacement (TAVR), new cerebral lesions have been detected among the majority of these patients using diffusion weighted magnetic resonance imaging (DWI-MRI), irrespective of access site strategy(1). According to the published reports, new cerebral DWI lesions have been associated with future neurological and cognitive decline; however, the relationship between these lesions and post-operative delirium (POD) following TAVR remains unknown. By means of this study, we aimed to assess the impact of new cerebral DWI lesions on t...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research

Keystone Heart touts TriGuard cerebral protection data in TAVR patients
Keystone Heart today released data from transcatheter aortic valve replacement patients treated with its TriGuard cerebral embolic protection device, touting a significant reduction in brain lesions with use of the device. The TriGuard is a cerebral embolic protection device designed to reduce the amount of embolic material entering blood circulation to the brain during TAVR or TAVI procedures. Results come from preliminary study findings of 51 patients who underwent TAVR procedures, Keystone Heart said, and were presented at the PCR London Valves 2016 Conference in London. “These data, together with previously rep...
Source: Mass Device - September 20, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Clinical Trials Vascular Keystone Heart Source Type: news

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?
CONCLUSION: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease. PMID: 27645551 [PubMed - as supplied by publisher]
Source: Annals of Thoracic and Cardiovascular Surgery - September 20, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, De Palma R, Gherli T, RERIC (Registro dell’Emilia Romagna degli Interventi Cardiochirurgici) Investigators Tags: Ann Thorac Cardiovasc Surg Source Type: research

Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement
Conclusions In patients with bicuspid aortic valve AI with root aneurysm, primary cusp repair with root reimplantation achieves equivalent midterm outcomes compared with Bentall root replacement.
Source: The Annals of Thoracic Surgery - September 19, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Exploring unmet needs in venous and arterial thromboembolism with rivaroxaban.
This article will introduce and provide context for these RCTs in the contemporary management of arterial and venous thromboembolism in the following underserved areas: Patients with both NVAF and acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI); patients with embolic stroke of undetermined source (ESUS); patients who require transcatheter aortic valve replacement (TAVR); patients with acute or chronic coronary artery disease (CAD; including those with heart failure [HF]); those at risk of or suffering from cancer-associated thrombosis (CAT) and those requiring long-term anticoagulation. It ...
Source: Thrombosis and Haemostasis - September 14, 2016 Category: Hematology Authors: Cappato R, Welsh R Tags: Thromb Haemost Source Type: research

The Challenge of Timing Surgery in Degenerative Mitral Regurgitation Is B-Type Natriuretic Peptide the Solution? ∗
Degenerative mitral regurgitation (MR) with prolapse or flail of mitral leaflets has become the most frequent cause of severe primary MR in Europe and North America (1,2). In its chronic stage, even severe MR is tolerated very well for a surprisingly long time, and patients may remain asymptomatic for years. During this compensated stage of disease, pre-load, afterload, and both contractility and ejection fraction of the left ventricle (LV) remain normal, and the total stroke volume is increased as a result of the compensatory enlargement of the end-diastolic LV volume, which is enabled by an adaptive process of the LV myo...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research

Fast-track cardiac care for adult cardiac surgical patients.
CONCLUSIONS: Low-dose opioid-based general anaesthesia and time-directed extubation protocols for fast-track interventions have risks of mortality and major postoperative complications similar to those of conventional (not fast-track) care, and therefore appear to be safe for use in patients considered to be at low to moderate risk. These fast-track interventions reduced time to extubation and shortened length of stay in the intensive care unit but did not reduce length of stay in the hospital. PMID: 27616189 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 12, 2016 Category: Journals (General) Authors: Wong WT, Lai VK, Chee YE, Lee A Tags: Cochrane Database Syst Rev Source Type: research

Prolonged Cross-Clamping During Aortic Valve Replacement Is an Independent Predictor of Postoperative Morbidity and Mortality: Analysis of the Japan Cardiovascular Surgery Database
Conclusions Prolonged ACCD offers an independent predictor of postoperative morbidity and mortality after isolated AVR for AS despite recent technologic advances and surgical refinements.
Source: The Annals of Thoracic Surgery - September 11, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Prolonged Cross-Clamping During Aortic Valve Replacement Is an Independent Predictor of Postoperative Morbidity and Mortality: Analysis of the Japan Cardiovascular Surgery Database.
CONCLUSIONS: Prolonged ACCD offers an independent predictor of postoperative morbidity and mortality after isolated AVR for AS despite recent technologic advances and surgical refinements. PMID: 27624296 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - September 10, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Iino K, Miyata H, Motomura N, Watanabe G, Tomita S, Takemura H, Takamoto S Tags: Ann Thorac Surg Source Type: research

Art and Science of Cerebrovascular Event Prevention After Transcatheter Aortic Valve Replacement Editorials
Source: Circulation: Cardiovascular Interventions - September 6, 2016 Category: Cardiology Authors: Dangas, G. D., Giustino, G. Tags: Aortic Valve Replacement/Transcatheter Aortic Valve Implantation, Ischemic Stroke, Transient Ischemic Attack (TIA) Editorials Source Type: research

Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis
ConclusionsThe clinical outcomes of TAVR in patients with bicuspid AS were favorable. New-generation devices were associated with less paravalvular leak and, hence, a higher device success rate than early-generation devices. (The  Bicuspid Aortic Stenosis Following Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR]; NCT02394184)
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - September 5, 2016 Category: Radiology Source Type: research

Transaortic Transcatheter Aortic Valve Implantation and Concomitant Off Pump Revascularization
We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting. All patients were discharged free from stroke, myocardial infarction, or access site complications either to rehabilitation facility or to the referring hospital with none or trace aortic regurgitation and patent grafts. These cases confirm the feasibility of those combined operations and should be considered as realistic alternative for surgical treatment in high-risk patients who are clearly identified to benefit fr...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure Structural Heart Disease
Conclusions— Redo TAVR for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter aortic valve prosthesis failure seems to be safe, and it is associated with favorable acute and midterm clinical and echocardiographic outcomes.
Source: Circulation: Cardiovascular Interventions - August 30, 2016 Category: Cardiology Authors: Barbanti, M., Webb, J. G., Tamburino, C., Van Mieghem, N. M., Makkar, R. R., Piazza, N., Latib, A., Sinning, J.-M., Won-Keun, K., Bleiziffer, S., Bedogni, F., Kapadia, S., Tchetche, D., Rodes-Cabau, J., Fiorina, C., Nombela-Franco, L., De Marco, F., de Ja Tags: Aortic Valve Replacement/Transcatheter Aortic Valve Implantation Structural Heart Disease Source Type: research

Long-Term Outcomes after Minimally Invasive Aortic Valve Surgery through Right Anterior Minithoracotomy.
Conclusion MIAV is safe and feasible with favorable long-term outcomes. In the future, it could serve as benchmark for interventional methods as soon as indications are expanded to young and low-risk patients. Randomized studies are needed to compare the long-term outcomes of these approaches. PMID: 27575273 [PubMed - as supplied by publisher]
Source: The Thoracic and Cardiovascular Surgeon - August 30, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Reser D, Walser R, van Hemelrijk M, Holubec T, Weber A, Plass A, Maisano F Tags: Thorac Cardiovasc Surg Source Type: research

Long-Term Outcomes after Minimally Invasive Aortic Valve Surgery through Right Anterior Minithoracotomy
Conclusion MIAV is safe and feasible with favorable long-term outcomes. In the future, it could serve as benchmark for interventional methods as soon as indications are expanded to young and low-risk patients. Randomized studies are needed to compare the long-term outcomes of these approaches. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: The Thoracic and Cardiovascular Surgeon - August 30, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Reser, Diana Walser, Roman van Hemelrijk, Mathias Holubec, Tomas Weber, Alberto Plass, Andr é Maisano, Francesco Tags: Original Cardiovascular Source Type: research

Study: TAVR safer than surgery in low-risk heart failure patients
Transcatheter aortic valve replacement procedures with self-expanding systems resulted in higher survival rates for patients at lower risk for surgery when compared to surgical aortic valve replacement procedures, according to a study released this month. Results from the study, which compared Medtronic‘s (NYSE:MDT) self-expanding CoreValve TAVR system, were published in JAMA Cardiology this month. The retrospective analysis compared patients from the CoreValve U.S. pivotal high-risk trial of patients with STS PROM scores of 7% or less who either underwent TAVR procedures or surgery, with a median STS Prom score of...
Source: Mass Device - August 29, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Cardiac Implants Cardiovascular Clinical Trials Medtronic Source Type: news

Rationale and design of the Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial
Publication date: Available online 26 August 2016 Source:American Heart Journal Author(s): Ernest Spitzer, Nicolas M. Van Mieghem, Philippe Pibarot, Rebecca T. Hahn, Susheel Kodali, Mathew S. Maurer, Tamim M. Nazif, Josep Rodés-Cabau, Jean-Michel Paradis, Arie-Pieter Kappetein, Ori Ben-Yehuda, Gerrit-Anne van Es, Faouzi Kallel, William N. Anderson, Jan Tijssen, Martin B. Leon Background Co-existence of moderate aortic stenosis (AS) in patients with heart failure with reduced ejection fraction (HFrEF) is not uncommon. Moderate AS increases afterload, while pharmacological reduction of afterload is a pillar of contemporary...
Source: American Heart Journal - August 27, 2016 Category: Cardiology Source Type: research

#HeartWarrior: Maddy Reyes
Maddy Reyes is a 12-year-old Heart Warrior participating in the 2016 Puget Sound Heart and Stroke Walk. She is also a social media ambassador, @MaddyGoCheer. I have a different heart than most kids. When I was born I was diagnosed with a heart condition called Tetralogy of Fallot. The doctors and surgeons were watching my heart very closely until I was four months old. When I was four months old my doctor told my parents that I would have to get open heart surgery to keep my heart safe. The surgeons fixed a hole in my heart and made my pulmonary artery bigger. My doctor is now watching my heart closely to see when ...
Source: Healthy Living - The Huffington Post - August 22, 2016 Category: Consumer Health News Source Type: news

Transfemoral aortic valve implantation with the repositionable Lotus valve for treatment of patients with symptomatic severe aortic stenosis: results from a single-centre experience.
CONCLUSIONS: In patients with severe aortic stenosis, transfemoral TAVI with the repositionable Lotus valve was associated with a high rate of device success, no moderate or severe residual aortic regurgitation, low rates of major vascular complications and mortality within 30 days. PMID: 27542789 [PubMed - in process]
Source: EuroIntervention - August 22, 2016 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research

Transcatheter Aortic Valve Replacement After Intraoperative Discovery of Porcelain Aorta in a Patient With Aortic Stenosis
PORCELAIN AORTA IS a major risk factor for stroke after cardiac surgery and may prompt alterations in surgical technique.1,2 Transcatheter aortic valve replacement (TAVR) has become a preferred treatment for patients with aortic stenosis and porcelain aorta.2 –4 Although TAVR has become a common procedure worldwide, this procedure typically is characterized by extensive preprocedural planning by a multidisciplinary heart team.5–9 This case conference describes a scenario in which TAVR was performed successfully on an urgent basis after intraoperative discovery of a porcelain aorta in a patient with severe aortic stenos...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 18, 2016 Category: Anesthesiology Authors: Rohesh Fernando, Jacob T. Gutsche, John G.T. Augoustides, Jeremy D. Kukafka, Warren Spitz, Jonathan Frogel, Michael Fabbro, Prakash A. Patel Tags: Case ConferenceVictor C. Baum, MDSection Editors? > Source Type: research

Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In  Vitro Study
Conclusions All of the valves tested provided good fluid dynamic performances. The sutureless bioprosthesis provided the best performance with the least hindrance to flow behavior. From the hydrodynamic perspective, the sutureless prosthesis may present an advance in the evolution of bioprostheses, ensuring low gradients and potential for low incidence of patient-prosthesis mismatch even in small annuli.
Source: The Annals of Thoracic Surgery - August 18, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In  Vitro Study.
CONCLUSIONS: All of the valves tested provided good fluid dynamic performances. The sutureless bioprosthesis provided the best performance with the least hindrance to flow behavior. From the hydrodynamic perspective, the sutureless prosthesis may present an advance in the evolution of bioprostheses, ensuring low gradients and potential for low incidence of patient-prosthesis mismatch even in small annuli. PMID: 27544288 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - August 17, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Tasca G, Vismara R, Mangini A, Romagnoni C, Contino M, Redaelli A, Fiore GB, Antona C Tags: Ann Thorac Surg Source Type: research

Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?
Conclusion For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: The Thoracic and Cardiovascular Surgeon - August 12, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Baumbach, Hardy Ahad, Samir Rustenbach, Christian Hill, Stephan Sch äufele, Tim Wachter, Kristina Franke, Ulrich Friedrich Wilhelm Tags: Original Cardiovascular Source Type: research

Reoperative Surgical Aortic Valve Replacement Versus Transcatheter Valve-in-Valve Replacement for Degenerated Bioprosthetic Aortic Valves.
CONCLUSIONS: For degenerated bioprosthetic aortic valves, TViV has similar operative mortality, strokes rates, and survival as SAVR in this high-risk cohort. Therefore, TViV is a viable alternative to SAVR, although studies using registry data are needed to establish noninferiority. PMID: 27526654 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - August 12, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Ejiofor JI, Yammine M, Harloff MT, McGurk S, Muehlschlegel JD, Shekar PS, Cohn LH, Shah P, Kaneko T Tags: Ann Thorac Surg Source Type: research

Conventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?
Conclusion For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients. PMID: 27517166 [PubMed - as supplied by publisher]
Source: The Thoracic and Cardiovascular Surgeon - August 12, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Baumbach H, Ahad S, Rustenbach C, Hill S, Schäufele T, Wachter K, Franke UF Tags: Thorac Cardiovasc Surg Source Type: research

Cerebrovascular Events With Transcatheter Aortic Valve Replacement Can We Identify Those Who Are at Risk? ∗
As interventional technologies evolve, careful assessment of the benefits and risks is urged (1,2). Stroke remains one of the most feared complications of percutaneous interventions(3), but has generally been a rare complication for percutaneous coronary intervention (
Source: Journal of the American College of Cardiology - August 9, 2016 Category: Cardiology Source Type: research

Multiple Cerebral Infarctions in a Patient with Adenomyosis on Hormone Replacement Therapy: A Case Report
A 59-year-old woman was admitted to our hospital because of repeated episodes of bilateral hand weakness. She had a 10-year history of combined estrogen –progestin therapy for menopausal symptoms. Magnetic resonance imaging on admission showed multiple hyperintense lesions in bilateral cerebral and cerebellar cortices on diffusion-weighted imaging. Transesophageal echocardiography showed thrombus formation on the aortic valve and moderate aortic i nsufficiency. Laboratory test demonstrated elevated CA125 (334.8 U/mL) and D-dimer (7.0 µg/mL) levels.
Source: Journal of Stroke and Cerebrovascular Diseases - August 9, 2016 Category: Neurology Authors: Nanako Hijikata, Yuki Sakamoto, Chikako Nito, Noriko Matsumoto, Arata Abe, Akane Nogami, Takahiro Sato, Hiroyuki Hokama, Seiji Okubo, Kazumi Kimura Tags: Case Studies Source Type: research

Long-Term Outcomes of the Ross Procedure versus Mechanical Aortic Valve Replacement: Propensity-Matched Cohort Study.
CONCLUSIONS: -Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiac and valve-related mortality as well as a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR. PMID: 27496856 [PubMed - as supplied by publisher]
Source: Circulation - August 5, 2016 Category: Cardiology Authors: Mazine A, David TE, Rao V, Hickey E, Christie S, Manlhiot C, Ouzounian M Tags: Circulation Source Type: research

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation: Insights From the Brazilian Transcatheter Aortic Valve Replacement Registry Structural Heart Disease
Conclusions— The 2 TAVR strategies, with or without BAVP, provided similar clinical and echocardiographic outcomes over a midterm follow-up although BAVP was associated with a higher rate of new onset persistent left bundle branch block, particularly in patients receiving a CoreValve.
Source: Circulation: Cardiovascular Interventions - August 5, 2016 Category: Cardiology Authors: Bernardi, F. L. M., Ribeiro, H. B., Carvalho, L. A., Sarmento-Leite, R., Mangione, J. A., Lemos, P. A., Abizaid, A., Grube, E., Rodes-Cabau, J., de Brito, F. S. Tags: Aortic Valve Replacement/Transcatheter Aortic Valve Implantation Structural Heart Disease Source Type: research

Embolic Protection Device in a Patient with Large Left Ventricular Thrombus Undergoing Transcatheter Aortic Valve Replacement
We present a case of TAVR in a patient with a large aneurism of LV performed using a supra-aortic trunks protection device.
Source: International Journal of Cardiology - August 4, 2016 Category: Cardiology Authors: Simona Gulino, Marco Barbanti, Corrado Tamburino Source Type: research

Cerebral Embolism During Transcatheter  Aortic Valve Replacement The BRAVO-3 MRI Study
ConclusionsThis study documented cerebral embolization in nearly two-thirds of patients during contemporary TAVR. There were no significant differences in cerebral embolization for bivalirudin versus heparin anticoagulation during TAVR. (Open-Label, Randomized Trial in Patients Undergoing TAVR to Determine Safety and Efficacy of Bivalrudin vs. UFH [BRAVO-2/3]; NCT01651780)
Source: Journal of the American College of Cardiology - August 2, 2016 Category: Cardiology Source Type: research

Cerebral Embolism A Silent Iatrogenic Complication of TAVR That Needs Voiced  Consideration ∗
Transcatheter aortic valve replacement (TAVR) has rapidly and definitely changed the way patients with aortic stenosis are treated. Both the number of procedures and the indications have increased worldwide, allowing the inoperable patient to be treated, the high risk patient to be treated less invasively, and the intermediate risk patient to have the choice of an alternative to surgery (1–4). Clinical stroke or transient ischemic attack is not uncommon after aortic stenosis treatment, ranging in the randomized studies from 5% to 6% at 30 days to 8% to 10% at 1 year —one-half of them being major/disabling strokes (Tabl...
Source: Journal of the American College of Cardiology - August 2, 2016 Category: Cardiology Source Type: research

Assessing Optimal Blood Pressure in Patients with Asymptomatic Aortic Valve Stenosis: The SEAS Study.
CONCLUSIONS: -Optimal BP seems to be systolic 130-139 mmHg and diastolic 70-90 mmHg in these patients with asymptomatic AS and no manifest atherosclerotic disease or diabetes. Clinical Trial Registration-http://www.clinicaltrials.gov; NCT00092677. PMID: 27486164 [PubMed - as supplied by publisher]
Source: Circulation - August 2, 2016 Category: Cardiology Authors: Nielsen OW, Sajadieh A, Sabbah M, Greve AM, Olsen MH, Boman K, Nienaber CA, Kesäniemi YA, Pedersen TR, Willenheimer R, Wachtell K Tags: Circulation Source Type: research

Embolic protection in patients undergoing transaortic transcatheter aortic valve replacement: initial experience with the TriGuard HDH embolic deflection device
CONCLUSIONSThis study shows the safety and feasibility of using the TriGuard HDH embolic protection device in transaortic TAVR. Further studies are warranted to determine the efficacy of embolic protection in this population.
Source: Journal of Cardiac Surgery - August 1, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Francisco Campelo ‐Parada, Ander Regueiro, Eric Dumont, Robert DeLarochellière, Jean‐Michel Paradis, Siamak Mohammadi, Daniel Doyle, Josep Rodés‐Cabau Tags: New Technologies Source Type: research

Micro Interventional Devices wins FDA nod for Permaseal
Micro Interventional Devices said today it won FDA 510(k) clearance for its Permaseal transapical access and closure device. The Permaseal device is designed to allow surgeons to access and close the left-ventricle without having to suture the myocardium using the companies compliant soft-tissue PolyCor anchor technology. “The FDA market clearance of Permaseal is another tremendous achievement for MID. This exciting development comes fast on the heels of our recent European approval.  Sales in Europe are exceeding our early expectations.  With the US approval, coming earlier than expected, MID will be initiating ...
Source: Mass Device - July 29, 2016 Category: Medical Equipment Authors: Fink Densford Tags: 510(k) Cardiovascular Food & Drug Administration (FDA) Regulatory/Compliance Micro Interventional Devices Source Type: news

E-093 Contraindications for Radial Access in Endovascular Therapy of Acute Ischemic Strokes
ConclusionAn inherent limitation of transradial access is the restriction to a 6–7 F catheter; however other factors must be considered when identifying cases amenable to radial access.These factors include extreme tortuosity, which not only presents a challenge for radial access, but for all access modalities, and patient height. Patients of above average height or have distal occlusions present a true challenge to the efficacy of radial access as current catheters are limited in length, and thus unable to reach the desired destination. These contraindications are important factors when considering this method of ap...
Source: Journal of NeuroInterventional Surgery - July 29, 2016 Category: Neurosurgery Authors: Sivakumar, K., Feuerwerker, S., Tiwari, A., Turkel-Parrella, D., Arcot, K., Farkas, J. Tags: Electronic poster abstracts Source Type: research

Critical Role of Coaptive Strain in Aortic Valve Leaflet Homeostasis: Use of a Novel Flow Culture Bioreactor to Explore Heart Valve Mechanobiology Cardiovascular Surgery
Conclusions Failure of AV to close initiates an extensive response characterized by expression changes common to progression to calcific aortic valve disease. AV coaptation, whether phasic or chronic, preserved phenotypic gene expression. These results demonstrate, for the first time, that coaptation of valve leaflets is a fundamentally important biomechanical cue driving homeostasis.
Source: JAHA:Journal of the American Heart Association - July 27, 2016 Category: Cardiology Authors: Maeda, K., Ma, X., Hanley, F. L., Riemer, R. K. Tags: Animal Models of Human Disease, Basic Science Research, Etiology, Physiology, Translational Studies Cardiovascular Surgery Source Type: research

Cardiovascular highlights from non-cardiology journals
Transcatheter aortic valve implantation in intermediate risk patients Transcatheter aortic valve implantation (TAVI) has had a major impact on both morbidity and mortality in high-risk and inoperable patients with severe aortic stenosis. Robust evidence has supported widespread adoption in this patient group but uncertainty exists as to whether TAVI may also achieve clinical equipoise with surgical aortic valve replacement (AVR) in lower risk groups. In the industry sponsored PARTNER 2 trial, patients deemed at intermediate surgical risk (generally with an STS score between 4 and 8) were randomized to either TAVI with the ...
Source: Heart - July 26, 2016 Category: Cardiology Authors: McCabe, J. M. Tags: Journal scan Source Type: research

Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging
Conclusion CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.
Source: European Journal of Echocardiography - July 21, 2016 Category: Cardiology Authors: Aplin, M., Kyhl, K., Bjerre, J., Ihlemann, N., Greenwood, J. P., Plein, S., Uddin, A., Tonder, N., Host, N. B., Ahlström, M. G., Hove, J., Hassager, C., Iversen, K., Vejlstrup, N. G., Lav Madsen, P. Tags: ORIGINAL ARTICLES Source Type: research

Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: A hint of real-world.
CONCLUSIONS: TAVI is feasible and shows comparable results to surgery in terms of early, 1-year mortality, as well as cerebrovascular events in patients with severe aortic stenosis and intermediate-low operative risk. Better transvalvular gradients, yet higher rates of AR were found, however, newer devices presented comparable rate of AR. PMID: 27439368 [PubMed - as supplied by publisher]
Source: Cardiology Journal - July 21, 2016 Category: Cardiology Authors: Castrodeza J, Amat-Santos IJ, Blanco M, Cortes C, Tobar J, Martin-Morquecho I, López J, Di Stefano S, Rojas P, Varela-Falcon LH, Gomez I, San Roman JA Tags: Cardiol J Source Type: research

Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis
Conclusions The SAPIEN 3 THV system was associated with low rates of 30-day mortality and major/disabling stroke as well as low rates of moderate or severe paravalvular regurgitation. Trial Registration ClinicalTrials.gov #NCT01314313.
Source: European Heart Journal - July 21, 2016 Category: Cardiology Authors: Kodali, S., Thourani, V. H., White, J., Malaisrie, S. C., Lim, S., Greason, K. L., Williams, M., Guerrero, M., Eisenhauer, A. C., Kapadia, S., Kereiakes, D. J., Herrmann, H. C., Babaliaros, V., Szeto, W. Y., Hahn, R. T., Pibarot, P., Weissman, N. J., Leip Tags: TAVI Source Type: research

Improving outcomes: case-matched comparison of novel second-generation versus first-generation self-expandable transcatheter heart valves ADULT CARDIAC
DISCUSSION TF-TAVI was feasible and safe using this new type of nitinol-based THV. Superiority to the current generation of self-expanding THVs was achieved regarding post-interventional pressure gradients and EOA, severity of residual PVL and rate of PM implantation. Results set a promising quality standard for TF-TAVI with a self-expanding THV, but will have to be confirmed in a larger patient cohorts for further clinical evaluation.
Source: European Journal of Cardio-Thoracic Surgery - July 20, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Schaefer, A., Treede, H., Schoen, G., Deuschl, F., Schofer, N., Schneeberger, Y., Blankenberg, S., Reichenspurner, H., Schaefer, U., Conradi, L. Tags: History, Transplantation - heart, Basic research vascular ADULT CARDIAC Source Type: research

Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Patients With Chronic Kidney Disease Stages 3b to 5
Conclusions CKD stages 3b to 5 increases the risk of mortality after TAVI and SAVR. In this subset of patients, SAVR was associated with somewhat better early and late survival. The risk of acute kidney injury was higher after SAVR. These findings suggest that CKD stages 3b to 5 does not contraindicate SAVR. Strategies to prevent severe acute kidney injury should be implemented with either SAVR or TAVI.
Source: The Annals of Thoracic Surgery - July 20, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome
Conclusions Right minithoracotomy MVS can routinely be performed with favorable outcomes in all comers when perfusion strategies and clamping techniques are carefully selected after proper evaluation of the patient’s preoperative characteristics.
Source: The Annals of Thoracic Surgery - July 18, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome.
CONCLUSIONS: Right minithoracotomy MVS can routinely be performed with favorable outcomes in all comers when perfusion strategies and clamping techniques are carefully selected after proper evaluation of the patient's preoperative characteristics. PMID: 27435516 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - July 16, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Barbero C, Marchetto G, Ricci D, El Qarra S, Attisani M, Filippini C, Boffini M, Rinaldi M Tags: Ann Thorac Surg Source Type: research