Enhancing Transcatheter Aortic Valve Implantation (TAVI) outcomes through virtual proctoring: a case series analysis.

Transcatheter Aortic Valve Implantation (TAVI) represents a pivotal advancement in the management of severe aortic stenosis, offering a minimally invasive alternative to surgical valve replacement. Despite its widespread adoption, the complexity of TAVI procedures, especially in high-risk anatomical scenarios such as valve-in-valve interventions, necessitates ongoing educational support for operators. This article explores the implementation of a virtual proctoring system for complex TAVI procedures, evaluating its feasibility, educational value, and impact on procedural success and safety.

Successful Crossing of Complex Radial and Brachial Artery Anatomy Using a New Approach: Railtracking.

BACKGROUND Use of the distal transradial artery (dTRA) for coronary angiography and PCI has been shown to be feasible and potentially has multiple advantages over proximal TRA regarding vascular complications, but when larger introducer sheaths (>6 Fr) are used, severe spasm and pain can be induced. However, in comparison with the more proximal part of the radial artery, the distal part is on average 0.5 mm smaller. As a consequence, when using dTRA, the use of slender techniques and miniaturization should be preferred to avoid a large sheath-to-artery mismatch, which has unfavorable consequences. A new approach named RailTracking, using a conventional 6 Fr or 7 Fr guiding catheter and a vascular dilator (the Railway Sheathless Access System [RS] from Cordis Company), allows use of distal arterial access without need for a sheet introducer. CASE REPORT We present 2 clinical cases with a difficult arterial access that were successfully managed using the RailTracking technique by dTRA access. In the first one, the conventional methods of arterial crossing failed because of the tortuosity and severe calcifications in the forearm and brachial artery. In the second case, the proximal TRA was occluded. Having arterial access on the dTRA and using the RailTracking allowed us to safely perform the interventions without need for vascular access site conversion. CONCLUSIONS A new approach, RailTracking, which includes sheathless distal radial access and use of the RSS system could potentially decrease the vascular complications and facilitate the crossing, even in cases of complex vessels anatomy.

Feasibility and Safety of Performing Complex Coronary Interventions by Distal Radial Artery Using the Railway Sheathless Vascular System.

AIMS: The aim of this clinical study is to assess the feasibility and safety of the 7 Fr Railway sheathless access system (Cordis Corporation) for complex percutaneous coronary interventions (PCI) using distal radial artery access. METHODS AND RESULTS: Over a 2-month period, we enrolled 20 patients (all those undergoing complex PCI) where a 7 Fr guide catheter was deemed necessary. Multiple bifurcation techniques and calcified plaque modifying tools were used. The primary endpoint was procedural success (95%) without need for access-site crossover (0%) or major adverse cardiovascular event within the first month (0%), while our secondary endpoint was the access-site complication rate (arterial spasm in 1 case [5%]). CONCLUSION: Distal radial access with the 7 Fr Railway sheathless access system was a feasible and safe access option for complex PCI in our very high-risk study population. This approach could be a valuable option for decreasing the risk of a major bleeding event or vascular complication in cases that require a large guide catheter.

Uncorrected acyanotic tetralogy of fallot decompensated in adulthood after an acute onset of malaria.

Tetralogy of Fallot is the most frequent cyanotic congenital heart disease. Usually, the condition is diagnosed and treated during the first year of life. Few reports of uncorrected tetralogy of Fallot reaching adulthood are found in the literature. Occasionally the pulmonary obstruction is relatively mild and the presentation is with minimal cyanosis. This particular situation is called "pink tetralogy" or "acyanotic tetralogy". For these adults surgical repair is still recommended, since the results of surgery are good and the operative risk is low. We report the case of a 55-year-old man with an uncorrected acyanotic tetralogy of Fallot diagnosed after right cardiac failure triggered by an acute onset of malaria.