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1.
Cardiovasc Revasc Med ; 62: 60-65, 2024 May.
Article in English | MEDLINE | ID: mdl-38184452

ABSTRACT

PURPOSE: Mechanical circulatory support (MCS) using a venoarterial extracorporeal membrane oxygenation (VA-ECMO) device or a catheter-type heart pump (Impella) is critical for the rescue of patients with severe cardiogenic shock. However, these MCS devices require large-bore cannula access (14-Fr and larger) at the femoral artery or vein, which often requires surgical decannulation. METHODS: In this retrospective study, we evaluated post-closure method using a percutaneous suture-mediated vascular closure system, Perclose ProGlide/ProStyle (Abbott Vascular, Lake Bluff, IL, Perclose), as an alternative procedure for MCS decannulation. Closure of 83 Impella access sites and 68 VA-ECMO access sites performed using Perclose or surgical method between January 2018 and March 2023 were evaluated. RESULTS: MCS decannulation using Perclose was successfully completed in all access sites without surgical hemostasis. The procedure time of ProGlide was shorter than surgical decannulation for both Impella and VA-ECMO (13 min vs. 50 min; p < 0.001, 21 min vs. 65 min; p < 0.001, respectively). There were no significant differences in the 30-day survival rate and major adverse events by decannulation including arterial dissection requiring endovascular treatment, hemorrhage requiring a large amount of red blood cell transfusion, and access site infection. CONCLUSION: Our results suggest that the post-closure technique using the percutaneous suture-mediated closure system appears to be a safe and effective method for large-bore MCS decannulation.


Subject(s)
Catheterization, Peripheral , Extracorporeal Membrane Oxygenation , Heart-Assist Devices , Hemostatic Techniques , Punctures , Vascular Closure Devices , Humans , Retrospective Studies , Male , Female , Treatment Outcome , Middle Aged , Aged , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/instrumentation , Time Factors , Hemostatic Techniques/instrumentation , Hemostatic Techniques/adverse effects , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/instrumentation , Device Removal/adverse effects , Suture Techniques/instrumentation , Suture Techniques/adverse effects , Femoral Artery , Shock, Cardiogenic/therapy , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/diagnosis , Risk Factors , Hemorrhage/etiology , Hemorrhage/prevention & control
2.
AsiaIntervention ; 9(2): 156-165, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37736211

ABSTRACT

Background: Coronary cannulation after TAVR is sometimes difficult due to an overlap between native and neo-commissures, especially in Evolut devices with a supra-annular position. The Evolut C-tab corresponds to a neo-commissure, and the hat marker is in a fixed position. Therefore, the orientation of the hat marker can be adjusted to minimise overlaps. Aims: We investigated whether the HAt marker-guided SHaft rotation method (HASH, stylised as the #rotation method) is effective in facilitating coronary artery access after transcatheter aortic valve replacement (TAVR) with an Evolut system. Methods: We retrospectively analysed 95 patients who underwent electrocardiogram-gated cardiac computed tomography after TAVR. In the #rotation method, the hat marker of the delivery catheter was adjusted to face the greater curvature of the descending thoracic aorta in the left anterior oblique view. Its orientation was maintained while the system passed through the aortic arch. Results: In total, 60 and 35 patients underwent TAVR with the #rotation and non-#rotation methods, respectively. A ±15° angle between the native and neo-commissures was more frequent in the #rotation group (p=0.001). Favourable angles and appropriate frame orientation for access to the left coronary artery were significantly more frequent in the #rotation group than in the non-#rotation group (p<0.001 and p=0.001). Although the #rotation method showed a higher rate of favourable angles and frames in the right coronary artery, statistically significant differences were not found. Conclusions: The #rotation method is useful for improving commissural post alignment in TAVR with Evolut devices, especially in the ostium of the left coronary artery.

3.
Heart Vessels ; 38(10): 1228-1234, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37349561

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is diagnosed in a very small percentage of patients with suspected acute coronary syndromes who undergo emergency coronary angiography. Although fibromuscular dysplasia (FMD) is known to coexist in patients with SCAD, the vascular sites of FMD and their frequency have not yet been clarified. We retrospectively reviewed the medical records of 16 patients who were diagnosed with and treated for SCAD at our hospital between 1 January 2011 and 31 January 2023. We have summarized their baseline and clinical characteristics and medical variables, including coronary and upper extremity angiography and in-hospital outcomes. One of our patients had concurrent cardiac tamponade requiring pericardial drainage, and another went into hemorrhage shock the following day from dissection of the gastric retroperitoneal artery. Characteristic angiographic features of partial or diffuse nonatherosclerotic stenosis were observed mainly in the distal parts of the coronary arteries or their branches. Notably, in six patients with SCAD who underwent upper extremity angiography, FMD of the brachial artery was revealed. For the first time, to our knowledge, we found a high prevalence of multifocal FMD of the brachial artery in patients with SCAD.


Subject(s)
Coronary Vessel Anomalies , Fibromuscular Dysplasia , Vascular Diseases , Humans , Retrospective Studies , Coronary Vessels/diagnostic imaging , Brachial Artery/diagnostic imaging , Fibromuscular Dysplasia/diagnosis , Fibromuscular Dysplasia/diagnostic imaging , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiology , Coronary Angiography , Upper Extremity , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/diagnostic imaging
4.
Ann Vasc Dis ; 16(1): 54-59, 2023 Mar 25.
Article in English | MEDLINE | ID: mdl-37006862

ABSTRACT

Objective: On April 16, 2016, earthquakes struck Kumamoto. In this report, the incidence and treatment of venous thromboembolism (VTE) in patients presenting to our hospital are summarized. Materials and Methods: We reviewed the details of 22 consecutive patients who were diagnosed with VTE at our hospital during the 2 weeks after the earthquakes. Results: Nineteen of the 22 patients stayed in their cars overnight after the earthquakes. Particularly, during the first 4 days, seven consecutive patients were hospitalized for pulmonary thromboembolism. All seven patients had sheltered in their cars after the earthquakes. The two patients transported on days 2.42 and 3.54 were the most severe cases. One patient was admitted after emergency initiation of venoarterial extracorporeal membrane oxygenation for treatment of hemodynamic collapse, whereas the other patient was admitted after resuscitation. By contrast, deep vein thrombosis (DVT) alone occurred within 5-9 days of the earthquakes. Bilateral DVT was the most common, which was followed by DVT on the right side only. Conclusion: The incidence of VTE might be higher after an earthquake, and an overnight stay in a car might be a risk factor for VTE. Stable patients based on the D-dimer concentration can be managed with nonwarfarin oral anticoagulants.

5.
Int Heart J ; 63(6): 1187-1193, 2022.
Article in English | MEDLINE | ID: mdl-36450558

ABSTRACT

The combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, referred to as ECPELLA, is a powerful transient mechanical circulatory support for patients with severe cardiogenic shock (CS). During ECPELLA support, VA-ECMO loads the left ventricle (LV) and Impella unloads the LV. Therefore, evaluating the degree of LV unloading during ECPELLA may be a prerequisite to protect the injured myocardium. Here we report a patient with CS due to an inferior ST-elevation myocardial infarction in which the degree of LV unloading on ECPELLA was confirmed by direct LV pressure (LVP) measurement. After the percutaneous coronary intervention for the right coronary artery on ECPELLA, the aortic pressure became nonpulsatile and the peak systolic LVP was reduced at approximately 10 mmHg with 20 mA of the Impella motor current (MC) amplitude, which we referred to as the total LV unloading condition. We maintained the condition in the early phase of ECPELLA by monitoring the Impella MC amplitude at 20 mA and less with nonpulsatile aortic pressure. The patient was successfully weaned off VA-ECMO on day 3, and Impella was explanted on day 8. Prior to the Impella explant, the Impella MC amplitude increased more than 100 mA and the estimated pressure gradient between the aortic pressure and LVP was well matched with the directly measured LVP. In this case, the patient was successfully treated by ECPELLA with the total LV unloading condition, and we showed that the degree of LV unloading on ECPELLA can be estimated from the aortic pressure and Impella MC amplitude at given Impella flows.


Subject(s)
Extracorporeal Membrane Oxygenation , Heart Ventricles , Humans , Shock, Cardiogenic/therapy , Systole , Myocardium
6.
Resusc Plus ; 10: 100244, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35620182

ABSTRACT

Aim: Extracorporeal cardiopulmonary resuscitation (E-CPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest. Although VA-ECMO preserves end-organ perfusion, it may affect left ventricular (LV) recovery due to increased LV load. An emerging treatment modality, ECPELLA, which combines VA-ECMO and a transcatheter heart pump, Impella, can simultaneously provide circulatory support and LV unloading. In this single-site cohort study, we assessed impact of ECPELLA support on clinical outcomes of refractory cardiac arrest patients. Method: We retrospectively reviewed 165 consecutive cardiac arrest patients, who underwent E-CPR by VA-ECMO with or without intra-aortic balloon pump (IABP) or ECPELLA from January 2012 to September 2021. We assessed 30-day survival rate, neurological outcome, hemodynamic data, and safety profiles including hemolysis, acute kidney injury, blood transfusion and embolic cerebral infarction. Results: Among 165 E-CPR patients, 35 patients were supported by ECPELLA, and 130 patients were supported by conventional VA-ECMO with or without IABP. Following propensity score matching of 30 ECPELLA and 30 VA-ECMO patients, the 30-day survival (ECPELLA: 53%, VA-ECMO: 20%, p < 0.01) and favorable neurological outcome determined by the Cerebral Performance Category score 1 or 2 (ECPELLA: 33%, VA-ECMO: 7%, p < 0.01) were significantly higher with ECPELLA. Patients receiving ECPELLA also showed significantly higher total mechanical circulatory support flow and lower arterial pulse pressure for the first 3 days (p < 0.01) of treatment. There were no statistical differences in safety profiles between treatment groups. Conclusion: ECPELLA may be associated with improved 30-day survival and neurological outcome in patients with refractory cardiac arrest.

7.
Cardiovasc Revasc Med ; 40S: 179-181, 2022 07.
Article in English | MEDLINE | ID: mdl-35400620

ABSTRACT

Transcatheter aortic valve implantation (TAVI) represents the standard of care for relieving aortic stenosis in high-risk patients for surgery. The transfemoral approach is preferable with respect to invasiveness, but is often difficult in patients with complex vascular structures. Recently, the clinical application of advanced visualization and guidance technology with three-dimensional computed tomography (3D-CT) during TAVI has received considerable attention. Herein we report successful transfemoral TAVI in a patient with a right-sided aortic arch and chronic aortic dissection without vascular complications by 3D-CT/fluoroscopy fusion imaging guidance.


Subject(s)
Aortic Dissection , Aortic Valve Stenosis , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Aortic Dissection/surgery , Aorta, Thoracic/surgery , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/etiology , Aortic Valve Stenosis/surgery , Fluoroscopy , Humans , Tomography, X-Ray Computed , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome
8.
Heart Vessels ; 37(3): 460-466, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34524498

ABSTRACT

TAVI is an established therapy for patients with severe aortic stenosis. Rapid or control pacing is necessary for TAVI, and most centers are familiar with right ventricular (RV) pacing. Although there are several reports on the efficacy and safety of LV pacing, they are still few. In addition, LV pacing has not been studied for different LV guidewires. Our aim is to study the effectiveness of left ventricular (LV) pacing and the thresholds of LV guidewires in patients who underwent transcatheter aortic valve implantation (TAVI). We retrospectively analyzed 252 consecutive patients who underwent trans-femoral TAVI (TF-TAVI) with LV pacing in our institute between December 2017 and November 2020. We excluded 48 patients from the total cohort due to TAVI with RV pacing, and the remaining 204 patients were analyzed (52 males, mean age 85 ± 5 years). Among them, 202 patients (99.0%) had successful LV pacing. In the two patients with failed LV pacing, SAFARI2™ Small was used. The CONFIDA™ group (n = 34) showed a significantly lower threshold than the SAFARI2™ group (n = 163) (median 3.0 vs. 5.0 V; P = 1.1 × 10-7). LV pacing with Lunderquist® was successful in all patients (n = 7). LV pacing in TAVI was an effective and safe strategy. CONFIDA™ wire may be particularly well suited for LV pacing in TAVI.


Subject(s)
Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/surgery , Heart Ventricles/diagnostic imaging , Humans , Male , Retrospective Studies , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
10.
Eur Heart J Case Rep ; 5(2): ytab033, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33629024

ABSTRACT

BACKGROUND: Determining the treatment strategy for cardiogenic shock following ST-elevation myocardial infarction in a patient with severe aortic stenosis remains challenging and is a matter of debate. CASE SUMMARY: An 84-year-old man with chest pain was transferred to our institute and subsequently diagnosed with ST-elevation myocardial infarction and Killip class III heart failure. The patient was intubated, and urgent coronary angiography revealed severe tandem stenosis from the proximal to mid-left anterior descending coronary artery. We performed a primary percutaneous coronary intervention (PCI) and deployed drug-eluting stents from the left main trunk to mid-left anterior descending coronary artery. Although the procedure was successful, the patient went into cardiogenic shock a few hours later. Transthoracic echocardiography revealed low cardiac function and severe aortic stenosis. We decided to perform transcatheter aortic valve implantation using a self-expandable valve, followed by the insertion of a left ventricular assist device. The combination of procedures achieved haemodynamic stability. DISCUSSION: It is difficult to treat cardiogenic shock that develops in patients with severe aortic stenosis and ST-elevation myocardial infarction. This case report demonstrates that combined transcatheter aortic valve replacement using a self-expanding valve and left ventricular assist device placement can be safe and effective after a primary PCI.

12.
Am J Cardiol ; 126: 82-88, 2020 07 01.
Article in English | MEDLINE | ID: mdl-32327190

ABSTRACT

Transcatheter aortic valve implantation (TAVI) theoretically increases cardiac output and renal blood flow, and renal function (RF) recovers in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damage RF. Data describing RF improvements after TAVI in patients with chronic kidney disease (CKD) are lacking. We aimed to determine preoperative predictors of RF improvement after TAVI in severe AS patients with CKD. This observational study included 121 consecutive patients with severe AS and CKD (grade ≥3) who underwent TAVI. The patients were grouped according to their RF improvement after TAVI that was defined as an estimated glomerular filtration rate (eGFR) increase ≥10% at discharge from their preoperative level. Sixty-five patients' (54%) RF improved after TAVI. Patients with lower preoperative eGFR tended to achieve greater eGFR increases after TAVI (r = -0.17, p = 0.059). After adjustments for the factors that were significant in the univariate analysis, the preoperative mean transaortic pressure gradient (TAPG) (adjusted odds ratio, 1.03; 95% confidence interval, 1.00 to 1.07) and E/e' (adjusted odds ratio, 0.93; 95% confidence interval, 0.88 to 0.99) independently predicted RF improvement. The cut-off values for the preoperative mean TAPG and E/e' for an RF improvement after TAVI were 47.0 mm Hg and 13.8, respectively. In conclusion, preoperatively, a high mean TAPG and a low E/e' could predict RF improvement after TAVI in patients with CKD.


Subject(s)
Aortic Valve Stenosis/surgery , Renal Insufficiency, Chronic/physiopathology , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve Stenosis/physiopathology , Blood Flow Velocity/physiology , Blood Pressure/physiology , Cohort Studies , Coronary Circulation/physiology , Female , Glomerular Filtration Rate/physiology , Humans , Male
13.
J Cardiol ; 75(4): 374-380, 2020 04.
Article in English | MEDLINE | ID: mdl-31615745

ABSTRACT

BACKGROUND: There is little knowledge about clinical outcomes after the percutaneous coronary intervention (PCI) in hemodialysis patients with long lesions. The objective of the present study was to examine the long-term prognosis after PCI in hemodialysis patients in the second-generation drug-eluting stents (DES) era. METHODS: We retrospectively enrolled 270 consecutive hemodialysis patients who underwent PCI using second-generation DES from January 2010 to July 2015. We defined long lesions as the total stent length >30mm. In total, 96 hemodialysis patients (35.6%) underwent PCI for long lesions. The median follow-up period was 2.7 years. The endpoints of this study were cardiac death, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, and TLR. RESULTS: The patients' baseline characteristics were similar between the long lesion and the non-long lesion groups, except for prior PCIs (long-lesion vs. non-long lesion=30.2% vs. 46.0%; p= 0.01). Kaplan-Meier analyses revealed that the incidence of cardiac death, TLR, and MACE were comparable between the two groups (long lesion vs. non-long lesion; 5.2% vs. 5.7%, log-rank p=0.84, 26.0% vs. 23.0%, log-rank p=0.29, and 43.8% vs. 40.2%; log-rank p=0.49, respectively). CONCLUSIONS: Clinical outcomes of PCI for long lesions in hemodialysis patients were similar to that of non-long lesions. Long-stenting in hemodialysis patients, who were considered high-risk subset of adverse cardiovascular events, might be acceptable in the second-generation DES era.


Subject(s)
Drug-Eluting Stents , Percutaneous Coronary Intervention , Aged , Cardiovascular Diseases , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Renal Dialysis , Treatment Outcome
15.
Heart Vessels ; 32(12): 1439-1447, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28681100

ABSTRACT

Therapeutic devices for acute myocardial infarction (AMI) have evolved dramatically in recent years. However, the impact of the Killip classification of AMI outcomes in patients undergoing aggressive percutaneous coronary intervention remains unclear. We performed a 10-year retrospective review of 2062 patients diagnosed with AMI, and divided the data into two 5-year intervals: 2005-2009 (n = 1071), and 2010-2014 (n = 991). No difference was observed in in-hospital mortality rate between the two periods (first period, 11.5% vs second period, 9.7%; P = 0.19). The incidence of stent thrombosis was not significantly different between the two periods, and very few thrombi occurred in patients who received second-generation drug-eluting stents (DES) (0.98%: 5/511). In-hospital mortality due to stent thrombosis was high in the full cohort (15%). During the second period, in-hospital mortality was lower in Killip class 4 patients, although the difference was not significant (59.1 vs 47.5%, P = 0.07). Multivariable logistic regression identified several factors that significantly affected in-hospital mortality, including age [odds ratio (OR) 1.07], left main trunk (OR 2.47), peak CPK value above 5000 IU/L (OR 3.18), and Killip class 4 (OR 15.63). We evaluated trends in in-hospital mortality among patients with AMI over a 10-year period. New DES and the frequent use of mechanical support in patients with hemodynamic compromise tended to improve in-hospital mortality, but the effect was not significant. Notably, Killip class 4 on admission was associated with an estimated 16-fold increased risk of in-hospital death.


Subject(s)
Drug-Eluting Stents , Forecasting , Myocardial Infarction/classification , Percutaneous Coronary Intervention/methods , Postoperative Complications/mortality , Registries , Risk Assessment , Aged , Coronary Angiography , Female , Hospital Mortality/trends , Humans , Japan/epidemiology , Male , Myocardial Infarction/diagnosis , Myocardial Infarction/surgery , Odds Ratio , Retrospective Studies , Risk Factors , Survival Rate/trends
16.
J Cardiol Cases ; 16(6): 186-188, 2017 Dec.
Article in English | MEDLINE | ID: mdl-30279831

ABSTRACT

A 92-year-old woman was transferred to our institute due to drug-resistant heart failure from severe aortic stenosis. She seemed to be a candidate for transcatheter aortic valve implantation (TAVI) because of her frailty and porcelain aorta. There were no severe calcified nodules in the left-ventricular outflow tract area. Because three-dimensional computed tomography analysis showed that her basal annulus area was 419 mm2, a 26-mm SAPIEN XT (Edwards Lifesciences, Irvine, CA, USA) was selected for implantation. After deployment of the valve with 10% reduced volume, aortic root rupture occurred and her blood pressure fell due to acute cardiac tamponade. Emergent cardiac pericardial fenestration was done and drained blood was continuously returned to the circulation through percutaneous cardiopulmonary bypass. Despite strenuous efforts to save her life, she died 13 h after the event. An autopsy revealed a thin porcelain aorta and aortic root rupture with a fragile aortic wall. .

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