ABSTRACT
The Cor-Knot surgical tying device (LSI Solutions) is an automated suture fastener with a titanium-crimpable sleeve that facilitates a fast and secure knot. The device is an alternative to hand tying, minimizing operation time, and its increasing use is anticipated for minimally invasive cardiac surgeries or in patients with small surgical anatomy. As its use expands, the likelihood of encountering this knotting device during structural interventions may increase. In this case, during the TAVR procedure, the coplanar angle estimated from preoperative computed tomography scan was easily adjusted referencing the line of Cor-Knot in her aortic annulus without administrating contrast despite poor radiodensity from the Trifecta valve. In the coplanar view, the TAVR valve depth was well appreciated in reference to the Cor-Knot line and the TAVR valve was deployed under controlled pacing without contrast use. We achieved mean aortic pressure gradient of 9 mm Hg without paravalvular leakage or conduction abnormalities. She was discharged to home the next day without renal injury.
Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Female , Humans , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/surgery , Risk FactorsSubject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Humans , Transcatheter Aortic Valve Replacement/methods , Feasibility Studies , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Tomography , Aortic Valve Stenosis/surgery , Prosthesis Design , Treatment OutcomeABSTRACT
Severe mitral regurgitation (MR) is associated with heart failure and impaired survival with an annual mortality risk in excess of 5% per year for unoperated patients. Despite availability of surgical mitral valve interventions, as many as half of all patients with severe MR do not receive interventions. Transcatheter edge-to-edge repair with MitraClip has been a revolutionary therapy for MR, with over 100,000 treated patients worldwide. The usage has also expanded to different challenging anatomies as well as tricuspid regurgitation. Additionally, other transcatheter edge-to-edge repair devices are being studied. The evolution of these devices as well as what to expect in the future will be discussed here.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Bioprosthesis , Computed Tomography Angiography , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Multidetector Computed Tomography , Prosthesis Failure , Transcatheter Aortic Valve Replacement/instrumentation , Aged , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Female , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Heart Valve Prosthesis Implantation/adverse effects , Hemodynamics , Humans , Jehovah's Witnesses , Predictive Value of Tests , Prosthesis Design , Religion and Medicine , Reoperation , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome , Ventricular Septum/diagnostic imaging , Ventricular Septum/injuriesSubject(s)
Atrial Appendage , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve/surgery , Aged , Atrial Appendage/diagnostic imaging , Atrial Appendage/physiopathology , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Humans , Male , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Prosthesis Design , Treatment OutcomeABSTRACT
INTRODUCTION: Evolution in the technology used in the cardiac catheterization laboratory has permitted a migration from the femoral to radial artery access for many interventional procedures while concurrently improving outcomes. As a disruptive technology, transradial access has been associated with several controversies including a dichotomous relationship with femoral access. Areas covered: Several different patient subsets along with perceived technical challenges in interventional cardiology are reviewed with regard to the issue of access site. Evolving technological improvements germane to transradial techniques are also discussed as garnered from the literature of recent clinical trials and reports. Expert commentary: Radial techniques have been enhanced by newer technology and the spread of knowledge. Fusion of radial techniques with those of the femoral approach is evolving into a unifying concept of using the access that is most appropriate for the patient. No one access technique can cover all clinical subsets of patients. There is a need for complimentary access skillsets for even the most advanced cardiovascular technology used in the cardiac catheterization laboratory if the patients' outcomes are to be idealized.