Comparison of two self-expanding transcatheter heart valves for degenerated surgical bioprostheses: the AVENGER multicentre registry.

BACKGROUND: There is a lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (valve-in-valve [ViV]). AIMS: We sought to compare outcomes of using two self-expanding transcatheter heart valve (THV) systems for ViV. METHODS: In this retrospective multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo2 (ACURATE group) or the Evolut R/PRO/PRO+ (EVOLUT group). The primary outcome measure was technical success according to Valve Academic Research Consortium (VARC)-3. Secondary outcomes were 30-day all-cause mortality, device success (VARC-3), coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM), and aortic regurgitation (AR) ≥moderate. Comparisons were made after 1:1 propensity score matching. RESULTS: The study cohort comprised 835 patients from 20 centres (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs EVOLUT 88.9%; p=0.20) and device success (69.7% vs 73.9%; p=0.36) as well as 30-day mortality (2.8% vs 1.6%; p=0.392) were similar between the two groups. The mean gradients and rates of severe PPM, AR ≥moderate, or CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with a true inner diameter (ID) >19 mm, whereas a true ID ≤19 mm was associated with higher device success - but not technical success - among Evolut recipients. CONCLUSIONS: ViV TAVI using either ACURATE or Evolut THVs showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with a true ID ≤19 mm, device success was higher when using Evolut.

A quality project for radiation reduction in the cath lab.

The radiation exposure in the cath lab of patients, cardiologists, and nurses was measured during three consecutive periods of 8 weeks. The first 8 weeks the baseline radiation exposure was obtained. In the second period standard incidences for coronarography and frame rate were changed, without compromising the image quality of the examination. In the third period, a pelvic shield covered the lower part of the patient. This pilot quality project demonstrates that further significant reduction in radiation exposure of 37% is possible for patients. A significant reduction in radiation exposure of 53 and 62% was obtained among cardiologists and nurses working in the cath lab, even with the already diminished radiation exposure over the last years by better equipment and general radioprotection measures.

[Intracardiac echocardiography: a new tool for interventional cardiology]. / Echographie intracardiaque: un nouvel outil en cardiologie interventionnelle.

Intracardiac echocardiography is a new technique based on the use of ultrasonic diagnostic catheter, which can be introduced through the femoral vein up of the right atrium. Intracardiac echocardiography provides bidimensional views, coupled to colour and pulsed Doppler. This review summarizes multiple applications of intracardiac echocardiography in the field of interventional cardiology, particularly during percutaneous closure of patent foramen ovale or atrial septal defect. A major advantage of intracardiac echocardiography is the possibility of avoiding general anaesthesia as well as providing equivalent information to the reference technique of transoesophageal echocardiography.

A case of coronary embolism in a patient with paroxysmal atrial fibrillation receiving tamoxifen.

Coronary embolism is an uncommon cause of myocardial infarction which should be considered especially in patients with associated conditions like atrial fibrillation, intracardiac prosthesis or infective endocarditis. We present the case of a 64-year-old man with lone paroxysmal AF who sustained an acute anterior wall infarction due to an embolism in the LAD. The patient was being treated with tamoxifen for benign gynaecomastia. The case illustrates some therapeutic problems of embolic myocardial infarction. Rescue PTCA after unsuccessful thrombolysis first resulted in distal embolization in diagonal branches with the need for aggressive anticoagulation. While the final angiographic result was satisfactory, the patient died of an intracranial hemorrhage. We present a short overview of the therapeutic options of coronary embolism and discuss the effect of the selective estrogen receptor modulator tamoxifen on arterial and venous thromboembolic disease which is suggestive of a pathogenic role.

Transient stress-induced cardiomyopathy with an "inverted takotsubo" contractile pattern.

We describe a patient who had transient cardiomyopathy with akinesia of the basal portions of the left ventricle and hyperkinesia of the apex triggered by alcoholic pancreatitis. This case seems to confirm recent publications suggesting a new or variant clinical entity with a clinical presentation similar to that of Takotsubo cardiomyopathy but with an Inverse left ventricular contractile pattern ("Inverted Takotsubo"). This entity could provide clues to the underlying pathophysiology of these syndromes of acute heart injury.