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1.
Catheter Cardiovasc Interv ; 100(2): 261-265, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35652174

RESUMO

Right-sided infective endocarditis is a common entity for which surgical intervention is frequently high-risk. Considering its invasive nature, potential complications, and challenging patient population, a less invasive endovascular option is desirable. The previous series have demonstrated the feasibility of percutaneous therapy for tricuspid valve (TV) vegetation utilizing a filter-based bypass circuit. However, the limited availability of a specialized team, resources, procedural complexity, and large bore sheath size restrict the broad adoption of this technique. The Inari FlowTriever System (Inari Medical) is an endovascular, catheter-based, aspiration, and mechanical thrombectomy system indicated for the removal of large-volume venous thrombus and pulmonary emboli. Independent of anesthesia, perfusion, or advanced imaging, this device's characteristics uniquely improve the operator's ability to safely remove unwanted debris from complex anatomy. This report describes the first, utilization of the Inari FlowTriever System for the removal of massive and inoperable TV vegetation.


Assuntos
Endocardite , Doenças das Valvas Cardíacas , Embolia Pulmonar , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Embolia Pulmonar/terapia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
2.
Catheter Cardiovasc Interv ; 81(2): 294-300, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22826017

RESUMO

OBJECTIVES: To investigate the safety and risk of vascular complications of arteriotomy closure devices (ACD) with the direct thrombin inhibitor bivalirudin in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: ACDs and manual compression have been shown to have a similar risk of complications in the setting of PCI with heparin ± glycoprotein (GP) IIb/IIIa inhibitor usage. In many centers bivalirudin is becoming the most frequent type of anticoagulation used during PCI. We sought to determine the risk of vascular complications using Angio-Seal, Perclose, and manual compression for groin hemostasis using predominantly bivalirudin. METHODS: Our institution's interventional database retrospectively identified 14,354 consecutive patients undergoing PCI from 2000 to 2008. Patients were grouped by the adjunctive anticoagulation used (bivalirudin vs. heparin + GP IIb/IIIa inhibitors) as well as ACD employed. The incidence of complications was evaluated using multivariable analysis to account for baseline differences between groups. RESULTS: Patients undergoing PCI with adjunctive bivalirudin had significantly fewer complications overall, regardless of closure method (2.9% vs. 8.7%, P < 0.001). The Perclose group had significantly fewer complications than the Angio-Seal and manual compression groups (3.9% vs. 5.6% vs. 9.0%, P < 0.001) respectively; the Angio-Seal group had significantly fewer complications than manual compression. Multivariable analysis also identified age ≥ 65, female gender, BMI ≤ 26, and operator as independent predictors of complications. CONCLUSIONS: The use of adjunctive bivalirudin during PCI was associated with fewer vascular complications. In addition, the Perclose and Angio-Seal devices had significantly fewer complications than manual compression and women ≥ 65 are at highest risk.


Assuntos
Antitrombinas/efeitos adversos , Virilha/irrigação sanguínea , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Hirudinas/efeitos adversos , Fragmentos de Peptídeos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Fatores Etários , Idoso , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Heparina/efeitos adversos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Inibidores da Agregação Plaquetária/efeitos adversos , Punções , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
3.
Arch Intern Med ; 171(7): 698-701, 2011 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-21149745

RESUMO

A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotopic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain.


Assuntos
Angiografia Coronária/efeitos adversos , Vasos Coronários/lesões , Erros Médicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Transplante de Coração , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/efeitos adversos
4.
Am Heart J ; 157(4): 606-12, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19332185

RESUMO

BACKGROUND: Pain management in patients with osteoarthritis or rheumatoid arthritis often requires long-term use of nonsteroidal antiinflammatory drugs (NSAIDs). However, the relative cardiovascular safety of these therapies remains uncertain. METHODS: The Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen Or Naproxen (PRECISION) trial will evaluate the cardiovascular safety of celecoxib, ibuprofen, and naproxen. Approximately 20,000 patients with symptomatic osteoarthritis or rheumatoid arthritis at high risk for, or with, established cardiovascular disease will be randomized in this double-blind, triple dummy, multinational, multicenter study. The primary end point is the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The trial will continue until 762 primary events occur with at least 18 months follow-up. Noninferiority of any of the regimens will require a 97.5% upper CI of the hazard ratio (HR) < or =1.33 and point estimate < or =1.12 for both intent-to-treat (ITT) and modified ITT populations. CONCLUSION: PRECISION, the first study of patients with high cardiovascular risk chronically treated with a cyclooxygenase-2 selective inhibitor or nonselective NSAID, will define the relative cardiovascular safety profile of celecoxib, ibuprofen, and naproxen and provide data to help guide NSAID use for pain management for this population.


Assuntos
Artrite/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Ibuprofeno/uso terapêutico , Naproxeno/uso terapêutico , Pirazóis/uso terapêutico , Sulfonamidas/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Celecoxib , Inibidores de Ciclo-Oxigenase/administração & dosagem , Inibidores de Ciclo-Oxigenase/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Seguimentos , Humanos , Ibuprofeno/administração & dosagem , Pessoa de Meia-Idade , Naproxeno/administração & dosagem , Estudos Prospectivos , Pirazóis/administração & dosagem , Sulfonamidas/administração & dosagem , Resultado do Tratamento
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