Complex interventional procedures for the management of early postoperative left main coronary artery embolism after bioprosthetic aortic valve insertion.

The incidence of calcified debris coronary embolism after aortic valve replacement (AVR) with a bioprosthesis is a rare but potentially life-threatening condition. We sought to describe a case of immediate postoperative left main coronary artery embolism, resulting to severe acute coronary syndrome and cardiogenic shock, after aortic valve surgery due to severe aortic valve stenosis, with the use of bioprosthesis. Complex interventional procedures and possible diagnostic challenges are being described.

Prospective non-randomized multi-centre evaluation of the non-polymer based ACHIEVE Paclitaxel Eluting Coronary Stent System in treatment of lesions with high risk of revascularization due to restenosis: the DELIVER II study.

BACKGROUND: The ACHIEVE Paclitaxel Eluting Coronary Stent System (CSS) is a non-polymeric paclitaxel coated stent loaded with a dose density of 3.0 microg/mm2 stent surface area. DELIVER II set out to evaluate the use of this stent in the treatment of patients with coronary lesions with a higher risk of revascularization including chronic total or sub-total occlusion, small vessel, bifurcated, and long lesions, multivessel disease, and restenotic lesions. METHODS: DELIVER II was a prospective, non-randomized, single-arm, multi-centre study. A total of 1531 patients with 1986 lesions were enrolled at 86 sites worldwide. The primary endpoint was target lesion revascularization (TLR) rate at six months follow-up. The lesion subsets were comprised of 28.5% restenotic lesions, 16.5% chronic total or subtotal occlusions, 29.0% bifurcation lesions, 37.4% small vessels and 16.6% long lesions. RESULTS: The Target Lesion Revascularization (TLR) rate (intent-to-treat) at 180 days was 8.2% (156/1909). The MACE rate for the overall per-protocol population was 3.6% (47/1310) at 30 days, 13.0% (167/1287) at 180 days, and in a sub-set of 500 patients, 20.5% (84/409) at 365 days. Multivariable logistic regression analysis identified that the factors leading to higher risk of revascularization were left anterior descending artery lesions, restenotic lesions, the post-procedural minimum luminal diameter, total stent length and number of diseased vessels. CONCLUSION: DELIVER II demonstrated comparatively low rates of TLR and MACE for the ACHIEVE Paclitaxel Eluting CSS in high risk patients. In addition, this registry helped to identify risk factors leading to an increased risk of revascularization in difficult-to-treat patient groups.

[B-type natriuretic peptide--current use in the diagnosis and management of heart failure]. / B-Typ-natriuretisches Peptid. Aktueller Stellenwert in der Diagnostik und Therapieoptimierung der Herzinsuffizienz.

Abstract B-natriuretic peptide (BNP) is a 32-amino acid polypeptide secreted from the cardiac ventricles in response to ventricular volume expansion and pressure overload. BNP levels are elevated in patients with symptomatic left ventricular dysfunction, and levels correlate with severity of symptoms and with prognosis. Numerous studies indicate that BNP may considerably improve the management of patients with heart failure and may become a routine serum parameter in clinical medicine. In this review, the utility of BNP in different clinical settings will be discussed.