The routine use of surgical exposure approach for trans-femoral implantation of the balloon expandable aortic prosthesis is associated to a low rate of vascular complications.

BACKGROUND: The most frequent complications of transfemoral aortic valve implantation are vascular (15-25%) and are related to an increase in mortality. We sought to assess the rate of vascular complications, its treatment and outcomes using a surgical approach for transfemoral implantation of Edwards-SAPIEN (Edwards Lifescience, Irvine, CA, USA) aortic valve. METHODS: We have conducted a multicenter registry including 4 hospitals using a systematic surgical exposure approach. Vascular complications have been collected following the definitions of the Valve Academic Research Consortium. RESULTS: From 2008 to 2013 a total of 312 consecutive patients have been included. Vascular complications were reported in 22 (7%), among those 6 (1.9%) were major whereas 16 (5.1%) were minor. Patients suffering vascular complications had significantly more previous history of peripheral vascular disease. All but one major complications occurred in women, aged 82-88 and with chronic renal failure. Hospital stay was longer in cases suffering complications (17.8±11 days vs. 9±7 days; P<0.0001). The 30 days mortality was 13.6% in patients with vascular complications, 33.3% in patients with major complications and 5.5% in patients with no complications (P=0.05). CONCLUSIONS: In this registry, the systematic use of a surgical exposure of the femoral artery for TAVR has been associated with a lower rate of vascular complications.

Postdilatation for treatment of perivalvular aortic regurgitation after transcatheter aortic valve implantation.

OBJECTIVES: The study is made to describe the efficacy and safety of balloon postdilatation (BPD) for the treatment of residual aortic regurgitation (RAoR) after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: A single-center observational study is made with 157 consecutive patients accepted to TAVI. The patients were divided into two groups (no BPD-period and BPD-period). Before BPD, RAoR ≥ 2 was seen in 25% of the patients in group 1 and in 29% of the patients in group 2 (P ≥ 0.593). BPD was carried out in 95% (n = 21) of the patients in group 2 with RAoR ≥ 2. Regurgitation improved one grade in 68% of the cases (n = 15), 2 grades in 14% (n = 3), and remained without change in 18% (n = 4). RAoR < 2 was achieved in 91% (n = 73) of the patients in group 2 versus 75% (n = 58) in group 1 (RR = 0.35, 95% CI 0.16-0.80, P = 0.013). We recorded no aortic ring ruptures, damage to the device or displacements. Slight central regurgitation not present before BPD was registered in one case. CONCLUSIONS: BPD offers a very good safety profile and reduces RAoR in a large percentage of cases. BPD should be considered for the treatment of moderate to severe RAoR following TAVI.

Angioplastia retrógrada sobre obstrucción crónica / Retrograde angioplasty in chronic total occlusion

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[Anomalous coronary arteries originating in the contralateral sinus of Valsalva: registry of thirteen Spanish hospitals (RACES)]. / Registro de anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral en 13 hospitales españoles (RACES).

The registry contains information collected during 2003 from thirteen Spanish hospitals on the incidence, clinical presentation, initial course, diagnostic imaging, and treatment of anomalous coronary arteries originating in the contralateral coronary sinus. In a total of 23,300 coronary angiograms, 98 anomalous coronary arteries were detected (incidence 0.4%): 46 circumflex coronary arteries (47%), 25 right coronary arteries (25.5%), 10 left main coronary arteries (10.2%), three left anterior descending arteries (3.1%), six single coronary arteries (6.1%), and eight other anomalies (8.2%). The most frequent indication for angiography was angina (43.9%). The initial course of the anomalous coronary artery was not identified in 40.8% of cases. In two patients (2%), diagnostic imaging was used to identify the initial course. Associated atherosclerotic disease was present in 51% of patients. In addition, 18.4% had associated valvular disease, with the aortic valve being affected most often (15.2%). Some 16.3% of patients underwent treatment for the coronary anomaly. The incidence was similar to that observed in other published series, with anomalies in the circumflex coronary artery being diagnosed most frequently. Diagnostic imaging was underused.

Registro de anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral en 13 hospitales españoles (RACES) / Anomalous coronary arteries originating in the contralateral sinus of valsalva: registry of thirteen spanish hospitals (RACES)

Este registro estudió la incidencia, la clínica asociada, el trayecto, los métodos diagnósticos de imagen y el tratamiento de las anomalías coronarias con origen en el seno coronario contralateral en 13 hospitales durante 2003. En 23.300 coronariografías se describieron 98 anomalías (incidencia del 0,4%): 46 circunflejas (47%), 25 coronarias derechas (25,5%), 10 coronarias izquierdas (10,2%), 3 descendentes anteriores (3,1%), 6 coronarias únicas (6,1%) y 8 incluidas en el apartado «otras» (8,2%). El motivo de la coronariografía más frecuente fue la angina (43,9%). El trayecto inicial de la coronaria anómala no fue identificado en el 40,8% de los casos. En 2 pacientes (2%) se emplearon métodos de imagen asociados. El 51% tenía enfermedad coronaria asociada y el 18,4%, valvular; la válvula aórtica era la más afectada (15,2%). El 16,3% recibió tratamiento para la anomalía. Se observó una incidencia similar a la de series previas, y las anomalías de la circunfleja fueron las más frecuentes. Los métodos de imagen asociados para el diagnóstico del trayecto inicial fueron infrautilizados

The registry contains information collected during 2003 from thirteen Spanish hospitals on the incidence, clinical presentation, initial course, diagnostic imaging, and treatment of anomalous coronary arteries originating in the contralateral coronary sinus. In a total of 23,300 coronary angiograms, 98 anomalous coronary arteries were detected (incidence 0.4%): 46 circumflex coronary arteries (47%), 25 right coronary arteries (25.5%), 10 left main coronary arteries (10.2%), three left anterior descending arteries (3.1%), six single coronary arteries (6.1%), and eight other anomalies (8.2%). The most frequent indication for angiography was angina (43.9%). The initial course of the anomalous coronary artery was not identified in 40.8% of cases. In two patients (2%), diagnostic imaging was used to identify the initial course. Associated atherosclerotic disease was present in 51% of patients. In addition, 18.4% had associated valvular disease, with the aortic valve being affected most often (15.2%). Some 16.3% of patients underwent treatment for the coronary anomaly. The incidence was similar to that observed in other published series, with anomalies in the circumflex coronary artery being diagnosed most frequently. Diagnostic imaging was underused

[Myocardial Infarction Registry in Asturias: the RIMAS project]. / Registro del Infarto de Miocardio en Asturias: proyecto RIMAS.

BACKGROUND AND OBJECTIVE: Spanish hospital registers of myocardial infarction (MI) are not uniform. The RIMAS project is trying to know the real situation of myocardial infarction in Asturias and to observe possible differences among hospitals and with other registers. PATIENTS AND METHOD: It was a cohorts study using a hospital registry of patients with MI. All cases arriving alive to all public and private-public Asturian hospitals during 1998 were included. Demographic data, cardiovascular risk factors, delays, evolution, treatments and techniques used, were all registered. RESULTS: 875 cases were registered with a coverage rate of 77%. The average age was 66.5 years (45.6% older than 70 years) and women represented 29.1%. Sixty three per cent of the patients had tobacco consumption, 43% had arterial hypertension, and 22.3% were diabetics. The extrahospital delay was 135 min and thrombolysis delay was 180 min. Thrombolytic therapy was administered to 34.1% of patients and 4% were treated with primary angioplasty. Intrahospital mortality was 14.4%. At discharge, antiagregant therapy was administrated to 94%, betablockers to 43.2%, ACE inhibitors to 33.3% and hypolipemiants to 25% of treated patients. CONCLUSIONS: People attended in Asturias with a MI are older and there is a higher percentage of women. There are delays which include the start of thrombolytic therapy. However, there are significant differences with regard to the adhesion to clinical practice guidelines between different hospitals.