Ivan D. Hanson

Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction

The aim of this study was to analyze clinical and angiographic differences between the two etiologic subtypes of perioperative myocardial infarction (PMI).

Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound

The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds.

Mitral valve repair after annuloplasty ring dehiscence using MitraClip

Dehiscence of a surgical mitral annuloplasty ring for repair of functional mitral regurgitation (MR) is an infrequently reported complication that often manifests as recurrent MR and heart failure. Re‐do mitral valve surgery to correct ring dehiscence may not be feasible for patients at high risk of operative mortality or serious morbidity. We report two cases of mitral annular ring dehiscence and severe mitral regurgitation in patients at prohibitive risk for re‐do mitral valve surgery who were successfully treated with MitraClip.

“Optimized” delivery of intracoronary supersaturated oxygen in acute anterior myocardial infarction: A feasibility and safety study

We sought to evaluate the feasibility and safety of catheter‐based supersaturated oxygen (SSO2) delivery via the left main coronary artery (LMCA) following primary percutaneous coronary intervention (PCI). Background: In the multicenter, randomized AMIHOT‐II trial, SSO2 delivered into the proximal or mid left anterior descending (LAD) artery via an indwelling intracoronary infusion catheter in patients with acute anterior ST‐segment elevation myocardial infarction (STEMI) following primary PCI significantly reduced infarct size but resulted in a numerically higher incidence of safety events. Methods: Patients with acute anterior STEMI presenting within 6 hr of symptom onset were enrolled at three centers. Following successful LAD stenting, SSO2 was infused into the LMCA via a diagnostic catheter for 60 min. The primary safety endpoint was the 30‐day rate of target vessel failure (composite of death, reinfarction, or target vessel revascularization). Cardiac magnetic resonance imaging (cMRI) was performed at 3–5 and 30 days to assess infarct size. Results: Twenty patients with acute anterior STEMI were enrolled. The infarct lesion was located in the proximal LAD in 7 cases (35%) and the mid LAD in 13 cases (65%). Following primary PCI, SSO2 was delivered successfully in all cases. Target vessel failure within 30 days occurred in 1 patient (5%). Median [interquartile range] infarct size was 13.7% [5.4–20.6%] at 3–5 days and 9.6% [2.1–14.5%] at 30 days. Conclusions: Following primary PCI in acute anterior STEMI, infusion of SSO2 via the LMCA is feasible, and is associated with a favorable early safety and efficacy profile.

Severe mitral regurgitation and biventricular heart failure successfully treated with biventricular percutaneous axial flow pumps as a bridge to mitral valve surgery.

Prompt recognition of acute right ventricular failure is essential in order to provide timely hemodynamic support. We report a case of a patient with severe mitral regurgitation complicated by cardiogenic shock that failed to improve with left ventricular support alone. The recognition of concomitant right ventricular failure led to the addition of a right ventricular support device, resulting in dramatic hemodynamic improvement.

Outcome of percutaneous coronary intervention following recent surgery.

Outcome data regarding postoperative acute coronary syndrome treated with percutaneous coronary intervention (PCI) are limited. The objective of this study was to determine clinical outcomes of patients undergoing PCI within 7 days after a surgical procedure. We assessed outcomes of 517 patients who underwent PCI within 7 days after a surgery across 44 hospitals from January 2010 to December 2011 from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry. Patients with postoperative PCI were compared with all other patients with PCI using propensity-matched analysis. Of the 65,175 patients who underwent PCI within the study period, 517 patients had undergone surgery within the previous 7 days. In unadjusted analysis, patients with postsurgical PCI had higher in-hospital mortality (6.96% vs 1.33%), stroke (0.96% vs 0.26%), bleeding events (6.96% vs 2.6%), heart failure (6.96% vs 2.36%), and cardiogenic shock (7.16% vs 1.95%). After propensity matching, mortality remained higher in postsurgical patients (6.5% vs 3.96%, odds ratio 1.7 [1.1 to 2.6], p = 0.02). The odds of mortality were especially high among patients who would otherwise be considered low risk (<1% of predicted mortality in a nonsurgical setting) in whom a recent surgery was strongly associated with death (odds ratio 5.7, p = 0.02). In conclusion, PCI performed within 7 days after a surgical procedure is associated with an increased risk of early mortality. Although some of this increased risk is related to an adverse clinical profile, higher mortality is also observed in patients otherwise considered low risk for PCI.

Evaluation of intracoronary hyperoxemic oxygen therapy in acute anterior myocardial infarction: The IC-HOT study

In the randomized AMIHOT‐II trial, supersaturated oxygen [SSO2] delivered into the left anterior descending (LAD) artery via an indwelling intracoronary infusion catheter following primary percutaneous coronary intervention (PCI) significantly reduced infarct size in patients with anterior ST‐segment elevation myocardial infarction (STEMI) but resulted in a numerically higher incidence of safety events.

Emergency Valve-in-Valve Transcatheter Aortic Valve Implantation for the Treatment of Acute Stentless Bioprosthetic Aortic Insufficiency and Cardiogenic Shock

Bioprosthetic aortic valve degeneration may present as acute, severe aortic regurgitation and cardiogenic shock. Such patients may be unsuitable for emergency valve replacement surgery due to excessive risk of operative mortality but could be treatable with transfemoral valve-in-valve transcatheter aortic valve implantation (TAVI). There is a paucity of data regarding the feasibility of valve-in-valve TAVI in patients presenting with cardiogenic shock due to acute aortic insufficiency from stentless bioprosthetic valve degeneration. We present one such case, highlighting the unique aspects of valve-in-valve TAVI for this challenging patient subset.

OUTCOME-BASED COST ANALYSIS OF TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENT USING FASCIA ILIACA COMPARTMENT BLOCK AND MINIMALIST CONSCIOUS SEDATION APPROACH VERSUS GENERAL ANESTHESIA

Background: Early studies demonstrated feasibility of minimalist conscious sedation (CS) for Transfemoral (TF) access for transcatheter aortic valve replacement (TAVR). A recent STS-ACC TVT Registry analysis demonstrated that a CS TF-TAVR has lower mortality, stroke, and shorter length of stay (LOS

TCT-808 Invasive Characterization of Atherosclerotic Plaque in Patients with Peripheral Arterial Disease Using Near Infrared Spectroscopy Intravascular Ultrasound

nos: 810 813 TCT-810 Percutaneous Mitral Valve Repair for Management of Systolic Anterior Motion and Mitral Regurgitation Associated with Hypertrophic Cardiomyopathy Saurabh Gupta, Elizabeth Moe, Matthew Slater, Stephen Heitner OHSU, Portland, Oregon, United States; Medtronic, portland, Oregon, United States; Oregon Health & Science University, Portland, Oregon, United States; Oregon Health and Science University, Portland, Oregon, United States BACKGROUND Hypertrophic cardiomyopathy (HCM) can be associated with abnormalities of the mitral valve (MV) apparatus, left ventricular outflow tract obstruction (LVOTO) and mitral regurgitation (MR). Therapies for symptomatic patients include septal myomectomy (SM) or alcohol septal ablation (ASA) but subsets of patients are