Justin Cox

Impact of Preprocedural B-Type Natriuretic Peptide Levels on the Outcomes After Transcatheter Aortic Valve Implantation.

There are limited data on the effect of baseline B-type natriuretic peptide (BNP) on the outcome after transcatheter aortic valve implantation (TAVI). We investigated the influence of baseline BNP levels on the short-term and midterm clinical outcomes after TAVI. During a 3-year period, 780 patients with severe aortic stenosis underwent TAVI at our institute and had baseline BNP levels. We compared the high, mid, and low tertiles of BNP levels. TAVI end points, device success, and adverse events were considered according to the Valve Academic Research Consortium 2 definitions. Device success was significantly lower for patients with high BNP (98.1% vs 96.2% vs 91.9% for the low, mid, and high BNP tertiles, respectively; p = 0.003). All-cause mortality up to 30 days was 1.2% (3 of 260) versus 2.3% (6 of 260) versus 5% (13 of 260), respectively (p = 0.03). Six-month mortality rate was 4.1% (10 of 241) for the low BNP tertile, 5% (12 of 239) for the mid BNP tertile, and 17.1% (40 of 234) for the high BNP tertile (p <0.001). In the multivariate model, high tertile of baseline BNP was found to be significantly associated with all-cause mortality (hazard ratio 3.3, 95% confidence interval 1.64 to 6.48; p = 0.001). In conclusion, elevated BNP levels are associated with increased short-term and midterm mortality after TAVI. We recommend measurement of baseline BNP as part of risk stratification models for TAVI.

Impact of body mass index on the outcomes following transcatheter aortic valve implantation

To investigate the influence of body mass index (BMI) on short‐ and midterm outcomes following transcatheter aortic valve implantation (TAVI).

Optical coherence tomography guided carotid artery stent procedure: technique and potential applications

To (1) present a guide on how to perform optical coherence tomography (OCT) in carotid artery stenting (CAS), to (2) highlight several instructive cases illustrating OCT‐guidance as an interventional strategy, and to (3) present the largest case‐series of OCT‐guided CAS performed in North America, demonstrating its feasibility as an imaging modality in this setting.

Not Your Typical Hole-in-the-Wall: Percutaneous Closure of an Acquired Post-Myocardial Infarction Ventriculoatrial Gerbode Defect.

A 58-year-old male patient presented with an inferior ST-segment elevation myocardial infarction complicated by a ventricular septal defect (VSD). The VSD was surgically repaired, but basal extension of necrotic tissue obligated a second repair 2 weeks later. Subsequently, he again presented in

Percutaneous Management of Aortic Root Rupture During Transcatheter Aortic Valve Replacement With Coil Embolization

Aortic root rupture is a rare, but potentially fatal, complication of transcatheter aortic valve replacement (TAVR).1,2 Despite the advances in TAVR technology, aortic root rupture continues to be associated with high mortality because of the lack of effective treatment options for this complication. We describe 2 cases of aortic root rupture occurring during TAVR that were managed percutaneously with coil embolization of the periaortic space created by the root rupture. A 79-year-old patient underwent TAVR with a 29-mm Evolut R (Medtronic, Inc, Minneapolis, MN). Pre-TAVR computed tomography revealed annular perimeter 81.6 mm (mean diameter, 26.0 mm). Because of significant paravalvular aortic regurgitation (Figure 1A; Movie IA in the Data Supplement), post-dilation was performed with a 26 mm×4.5 cm True Balloon (Figure 1B; Movie IB in the Data Supplement). Immediately after post-dilation, a large pericardial effusion was noted (Figure 1C; Movie IC in the Data Supplement). Emergent pericardiocentesis was performed. Selective injection into the left coronary cusp with a 6F XB-LAD 3.5 guide catheter revealed the site of aortic root rupture in the left coronary sinus, with contrast extravasating into the pericardial space (Figure 1D and 1E; Movie ID …

OUTCOMES OF TRANSCATHETER CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT

As care and outcomes for acute myocardial infarction (MI) continue to improve, ventricular septal defect (VSD) remains a very serious mechanical complication of acute MI that is associated with high mortality and morbidity. Patients with post-MI VSD are often late presenting acute coronary syndrome

Don't you forget about me! The 80s still matter!

Invasive therapy had a significantly lower odds ratio of death at 28 days in elderly patients Patients treated with a conservative approach received significantly less guideline directed medical therapy The highest risk (those most likely to benefit) were less likely to get invasive therapy