Konstantinos Voudris

Radial Interventions: Present and Future Indications

Opinion statementSince its first introduction, radial access for diagnostic and interventional cardiovascular procedures has progressively evolved with advances in understanding, capabilities, and ease of operation. Numerous studies have demonstrated its safety, efficacy, and cost-effectiveness. Overall, radial catheterization is a valid alternative to the femoral approach with additional benefits of shorter length of hospital stay and reduced patient costs when performed by experienced interventionists. Moreover, with reduced rates of access site complications and enhanced patient satisfaction, the transradial approach has emerged as the preferred vascular access route for most coronary interventions, even in cases of acute myocardial infarction.

Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage

Abstract Background and Objectives Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. Methods From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. Results The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioners decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. Conclusion Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.

Hybrid Coronary Revascularization: Present Indications and Future Perspective

Opinion statementHybrid coronary revascularization (HCR) strategy consists of minimal invasive left internal mammary artery to left anterior descending bypass grafting and percutaneous coronary intervention (PCI) of the remaining lesions. HCR combines the known benefits of the LIMA-to-LAD graft (LIMA: left internal mammary artery, LAD: left anterior descending) and drug eluting stent (DES) to non-LAD regions and is currently reserved for particularly high-risk patients with favorable anatomy. Despite the lack of multicenter randomized trials, several small non-randomized studies have shown that HCR is safe with low mortality rates, low morbidity, and shorter intensive care unit and hospital stay. Up to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.

Timing and Outcomes of PCI in the TAVR Era

Purpose of reviewTranscatheter aortic valve replacement (TAVR) has become an established therapy for patients with symptomatic severe aortic stenosis (AS). As the number of patients referred for TAVR increases, so does the prevalence of untreated obstructive coronary artery disease (CAD) in the population under evaluation. Despite the high prevalence of CAD in patients treated with TAVR, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty.Recent findingsPercutaneous coronary intervention (PCI) in patients with CAD and severe AS has been shown to be feasible and safe. Whether revascularization before, during, or after TAVR is optimal remains a subject of debate. All three approaches represent valid strategies with advantages and disadvantages that need to be carefully weighed on an individual basis.SummaryCurrent expert opinions recommend that PCI should be performed before or at the time of TAVR as long as the risk of the procedure does not outweigh the potential benefits. The results of large clinical trials evaluating the optimal revascularization time are closely awaited.

PERIPROCEDURAL BLOOD TRANSFUSIONS IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Background: Transcatheter Aortic Valve Replacement (TAVR) has become the standard of care for inoperable or high-risk patients with symptomatic severe aortic stenosis. We sought to compare clinical characteristics and in hospital procedural outcomes in patients receiving periprocedural blood

TCT-709 Trans-apical Transcatheter Aortic Valve Replacement in Patients with History of Coronary Artery Bypass Grafting: An Analysis from the National Inpatient Sample Database

TCT-708 Safety and Efficacy of the Percutaneous Transaxillary Access for Transcatheter Aortic Valve Implantation using various Transcatheter Heart Valves in 100 Consecutive Patients Ulrich Schafer, Florian Deuschl, Niklas Schofer, Christian Frerker, Daniel Reichart, Johannes Schirmer, Tobias Schmidt, Karl-Heinz Kuck, Felix Kreidel, Izamu Mizote, Hermann Reichenspurner, Stefan Blankenberg, Lenard Conradi Universitaeres Herzzentrum Hamburg, Hamburg, Germany; University Hospital Hamburg Eppendorf, Hamburg, Germany; University Heart Center Hamburg, 20246, Germany; Asklepiosklinikum St. Georg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany; Cardiovascular Surgeon, Hamburg, Germany; Asklepios Klinik St. Georg, Hamburg, Germany; Asklepios Hospital St. Georg, Hamburg, Germany; Asklepios Klinik St. Georg, Hamburg, Germany; University Heart Center Hamburg; University Heart Center Hamburg; Universitäres Herzzentrum Hamburg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany

TCT-141 Percutaneous Coronary Intervention (PCI) for Acute Myocardial Infarction in patients with Systemic lupus erythematosus: analysis from Nationwide Inpatient Sample (NIS)

Systemic lupus erythematosus (SLE) has been previously shown to increase risk of poor outcomes after acute myocardial infarction (AMI). Over the last years, numerous advances in PCI and SLE therapy have been achieved. Our objective was to evaluate contemporary outcomes and complications of AMI in

TCT-143 Outcomes of Percutaneous Coronary Intervention for Acute Myocardial Infarction in patients with history of Malignancy.

RESULTS Among 50,266,301 pts with as history of malignancy, 246,081 (0.49%) were treated with PCI for AMI during the study period. AMI with PCI was most prevalent in skin cancer pts increasing by 32.6% over the twelve-year period from 0.81% of the patients in 2002 to 1.07% in 2013. The highest increase, 78.8%, was observed in gynecologic cancer; incidence increased from 0.22% in 2002 to 0.39% in 2013, followed by pulmonary cancer, 75.6% increase, from 0.26% in 2002 to 0.46% in 2013. Incidence of AMI also increased in genitourinary, gastrointestinal, hematologic and breast cancer pts by 47.1%, 42.3%, 72.1% and 42.8% respectively. The reported increase in the incidence of AMI requiring PCI was statistically significant in all malignancy subtypes over the study period (P<0.001). (Figure 1.)

TCT-745 In-Hospital Clinical Outcomes Post Transcatheter Aortic Valve Replacement (TAVR) in Patients with History of Non-Cardiac Transplantation: Insights from the National Inpatient Sample (NIS) Database

Peri-procedural clinical outcomes in patients (pts) with prior history of non-cardiac transplantation (NCT) undergoing TAVR is currently unknown.nnWe sought to compare the clinical characteristics and in-hospital procedural outcomes in pts with and without prior history of NCT undergoing TAVR using

Radiation Exposures Associated With Radial and Femoral Coronary Interventions

Opinion statementThe volume of cardiac diagnostic procedures involving the use of ionizing radiation has increased rapidly in recent years, and the radiation exposure experienced by patients undergoing any medical imaging procedure has recently obtained a growing attention. Transradial (TR) access is being increasingly used worldwide for diagnostic coronary angiography (CA), and percutaneous coronary interventions, since it offers several benefits as compared to transfemoral (TF) access, such as by reducing hemostasis time and vascular complications, increased patient comfort, reduced hospital stay, and lower cost. In contrast, TR CA is thought to be associated with increased radiation exposure parameters compared with the traditional TF access. Although experienced operators may almost counterbalance this shortcoming, the increase in radiation exposure associated with TR approach seems not to be present in most clinical settings.