Nilesh J. Goswami

Angiogenic bFGF expression from gas-plasma treated implants

Abstract Purpose: In vivo experiments indicate that gas-plasma-treated d,l-polylactide polymers expressing basic fibroblast growth factor (bFGF) exhibit enhanced angiogenesis. bFGF is not a single entity, but it is instead a family of isoforms. Consequently, we sought to determine which bFGF isoforms and levels initiate angiogenesis in nude mice peritoneums. Methods: Cytoplasmic and nuclear bFGF were characterized for nude mice peritoneums incubated with nontreated scaffolds containing HAEC (CW), its respective polymer-only scaffolds (C p ) and gas-plasma treated scaffolds with HAEC (TW) and without cells (T p ). NuPAGE electrophoresis and WesternBreeze Chemiluminescent kits were used to analyze relative bFGF densities and molecular weights. VEGF was quantified using ImageJ. Results: bFGF bands were located at molecular weights of 24, 48, 58, 72 and 80 kDa, depending on whether they were from cytoplasms or nuclei. At 12, 24 and 72 days, 58-kDa bFGF bands were observed from nuclei of TW and T p , 80-kDa bFGF bands were only observed in cytoplasmic fractions ≤24 days. Total cytoplasmic and nuclear bFGF intensities increased from 12 to 24 days, then declined by 72 days. Conclusions: (1) Gas-plasma treated scaffolds up-regulate bFGF isoforms. (2) bFGF was expressed in the nuclei; however, 80-kDa bFGF was seen only in cytoplasms.

VEGF analysis induced by endothelialized gas-plasma treated D,L-PLA scaffolds.

PURPOSE Vascular endothelial growth factor (VEGF) isoforms play different roles in the temporal sprouting of endothelial-lined vessels in a nude mouse peritoneal model as cells respond to nontreated control and gas-plasma-treated bioresorbable poly-D,L-lactide acid 3D scaffolds with human aortic endothelial cells (HAEC). METHODS AND MATERIALS Nude mice peritoneums were incubated with HAEC (CW = control; TW = gas-plasma treated) or polymer scaffolds (Cp = control; Tp = treated) for 12, 24 and 72 days. Cytoplasmic and nuclear protein fractions were isolated using NER, electrophoresized using NuPAGE-MES and analyzed by WesternBreeze Chemiluminescent. RESULTS Prominent VEGF bands included 28, 45 and 62 kDa; 52-kDa VEGF observed in cytoplasmic TW fractions contributed about 18.6% at 12 days, 20.0% at 24 days and 13.1% at 72 days of the total VEGF signal. Yet, it was only noted in CW at 72 days where it accounted for 6.9%. A unique 32-kDa band appeared in both Cp (24.6%) and Tp (18.3%). Significant differences between band densities occurred for cytoplasmic nuclear CW24- TW24 (P = .022), CW72-TW72 (P = .011) and, also, cytoplasmic Cp24-Tp24 (P = .038). CONCLUSIONS The temporal and spatial organization of the TW isoforms results in more angiogenesis.

Percutaneous thoracic aortic aneurysm repair through transcaval aortic access

Transcaval aortic access has been used for deployment of transcatheter aortic valves in patients in whom conventional arterial approaches are not feasible. This access can be vital in other situation when large bore access is needed. We described a case of 65‐year‐old man who had large thoracic descending aortic aneurysm with diffuse bilateral iliac disease precluding the arterial access required for the procedure. The patient underwent successful transcaval access with placement of 22‐Fr balloon expandable sheath followed with successful deployments of 32 mm × 32 mm × 150 mm Valiant stent graft (Medtronic, Minneapolis, MN). The aorto‐vena cava tract was closed successfully using 12 × 10 PDA occluder device with no residual flow at the end of the case, which was confirmed on repeated CT next day.

Percutaneous Mechanical Reperfusion During Acute Myocardial Infarction

The treatment of acute myocardial infarction has progressed from bedrest to mechanical, catheter-based reperfusion. The authors review the use of percutaneous coronary intervention (PCI) as a primary treatment for acute myocardial infarction and the use of adjunctive agents. The most recent American College of Cardiology/ American Heart Association (ACC/AHA) guidelines for the use of PCI in ST segment elevation myocardial infarction (MI) advocate the use of PCI as primary therapy at those centers in which the procedure can be performed within accepted standards. Because a majority of hospitals (80%) do not have the capability of performing primary PCI, most patients are treated with thrombolytic therapy. PCI should be considered in those patients treated with thrombolytic therapy who have persistent or recurrent ischemia and/or cardiogenic shock. For patients with non-ST elevation MI, the use of an invasive strategy (early angiography and PCI if needed) has recently shown to be beneficial. Although revascularization is the basis of the acute therapy of MI, additional pharmacologic therapy in the acute setting is now recognized as a key to favorable long-term outcome.

ECHOCARDIOGRAPHY DERIVED PREDICTORS OF LONG-TERM OUTCOMES AFTER TAVR

Transaortic flow, maximum velocity (V max), mean gradient (MG), Ejection Fraction (EF), Aortic valve area (AVA) and dimensional index (DI) are important determinant of prognosis in patients with severe aortic stenosis. The specific role of these echocardiography-derived values plays in predicting

REDUCING COST OF TAVR PROGRAM THROUGH APPLYING LEAN PROCESSES

Although transcatheter aortic valve replacement TAVR provides an important alternative for patients with severe aortic stenosis, it is associated with high cost with potential economical burden on hospital performing it. Applying lean processes may help in identifying and reducing potential wastes

Thoracic endovascular repair versus medical management for acute uncomplicated type B aortic dissection

Current treatment options and outcomes for acute uncomplicated thoracic Type‐B aortic dissection (TBAD) remain unclear between medical management (MED) and thoracic endovascular aortic repair (TEVAR). In this study we aim to compare both strategies in terms of all‐cause mortality, aortic dilation, and aortic rupture.

Endovascular repair of complex Juxtarenal aortic aneurysm using a combined fenestrated endograft and chimney technique

Chimney EVAR (CHEVAR) and Fenestrated EVAR (FEVAR) are two options for management of very complex abdominal aortic aneurysm (AAA). While some anatomical factors may favor one strategy over the other, there are some cases where the anatomical challenges may require using a hybrid approach. We are reporting the case of an 84-year-old male with a 6.8×5.7cm infrarenal abdominal aortic aneurysm that arises immediately below the level of the renal arteries and extends down to just above the iliac bifurcation with occluded celiac and inferior mesenteric arteries and severe bilateral renal artery stenosis with caudally oriented right renal and cranially oriented left renal artery. This case shows that a combined strategy with fenestrated graft and Chimney stenting is feasible for aortic aneurysm repair and may offer a reasonable option for patients with very complex aortic anatomy.