Tomás Benito-González

Double Guide Catheter Technique for Sealing an Iatrogenic Coronary Perforation

Introduction: Coronary vessel perforation is one of the most feared complications of coronary angioplasty. The treatment of this complication relies mostly on the implantation of covered stents. However, due to their design, covered stents are difficult to advance in a tortuous or calcified vessel. Case Presentation: We present a case of a grade III coronary perforation in which the double guiding catheter technique helped us to deliver the graft stent. Conclusions: The double-guiding technique is useful in emergency situations to increase the safety and efficacy of sealing a coronary perforation.

Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Objectives MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip. Methods Prospective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE. Results During a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup. Conclusions BE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.

Late Left Coronary Artery Compromise After Corevalve Implantation: Insights From Instant Free Ratio Analysis

The Supplemental Figure can be viewed in the online version of this article [http://dx.doi.org/10.1016/ j.athoracsur.2016.10.068] on http://www.annalsthoracic Arevascularization of triple-vessel disease received a diagnosis of symptomatic severe aortic stenosis. A 29-mm CoreValve Evolut R (Medtronic, Minneapolis, MN) was implanted through a transfemoral approach. One month later, the patient was readmitted for unstable angina. Aortic angiography showed a too-high position of the valve, so that the left main (LM) ostium was below the plane of the bioprosthetic leaflets and the struts impinged the left coronary sinus (LCS; Fig 1, red arrow).Nonselective coronary contrast injections showed patent vessels with thrombolysis in myocardial infarction (TIMI) 3 flow.AVerrata pressurewire (Volcano Corp, San Diego, CA) was advanced through the frame into theLCS (Fig 2A,bluearrow), and instant free ratio (iFR) measurements demonstrated severe flow impairment (Fig 2B).Manual pullbackwith the pressure wire showed an important pressure drop across the struts (Fig 2C, redarrow) because of narrowing at the LCS, thus limiting LM flow. Thereafter, the patient underwent open-heart surgery for aortic valve replacement (Supplemental Fig 1A, 1B) and referred symptomatic relief during follow-up. iFR is a resting index of stenosis severity that is measured without the need to use a vasodilator. iFR pullback is useful to locate the areas that can cause the predominant pressure loss in complex scenarios. Given prior multivessel revascularization and patent left main ostia in the angiography, the pressure wire enabled confirmation of LM functional compromise because of impaired LCS filling.

Percutaneous paravalvular leak closure after CoreValve transcatheter aortic valve implantation using an arterio-arterial loop

Significant periprosthetic aortic regurgitation after transcatheter aortic valve implantation has become a major concern of this technique given its association with impaired survival. We report the successful closure of such defect using a vascular occlusion device with the creation of an arterio-arterial loop to gain enough support to advance the delivery sheath into de the left ventricle.

Percutaneous Valvular Therapies in Heart Failure

Heart failure (HF) is one of the most important causes of morbidity and mortality in Western countries. Likewise, hospitalizations due to this condition are increasing as well resulting in very high costs for our health systems.

TCT-643 Percutaneous Mitral Valve Repair for Acute Mitral Regurgitation Following an Acute Myocardial Infarction

MitraClip® (Abbott Vascular, Santa Clara, CA, USA) has become the most frequently used transcatheter mitral valve repair technology for correcting mitral regurgitation (MR). Data form real-world registries have shown that in a high-risk population with functional MR, left ventricular dysfunction (

Mean platelet volume: ready for prime time?

Coronary artery disease (CAD) represents a leading cause of death worldwide despite current advances in drug and revascularization therapies. Given it adverse prognosis, risk stratification of patients with an acute coronary syndrome (ACS) remains a challenging issue. In this regard, different biomarkers are becoming more and more important in diagnosis assessment and outcome prediction.