Vincent Varghese

Percutaneous mitral valve repair: lessons from the EVEREST II (Endovascular Valve Edge-to-Edge REpair Study) and beyond.

The 24-month results of the EVEREST II (Endovascular Valve Edge-to-Edge REpair Study), presented at the American College of Cardiology 2011 Scientific Sessions/i2 Summit and recently published ([1][1]), investigating the safety and efficacy of the MitraClip (Abbott Vascular, Santa Clara, California

Intracardiac Echocardiography Evolving Use in Interventional Cardiology

Intracardiac echocardiography (ICE) uses a catheter‐based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia. Intracardiac echocardiography is generally well tolerated and provides adequate images and sufficient information for the procedure performed. In the cardiac catheterization laboratory, ICE is routinely used for patent foramen ovale, atrial septal defect, and ventricular septal defect closures, allowing adequate percutaneous placement of septal occluders. It is now being considered in the current era of transcatheter aortic valve implantation necessitating improved imaging approaches for accurate placement. It is also routinely used for trans‐septal punctures during mitral valvuloplasty and, more recently, with the advent of left atrial appendage closure devices. This article provides a comprehensive review of the current technology for ICE and its growing applications in the realm of interventional cardiology.

Ostial left main occlusion following surgical aortic valve replacement (SAVR)

Left main coronary artery (LMCA) obstruction may occur following both transcatheter and surgical aortic valve replacement (SAVR).We present images of LMCA obstruction follow SAVR and describe its management with a bare metal stent (BMS). A 70-year-old femalewith a bicuspid aortic valve and severe aortic stenosis (mean gradient of 51mmHg; aortic valve area of 0.78 cm) and a 70% first diagonal stenosis underwent a SAVR with a 19-mm Medtronic Mosaic bioprosthesis (Medtronic Inc., Minneapolis, MN)

Transcatheter aortic valve implantation: lessons from the PARTNER (Placement of Aortic Transcatheter Valves) trial.

The PARTNER (Placement of Aortic Transcatheter Valves) trial, recently published ([1][1]) and presented at the 2010 Transcatheter Cardiovascular Therapeutics conference, investigated the safety and efficacy of transcatheter aortic-valve implantation (TAVI) in patients deemed unsuitable for surgical

PHYSIOLOGICAL ASSESSMENT OF ISCHEMIA USING FRACTIONAL FLOW RESERVE IN CORONARY CHRONIC TOTAL OCCLUSIONS

The ideal treatment strategy of coronary artery chronic total occlusions (CTO) remains a topic of debate and discussion in regards to medical therapy versus percutaneous revascularization. Despite the presence of well-established collaterals, fractional flow reserve (FFR) in myocardial territories

Effect of hemostatic device on radial artery occlusion: A randomized comparison of compression devices in the radial hemostasis study

BACKGROUND Asymptomatic radial artery occlusion (RAO) is a major limitation of transradial catheterization (TRC). Two radial compression hemostatic devices are compared for their respective effects on RAO. METHODS In a prospective, randomized, single center, blinded trial, 320 patients were randomly treated with a TR band (Terumo Corporation) or Safeguard Radial (Merit Medical). Institution wide protocols consisting of anticoagulation, patent hemostasis, duration of compression, and use of 6 French slender sheaths (Terumo Corporation) were observed. Patient discomfort related to the device was recorded using the universal pain scale. Radial artery patency was evaluated by reverse Barbeaus test prior to discharge (1-hour post-diagnostic catheterization or 6-24 hour post-intervention) and at 30-days. RESULTS Of the 320 patients, 155 were randomized to the TR group (TRG) and 159 to the Safeguard group (SGG). 6 patients were excluded due to the inability to insert 6 Fr slender sheaths or patient withdrawing consent. Demographic and procedural characteristics were similar with the exception of the type of coronary procedure performed. Both bands were equally effective in achieving patent hemostasis. Despite having a higher rate of post-procedure hematoma (1.29% TRG vs. 3.1% SGG, p = 0.04) and acute RAO (3.8% TRG vs. 6.28% SGG, p = 0.05) with the Safeguard band, at 30 days RAO was similar in both groups (1.9% TRG vs. 2.5% SGG; p = 0.21). Patients in the SGG reported significantly less band discomfort and were found to require less air to achieve patent hemostasis. CONCLUSION Evidence-based contemporary TRC protocols of using smaller diameter access, anticoagulation, and use of just enough pressure for the shortest duration of time to achieve hemostasis is associated with very low RAO rate at 30 days irrespective of the radial compression device used.

FEMORAL ARTERY CHRONIC TOTAL OCCLUSION REVASCULARIZATION (FACTOR) STUDY: VALIDATION OF A PERIPHERAL CTO ALGORITHM AND SCORE

Superficial femoral artery (SFA) disease is the most common cause of symptomatic peripheral arterial disease (PAD), and can progress from lifestyle limiting claudication to critical limb ischemia and limb loss. Chronic total occlusions (CTO) of the lower extremities, found in 40% of symptomatic PAD