Zisis Dimitriadis

Balloon Expandable Sheath for Transfemoral Aortic Valve Implantation: A Viable Option for Patients with Challenging Access

BACKGROUND AND OBJECTIVESnTranscatheter aortic valve replacement (TAVR) via femoral access is a new option for patients with severe aortic valve stenosis considered to be at high risk for conventional open-heart surgery. This procedure requires peripheral arteries that are able to accommodate the large sheaths required for valve delivery. We present a series of patients with suboptimal vascular conditions, who received a self-expandable vascular sheath.nnnMETHODS AND RESULTSnFrom January 2009 to September 2011, a total of 96 patients (43% male) were treated with the 18F Medtronic CoreValve (Medtronic, Minneapolis, MN, USA). The patients average age was 82.5u2009±u20094.6 years, and the mean EuroSCORE was 29%. In eight cases, vascular conditions were inadequate either due to advanced atherosclerotic disease (nu2009=u20095, 62.5%), or an arterial diameter ≤7u2009mm (nu2009=u20093, 37.5%). Instead of the standard 18F sheath, a balloon-expandable transfemoral introducer (SoloPath Introducer, Onset Medical Corporation, Irvine, CA, USA) was delivered and removed without complications in all but one (87.5%) patient. In the last case, rupture of the right femoral artery occurred after removal of the sheath with the need of vascular surgery.nnnCONCLUSIONnThe SoloPath sheath is a feasible alternative to conventional sheaths for transfemoral TAVR patients with difficult femoral vascular access.

Erratum to: Third generation drug eluting stent (DES) with biodegradable polymer in diabetic patients: 5 years follow-up

© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Erratum to: Cardiovasc Diabetol (2017) 16:23 DOI 10.1186/s12933‐017‐0500‐3 After publication of the original article [1], it came to the authors’ attention that there was a typo within the author list. The family name of Sinisa Stojkovic was incorrectly spelled ‘Stoikovic’. The author’s name appears in its correct form in this erratum.

63‐year Survival after Blalock‐Taussig Shunt Operation in a Patient with Single Ventricle, Tricuspid Atresia, and Pulmonary Stenosis

A 63-year-old female with complex congenital heart disease underwent a classical Blalock-Taussig (B-T) shunt operation at the age of 3 years in 1948. The cardiac morphology was not amenable to further definite surgical repair in that period of time. With this palliative operation, the patient survived to the age of 63 years and now presented with exercise intolerance and significant desaturation. Cardiac catheterization with angiography revealed a severe stenosis of the B-T shunt at the pulmonary end. Balloon dilation and stent implantation could be performed successfully. Follow-up after 5 months showed a patent B-T shunt and an increase of oxygen saturation from 65% to 80% and mild improvement of pulmonary blood flow and exercise tolerance.

GENDER-RELATED ASSOCIATION BETWEEN RESPIRATORY STABILITY AND CHEYNE-STOKES RESPIRATION IN CHRONIC HEART FAILURE: A MATCHED CONTROL STUDY

Introduction: Hypersensitive ventilatory feedback loop has major impact on the manifestation of Cheyne-Stokes respiration (CSA) in chronic heart failure (CHF). As CSA mainly affects male CHF patients (pts), this study aims to clarify the role of respiratory stability in the evolution of CSA in men and women. Methods: We investigated 563 pts with CHF (91 female, LVEF ≤45%, NYHA-class ≥2) using echocardiography, cardiopulmonary exercise testing (CPX), cardiorespiratory polygraphy, measurement of hyperoxic, hypercapnic ventilatory response (HCVR), and standard laboratory. Adjusted for age (±2 years), body mass index (BMI; ± 2), and LVEF (± 3%) 79 matched pairs (male/female) were eligible for analysis. Results: Obstructive sleep apnoea (AHI ≥5/h) was present in 12 female (15.2%) and 13 male (16.4%) pts (p=n.s.), CSA (AHI ≥5/h) in 30 (37.9%) female and 54 (68.4%) male pts (p 2 36.7 (interquartile range (IQR) 34.4-39.4) vs. 36.7 (IQR 34.8-38.7), VE/VCO 2 slope during CPX 34 (IQR 30-40) vs. 35 (IQR 31-40), HCVR 2.32 (IQR 1.71-3.49) vs. 2.69 (IQR 2.01-4.45) did not show a significant difference. Adjusted for age, NYHA-class, BMI, heart rate, LVEF, CRP, creatinine, NT-proBNP stepwise regression analysis revealed HCVR (p=0.03) an independent predictor for CSA in male pts while NYHA-class (p=0.04) was the only independent predictor for CSA in female pts. Conclusion: These data suggest gender-related differences in the evolution of CSA. Additional studies are warranted to figure out a more sophisticated pathophysiological concept that may elucidate these findings.