Transcatheter aortic valve replacement (TAVR) is now the standard of care for patients with symptomatic severe aortic stenosis who are at extreme, high, or intermediate risk for surgery. This multicenter, prospective study (Feasibility of Transcatheter Aortic Valve Replacement in Low-Risk Patients With Symptomatic, Severe Aortic Stenosis) included low-risk patients and was approved by the United…
Myocardial Revascularization Surgery Hits a Plateau
Hopes were raised high by the ARTS study, when set to show the benefit of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery compared over the use of a single internal mammary artery (SIMA) at 10 year follow up, but only one sub-study was able to show an advantage over radial grafts.…
Practical Management of Coronary Perforations
Coronary perforation has an incidence of 0.5% and it is associated with a 13-fold increase in in-hospital events and a 5-fold increase in 30-day mortality. This event is so catastrophic that its management has become indispensable knowledge to all interventional cardiologists. This accident is most frequently provoked by artery over-dilation caused by a balloon or…
How to predict post TAVR quality of life in “real world” patients
Despite the benefit for most patients, a small number of patients still show poor outcomes after transcatheter aortic valve implantation (TAVR). This work was able to recalibrate a previously developed risk model to predict post TAVR quality of life and provide us with a potential tool to properly estimate the chances of good recovery, or…
New Anticoagulant Agents in Atrial Fibrillation in Latin American Patients, Specifically
There is limited information on the use of antithrombotic therapies and their outcomes in Latin American patients with atrial fibrillation. This stands true in almost all aspects of medicine: large multicenter randomized studies rarely include Latin American countries, and when they do, the population included is not representative of the overall population. The only exception…
Complete Revascularization Improves Long-Term Prognosis in Acute Coronary Syndromes
Going beyond the culprit artery during angioplasty was associated with lower mortality, although this was a cohort study that should be confirmed through randomized trials. According to this new observational study, patients experiencing non-ST-segment elevation myocardial infarction with multivessel disease seem to benefit from complete revascularization during initial angioplasty. This study, published online before…
iFR Assessment of Intermediate Aortic Stenosis Lesions Consolidates
Once a big void that prevented us from effectively assessing functional compromise, intermediate aortic stenosis has made us treat many lesions “just in case”, to save us what would be a complicated procedure, had a valve been placed. Auspiciously, some light has been shed by several, most welcome, studies simultaneously published in J Am Coll…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
ICELAND MI: Unrecognized MI Have Similar Prognosis to Recognized MI
At 10-year follow-up, unrecognized or silent MIs have similar mortality to clinically recognized MI and, even though this does not justify routine screening, these findings call for more aggressive prevention. Unrecognized MI, detected by MRI, is associated to long term mortality risk similar to that of recognized MI; therefore, these patients have higher risk…
Discharge During the Weekend After Cardiac Surgery Is Not Associated with Readmissions
According to this new work (soon to be published in Ann Thorac Surg), discharging a patient during the weekend or a holiday after cardiac surgery is not associated with higher rates of readmission compared with patients discharged during weekdays. A total of 4877 patients were discharged after cardiac surgery in high-volume sites in the United States. Among them,…