This is the largest and most recent analyzis to show colonic ischemia is more frequent after open abdominal aortic aneurysm repair (2.1% a 3.6%), compared against endovascular repair (0.5% a 1%), especially in elective patients. Most cases presented within the first 7 days. The evidence is not enough to determine the cause behind the different…
Maintaining Physical Activity After an Acute Myocardial Infarction Reduces Mortality
Performing a successful primary angioplasty and prescribing preventive medication without advising on the importance of keeping up with or taking up physical activity is a waste of one of our many opportunities to improve the quality of life of our patients and reduce mortality among them. If clinical cardiologists do not take over the patient,…
Restenosis Does Not Seem as Benign as We Thought
Elective, uncomplicated repeat revascularization after stent restenosis is associated with higher mortality rates according to a new meta-analysis that will be published soon in J Am Coll Cardiol Intrv. Historically, interventional cardiologists have seen target lesion revascularization (TLR) as a procedure that “unjustly” increased combined events in clinical studies and our own databases, thus representing…
The Higher the LDL-C Level, the Greater the Benefit in Mortality with Aggressive Therapy
The latest studies seem to support higher baseline LDL-C levels would justify further intensifying and already aggressive drug strategy. A more aggressive hypolipidemic therapy would involve adding far more expensive new drugs that many specialists are reluctant to accept, in terms of their cost benefit ratio. The intensive therapy to lower LDL-C levels reduces cardiovascular…
Hybrid Revascularization or Conventional Surgery: History Is Still Being Written
Hybrid revascularization seems to achieve results similar to those of conventional myocardial revascularization surgery at 5 years, although studies published so far do not seem to be enough for a definitive answer. This new work, soon to be published in J Am Coll Cardiol Intv, has had promising results in selected patients with multivessel disease; however,…
Baseline Pulmonary Hypertension Should Not Preclude TAVR
Pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) should not preclude this procedure. In fact, TAVR will resolve this condition in most cases. More than three quarters of patients undergoing TAVR have some level of PH, though this has not been associated to increased mortality, according to this…
Liver Failure as a Challenge for TAVR
Although surgical risk scores do not include liver failure (LF), patients who suffer from it and undergo cardiovascular surgery present high rates of morbidity and mortality. This is due to alteration of cardiac function, increased infection susceptibility, gastrointestinal complications, and increased bleeding. As regards transcatheter aortic valve replacement (TAVR), these patients have not been included…
TAVR with Prior MRS: A New Challenge
The benefits of transcatheter aortic valve replacement (TAVR) for high-risk, prohibitive-risk (class I) or intermediate-risk (class IIa) patients have already been proven, but there is a growing population of patients with a history of myocardial revascularization surgery (MRS) who experience severe aortic stenosis. Decision-making in these cases is anything but simple, mainly due to the presence of…
Bicuspid Valves Do Not Increase Mortality in TAVR
The frequency of bicuspid aortic valves (BcAV) are around 1%, but in 60+ patients it is associated to severe aortic stenosis. Even though surgery is the standard treatment, TAVR is the “off label” indication in high risk patients. BcAV presents differences with tricuspids given that it is more elliptic, has asymmetric calcification and more…
Significant Association Between Suprarenal Fixation of Endoprostheses and Renal Dysfunction
According to this meta-analysis, soon to be published in Eur. J. Vasc. Endovasc. Surg., endovascular abdominal aortic aneurysm repair prostheses with suprarenal fixation do not alter significantly the glomerular filtration rate at one year from device implantation. However, we should acknowledge that long-term outcomes are still unknown. The literature is inconsistent as regards the definition…