All interventional cardiologists must be able to perform a pericardiocentesis. Whether we deal with a chronic total occlusion, a supposedly simple coronary angioplasty (we all have witnessed the perforation of a supposedly risk-free coronary artery), or a transcatheter aortic valve replacement (whose rise gave us another significant source of tamponades), we must all be ready…
Stroke, Migraine and Patent Foramen Ovale Not Necessarily Temporary Associated
Cryptogenic stroke patients with migraine have high prevalence (79%) of patent foramen ovale (PFO) with right to left shunt. However, the timing of stroke in migraineurs is not usually associated to a migraine attack. These observations are consistent with the hypothesis that the most likely mechanism of stroke in these patients with migraine is a…
We Should Consider Mitral Stenosis Before TAVR
The association between aortic stenosis and some degree of mitral stenosis (MS) is around 10% (depending on the series), and it is related with negative outcomes. In high-risk and inoperable patients who underwent TAVR, that association and its significance have not been studied yet. The study analyzed data from the Society of Thoracic Surgeons/American…
Morbidity and Mortality During Authorization Wait-Times for TAVR
For this Canada-based study, the increased number of patients who required a transcatheter aortic valve replacement (TAVR) may have come hand in hand with an equal increase in healthcare financing, so as to cover procedural costs. In spite of that, the wait-time between the formal request for authorization and the actual procedure was 3 months, and…
Do the Best Coronary Revascularization Prior TAVR
The presence of coronary artery disease (CAD) in patients with aortic stenosis is high, reaching 50% to70% of cases. This poses a great challenge as to what strategy to use and the things we can do. Even though it has been shown complete revascularization is beneficial, it is often difficult to achieve. Instead, reasonable incomplete…
Contrast Induced Kidney Injury, Infamous Problem with No Magical Solutions
In patients at high risk of developing kidney complications undergoing angiography, we did not observe benefits when administering intravenous sodium bicarbonate vs. saline, or oral N-acetylcysteine vs. placebo, as to the prevention of death, dialysis or persistent deterioration of kidney function at 90 days, or the prevention of contrast induced kidney failure. Many small studies…
Elderly Patients with ACS: Clopidogrel or Reduced-Dose Prasugrel?
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full…
Peri-Procedural Infarction: More Frequent than and Not as Innocent as We Thought
Almost 30% of all patients experience some degree of myocardial injury after elective angioplasty, a statistic associated to an increase in cardiovascular events at 30 days and 1 year, according to this study recently published in Eur Heart J. The study only included consecutive patients who underwent elective angioplasty with a negative troponin level at admission. The…
Peri-Procedural Infarction: More Frequent than and Not as Innocent as We Thought
Almost 30% of all patients experience some degree of myocardial injury after elective angioplasty, a statistic associated to an increase in cardiovascular events at 30 days and 1 year, according to this study recently published in Eur Heart J. The study only included consecutive patients who underwent elective angioplasty with a negative troponin level at admission. The…
TAVR in Patients with Classical Low Flow, Low Gradient
Classical symptomatic low-flow, low-gradient (LFLG) severe aortic stenosis is associated with low survival rates at 3 years (<50%). However, in the medium term and with surgery, those rates improve (although mortality rates are 6%-30%, depending on the series). In patients without contractile reserve, surgical mortality is higher. Patient evolution in TAVR is still mostly unclear. …