For many years, percutaneous transluminal coronary angioplasty (PCTA) has expanded significantly worldwide. However, despite the demonstrated advantages of intravascular ultrasound (IVUS) in terms of minimal luminal area, reduced cardiovascular events, and restenosis, its use is not very common due to various reasons. On the other hand, optical coherence tomography (OCT) offers even higher resolution than...
TAVI-in-TAVI with Balloon-Expandable Valves
TAVI (Transcatheter Aortic Valve Implantation) has proven to be beneficial and is currently performed in increasingly younger and lower-risk patients. However, as with surgical bioprostheses, structural deterioration, whether due to stenosis or regurgitation, is one of the challenges we must address. While currently uncommon, this is an issue we will probably see more and more...
Degenerative Mitral Regurgitation: Impact on Post-Procedural Gradient
Primary or degenerative mitral regurgitation (MR) occurs frequently. Even though surgery continues to be the standard treatment at present, it remains risky for one group of patients, which makes edge-to-edge mitral valve repair (MV-TEER) a viable alternative. We are well aware that moderate to severe MR is associated with worse prognosis. However, post procedural mean...
MyVal Device in Non-Calcified Severe Aortic Regurgitation
Due to the proven long-term results and substantial increase in the number of transcatheter aortic valve implantation (TAVI) procedures conducted, the application of TAVI has been extended to clinical situations outside the original scope, such as non-calcified aortic regurgitation (NCAR). Device placement in these new scenarios entails a technical challenge due to the absence of...
Mitral Valve Edge to Edge Repair for Papillary Muscle Rupture after Acute Myocardial Infarction
With an approximate incidence of 0.05% to 0.25%, post-acute myocardial infarction (AMI) mitral valve failure caused by papillary muscle rupture is not exactly common. However, it is associated to high mortality rate, ranging between 36% and 80%. Current guidelines recommend surgical treatment, but more often than not surgery involves prohibitive or extremely high risk, with...
Relationship between Distal Vessel Quality and Outcomes in the Treatment of Chronic Total Occlusions
Percutaneous treatment of chronic total occlusions has increase, and has become a a more habitual therapeutic challenge. However, there is limited information on distal vessel quality and its association with outcomes and techniques. This variable appears to be excluded form CTO scores, except for the RECHARGE (REgistry of CrossBoss and Hybrid procedures in FrAnce, the...
A New Alternative for the Treatment of Heart Failure: Left Atrial to Coronary Sinus Shunt with the APTURE Device
ALT FLOW device for left atrial to coronary sinus shunting in symptomatic heart failure patients. In the treatment of heart failure (HF), significant improvement in patient quality of life and prognosis has been achieved through appropriate medical treatment and, in some cases, the use of devices. However, in certain cases, satisfactory clinical improvement cannot be...
We Should Revascularize Patients with Stable Coronary Syndromes and Ischemia Assessed by iFR
Chronic stable angina has shown a good response to medical treatment, and the Ischemia study has recently demonstrated the safety of such treatment in stable chronic angina with moderate to severe ischemia. However, this study excluded left main coronary artery (LMCA) lesions. The FAME Study has shown the safety and efficacy of fractional flow reserve...
5 Year Evolution of PCI vs CABG in Large Randomized Studies on Acute and Chronic Coronary Syndrome
Left main lesions in acute coronary syndrome (ACS) represent a major risk and, at present, the best revascularization strategy is a matter of debate. Though many studies and registries have excluded this group of patients, there is data on the pros and cons of both percutaneous coronary intervention (PCI) and cardiac artery bypass graft (CABG). ...
Frequency and Causes of Mortality in Chronic Total Occlusion
In recent years, there has been an increase in the number of percutaneous coronary interventions (PCI) performed to treat chronic total occlusion (CTO). This increase is due to the availability of more advanced technology and greater experience of both operators and specialized centers. However, it is important to note that this technique is not free...