US Cardiology Review最新文献

{"title":"Transcatheter Aortic Valve Replacement Optimization Strategies: Cusp Overlap, Commissural Alignment, Sizing, and Positioning.","authors":"Saima Siddique, Resha Khanal, Amit N Vora, Hemal Gada","doi":"10.15420/usc.2021.24","DOIUrl":"10.15420/usc.2021.24","url":null,"abstract":"<p><p>As transcatheter aortic valve replacement (TAVR) rapidly expands to younger patients and those at low surgical risk, there is a compelling need to identify patients at increased risk of post-procedural complications, such as paravalvular leak, prosthesis-patient mismatch, and conduction abnormalities. This review highlights the incidence and risk factors of these procedural complications, and focuses on novel methods to reduce them by using newer generation transcatheter heart valves and the innovative cusp-overlap technique, which provides optimal fluoroscopic imaging projection to allow for precise implantation depth which minimizes interaction with the conduction system. Preserving coronary access after TAVR is another important consideration in younger patients. This paper reviews the significance of commissural alignment to allow coronary cannulation after TAVR and discusses recently published data on modified delivery techniques to improve commissural alignment.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e10"},"PeriodicalIF":0.0,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45231487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valve-in-valve Transcatheter Aortic Valve Replacement for Failed Surgical Valves and Adjunctive Therapies.","authors":"Emily Perdoncin, Gaetano Paone, Isida Byku","doi":"10.15420/usc.2021.20","DOIUrl":"10.15420/usc.2021.20","url":null,"abstract":"<p><p>While redo surgical aortic valve replacement has traditionally been the gold standard for the treatment of failed surgical valves, valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has arisen as a viable, less invasive option with the potential for improved short-term morbidity and mortality. Retrospective registry data regarding ViV TAVR outcomes have been encouraging, with excellent 1-year mortality, and sustained valve performance and quality of life improvement out to 3 years. Operators must be comfortable with CT analysis for procedural planning, and be able to identify and troubleshoot patients who are at risk for coronary obstruction and patient prosthesis mismatch. The authors provide a review of clinical outcomes associated with ViV TAVR, procedural planning recommendations, and strategies to overcome technical challenges that can occur during ViV TAVR.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e09"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46443065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiography in the Evaluation of the Right Heart.","authors":"Angelos Tsipis, Evdokia Petropoulou","doi":"10.15420/usc.2021.03","DOIUrl":"10.15420/usc.2021.03","url":null,"abstract":"<p><p>The significance of the right ventricle (RV) as a predictor of outcomes in a series of cardiac conditions has recently been recognized. Consequently, more studies are now focusing on improving the assessment of the RV. Its primary function is to support adequate pulmonary perfusion pressure in different circulatory and loading situations and to ensure that there is a low systemic venous pressure. Echocardiography is the first-line method of choice due to its accuracy when assessing RV structure and function, as well as its wide availability. The geometry of the RV is complex and its evaluation can be difficult. Integrating and combining multiple parameters may be a more reliable way to determine normal or abnormal function. Novel techniques are increasingly being performed more routinely in clinical practice and are facilitating diagnosis and treatment choices.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"1 1","pages":"e08"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42895263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redo-Transcatheter Aortic Valve Replacement: Strategies When the First Transcatheter Aortic Valve Replacement Fails.","authors":"Nils Perrin, Anita W Asgar","doi":"10.15420/usc.2021.18","DOIUrl":"10.15420/usc.2021.18","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) is the standard of care for patients with symptomatic severe aortic stenosis at high or prohibitive surgical risk. The 2020 valvular heart disease guidelines from the American College of Cardiology and American Heart Association now include TAVR as a class I indication for patients aged 65-80 years and not at high or prohibitive risk. The longer life expectancy of this patient population raises the issue of TAVR valve durability and the management of bioprosthetic valve failure of TAVR valves. In this review, the authors discuss bioprosthetic valve dysfunction and summarize existing data regarding redo-TAVR and surgery for failed TAVR. Finally, they propose an approach to evaluate patients with failed TAVR and plan for a second TAVR procedure as indicated.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e07"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46631778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advocacy and Legislation for Regionalization Practices in the Treatment of Cardiogenic Shock: The Time Is Now.","authors":"Kari Gorder, Steve Rudick, Timothy D Smith","doi":"10.15420/usc.2021.14","DOIUrl":"10.15420/usc.2021.14","url":null,"abstract":"<p><p>Cardiogenic shock is a complex hemodynamic state that, despite improvements in care, often remains challenging to treat and confers a high mortality rate. Timely application of advanced strategies, including advanced hemodynamic management and mechanical circulatory support, is of the utmost importance for this critically ill patient population. Based on data and historic experiences with similar life-threatening conditions, a national system in the US of regionalized, structured care for patients with cardiogenic shock has the potential to improve outcomes and save lives. To enact this, national and state leaders, as well as federal regulatory bodies, physician thought leaders, industry representatives, and national organizations, must collaborate and advocate for a clear, structured cardiac shock center network with a tiered model for delivery of care for the sickest population of cardiac patients.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e06"},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48242065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic-based Assessment and Management of Cardiogenic Shock.","authors":"Jaime Hernandez-Montfort, Diana Miranda, Varinder Kaur Randhawa, Jose Sleiman, Yelenis Seijo de Armas, Antonio Lewis, Ziad Taimeh, Paulino Alvarez, Paul Cremer, Bernardo Perez-Villa, Viviana Navas, Emad Hakemi, Mauricio Velez, Luis Hernandez-Mejia, Cedric Sheffield, Nicolas Brozzi, Robert Cubeddu, Jose Navia, Jerry D Estep","doi":"10.15420/usc.2021.12","DOIUrl":"10.15420/usc.2021.12","url":null,"abstract":"<p><p>Cardiogenic shock (CS) remains a deadly disease entity challenging patients, caregivers, and communities across the globe. CS can rapidly lead to the development of hypoperfusion and end-organ dysfunction, transforming a predictable hemodynamic event into a potential high-resource, intense, hemometabolic clinical catastrophe. Based on the scalable heterogeneity from a cellular level to healthcare systems in the hemodynamic-based management of patients experiencing CS, the authors present considerations towards systematic hemodynamic-based transitions in which distinct clinical entities share the common path of early identification and rapid transitions through an adaptive longitudinal situational awareness model of care that influences specific management considerations. Future studies are needed to best understand optimal management of drugs and devices along with engagement of health systems of care for patients with CS.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e05"},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44360702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Antiplatelet Regimens for Transcatheter Aortic Valve Replacement and Corresponding Cardiac CT Evaluation of the Leaflets: Single-center Experience.","authors":"Mirvat Alasnag, Waqar Ahmed, Ibrahim Al-Nasser, Khaled Al-Shaibi","doi":"10.15420/usc.2021.07","DOIUrl":"10.15420/usc.2021.07","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) is a globally established therapy. However, there is significant variability in the antithrombotic management post-procedure. The data on antiplatetet and direct antithrombin agents suggest antiplatelet agents suffice. The degree of leaflet thickening on cardiac CT and the clinical implications of this finding remain poorly understood. Here, the authors aim to examine a low-risk cohort treated with dual antiplatelet therapy and the corresponding cardiac CT and clinical findings.</p><p><strong>Methods: </strong>This is a descriptive single center study examining patients who received dual antiplatelet therapy post-TAVR from 2017 to 2019. Patients underwent clinical, echocardiographic and cardiac CT follow up. Signs and symptoms of ischemic stroke, valve function, gradient, and cardiac CT findings of hypo-attenuated leaflet thickening and reduced leaflet mobility were recorded for all those who completed 6 months of follow-up. The study was registered and approved by the Ethics Committee.</p><p><strong>Results: </strong>A total of 116 patients were included. Hypo-attenuated leaflet thickening was detected in 11 patients. Only one had accompanying reduced leaflet mobility and an increase in gradient. This patient did not have any evidence of stroke or valve dysfunction. After switching to rivaroxaban, the gradient improved and a repeat cardiac CT demonstrated resolution of the leaflet thickening.</p><p><strong>Conclusion: </strong>This study illustrates the utility of cardiac CT in detecting leaflet thickening and restricted mobility post-TAVR in low-risk individuals treated with dual antiplatelet therapy. However, its role in guiding antithrombotic regimens cannot be ascertained from this study and additional larger scale studies comparing different regimens in both symptomatic and asymptomatic patients are necessary.</p><p><strong>Trial registration: </strong>N/A.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e04"},"PeriodicalIF":0.0,"publicationDate":"2022-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45540493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic Shock Management and Research: Past, Present, and Future Outlook.","authors":"Sascha Ott, Laura Leser, Pia Lanmüller, Isabell A Just, David Manuel Leistner, Evgenij Potapov, Benjamin O'Brien, Jan Klages","doi":"10.15420/usc.2021.25","DOIUrl":"10.15420/usc.2021.25","url":null,"abstract":"<p><p>Although great strides have been made in the pathophysiological understanding, diagnosis and management of cardiogenic shock (CS), morbidity and mortality in patients presenting with the condition remain high. Acute MI is the commonest cause of CS; consequently, most existing literature concerns MI-associated CS. However, there are many more phenotypes of patients with acute heart failure. Medical treatment and mechanical circulatory support are well-established therapeutic options, but evidence for many current treatment regimens is limited. The issue is further complicated by the fact that implementing adequately powered, randomized controlled trials are challenging for many reasons. In this review, the authors discuss the history, landmark trials, current topics of medical therapy and mechanical circulatory support regimens, and future perspectives of CS management.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e03"},"PeriodicalIF":0.0,"publicationDate":"2022-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44953317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Percutaneous Coronary Intervention: The Good, the Bad, and What is to Come.","authors":"Laura Young, Jaikirshan Khatri","doi":"10.15420/usc.2020.28R1","DOIUrl":"10.15420/usc.2020.28R1","url":null,"abstract":"<p><p>The introduction of robots into healthcare has brought a wealth of opportunity for technical advancements, ranging from cleaning robots to disinfect hospital rooms to the high-tech surgical robots used in the operating room. Robotic-assisted percutaneous coronary intervention (R-PCI) has been a more recent development in the field, and is particularly revolutionary in that it serves to benefit the interventional cardiologist as well as the patient. Published data on R-PCI have shown its feasibility, safety, and more recently, its potential benefits. This review examines the current role of the robot in the catheterization laboratory, the authors' experience with the most current generation of the robot, and what is yet to come.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e02"},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43133864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulnerable Plaque in Patients with Acute Coronary Syndrome: Identification, Importance, and Management.","authors":"Atsushi Sakamoto, Anne Cornelissen, Yu Sato, Masayuki Mori, Rika Kawakami, Kenji Kawai, Saikat Kumar B Ghosh, Weili Xu, Biniyam G Abebe, Armelle Dikongue, Frank D Kolodgie, Renu Virmani, Aloke V Finn","doi":"10.15420/usc.2021.22","DOIUrl":"10.15420/usc.2021.22","url":null,"abstract":"<p><p>MI is a leading cause of morbidity and mortality worldwide. Coronary artery thrombosis is the final pathologic feature of the most cases of acute MI primarily caused by atherosclerotic coronary artery disease. The concept of vulnerable plaque has evolved over the years but originated from early pioneering work unveiling the crucial role of plaque rupture and subsequent coronary thrombosis as the dominant cause of MI. Along with systemic cardiovascular risk factors, developments of intravascular and non-invasive imaging modalities have allowed us to identify coronary plaques thought to be at high risk for rupture. However, morphological features alone may only be one of many factors which promote plaque progression. The current vulnerable-plaque-oriented approaches to accomplish personalized risk assessment and treatment have significant room for improvement. In this review, the authors discuss recent advances in the understanding of vulnerable plaque and its management strategy from pathology and clinical perspectives.</p>","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" ","pages":"e01"},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45371884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}