Publications by authors named "Eulogio Garcia"

139 Publications

Local intracoronary fibrinolysis in acute myocardial infarction of ectatic coronary arteries in the post-abciximab era.

Cardiovasc Revasc Med 2021 Jan 14. Epub 2021 Jan 14.

Clinical Cardiology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain.

Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.
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http://dx.doi.org/10.1016/j.carrev.2021.01.005DOI Listing
January 2021

Percutaneous repair of TAVI induced aortic pseudoaneurysm.

Rev Esp Cardiol (Engl Ed) 2020 Nov 21. Epub 2020 Nov 21.

Unidad de Imagen Cardiaca, HM CIEC-Centro Integral de Enfermedades Cardiovasculares, HM Hospitales, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2020.10.005DOI Listing
November 2020

Transradial Secondary Approach During Transfemoral TAVI: Usefulness of Placing a Wire Before Femoral Puncture for Management and Treatment of Vascular Complications.

Cardiovasc Revasc Med 2021 Feb 3;23:94-99. Epub 2020 Aug 3.

Clinical Cardiology, HM Hospitales-Centro Integral de enfermedades Cardiovasculares HM-CIEC, Madrid, Spain.

Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.
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http://dx.doi.org/10.1016/j.carrev.2020.07.024DOI Listing
February 2021

Percutaneous closure of an atrial septal defect in a patient with Ebstein anomaly and right-to-left shunt.

Rev Port Cardiol 2020 Aug 3;39(8):475.e1-475.e3. Epub 2020 Aug 3.

Clinical Cardiology Unit, HM CIEC, Hospital Universitario HM Montepríncipe, Hospital Universitario HM Sanchinarro, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.

Ebstein anomaly is a congenital disease frequently associated with atrial septal defects, which can generate a right-to-left shunt, leading to systemic desaturation and right ventricular failure. We describe the case of a 68-year-old man with central cyanosis due to Ebstein anomaly and a patent foramen ovale. An atrial septal occluder was initially implanted after having performed prolonged test occlusion of the interatrial communication. In this case, device embolization occurred due to high right pressure. Percutaneous closure of atrial septal defects in the presence of a right-to-left shunt can offer a significant clinical improvement in selected cases. In patients with Ebstein anomaly, the implantation of atrial septal defect closure devices may be desirable, due to the larger size of the waist, which may provide better stability in the event of an increase in right pressure.
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http://dx.doi.org/10.1016/j.repc.2019.01.010DOI Listing
August 2020

Coronary arterial segmental stenosis quantified by MDCT: correlation with quantitative coronary analyses by invasive angiography.

Rev Esp Cardiol (Engl Ed) 2020 12 18;73(12):1068-1070. Epub 2020 Jul 18.

Unidad de Imagen Cardiaca, Hospital Universitario HM Montepríncipe-CIEC, HM Hospitales, Madrid, Spain; Servicio de Cardiología, Hospital Universitario HM Montepríncipe-CIEC, HM Hospitales, Madrid, Spain; Universidad CEU San Pablo, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain. Electronic address:

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http://dx.doi.org/10.1016/j.rec.2020.04.029DOI Listing
December 2020

Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in Patients with Severe Calcification.

J Cardiovasc Transl Res 2021 Feb 1;14(1):131-139. Epub 2020 Apr 1.

Unidad de Imagen Cardiaca, Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain.

Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.
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http://dx.doi.org/10.1007/s12265-020-09977-4DOI Listing
February 2021

Percutaneous treatment of prosthetic mitral valve thrombosis.

Rev Esp Cardiol (Engl Ed) 2020 Jun 4;73(6):500. Epub 2019 Dec 4.

Departamento de Cardiología Clínica, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2019.09.020DOI Listing
June 2020

Percutaneous Closure of Mitral Paravalvular Leaks Generating Refractory Heart Failure in the Immediate Postoperative Period.

J Invasive Cardiol 2019 Aug;31(8):E259-E260

Unidad de Hemodinámica y Cardiología Intervencionista, HM Hospitales-Hospital Universitario HM Montepríncipe, Avenida de Montepríncipe, 25, 28668 Boadilla del Monte, Madrid, Espaņa.

We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.
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August 2019

Percutaneous Closure of a Poorly Tolerated Ventricular Septal Defect After Triple Valvular Prosthesis Surgery.

J Invasive Cardiol 2019 Jun;31(6):E154

Hospital Universitario HM Montepríncipe, Av. de Montepríncipe, 25, 28660 Boadilla del Monte, Madrid, Spain.

We describe the case of an 81-year-old woman with three biological prostheses at the aortic valve, mitral valve, and tricuspid valve with recurrent hospitalizations due to heart failure. To the best of our knowledge, this is the first percutaneous closure of ventricular septal defect in the presence of three valvular prostheses.
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June 2019

Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation.

Cardiovasc Revasc Med 2019 Nov 9;20(11):949-955. Epub 2019 Jan 9.

Clinical Cardiology, Hospital Universitario HM Montepríncipe, Spain.

Objectives: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis.

Background: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3.

Methods: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed.

Results: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8).

Conclusions: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.
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http://dx.doi.org/10.1016/j.carrev.2019.01.006DOI Listing
November 2019

Successful Percutaneous Treatment of an Acute Left Main Coronary Occlusion Due to Iatrogenic Dissection Extending Into the Ascending Aorta.

JACC Cardiovasc Interv 2018 09 29;11(18):1897-1899. Epub 2018 Aug 29.

Interventional Cardiology Unit, Hospital Universitario HM Montepríncipe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.jcin.2018.06.054DOI Listing
September 2018

Percutaneous Closure of a Femoral Arteriovenous Fistula During Transfemoral TAVI.

J Invasive Cardiol 2018 08;30(8):E67-E68

Hospital Universitario, Madrid Montepríncipe, Madrid, Spain.

Percutaneous AVF closure was performed post TAVI in a patient with severe aortic stenosis and an AVF between the right SFA and femoral vein.
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August 2018

Electrocardiographic changes and conduction disturbances after transfemoral aortic valve implantation with Edwards Sapien 3 prosthesis.

J Electrocardiol 2018 May - Jun;51(3):416-421. Epub 2018 Feb 20.

Clinical Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain.

Objectives: The aim of this study is to describe electrocardiographic changes and conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: 76 patients who underwent TAVI using Edwards Sapien 3 prosthesis were included, comparing electrocardiographic registries at admission, post-procedure and before discharge.

Results: Patients after TAVI presented a longer PR interval, a wider QRS, and a longer corrected QT, with a left deviation of QRS axis and T waves; reversible changes that tended to correct in the following days after TAVI. Complete atrioventricular block incidence was 2.9%. New-onset left bundle branch block (LBBB) incidence was 39%, although solved in almost half of patients before discharge.

Conclusions: TAVI was associated with different reversible electrocardiographic changes that suggest a transient impact on the conduction system. One of every five patients presented permanent LBBB after valve implant.
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http://dx.doi.org/10.1016/j.jelectrocard.2018.02.009DOI Listing
March 2019

Percutaneous treatment of an anomalous left main arising from the opposite sinus with subpulmonic course.

Cardiovasc Revasc Med 2018 Jul - Aug;19(5 Pt B):632-637. Epub 2018 Feb 7.

Cardiology, Hospital Universitario HM Puerta del Sur, Móstoles, Spain.

Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare malformation traditionally considered "malignant" in cases of interarterial course. Recently, a protective effect of the low interarterial subtype (between the aorta and the right ventricle outflow tract) has been described. We present an IVUS-guided percutaneous intervention in a patient with anomalous origin of the left coronary artery from the right coronary sinus presenting with anterior ischemia. In patients with ACAOS, the integration of complementary image techniques is recommended, defining the anomalous course of the vessel and providing an accurate assessment of the individual risk for each patient. The use of IVUS may be advisable, emerging as a really useful tool to complete the study and guide the treatment.
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http://dx.doi.org/10.1016/j.carrev.2018.01.008DOI Listing
July 2019

Autologous stem cell transplantation for primary mediastinal B-cell lymphoma: long-term outcome and role of post-transplant radiotherapy. A report of the European Society for Blood and Marrow Transplantation.

Bone Marrow Transplant 2018 08 20;53(8):1001-1009. Epub 2018 Feb 20.

EBMT Lymphoma Working Party, Paris, France.

The purpose of this retrospective registry study was to investigate the outcome of autoSCT for primary mediastinal B-cell lymphoma (PMBCL) in the rituximab era, including the effects of eventual post-transplant radiotherapy (RT) consolidation. Patients with PMBCL aged between 18 and 70 years who were treated with a first autoSCT between 2000 and 2012 and registered with the EBMT were eligible. Eighty-six patients with confirmed PMBCL and the full data set required for this analysis were evaluable. Sixteen patients underwent autoSCT in remission after first-line therapy (CR/PR1), 44 patients were transplanted with chemosensitive relapsed or primary refractory disease (CR/PR >1), and 24 patients were chemorefractory at the time of autoSCT. With a median follow-up of 5 years, 3-year estimates of relapse incidence, progression-free survival, and overall survival were 6%, 94%, and 100% for CR/PR1; 31%, 64%, and 85% for CR/PR >1; and 52%, 39%, and 41% for REF, respectively. Whilst there was no significant benefit of post-transplant RT in the CR/PR >1 group, RT could completely prevent disease recurrence post d100 in the refractory group. In conclusion, autoSCT with or without consolidating RT is associated with excellent outcome in chemoimmunotherapy-sensitive PMBCL, whereas its benefits seem to be limited in chemoimmunotherapy-refractory disease.
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http://dx.doi.org/10.1038/s41409-017-0063-7DOI Listing
August 2018

Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

Cardiovasc Revasc Med 2018 04 30;19(3 Pt A):251-256. Epub 2017 Aug 30.

Cardiology, Hospital Universitario Madrid Montepríncipe.

Introduction And Objectives: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts.

Methods: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups.

Results: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04).

Conclusions: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.
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http://dx.doi.org/10.1016/j.carrev.2017.08.012DOI Listing
April 2018

Percutaneous closure of a giant coronary artery fistula after surgical pericardiectomy. Review of the literature.

Cardiovasc Revasc Med 2017 Jul - Aug;18(5):384-389. Epub 2017 Mar 9.

Anesthesiology, Hospital Universitario Madrid Montepríncipe, Madrid, Spain.

Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.
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http://dx.doi.org/10.1016/j.carrev.2017.03.002DOI Listing
May 2018

Outcomes and predictors of success and complications for paravalvular leak closure: an analysis of the SpanisH real-wOrld paravalvular LEaks closure (HOLE) registry.

EuroIntervention 2017 Mar;12(16):1962-1968

Hospitales Universitarios Montepríncipe and Moncloa, Madrid, Spain.

Aims: The aim of the study was to assess the safety and efficacy of percutaneous closure of paravalvular prosthetic leak (PVL) and to identify the predictors of procedural success and early complications.

Methods And Results: A total of 514 first-attempt percutaneous PVL closure in 469 patients were included at 19 centres. Technical and procedural success was achieved in 86.6% and 73.2% of the patients, respectively. In multivariate analysis, the independent predictors for procedural success in mitral lesions were the type of device used (AMPLATZER AVP III vs. others, HR 2.68 [1.29-5.54], p=0.008) and the number of procedures performed at the centre (top quartile vs. others, HR 1.93 [1.051-3.53], p=0.03). For aortic leaks the only predictor of procedural success was the leak size (≥10 mm vs. <10 mm, HR 3.077 [1.13-8.33], p=0.027). The overall major adverse events rate (death or emergency surgery or stroke) at 30 days was 5.6%; the only predictor for combined adverse events was New York Heart Association functional Class IV (HR 4.2 [1.42-12.34], p=0.009).

Conclusions: Percutaneous closure of PVL can be performed with a reasonable rate of procedural success and a low rate of major complications. The type of device used, the accumulated experience and the leak size are predictors of procedural success.
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http://dx.doi.org/10.4244/EIJ-D-16-00581DOI Listing
March 2017

Percutaneous Repair of a Complex Periprosthetic Aortic Leak.

Rev Esp Cardiol (Engl Ed) 2017 Sep 23;70(9):771. Epub 2016 Nov 23.

Unidad de Imagen Cardiaca, Hospital Universitario Madrid Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.10.011DOI Listing
September 2017

Transcatheter Aortic Valve Implantation in Patients With Arterial Peripheral Vascular Disease.

Rev Esp Cardiol (Engl Ed) 2017 06 22;70(6):510-512. Epub 2016 Nov 22.

Servicio de Cardiología, Hospital Universitario Madrid Montepríncipe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.10.008DOI Listing
June 2017

Clinical and hemodynamic results after direct transcatheter aortic valve replacement versus pre-implantation balloon aortic valvuloplasty: A case-matched analysis.

Catheter Cardiovasc Interv 2017 Nov 12;90(5):809-816. Epub 2016 Aug 12.

Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.

Objectives: To evaluate the safety and midterm hemodynamic results of direct transcatheter aortic valve replacement (TAVR) without pre-implantation balloon aortic valvuloplasty (BAV).

Background: BAV was considered a mandatory previous step in TAVR procedures.

Methods: A total of 339 consecutive patients who underwent transfemoral TAVR were prospectively selected. A 1:1 matching was conducted, pairing age, prosthesis type (self-expandable or balloon expandable) and size, and valve calcification grade (48% with moderate to severe valve calcification). Finally, 102 pairs (102 patients with previous BAV and 102 without BAV) were obtained.

Results: Direct TAVR was feasible in all patients without any crossover to BAV group. Device success was achieved in 91.2% and 90.2% of cases in direct TAVR and pre-BAV groups (P = 0.810), respectively, without any differences in balloon postdilation rate and residual aortic regurgitation. The amount of contrast agent, acute kidney injury and myocardial injury was significantly lower in the direct implantation group (P < 0.05). No differences were found in 30-day and 1-year mortality between both groups (4.9% vs. 9.8%, P = 0.177 and 14.0% vs. 23.8%, P = 0.771, respectively). Hemodynamic parameters remained stable after 1-year follow-up in both groups.

Conclusions: Direct transfemoral TAVR without prior BAV was safe in patients with calcified severe aortic stenosis. Pre-implantation BAV could be omitted in patients undergoing TAVR, without influence in procedure success rate, and subsequent patients' clinical course and valve hemodynamic performance. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ccd.26671DOI Listing
November 2017

Complex anatomy making it difficult for left atrial appendage closure.

Cardiovasc Revasc Med 2016 Mar 24;17(2):146-7. Epub 2015 Dec 24.

Department of Cardiology, Monteprincipe University Hospital, Madrid, Spain.

Left atrial appendage closure is a useful technique for patients at high thromboembolic risk and contraindications for oral anticoagulation therapy. However, it can be challenging when anatomical difficulties are encountered. We present a unique case of atypical appendage uptake and how we completed the procedure.
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http://dx.doi.org/10.1016/j.carrev.2015.12.006DOI Listing
March 2016

Combined Percutaneous Mitral Valve Implantation and Paravalvular Leak Closure in a High-risk Patient With Severe Mitral Regurgitation.

Rev Esp Cardiol (Engl Ed) 2015 Dec 21;68(12):1186-8. Epub 2015 Oct 21.

Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.08.008DOI Listing
December 2015

Congenital atresia of the left main coronary artery in an adult: A rare anomaly with an unfavorable prognosis. Review of the literature.

Cardiovasc Revasc Med 2015 Dec 21;16(8):498-502. Epub 2015 Aug 21.

Hospital Universitario Madrid Montepríncipe.

Congenital atresia of the left main coronary artery (LMCA) is one of the rarest congenital anomalies, which may have an unfavorable prognosis leading to myocardial ischemia, ventricle dysfunction or even sudden cardiac death. There are 34 cases of LMCA in adults reported in the literature, most of them successfully treated with coronary revascularization. We report the case of an adult with LMCA who presented with terminal heart failure that required biventricular assistance and heart transplant.
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http://dx.doi.org/10.1016/j.carrev.2015.08.006DOI Listing
December 2015

Percutaneous Closure of an Ascending Aortic Pseudoaneurysm.

Rev Esp Cardiol (Engl Ed) 2015 Dec 12;68(12):1176. Epub 2015 Jun 12.

Servicio de Radiodiagnóstico, Hospital Universitario Madrid-Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.03.013DOI Listing
December 2015

Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.

Heart 2015 Sep 9;101(17):1395-405. Epub 2015 Jun 9.

Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.

Objectives: Mitral regurgitation (MR) is a common entity in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but its influence on outcomes remains controversial. The purpose of this meta-analysis was to assess the clinical impact of and changes in significant (moderate-severe) MR in patients undergoing TAVR, overall and according to valve design (self-expandable (SEV) vs balloon-expandable (BEV)).

Methods: All national registries and randomised trials were pooled using meta-analytical guidelines to establish the impact of moderate-severe MR on mortality after TAVR. Studies reporting changes in MR after TAVR on an individual level were electronically searched and used for the analysis.

Results: Eight studies including 8015 patients (SEV: 3474 patients; BEV: 4492 patients) were included in the analysis. The overall 30-day and 1-year mortality was increased in patients with significant MR (OR 1.49, 95% CI 1.16 to 1.92; HR 1.32, 95% CI 1.12 to 1.55, respectively), but a significant heterogeneity across studies was observed (p<0.05). The impact of MR on mortality was not different between SEV and BEV in meta-regression analysis for 30-day (p=0.360) and 1-year (p=0.388) mortality. Changes in MR over time were evaluated in nine studies including 1278 patients. Moderate-severe MR (SEV: 326 patients; BEV: 192 patients) improved in 50.5% of the patients at a median follow-up of 180 (30-360) days after TAVR, and the degree of improvement was greater in patients who had received a BEV (66.7% vs 40.8% in the SEV group, p=0.001).

Conclusions: Concomitant moderate-severe MR was associated with increased early and late mortality following TAVR. A significant improvement in MR severity was detected in half of the patients following TAVR, and the degree of improvement was greater in those patients who had received a BEV.
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http://dx.doi.org/10.1136/heartjnl-2014-307120DOI Listing
September 2015

Transcatheter aortic valve implantation in patients with bicuspid aortic valve: A patient level multi-center analysis.

Int J Cardiol 2015 11;189:282-8. Epub 2015 Apr 11.

Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address:

Objective: We sought to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BiAV).

Background: BiAV remains a relative contraindication to TAVI resulting in exclusion from TAVI trials and thus limiting data on the clinical performance of transcatheter valves in these patients.

Methodology: We conducted an international patient level multicenter analysis on outcomes in patients with BiAV undergoing TAVI. The primary outcome of the study was the combined early safety endpoint--a composite of 30 day mortality, stroke, life-threatening bleeding, acute kidney injury, coronary artery obstruction, major vascular complication and valve related dysfunction. Secondary endpoints included the individual components of the primary endpoint as well as post-TAVI paravalvular leak (PVL), rehospitalization, new pacemaker insertion and device success rates at 30 days and 1 year.

Results: A total of 108 patients with BiAV were identified in 21 centers in Canada, Spain, Italy, Poland and Singapore who underwent TAVI between January 2005 and March 2014. The composite primary outcome occurred in one quarter of patients (26.9%)--mainly driven by re-intervention for valve malposition (9.3%). The 30-day and 1 year mortality rates were 8.3% and 16.9% respectively with AR ≥ 3+ occurring in 9.6% of patients. Device success was achieved in 85.2% of cases with pacemaker insertion in 19.4%. While PVL was not associated with an increased risk of 30 day or 1 year mortality--Type I BiAV anatomy with left and right cusp fusion had significantly better outcomes than other valve variants.

Conclusion: In selected patients with BiAV and severe aortic stenosis, TAVI appears both safe and feasible with acceptable clinical outcomes. Clinical studies of TAVI in this patient population are warranted.
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http://dx.doi.org/10.1016/j.ijcard.2015.04.066DOI Listing
April 2016

Comparison between diabetic and non-diabetic patients after successful percutaneous coronary intervention for chronic total occlusions in the drug-eluting stent era.

Rev Port Cardiol 2015 Apr 1;34(4):263-70. Epub 2015 Apr 1.

Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. Electronic address:

Objective: Diabetes mellitus and chronic total occlusions are associated with unfavorable outcome after percutaneous coronary intervention. We sought to assess the clinical and angiographic outcomes of diabetic and non-diabetic patients who underwent successful percutaneous revascularization of chronic total occlusions with drug-eluting stents.

Methods: Baseline clinical and angiographic characteristics, procedural details, nine-month angiographic follow-up and clinical events at 12 months were compared between 75 diabetic and 132 non-diabetic patients included in a clinical trial that randomized successful recanalization of chronic total occlusions to receive sirolimus- or everolimus-eluting stents.

Results: In both diabetic and non-diabetic groups there was a favorable non-significantly different angiographic result at nine months, with low in-stent late loss (0.14±0.60 mm vs. 0.25±0.68 mm, p=0.305) and rates of binary restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%, p=0.334). During follow-up similar survival from death (97.3±1.9% vs. 99.2±0.8%, log-rank p=0.273), acute myocardial infarction (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192), target vessel revascularization (88.7±3.8% vs. 88.2±2.9%, log-rank p=0.899) and stent thrombosis (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192) was observed. Furthermore, the presence of more diffuse peripheral and coronary artery disease and higher frequency of calcified lesions in diabetic patients did not lead to significant differences in the approach (20.0% vs. 25.0% radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy, p=0.353), total stent length (48.1±24.6 mm vs. 49.2±23.9 mm, p=0758) or contrast volume (261.3±116.4 ml vs. 297.4±135.9 ml, p=0.109) required for revascularization.

Conclusions: In the drug-eluting stent era, diabetic and non-diabetic patients have comparable favorable clinical and angiographic outcomes after successful percutaneous revascularization of chronic total occlusions.
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http://dx.doi.org/10.1016/j.repc.2014.10.009DOI Listing
April 2015

Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry.

Circulation 2015 May 9;131(18):1566-74. Epub 2015 Mar 9.

From Quebec Heart & Lung Institute, Quebec, Canada (I.J.A.-S., H.B.R., M.U., E.D., P.P., J.R.-C.); Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., J.L, A.S.R.); Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.M.-Z., B.I., A.V.); Hôpital Charles Nicolle, University of Rouen, France (H.E., E.D.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia, E.M.T.); Emory University School of Medicine, Division of Cardiology, Atlanta, GA (S.L., S.S.H.); St. Michael's Hospital Toronto, ON, Canada (A.C.); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (E.G.-I., R.A.-L.); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., J.J.G.-D.); Hospital Universitario Reina Sofía, Córdoba, Spain (M.P., J.C.C.); St. Paul's Hospital, Vancouver, BC, Canada (J.G.W., D.D.); Hospital of the University of Pennsylvania, Philadelphia (H.H.); Columbia University Medical Center/New York Presbyterian Hospital, NY (S. Kodali, M.B.L.); Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., E.G., J.C., I.V.); Ferrarotto Hospital, University of Catania, Italy (C.T., M.B.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J., R.M.); Centre Hospitalier de l'Université de Montréal, QC, Canada (J.-B.M.); Hospital Israelita Albert Einstein, Sao Paulo, Brazil (F.S.d.B.); Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil (M.C.F.); Hospital Sao Francisco-Santa Casa de Misericórdia, Porto Alegre, Porto Alegre, Brazil (V.C.L.); and Hospital Beneficência Portuguesa, Sao Paulo, Brazil (J.A.M.).

Background: We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).

Methods And Results: This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1-14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55-9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37-7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality.

Conclusions: The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014089DOI Listing
May 2015