Among patients who have undergone percutaneous coronary intervention (PCI), the use of dual antiplatelet therapy (DAPT) is associated with increased risk of bleeding, but decreased stent thrombosis ...and myocardial infarction unrelated to the stent. As PCI techniques and devices have progressed, the optimal duration of DAPT has come into question. We identified all randomized controlled trials (RCTs) of patients undergoing PCI, who received one or more drug eluting stents (DES) for stable coronary artery disease (CAD) or acute coronary syndrome (ACS), and randomized to short (1–3 months) versus standard duration DAPT. The prespecified primary outcome was major adverse cardiovascular events (MACE). Important secondary outcomes were net adverse clinical events (NACE) defined as MACE and major bleeding; any bleeding; major bleeding; all-cause death; cardiovascular death. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random-effects model. Analysis included 7 RCTs, comprising 35,857 patients and 53,321 patient-years of follow-up. The mean (SD) age of patients was 64.4 (10.6) years, 49.6% of patients presented with ACS, and 25.5% were female. There was no difference between short and standard-length DAPT in regards to MACE (HR = 0.93; 95% CI 0.84–1.03; p = 0.19), NACE (HR = 0.93; 95% CI 0.85–1.02; p = 0.12), all-cause death (HR = 0.92; 95% CI 0.80–1.05; p = 0.21), or cardiovascular death (HR = 0.85; 95% CI 0.64–1.13; p = 0.26). However, short-term DAPT was associated with significantly reduced major bleeding events (HR = 0.67; 95% CI 0.47–0.95; p = 0.03) and any bleeding event (HR = 0.63; 95% CI 0.44–0.90; p = 0.01) compared with standard-length DAPT. Among patients undergoing PCI for CAD, the use of short-term DAPT (1–3 months) followed by single antiplatelet therapy was associated with a lower incidence of clinically relevant bleeding events, but with similar risk of MACE, all-cause death, and cardiovascular death compared with standard duration DAPT.
Living-donor liver transplant for hepatocellular carcinoma located on hepatocaval confluence or in contact with the inferior vena cava is technically challenging, and candidates for this kind of ...procedure should be carefully selected. It is difficult to rule out major vascular invasion except after hepatectomy and histologic examination; in addition, the possible dissemination of cancer cells during recipient hepatectomy is a considerable risk. Herein, we report the first case in Saudi Arabia of right lobe living-donor liver transplant combined with inferior vena cava reconstruction using cryopreserved iliac vein graft after en bloc resection of the liver with part of the diaphragm, anterior wall of retrohepatic inferior vena cava, and a 5-cm hepatocellular carcinoma in segment 7. Our patient achieved so far 3-year disease-free survival. Tumor recurrence and risk of thrombosis related to inferior vena cava reconstruction are the main concerns; therefore, long-term follow-up of those patients is mandatory.
Bi‐cuspid TAVR; bye or buy Zahr, Firas; Lantz, Gurion
Catheterization and cardiovascular interventions,
11/2023, Volume:
102, Issue:
5
Journal Article
Peer reviewed
Key Points
Mid term data of TAVR in stenotic bicuspid aortic valves is promising both in term of mortality and valve performance.
Many factors should be considered before we generalize these results ...to all types of bicuspid native valves, TAVR valves, and patient populations.
A randomized trial to SAVR versus TAVR remains the missing piece before we solve this complex clinical equation.
Key Points
3‐year data of the CLASP EFS trial demonstrate sustainable results of the PASCAL device with similar adverse events to previously published data.
Contempoarary heart failure medical ...therapy should be considered and evaluated especially for the FMR population.
Published guidelines and detailed echocardiographic data should be carefully examined especially as we target differentiating post M‐TEER residual MR ≤1 vs. ≤2.
There is an incomplete understanding of the predictors of morbidity and mortality in patients with severe tricuspid regurgitation (TR). This study sought to identify key risk factors for all-cause ...mortality and heart failure (HF) hospitalization among patients with severe TR.
Patients with severe TR were identified from 2 centers, Oregon Health & Science University and Abrazo Health, from January 01, 2016 to December 31, 2018. Patients with any concomitant severe valvular diseases or prior valvular intervention were excluded. Multivariable regression was utilized to identify demographic, clinical, and echocardiographic variables independently associated with all-cause mortality or HF hospitalization.
435 patients with severe TR were followed for a median of 2.8 years. The mean age of the population was 66.9 ± 18.5 years and 58% were female. All-cause mortality was identified in 20.5% of the population. Of the cohort, 35.4% of patients were hospitalized for HF. Isolated tricuspid valve intervention was performed in 2.5% of patients. Independent predictors of all-cause mortality included history of solid tumor (odds ratio OR 6.6, 95% confidence interval CI 2.1-19.1, p = 0.001), history of peripheral artery disease (OR 3.5, 95% CI 1.2-9.4, p = 0.013), and elevated international normalized ratio in the absence of anticoagulation (OR 1.9, 95% CI 1.2-3.2, p = 0.008). Predictors of HF hospitalization included history of diabetes mellitus (OR 2.2, 95% CI 1.1-4.0, p = 0.014) and history of reduced left ventricular ejection fraction (OR 5.7, 95% CI 2.9-11.7, p < 0.0001).
Severe untreated TR is associated with high mortality and frequent HF hospitalizations. Understanding predictors of these outcomes is important to identify patients who may benefit from early tricuspid valve intervention to help improve outcomes in this patient population.
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