Left ventricular dysfunction is a powerful prognostic predictor in patients with coronary artery disease and increasing number of patients with CAD and ischemic left ventricular (LV) dysfunction is a ...major clinical problem. Congestive heart failure is a frequent complication which is associated with significant health care costs and two–third of cases have ischemic cardiomyopathy. In such patients, coronary revascularization can lead to symptomatic and prognostic improvement and reversal of LV remodeling which led to the concept of viable myocardium to select patients in whom recovery of LV function and improvement of prognosis will outweigh the risk of surgical revascularization. The aim of this review article is to understand the different modalities for assessing myocardial viability and clinical impact of revascularization in relation to the evidence of viability in patients with LV dysfunction.
Arteriotomy closure devices (ACDs) are routinely used for vascular closure during invasive cardiovascular procedures. They decrease time to hemostasis as well as length of stay. Major complications ...such as arterial ischemia and occlusion can be encountered in a minority of patients. We are describing a series of 3 patients with access site closure using Angio-Seal after coronary angiography who developed intermittent claudication within 2–3 weeks of follow-up. Access site thrombosis/stenosis in the CFA was found in all the three cases. They were successfully revascularized using Jetstream atherectomy with embolic protection filter followed by balloon angioplasty. This technique can treat extensive thrombus burden as well as extract the collagen and foot plate of Angio-Seal through atherectomy with cutting blades and thrombectomy via rheolytic macerating aspiration port. All cases had excellent angiographic and clinical results.
Abstract only
Background:
Transcatheter aortic valve replacement (TAVR) is indicated in patients with severely reduced left ventricular ejection fraction (LVEF) and can restore left ventricular (LV) ...function. However, mortality outcomes in this unique subset of patients has been studied only in limited cohorts.
Methods:
Extensive search on PubMed and Google Scholar yielded 1069 reports meeting inclusion criteria. These studies were independently evaluated by 2 physicians. Nine studies comparing all-cause mortality in patients undergoing TAVR with and without severely reduced LVEF (<35%) were included with a total of 31,952 patients. A study-level analysis was done using Review manager 5.3. As a guide, an I2 >30% was considered an indicator of statistical heterogeneity among the studies. A Mantel-Haenszel Random effects model was used to calculate the Odds Ratio for homogeneous endpoints. A p value <0.05 was considered significant.
Results:
30-day and 1-year all-cause mortality was significantly higher among patients with severely reduced LVEF yielding Odds Ratios of 1.80CI 1.33-2.87; p=0.01; I
2
= 77% (A) and 1.81 1.65-1.99 p<0.001; I
2
= 26% (B). respectively.
Conclusion:
There is a staggering 80% increased risk of short- and long-term mortality in patients with severely reduced LV function following TAVR. These findings are concerning despite lack of randomized data. Interdisciplinary management with advanced heart failure teams should be undertaken pre-emptively in these patients for close monitoring and early intervention.
Background
Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these ...predictors on the occurrence of RAO has not been evaluated.
Methods
Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one‐bladder band versus two‐bladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6‐Fr slender introducer sheath or 7‐Fr slender introducer sheath and hemostasis with either a one‐bladder band or a two‐bladder band. The radial artery was evaluated using ultrasound.
Results
Total of 2019 patients undergoing CA or PCI were included in the analysis. In the one‐bladder band group, the incidence of RAO with a 6‐Fr slender introducer sheath was 4.2%. In those receiving hemostasis with a two‐bladder band, RAO occurred in 1% of patients receiving a 6‐Fr slender introducer sheath versus 0.9% in those receiving a 7‐Fr slender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two‐bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO.
Conclusion
A two‐bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7‐Fr capable system for complex transradial PCI.
Due to inconsistent findings between stress echocardiogram and coronary angiogram, Fractional flow reserve (FFR) was measured in all 3 vessels using intracoronary adenosine.
Background Aspiration thrombectomy is reasonable in acute coronary syndrome when a high thrombus burden is encountered. Decision Making Emergent coronary angiography revealed a right coronary artery ...thrombus, causing 90% occlusion (A).
Subjects with lung cancer were shown to present a variety of immune abnormalities including cellular immune dysfunction, cytokine alterations, and antigen presentation defects. As discouraging ...results are commonly seen with the existing therapies in lung cancer, more innovative treatment strategies are needed.
The authors review comprehensively the immune abnormalities in individuals with lung cancer, describe the lung cancer immunotherapy candidates that are most advanced in their clinical development, and summarize recent data from clinical trials of these agents.
Enhancing the immune system represents an appealing avenue for lung cancer therapy. Several immunomodulating agents have activity in this regard including ipilimumab, a monoclonal antibody against the CTLA-4, and talactoferrin, a dendritic cell activator. In addition, a significant activity was shown with belagenpumatucel-L, a whole-cell-based vaccine that blocks the action of TGF-β2. Other promising vaccines are protein-specific vaccines against tumor antigens such as MAGE-A3, EGF, and MUC1. Although some of these immunotherapies may have lackluster performance as single agents in advanced disease, more impressive results are seen in combination with chemotherapy agents. Given their proven activity in lung cancer, these immunotherapies may soon become a powerful addition to the oncologist's toolbox.
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