27 research outputs found
“Water running in my chest”: Delayed spontaneous rupture of an aortocoronary saphenous vein graft aneurysm
No full textIMPACT OF STATINS ON LONG TERM MORTALITY IN HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF)
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Paradoxical pulmonary artery systolic pressure response with catheter-directed therapies for pulmonary embolism
No full textBackground: Early data on use of catheter-directed therapies (CDT) for treatment of Intermediate or High-Risk pulmonary embolism (PE) show improvement in pulmonary artery systolic pressures (PAsP) and RV/LV ratios. Occasionally a paradoxical rise in PAsP was observed with CDT utilizing ultrasound-assisted thrombolysis (USAT). It is unclear whether this pattern is seen with CDT utilizing mechanical aspiration. Objectives: To investigate and compare the changes in PAsP between those who underwent CDT with USAT to those with mechanical aspiration. Methods: A retrospective analysis of those diagnosed with Intermediate or High-Risk PE who underwent CDT using USAT or mechanical aspiration from 7/2013 to 3/2023. The primary outcome was comparison of PAsP changes between the two modalities. Secondary outcomes include length of stay, mortality, and bleeding complications. Results: A total of 142 patients were analyzed, of which 93 underwent USAT and 49 underwent mechanical thrombectomy. The mechanical thrombectomy group had significantly lower post-intervention PAsP than the USAT group (42.2 ± 13.4 mmHg vs 54.5 ± 15.2 mmHg, p < 0.0001) and a greater adjusted mean reduction (−16.5 ± 2.7 vs. −7.7 ± 3.2 mmHg. p < 0.0001). A higher frequency of a paradoxical rise in PAsP was observed in the USAT group (22 % vs 4.1 %, p < 0.001). Conclusions: CDT utilizing mechanical thrombectomy was associated with lower post-interventional PAsP and greater mean negative change compared to USAT. Occasional paradoxical rises in PAsP were observed with both types of CDT, but they were more frequent with USAT. Hemodynamic monitoring should be considered after CDT. Condensed unstructured abstract: We report a retrospective comparison of changes to pulmonary artery systolic pressures (PAsPs) between catheter-directed ultrasound-assisted thrombolysis (USAT) and catheter-directed mechanical thrombectomy in Intermediate and High-Risk pulmonary embolism. Those treated with mechanical thrombectomy compared to USAT had significantly lower post-interventional PAsP (42.2 ± 13.4 mmHg vs 54.5 ± 15.2 mmHg, p < 0.0001) and a greater adjusted mean reduction (−16.2 ± 2.7 vs. −7.5 ± 3.2 mmHg, p < 0.0001). A paradoxical rise in PAsP was observed more frequently in the USAT group than the mechanical thrombectomy group (22 % vs 4.1 %, p < 0.001)
Neurological Manifestations of SARS-CoV-2 Infection: Protocol for a Sub-analysis of the COVID-19 Critical Care Consortium Observational Study
No full textINTRODUCTION: Neurological manifestations and complications in coronavirus disease-2019 (COVID-19) patients are frequent. Prior studies suggested a possible association between neurological complications and fatal outcome, as well as the existence of potential modifiable risk factors associated to their occurrence. Therefore, more information is needed regarding the incidence and type of neurological complications, risk factors, and associated outcomes in COVID-19. METHODS: This is a pre-planned secondary analysis of the international multicenter observational study of the COVID-19 Critical Care Consortium (which collected data both retrospectively and prospectively from the beginning of COVID-19 pandemic) with the aim to describe neurological complications in critically ill COVID-19 patients and to assess the associated risk factors, and outcomes. Adult patients with confirmed COVID-19, admitted to Intensive Care Unit (ICU) will be considered for this analysis. Data collected in the COVID-19 Critical Care Consortium study includes patients' pre-admission characteristics, comorbidities, severity status, and type and severity of neurological complications. In-hospital mortality and neurological outcome were collected at discharge from ICU, and at 28-days. ETHICS AND DISSEMINATION: The COVID-19 Critical Care Consortium main study and its amendments have been approved by the Regional Ethics Committee of participating sites. No further approval is required for this secondary analysis. TRIAL REGISTRATION NUMBER: ACTRN12620000421932
Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery.
No full textINTRODUCTION: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery.
METHODS: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes.
RESULTS: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees\u3e of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%).
CONCLUSIONS: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings
Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery
No full textIntroduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery.
Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes.
Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees\u3e of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%).
Conclusions: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings
Mechanical Support in High-Risk Pulmonary Embolism: Review Article
No full textAcute pulmonary embolism (PE) may manifest with mild nonspecific symptoms or progress to a more severe hemodynamic collapse and sudden cardiac arrest. A substantial thrombotic burden can precipitate sudden right ventricular strain and failure. Traditionally, systemic thrombolytics have been employed in such scenarios; however, patients often present with contraindications, or these interventions may prove ineffective. Outcomes for this medically complex patient population are unfavorable, necessitating a compelling argument for advanced therapeutic modalities or alternative approaches. Moreover, patients frequently experience complications beyond hemodynamic instability, such as profound hypoxia and multiorgan failure, necessitating assertive early interventions to avert catastrophic consequences. The existing data on the utilization of mechanical circulatory support (MCS) devices are not exhaustive. Various options for percutaneous MCS devices exist, each possessing distinct advantages and disadvantages. There is an imminent imperative to develop a tailored approach for this high-risk patient cohort to enhance their overall outcomes
Snorkel Stenting During Transcatheter Aortic Valve Implantation: A Single-Center Study
No full textBackground and Objectives: Coronary obstruction (CO) is a potentially fatal complication that can occur during transcatheter aortic valve implantation (TAVI). The snorkel stenting technique was developed to mitigate the risk of CO. The aim of the current study was to evaluate the safety and clinical outcomes of snorkel stenting in patients at high risk of developing CO. Materials and Methods: All patients undergoing TAVI with snorkel stenting between January 2018 and December 2023 were retrospectively included. The primary outcome was the evaluation of perioperative CO and myocardial infarction (MI) at follow-up. Results: Between 2018 and 2023, a total of 1476 TAVI procedures were conducted, with 21 patients undergoing snorkel stenting for CO prevention. Median STS was 5.0 [IQR 3.0–8.0]. Four patients (19.0%) had a history of prior percutaneous coronary intervention, and 85.7% (n = 18) had a degenerated bioprosthesis. Preoperative multidetector CT revealed a mean sinus of Valsalva diameter of 24.6 ± 6.8 mm and a mean annulus area of 402.0 ± 59.7 mm2. The mean heights of the left and right coronary ostia were 7.9 ± 3.3 mm and 10.6 ± 5.5 mm, respectively. Nine patients (42.9%) presented with severe aortic regurgitation. Snorkel stenting was performed on the left main coronary in nine cases, on the right coronary in 10 cases, and on both the left main and right coronary arteries in two cases. No procedural complications were observed. Postoperatively, there were no MIs; one patient suffered from a disabling stroke, and another patient required a new pacemaker implant. Thirty-day mortality rate was 0%. At a median follow-up of 1.25 years (IQR: 1.05–3.05), there were five rehospitalizations for heart failure, no aortic valve reinterventions, one disabling stroke (sub-acute), and one MI. Overall, four patients died, including two cardiovascular-related deaths. Conclusions: Snorkel stenting should be considered for selected high- or prohibitive-surgical-risk patients undergoing TAVI who are at increased risk of developing CO. This technique showed favorable procedural outcomes for preventing CO occurring during or in the perioperative period of TAVI procedures. The abstract of the present study was accepted for oral presentation at the New York Valves on 26 June 2025
