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Hacı Ahmet Kasapkara, Abdullah Nabi Aslan, Hüseyin Ayhan, Serdal Baştuğ, Hakan Süygün, Telat Keleş, Tahir Durmaz, Engin Bozkurt
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has been accepted as an alternative to surgery in high risk or inoperable patients with severe aortic stenosis (AS). Although transfemoral approach is the most often preferred means of access, in patients with severe ilio-femoral arteriopathy, other vascular access sites may be required. The aim of the present study was to report our experience with trans-subclavian approach for TAVR using different valve systems. METHODS: Among 273 patients undergoing TAVR between June 2011 and May 2016, 10 patients (mean age: 68...
October 2016: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Charat Thongprayoon, Wisit Cheungpasitporn, Narat Srivali, Andrew M Harrison, Wonngarm Kittanamongkolchai, Kevin L Greason, Kianoush B Kashani
BACKGROUND: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR). METHODS: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria...
October 21, 2016: Renal Failure
Vivian L Bishay, Derek M Biederman, Thomas J Ward, Imramsjah Martijn J van der Bom, Rahul S Patel, Edward Kim, Francis S Nowakowski, Robert A Lookstein, Aaron M Fischman
OBJECTIVE: The transradial approach (TRA) has been shown to reduce the morbidity and mortality associated with arterial coronary interventions. Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. We report our initial experience with and technique for using the TRA for SIRT...
November 2016: AJR. American Journal of Roentgenology
Robert M Van Haren, Lee J Goldstein, Omaida C Velazquez, Jagajan Karmacharya, Arash Bornak
OBJECTIVE: Aortobifemoral bypass has been the gold standard treatment for extensive aortoiliac occlusive disease. Endovascular therapy and stenting of aortic and iliac occlusive lesions has proven to be efficacious, especially when dealing with short segment lesions. Endovascular treatment of TransAtlantic Inter-Society Consensus II (TASC) D aortoiliac occlusive lesions remains a challenge, but a valuable treatment option in poor surgical candidates. We present our operative technique and midterm results in treating TASC D aortoiliac occlusive disease using unibody bifurcated endografts...
October 17, 2016: Journal of Vascular Surgery
Nicolas Debry, Cédric Delhaye, Alexandre Azmoun, Ramzi Ramadan, Sahbi Fradi, Philippe Brenot, Arnaud Sudre, Mouhamed Djahoum Moussa, Didier Tchetche, Said Ghostine, Darren Mylotte, Thomas Modine
OBJECTIVES: The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR). BACKGROUND: Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures. METHODS: Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers...
October 24, 2016: JACC. Cardiovascular Interventions
Matthew C Henn, Thomas Percival, Alan Zajarias, Spencer J Melby, Brian R Lindman, Nishath Quader, Ralph J Damiano, Marc R Moon, John M Lasala, Ravinder S Rao, Jennifer Bell, Marci S Damiano, Hersh S Maniar
BACKGROUND: Smaller transcatheter aortic valve replacement (TAVR) delivery systems have increased the number of patients eligible for transfemoral procedures while decreasing the need for transaortic (TAo) or transapical (TA) access. As a result, newer TAVR centers are likely to have less exposure to these alternative access techniques, making it harder to achieve proficiency. The purpose of this study was to evaluate the learning curve for TAVR approaches and compare perioperative outcomes...
October 17, 2016: Annals of Thoracic Surgery
Mark A Groh, Ivan Diaz, Alan M Johnson, Stephen W Ely, Oliver A Binns, Gerard L Champsaur
BACKGROUND: Patients at intermediate risk (IR) according to The Society of Thoracic Surgeons risk score are today frequently oriented toward the transfemoral aortic valve replacement (TAVR) option. Our goal was to evaluate the best treatment strategies for IR patients with severe aortic stenosis. METHODS: Of a consecutive series of 1,144 surgical aortic valve replacements (AVRs) performed in our institution between 2008 and 2014, we reviewed the early and late outcomes of two different groups: a low-risk (LR) group of 470 patients, and an IR group of 620...
October 15, 2016: Annals of Thoracic Surgery
Gregory M Weiner, Rafey Feroze, David M Panczykowski, Amin Aghaebrahim, William Ares, Nitin Agarwal, John Enis, Xiao Zhu, Andrew F Ducruet
INTRODUCTION: Tandem occlusion resulting in acute ischemic stroke (AIS) is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present two cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques...
October 14, 2016: World Neurosurgery
Sheshagiri Rao Damera, Ramachandra Barik, Akula Siva Prasad
The angioplasty of chronic total aortoiliac occlusion using transfemoral is controversial. From March 2014 to December 2015, four consecutive patients (4 males; mean age 58.2±6.8 years; age of range 51-65 years) underwent angioplasty and stenting of TASC-D occlusion. In all the cases, we failed to cross from femoral approach. On switching over to left brachial access, angioplasty was done successfully in all. There was no procedural site complication or clinical evidence cerebral thromboembolism. Self-expandable stents were implanted in all with adequate pre and post dilation...
September 2016: Indian Heart Journal
George Joseph, Mithun J Varghese, Oommen K George
Balloon mitral valvotomy (BMV) performed by the conventional transfemoral approach can be difficult or even impossible in the presence of structural impediments such as severe kyphoscoliosis, gross cardiac anatomic distortion and inferior vena caval anomalies. A 25-year-old woman with severe thoracolumbar kyphoscoliosis due to poliomyelitis presented with symptomatic rheumatic mitral valve stenosis. After the failure of transfemoral BMV, the procedure was attempted from the right jugular access, using a modified septal puncture technique...
September 2016: Indian Heart Journal
Maria Lennerås, Georgios Tsikandylakis, Margarita Trobos, Omar Omar, Forugh Vazirisani, Anders Palmquist, Örjan Berlin, Rickard Brånemark, Peter Thomsen
The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment-adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients...
October 17, 2016: Journal of Biomedical Materials Research. Part A
Robert D Gregg, Anne E Martin
Recent work has extended the control method of virtual constraints, originally developed for autonomous walking robots, to powered prosthetic legs for lower-limb amputees. Virtual constraints define desired joint patterns as functions of a mechanical phasing variable, which are typically enforced by torque control laws that linearize the output dynamics associated with the virtual constraints. However, the output dynamics of a powered prosthetic leg generally depend on the human interaction forces, which must be measured and canceled by the feedback linearizing control law...
July 2016: Proceedings of the ... American Control Conference
Thandar Aye, Thanh Trung Phan, Douglas Findlay Muir, Nicholas John Linker, Richard Hartley, Andrew John Turley
AIM: This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. METHOD AND RESULTS: Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion...
October 14, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
David Lidwell, Colin A Meghoo
Skeletal traction is a useful technique for managing proximal femur fractures in austere environments where fracture stabilization for this injury is difficult. We present a technique and a construct appropriate for field use that facilitates patient evacuation, and we provide guidelines for the use of this technique by an advanced medical provider managing these injuries. The objectives of this article are to enable to reader to (1) recognize the role of skeletal traction in managing proximal femur fractures in an austere environment, (2) identify the key steps in placing transfemoral skeletal traction pins, and (3) identify options and requirements for building a traction construct in resource-limited environments...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Samir B Pancholy, Gaurav Patel, Sukrut P Nanavaty, Maitri S Pancholy
Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) is a devastating complication and continues to have a high mortality rate. Coronary revascularization with percutaneous coronary intervention (PCI) is the cornerstone in the management of CS; however, PCI-related access-site bleeding has been observed to be more prevalent in CS patients. Historically, PCI by transfemoral access (TFA) has been the preferred approach over transradial access (TRA) in CS patients due to weak radial pulse, operators' inexperience with TRA, and the use of TFA for concomitant mechanical cardiovascular support...
October 11, 2016: Minerva Cardioangiologica
Paweł Kleczyński, Maciej Bagieński, Artur Dziewierz, Łukasz Rzeszutko, Danuta Sorysz, Jarosław Trębacz, Robert Sobczyński, Marek Tomala, Maciej Stąpór, Dariusz Dudek
PURPOSE: Restoration of quality of life (QoL) and improvement of clinical outcomes is crucial in elderly patients undergoing transcatheter aortic valve implantation (TAVI). We sought to evaluate changes in QoL and all-cause mortality 12 months after TAVI. METHODS: A total of 101 patients who underwent TAVI were included. Patients were followed for 12 months. QoL was assessed at baseline and at 1, 6 and 12 months after TAVI using EQ-5D-3L with a visual analog scale (VAS)...
October 10, 2016: International Journal of Artificial Organs
Martine Gilard, Hélène Eltchaninoff, Patrick Donzeau-Gouge, Karine Chevreul, Jean Fajadet, Pascal Leprince, Alain Leguerrier, Michel Lievre, Alain Prat, Emmanuel Teiger, Thierry Lefevre, Didier Tchetche, Didier Carrié, Dominique Himbert, Bernard Albat, Alain Cribier, Arnaud Sudre, Didier Blanchard, Gilles Rioufol, Frederic Collet, Remi Houel, Pierre Dos Santos, Nicolas Meneveau, Said Ghostine, Thibaut Manigold, Philippe Guyon, Dominique Grisoli, Herve Le Breton, Stephane Delpine, Romain Didier, Xavier Favereau, Geraud Souteyrand, Patrick Ohlmann, Vincent Doisy, Gilles Grollier, Antoine Gommeaux, Jean-Philippe Claudel, Francois Bourlon, Bernard Bertrand, Marc Laskar, Bernard Iung
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES: This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS: The FRANCE-2 registry prospectively included all TAVRs performed in France...
October 11, 2016: Journal of the American College of Cardiology
Georg Nickenig, Christoph Hammerstingl, Robert Schueler, Yan Topilsky, Paul A Grayburn, Alec Vahanian, David Messika-Zeitoun, Marina Urena Alcazar, Stephan Baldus, Rudolph Volker, Michael Huntgeburth, Ottavio Alfieri, Azeem Latib, Giovanni La Canna, Eustachio Agricola, Antonio Colombo, Karl-Heinz Kuck, Felix Kreidel, Christian Frerker, Felix C Tanner, Ori Ben-Yehuda, Francesco Maisano
OBJECTIVES: This study sought to show safety and efficacy of the Cardioband system during 6 months after treatment. BACKGROUND: Current surgical and medical treatment options for functional mitral regurgitation (FMR) are limited. The Cardioband system (Valtech Cardio, OrYehuda, Israel) is a novel transvenous, transseptal direct annuloplasty device. METHODS: Thirty-one patients (71.8 ± 6.9 years of age; 83.9% male; EuroSCORE II: 8.6 ± 5.9) with moderate to severe FMR, symptomatic heart failure, and depressed left ventricular function (left ventricular ejection fraction 34 ± 11%) were prospectively enrolled...
October 10, 2016: JACC. Cardiovascular Interventions
O B Pattanashetty, Dayanand B B, Arravind Pillai, Preetish Endigeri
INTRODUCTION: Dedifferentiated chondrosarcoma (DDCS) is a rare and malignant form of primary bone tumor refractive to chemotherapy and radiotherapy. It accounts for 1-2% of all primary bone tumors. Surgical resection, limb-salvage surgeries and amputation remain the mainstay of treatment. The prognosis of dedifferentiated chondrosarcoma is poor. CASE REPORT: We report a case of a 51-year-old male having a swelling and an ulcer distal to the left knee later diagnosed with dedifferentiated chondrosarcoma of proximal tibial and fibular metaphysis...
April 2016: Journal of Orthopaedic Case Reports
Tomo Ando, Alexandros Briasoulis, Anthony A Holmes, Hisato Takagi, David P Slovut
BACKGROUND: The transfemoral (TF) approach has become the preferred approach for transcatheter aortic valve replacement (TAVR) because of its low risk profile. However, the relative safety of the percutaneous approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim was to compare the outcomes between PC versus SC access in patients undergoing TF-TAVR using a meta-analysis. METHODS: We conducted a systematic electronic database search for studies reporting major and minor vascular complications (VC), major and minor bleeding, and perioperative all-cause mortality, in PC versus SC TF-TAVR cases...
October 3, 2016: Journal of Cardiac Surgery
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