• Issue

    Catheterization and Cardiovascular Interventions: Volume 97, Issue 6

    i-viii, 1109-1308, E748-E899
    May 1, 2021

ISSUE INFORMATION - COPYRIGHT

Free Access

Issue Information - Copyright

  • Page: i
  • First Published: 11 May 2021

ISSUE INFORMATION - EDITORIAL BOARD

Free Access

Issue Information - Editorial Board

  • Page: ii
  • First Published: 11 May 2021

ISSUE INFORMATION - TOC

Free Access

Issue Information - TOC

  • Pages: iv-viii
  • First Published: 11 May 2021

CORONARY ARTERY DISEASE

EDITORIAL COMMENT

The remnant of our success

  • Pages: 1118-1119
  • First Published: 11 May 2021
Key Points

  • Mortality associated with ST-elevation myocardial infarction (STEMI) has increased despite improved door to balloon times due to increased patient complexity with more patients presenting to the catheterization lab with cardiac arrest and cardiogenic shock.
  • Emphasis on multimodal treatments of STEMI patients presenting with cardiogenic shock including early percutaneous coronary intervention with circulatory support when appropriate will likely provide the best clinical outcomes.
  • Future research should involve continued study of clinical outcomes in STEMI patients as use of various mechanical support increases.

EDITORIAL COMMENT

Supersaturated oxygen therapy in acute anterior myocardial infarction: Going small is the next big thing

  • Pages: 1127-1128
  • First Published: 11 May 2021
Key Points

  • Improving myocardial salvage and reducing infarct size to optimize post-myocardial infarction sequelae of heart failure and mortality remain an important goal in the primary PCI era.
  • Intra-coronary supersaturated oxygen therapy is relatively new with unknown long-term outcomes.
  • The current study presents evidence of improved clinical outcomes after supersaturated oxygen therapy but is limited in size and study design necessitating further investigation before widespread adoption.

EDITORIAL COMMENT

Lies, damned lies, and statistics, but bleeding and acute limb ischemia are facts!

  • Pages: 1139-1140
  • First Published: 11 May 2021
Key Points

  • Bleeding and ischemic limb complications continue to plague patients with cardiogenic shock.
  • These complications are iatrogenic as they are not part of the pathophysiology of cardiogenic shock syndrome and are an attractive target for quality improvement.
  • Standardized care with vascular bundles may represent an important concept to reduce complications in this high-risk patient group.

EDITORIAL COMMENT

The inconsistency of manual thrombectomy and the role of contemporary thrombus grading in PCI for STEMI

  • Pages: 1149-1150
  • First Published: 11 May 2021
Key Points

  • Manual thrombectomy (MT) is a negative determinant for MVO occurrence and extent in STEMI patients with a high thrombus grade.
  • Integration of contemporary thrombus grading classification is essential to ensure efficacious and safe PCI.
  • Aiming to reduce MVO occurrence and extent in STEMI patients indicates a role for power sourced, real mechanical thrombectomy devices as the preferred revascularization tools in heavy thrombus burden.

EDITORIAL COMMENT

GRACEfully assessing the timeline for noninfarct-related artery intervention in ST-elevation myocardial infarction patients

  • Pages: 1160-1161
  • First Published: 11 May 2021
Key Points

  • A large registry study of ST-elevation myocardial infarction (STEMI) patients with multivessel disease and without cardiogenic shock demonstrated that staged in-hospital intervention of the noninfarct-related artery was associated with a reduced risk of all-cause mortality when compared to culprit-only PCI or immediate multivessel intervention.
  • A subgroup analysis stratified by the Global Registry of Acute Coronary Events (GRACE) score, showed a mortality benefit in high-risk patients (GRACE score > 140) undergoing staged in-hospital intervention of the noninfarct-related artery with a median interval between the two procedures of 5 days.
  • Further large, randomized trials are needed to help clarify appropriate timing for nonculprit staged intervention in STEMI patients.

EDITORIAL COMMENT

With great power comes great responsibility: When and how to use the retrograde approach to chronic total occlusion interventions

  • Pages: 1174-1175
  • First Published: 11 May 2021
Key Points

  • The retrograde approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a powerful tool for successful CTO crossing, especially in complex occlusions.
  • Compared with antegrade-only CTO PCI, the retrograde approach is associated with increased risk of periprocedural complications.
  • The retrograde approach should be used when the anticipated benefits outweigh the potential risks and should be performed in a meticulous, systematic, and stepwise fashion to maximize the likelihood of success and minimize the risk of complications.

EDITORIAL COMMENT

Chronic coronary total occlusions: Let's make the long story short

  • Pages: 1184-1185
  • First Published: 11 May 2021
Key Points

  • Noninfarct-related chronic total occlusions are encountered approximately in 15% of patients presenting with acute ST-elevation myocardial infarction.
  • The presence of noninfarct-related chronic total occlusion portends worse mid- and long-term clinical outcomes in accordance with the “spare tire” hypothesis.
  • Numerous risk scores have been developed for ascertaining procedural success for chronic total occlusion percutaneous coronary interventions.
  • Complete occlusion length over 20 mm is a readily available, important factor for unsuccessful chronic total occlusion recanalization, both in stable coronary artery disease and in patients with noninfarct-related chronic total occlusion.

EDITORIAL COMMENT

The enigma continues: Obesity in chronic total occlusion patients does not affect success or complications…but Americans are still too fat!

  • Pages: 1194-1195
  • First Published: 11 May 2021
Key Points

  • Eighty-five percent of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the OPEN-CTO registry were either overweight or obese.
  • There is no difference in procedure success and outcomes between overweight and obese patients undergoing CTO PCI compared to normal weight.
  • Overweight and obese patients derive similar health status benefits after CTO PCI.

EDITORIAL COMMENT

Achieving radiation reduction by adapting to technology advances

  • Pages: 1207-1208
  • First Published: 11 May 2021
Key Points

  • This study demonstrates that the combination of image processing enhancements along with meticulous attention by operators to radiation hygiene can lead to significant and clinically meaningful reductions in radiation exposure.
  • The results obtained from a single experienced chronic total occlusion (CTO) operator in two sequential time periods are a reasonable substitute for a randomized trial.
  • Radiation exposure to patients and operators remains a significant hazard of CTO procedures.
  • Avoiding excessive dosage removes a barrier to successful procedural completion.

VALVULAR AND STRUCTURAL HEART DISEASES

EDITORIAL COMMENT

More energy, more costs

  • Page: 1235
  • First Published: 11 May 2021
Key Points

  • Transseptal access has been widely disseminated with a relatively low complication rate.
  • The VersaCross Transseptal system utilizes radiofrequency energy to facilitate transseptal access enhancing ease and efficiency of procedures.
  • Rising costs of structural heart interventions may impact resource allocation for medical devices.

EDITORIAL COMMENT

Should the mean left atrial pressure be the ultimate goal after TMVR?

  • Pages: 1250-1251
  • First Published: 11 May 2021
Key Points

  • Transcatheter mitral valve repair (TMVR) using Mitraclip is now the standard of care for treatment of severe symptomatic mitral regurgitation (MR) in patients who are at high-surgical risk.
  • Although acute reduction in regurgitant MR volume has been the main goal of successful treatment, many other hemodynamic parameters also important for accurate assessment and confirmation of the acute procedural outcome.
  • Acute reduction of the mean left atrial pressure (MLAP) following TMVR seems to be well correlated with successful clinical outcomes at 30 days.

EDITORIAL COMMENT

Clipping mitral valve or atrial fibrillation? Two is better than one!

  • Pages: 1257-1258
  • First Published: 11 May 2021
Key Points

  • Patients with atrial fibrillation (AF) undergoing MitraClip experience a doubled risk of in-hospital stroke and higher 30-day mortality.
  • Strategies to prevent in-hospital stroke in AF patients undergoing MitraClip may involve both pre- and intra-procedural management.
  • Specific trials are needed to assess the impact of uninterrupted anticoagulation, early heparinization, and previous AF ablation on outcome following MitraClip.

EDITORIAL COMMENT

Tailwind of transcatheter mitral valve repair pushes forward the treatment of acute mitral regurgitation after myocardial infarction

  • Pages: 1268-1269
  • First Published: 11 May 2021
Key Points

  • Acute mitral regurgitation after myocardial infarction is associated with high mortality and morbidity.
  • Treatment with the MitraClip is associated with high procedural success and acceptable mortality whether they presented in or out of cardiogenic shock, provided initial hemodynamic stabilization was first achieved before PMVR.
  • This transcatheter technique represents a valid alternative for selected patients and prospective studies are warranted to inform patient selection and periprocedural management in this acute setting.

EDITORIAL COMMENT

Large-bore vascular closure: Evolution not revolution for now

  • Pages: 1279-1280
  • First Published: 11 May 2021
Key Points

  • Closure technology has expanded modestly since the dawn of transcatheter aortic valve replacement (TAVR)—most improvements in outcomes have come from evolving techniques, smaller TAVR devices, better operator skills, and lower risk patients.
  • The MANTA device adapts a well-established sandwiching of a resorbable anchor and collagen plug to large-bore closure.
  • The choice of large-bore closure devices will remain one of the operator's preference pending a sufficiently powered randomized trial.

CORONARY ARTERY DISEASE

ORIGINAL STUDIES

VALVULAR AND STRUCTURAL HEART DISEASES

ORIGINAL STUDIES