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Article ; Online: A debate

Dabit Arzamendi

REC: Interventional Cardiology, Vol 3, Iss 3, Pp 213-

Intervención sobre las válvulas mitral y tricúspide. Perspectiva desde la cardiología intervencionista

2021 Volume 215

Abstract: PREGUNTA: ¿Cuál es el estado actual del intervencionismo percutáneo para la insuficiencia mitral (IM) funcional? RESPUESTA: Las terapias de reparación mitral transcatéter son la técnica con mayor evidencia científica en la actualidad. Así lo muestran las ...

Abstract	PREGUNTA: ¿Cuál es el estado actual del intervencionismo percutáneo para la insuficiencia mitral (IM) funcional? RESPUESTA: Las terapias de reparación mitral transcatéter son la técnica con mayor evidencia científica en la actualidad. Así lo muestran las nuevas guías clínicas1 para pacientes con patologías valvulares de la American Heart Association (AHA), en las que para aquellos con IM funcional y disfunción ventricular grave se recomienda la reparación transcatéter (clase IIa-BR), quedando reservada la cirugía para los casos que requieren revascularización coronaria concomitante. No hemos de olvidar que la reparación transcatéter es la única técnica para la que se dispone de estudios aleatorizados2,3, y eso hace que las guías de práctica clínica la indiquen como terapia de primera línea. Hemos de acabar con la escuela de «a propósito de .
Keywords	Internal medicine ; RC31-1245
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Debate

Dabit Arzamendi

REC: Interventional Cardiology (English Ed.), Vol 3, Iss 3, Pp 213-

Intervention on the mitral and the tricuspid valves. Perspective from interventional cardiology

2021 Volume 215

Abstract: QUESTION: What is the current status of percutaneous coronary interventions to treat functional mitral regurgitation (MR)? ANSWER: To this date, transcatheter mitral valve repair therapies are backed by the highest scientific evidence. This has been ... ...

Abstract	QUESTION: What is the current status of percutaneous coronary interventions to treat functional mitral regurgitation (MR)? ANSWER: To this date, transcatheter mitral valve repair therapies are backed by the highest scientific evidence. This has been confirmed by the new clinical practice guidelines1 on the management of patients with valve disease published by the American Heart Association (AHA) where transcatheter repair (class IIa-Level of Evidence BR) is recommended for patients with functional MR and severe ventricular dysfunction. However, surgery is spared for cases that require concomitant coronary revascularization. We should not forget that transcatheter repair is the only technique on which there are randomized clinical trials available.2,3 That is why it is indicated as the first-line therapy by the clinical practice guidelines. We should put the old sayings «regarding a case» or «in my hands, results are better» to sleep. Multicenter randomized clinical trials assess the reproducibility of the technique, and that is the key to generalize this or that therapy. In my opinion, the clinical cardiologist should place transcatheter mitral valve repair in the same level as cardiac resynchronization therapy. And, same as it happens with resynchronization, the right selection of patients is of paramount importance. When should repair be considered?.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Implementación de un programa de alta precoz tras TAVI en tiempos de la COVID-19

Lluis Asmarats / Xavier Millán / Hector Cubero-Gallego / Jonatan Valverde / Chi Hion Li / Dabit Arzamendi

REC: Interventional Cardiology, Vol 4, Iss 2, Pp 150-

¿necesidad u oportunidad?

2022 Volume 152

Abstract: Sr. Editor: A pesar de que el uso del implante percutaneo de valvula aortica (TAVI) se ha extendido a pacientes de menor riesgo, la estancia hospitalaria tras TAVI sigue siendo larga, segun el registro espanol de TAVI se situa en torno a los 8 dias1. ... ...

Abstract	Sr. Editor: A pesar de que el uso del implante percutaneo de valvula aortica (TAVI) se ha extendido a pacientes de menor riesgo, la estancia hospitalaria tras TAVI sigue siendo larga, segun el registro espanol de TAVI se situa en torno a los 8 dias1. Estudios recientes confirman que el alta precoz tras un TAVI transfemoral con valvula balonexpandible resulta una opcion viable y segura2,3. La demanda sin precedentes que han soportado los servicios sanitarios durante la pandemia de COVID-19 ha obligado a redirigir los recursos y a restringir muchas intervenciones cardiovasculares para salvaguardar los limitados recursos disponibles tales como el soporte anestesico y los ventiladores, asi como las infraestructuras vinculadas a los cuidados criticos. El actual protocolo de alta precoz se desarrollo en respuesta a la pandemia de COVID-19 para valorar la seguridad y viabilidad que ofrece el alta precoz, en nuestro ambito, tras un TAVI minimamente invasivo con valvulas balon- o auto-expandibles. Se incluyo prospectivamente a los pacientes tratados con TAVI transfemoral. Los criterios de inclusion en el programa de altas precoces se basaron en los fijados por el estudio 3M TAVI: acceso femoral apto para cierre percutaneo, indice de masa corporal < 35, anatomia del anillo aortico de bajo.
Keywords	Internal medicine ; RC31-1245
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Implementing a fast-track TAVI pathway in times of COVID-19

Lluis Asmarats / Xavier Millán / Héctor Cubero-Gallego / Jonatan Valverde / Chi Hion Li / Dabit Arzamendi

REC: Interventional Cardiology (English Ed.), Vol 4, Iss 2, Pp 150-

necessity or opportunity?

2022 Volume 152

Abstract: To the Editor, Despite the expansion of transcatheter aortic valve implantation (TAVI) to lower-risk patients, the length of stay after TAVI remains high for an average 8 days according to the Spanish TAVI registry.1 Recently published studies have ... ...

Abstract	To the Editor, Despite the expansion of transcatheter aortic valve implantation (TAVI) to lower-risk patients, the length of stay after TAVI remains high for an average 8 days according to the Spanish TAVI registry.1 Recently published studies have demonstrated that early discharge following balloon-expandable transfemoral TAVI is feasible and safe.2,3 The unprecedented demand sustained by the healthcare services during the current COVID-19 pandemic has led to redirecting assets and restricting many cardiovascular procedures to protect the limited resources available like anesthesia support, ventilators, and critical care infrastructures. The present fast-track protocol was developed in response to the COVID-19 pandemic to assess the safety and feasibility of early discharge after minimalist TAVI with either balloon-expandable or self-expanding valves in our setting. Patients undergoing transfemoral TAVI were prospectively recruited. The inclusion criteria in the fast-track pathway were based on the 3M TAVI study: femoral access eligible for percutaneous closure, body mass index < 35, low-risk aortic annulus anatomy (coronary height > 10 mm, tricuspid valve, non-severe left ventricular outflow tract calcification), ejection fraction ≥ 30%, low anticipated risk of advanced conduction disturbances (PR interval < 240 ms, absence of right bundle branch block), familial support within the first 24-48 hours. All procedures were performed.
Keywords	Medicine ; R
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: New PASCAL Ace implant system in complex percutaneous mitral valve repair

Chi-Hion Pedro Li / Lluís Asmarats / M. Luz Maestre / Estefanía Fernández / Antonio Serra / Dabit Arzamendi

REC: Interventional Cardiology (English Ed.), Vol 4, Iss 1, Pp 65-

2022 Volume 66

Abstract: To the Editor, We present the case of a 73-year-old woman with arterial hypertension, morbid obesity (122 kg, body mass index = 44), and chronic lower limb swelling with recurrent skin infections due to multi-drug resistant microorganisms. She had a ... ...

Abstract	To the Editor, We present the case of a 73-year-old woman with arterial hypertension, morbid obesity (122 kg, body mass index = 44), and chronic lower limb swelling with recurrent skin infections due to multi-drug resistant microorganisms. She had a significant degenerative mitral regurgitation with moderate pulmonary hypertension and dyspnea, and NYHA functional class II. Despite the patients’ low surgical risk scores (1.5% and 1.29% in the Society of Thoracic Surgeons and EuroSCORE II scales, respectively) she was considered noneligible for mitral surgery because of her obesity and perioperative infectious risk. The heart team studied the case and decided to treat the mitral regurgitation with percutaneous treatment whose overall risk is lower. The patient’s informed consent was obtained for data publication in observance of the Declaration of Helsinki ethical principles. While planning the procedure, the presence of degenerative mitral regurgitation was confirmed associated with chord rupture and posterior leaflet eversion (flail) of the P1 scallop (figure 1A,B, asterisks) of 9 mm in height and 14 mm of amplitude. Quantitative parameters suggested a 1.3 cm2 anatomical regurgitant orifice, a 50 mL regurgitant volume, and a 51% regurgitant fraction with hemodynamic repercussion on the right superior pulmonary vein and systolic component reversal. The mitral.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Nuevo PASCAL Ace en la reparación percutánea valvular mitral compleja

Chi-Hion Pedro Li / Lluís Asmarats / M. Luz Maestre / Estefanía Fernández / Antonio Serra / Dabit Arzamendi

REC: Interventional Cardiology, Vol 4, Iss 1, Pp 65-

2022 Volume 66

Abstract: Sr. Editor: Se presenta el caso de una mujer de 63 años con hipertensión arterial, obesidad mórbida (122 kg, índice de masa corporal de 44) y edemas crónicos en los miembros inferiores, con infecciones cutáneas de repetición por microorganismos ... ...

Abstract	Sr. Editor: Se presenta el caso de una mujer de 63 años con hipertensión arterial, obesidad mórbida (122 kg, índice de masa corporal de 44) y edemas crónicos en los miembros inferiores, con infecciones cutáneas de repetición por microorganismos multirresistentes. Presentaba una regurgitación mitral degenerativa importante, con hipertensión pulmonar moderada y disnea, en clase funcional III. A pesar de tener un riesgo quirúrgico bajo, con una puntuación de la Society of Thoracic Surgeons del 1,5% y EuroSCORE II del 1,29%, fue rechazada para cirugía mitral por su obesidad y por el riesgo infeccioso perioperatorio. Se discutió el caso por el equipo multidisciplinario y se decidió realizar tratamiento percutáneo de la insuficiencia mitral, con menor riesgo global. Se obtuvo el consentimiento informado de la paciente para la publicación de los .
Keywords	Internal medicine ; RC31-1245
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Use of radial access to create an arterio-arterial loop to facilitate the percutaneous closure of paravalvular aortic leak. Is it feasible?

Gustavo Jiménez-Brítez / Alejandro Panaro / Giulana Maldonado / Dabit Arzamendi / Julio Carballo

REC: Interventional Cardiology (English Ed.), Vol 2, Iss 3, Pp 228-

2020 Volume 229

Abstract: To the Editor, Transcatheter paravalvular leak (PVL) closure through the implantation of occlusion devices has become an alternative to surgery.1 The closure of aortic PVLs is usually performed through retrograde approach (via femoral artery and with ... ...

Abstract	To the Editor, Transcatheter paravalvular leak (PVL) closure through the implantation of occlusion devices has become an alternative to surgery.1 The closure of aortic PVLs is usually performed through retrograde approach (via femoral artery and with echocardiographic and fluoroscopic guidance).2 There are times that the antegrade approach is necessary (via femoral vein through transseptal puncture, rarely transapical approach). However, certain cases require additional support using an arteriovenous loop. This is often done through the snaring of a wire introduced into the left atrium with a catheter that is advanced through the interatrial septum (transseptal).3-4 We describe a non-reported approach so far: the transcatheter closure of paravalvular leak using an arterio-arterial loop by passing the wire through the bioprosthesis and using radial access to snare the wire.
Keywords	Medicine ; R
Language	English
Publishing date	2020-08-01T00:00:00Z
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Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Uso del acceso radial para crear un asa arterio-arterial para facilitar el cierre percutáneo de una fuga paravalvular aórtica. ¿Es posible?

Gustavo Jiménez-Brítez / Alejandro Panaro / Giulana Maldonado / Dabit Arzamendi / Julio Carballo

REC: Interventional Cardiology, Vol 2, Iss 3, Pp 228-

2020 Volume 229

Abstract: Sr. Editor:, El cierre transcatéter de fuga periprotésica (FP) mediante el implante de dispositivos de oclusión se ha convertido en una alternativa a la cirugía1. El cierre de FP aórticas suele realizarse mediante abordaje retrógrado (por la arteria ... ...

Abstract	Sr. Editor:, El cierre transcatéter de fuga periprotésica (FP) mediante el implante de dispositivos de oclusión se ha convertido en una alternativa a la cirugía1. El cierre de FP aórticas suele realizarse mediante abordaje retrógrado (por la arteria femoral y con uso de ecocardiografía y fluoroscopia)2. En ocasiones es necesario el abordaje anterógrado (por la vena femoral y mediante punción transeptal, raras veces mediante abordaje transapical). No obstante, ciertos casos requieren soporte adicional con un asa arteriovenosa. Esto se suele hacer capturando la guía introducida en la aurícula izquierda con un catéter que se hace avanzar a través del septo interauricular (transeptal)3-4. Detallamos a continuación un abordaje no descrito hasta la fecha: el cierre transcatéter de una fuga periprotésica empleando un asa arterio-arterial, pasando la guía a través de la válvula bioprotésica y empleando el abordaje radial para capturar la guía.
Keywords	Internal medicine ; RC31-1245
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Permanyer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders

Jordi Mill / Victor Agudelo / Chi Hion Li / Jerome Noailly / Xavier Freixa / Oscar Camara / Dabit Arzamendi

REC: Interventional Cardiology (English Ed.), Vol 3, Iss 4, Pp 278-

2021 Volume 285

Abstract: ABSTRACT Introduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients ... ...

Abstract	ABSTRACT Introduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients treated with LAAO develop device-related thrombosis (DRT) after device implantation. Our study aimed to identify the key blood flow characteristics leading to DRT using patient-specific flow simulations. Methods: Patients treated with LAAO between 2014 and 2019 at a single center with preoperative and follow-up computerized tomography images and ultrasound imaging (US) were used to create patient-specific flow simulations. Amulet LAAO devices were implanted in the study patients. Flow simulations were blindly assessed to discard the presence of DRT in the follow-up imaging. Results: A total of 6 patients were processed in this pivotal study, half of them with DRT at the follow-up according to the imaging analysis. After a comprehensive analysis of the simulations, the most relevant in silico indices associated with DRT were the presence of stagnant blood flow, recirculation with low flow velocities (< 0.20 m/s) next to the device surface, and regions with high flow complexity combined with low wall shear stress. Conclusions: Patient-specific flow simulations of LAAO were successfully used to predict blood flow patterns with different device configurations. The results show the potential of the present modelling and simulation approach to recommend optimal settings capable of minimizing the risk of DRT.
Keywords	Device-related thrombosis ; Flow simulation ; Left atrial appendage occlusion ; Patient-specific ; Medicine ; R
Language	English
Publishing date	2021-11-01T00:00:00Z
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Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Análisis de la formación de trombo después del cierre de orejuela utilizando simulaciones de flujo personalizadas

Jordi Mill / Victor Agudelo / Chi Hion Li / Jerome Noailly / Xavier Freixa / Oscar Camara / Dabit Arzamendi

REC: Interventional Cardiology, Vol 3, Iss 4, Pp 278-

2021 Volume 285

Abstract: RESUMEN Introducción y objetivos: El cierre de la orejuela izquierda (COI) puede ser una alternativa de tratamiento eficaz para prevenir eventos cardiovasculares en pacientes con fibrilación auricular, en especial en aquellos con alto riesgo de sangrado. ...

Abstract	RESUMEN Introducción y objetivos: El cierre de la orejuela izquierda (COI) puede ser una alternativa de tratamiento eficaz para prevenir eventos cardiovasculares en pacientes con fibrilación auricular, en especial en aquellos con alto riesgo de sangrado. Sin embargo, algunos de estos pacientes en los que se realiza COI desarrollan trombosis relacionada con el dispositivo (TRD). Este estudio presenta las características del flujo sanguíneo que son clave en la formación de TDR, a partir de simulaciones personalizadas para cada paciente. Métodos: Para crear las simulaciones personalizadas se incluyeron en el estudio pacientes intervenidos de COI entre 2014 y 2019 en un único centro, de quienes se disponía de imágenes de tomografía computarizada previas al procedimiento y de seguimiento, así como de control ecocardiográfico. Para el COI se utilizaron los dispositivos Amulet. Las simulaciones se analizaron de forma ciega al diagnóstico de TRD. Resultados: En total se estudiaron 6 pacientes, de los que la mitad presentaban TRD según las imágenes del seguimiento clínico. Tras analizar los resultados de las simulaciones, los índices hemodinámicos asociados con TRD fueron la presencia de flujo estancado, las recirculaciones de sangre a velocidades bajas (< 0,20 m/s) cerca de la superficie del dispositivo y las regiones con alta complejidad de flujo y baja tensión de cizallamiento en la pared. Conclusiones: Las simulaciones de flujo personalizadas en pacientes con COI predijeron correctamente el diagnóstico clínico de TRD en todos los casos analizados. Los resultados obtenidos demuestran el potencial de los modelos personalizados para recomendar configuraciones óptimas del dispositivo y minimizar el riesgo de TRD.
Keywords	Trombosis relacionada con el dispositivo ; Simulaciones de flujo ; Cierre de la orejuela izquierda ; Personalización del paciente ; Internal medicine ; RC31-1245
Language	English
Publishing date	2021-11-01T00:00:00Z
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Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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