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Access site vascular complications remain a recognised complication following transcatheter aortic valve implantation (TAVI). Suture-based vascular closure devices (VCDs) such as ProGlide® (Abbott Vascular Inc., Santa Clara, CA, USA) are widely used in order to achieve rapid haemostasis. The MANTATM (Essential Medical Inc., Malvern, PA, USA) is a collagen plug-based VCD which can be used as an alternative to traditional suture-based devices, but is significantly more expensive per-unit. We compare the efficacy, safety and total cost associated with the use of the MANTATM and ProGlide® VCDs.
This retrospective study included all consecutive patients who underwent transfemoral (TF) TAVI between November 2017-June 2018. The primary endpoints were primary access site-related VARC-2 vascular complications, VARC-2 bleeding and the overall per-patient cost incorporating treatment for complications or use of additional VCDs.
A total of 136 patients were included in this study; 86 in the ProGlide® group and 50 in the MANTATM group. Baseline characteristics of the two groups were well-matched. Three patients in the ProGlide® group required surgical repair compared to none in the MANTATM group. However, no significant differences were observed with respect to overall primary access site-related VARC-2 vascular complications (10.5% vs. 10%; p=0.93) or VARC-2 bleeding (9.3% vs. 4.0%; p=0.25). There was no significant difference in the mean cost per patient when taking into consideration the use of additional VCDs and treatments for vascular complications (£568.79 vs. £599.95; p=0.90).
The use of the MANTATM VCD following TF TAVI is cost-neutral compared to ProGlide® VCDs, whilst being associated with no increase in VARC-2 vascular or bleeding complications.
Transcatheter valve interventions; Vascular complications; Vascular closure devices (VCD).
Cardiovascular disease (CVD) is the leading cause of death globally, with Blacks in the United States (U.S.) disproportionately affected. Healthcare access and utilization have been reported as risk factors for poorer cardiovascular health among several U.S.
Aims and Objectives
The purpose of this systematic literature review was to examine the results of existing studies reporting on cardiovascular health and healthcare utilization by African-born compared to U. S. -born Blacks.
A systematic literature review was conducted using keywords and medical subject headings (MESHs) in the PUBMED, Web of Science and CINAHL electronic databases. Exclusion and inclusion criteria determined articles to be reviewed for eligibility and methodological soundness. A pooled analysis was performed on all studies.
Only seven studies met inclusion criteria. Four compared U. S. -born with African-born Blacks residing in the United States, while three compared U. S. -born Blacks with Blacks residing elsewhere. None of the studies examined the associations between healthcare utilization and cardiovascular health for these populations.
The results of this review indicate a need to examine the impact of healthcare utilization for increasing awareness, prevention and treatment of CVD in Blacks who reside in the United States regardless of their nativity.
Cardiovascular health; African-born Blacks; U.S-born blacks; Healthcare utilization.
CVD: Cardiovascular disease; US: United States; MESHs: Medical subject headings; sBP: Systolic blood pressure; dBP: Diastolic blood pressure; BMI: Body mass index; BP: Blood pressure.
This case report illustrates a challenging case of worsening heart failure in a previously well-compensated patient with unclear etiology. Further workup revealed the patient’s cardiac resynchronization therapy-defibrillator (CRT-D) left ventricle (LV) lead was losing capture during positional changes. This case demonstrates the importance of device optimization, as well as electrocardiogram (ECG) monitoring to elucidate possible causes of acute systolic heart failure.
Cardiac resynchronization; cardiac resynchronization therapy (CRT); Systolic heart failure; Lead positioning;
Advanced heart failure.
Giant cell myocarditis is a rare condition first described in 1905. It has a reported incidence range from 0.007% to 0.051%. It affects female and male individuals, equally, and usually occurs in young and middle-aged persons. The underlying aetiology of giant cell myocarditis is unknown but it is thought to be mediated by T-lymphocytes. Diagnosis is made via histological examination of myocardial tissue and is characterized by a mixed inflammatory cell infiltrate with multinucleated giant cells and cardiomyocyte necrosis, predominantly affecting the ventricles. The following report describes a rare case of giant cell myocarditis in a 71-year-old man with a history of hypertension and heart failure, who died while waiting to be seen in the emergency department. Autopsy findings revealed an enlarged, dilated heart with histologic features in keeping with giant cell myocarditis, along with features of heart failure. Diagnosis of giant cell myocarditis is less common in the elderly age group, possibly due to a less severe disease process in this age group and it may be misdiagnosed because older individuals may have other cardiovascular diseases (CVDs).
Myocarditis; Giant cell myocarditis; Autopsy; Elderly, Cardiovascular.
Sudden death is the principal cause of fatality in Chagas disease, afflicting to non-symptomatic patients younger than 50-years. For this, sudden death associated with chagasic malignant arrhythmias is underdiagnosed and their pathophysiological basis is poorly understood.
In this sense, this work aimed to analyze the histopathological alterations in cardiac structures specialized in the generation/conduction of action potential in an anatomopathological case of non-diagnosed sudden death living in a Chagasic endemic area.
The donor was a woman, 62-year-old, which ingressed without vital signs to the emergency room of “Antonio María Pineda” hospital, without any apparent antecedents of cardiac disease. The gross examination was normal, with no external evidence of structural/ischemic disease.
Microscopic examination revealed nodal like cell depopulation, microvascular disturbances, chronic myocarditis with mononuclear and mast cell infiltrate plus extracellular matrix reaction, and profuse damage of neural structures placed in nodal region. amastigote nest of Trypanosoma cruzi (T. cruzi) was detected.
These findings suggest a complex association among parasite persistence, sinus disease, micro-ischemia foci, and neural inflammation in the genesis of malignant arrhythmias of Chagas disease despite the absence of structural disease or massive necrosis. It is important to perform a protocol of examination for no explained sudden death cases in chagasic endemic countries, to avoid misdiagnosed of sudden death associated with Chagas disease.
letter to the editor
Severe psoriasis is associated with an enhanced risk of cardiovascular (CV) diseases. The potential impact of psoriasis on the prognosis following coronary revascularization (percutaneous coronary intervention (PCI) or surgical) is not well studied and sparse data available in literature points towards a grim long-term prognosis. The following two cases highlight this phenomenon. We also discuss the plausible reasons responsible for the poor prognosis and propose some possible mechanisms for the same.
Pulmonary artery hypertension (PAH) ultimately leads to straining of the right ventricle and increases the risk of heart failure in affected patients. Its clinical presentation is similar to that of many other diseases thus delaying the diagnosis until the disease is far advanced. It remains one of the leading causes of death in adults with sickle cell anaemia (SCA) worldwide. It confers a high risk of death with two-year mortality rates as high as 40-50% even at modest elevation of pulmonary artery pressure. Median survival age after detection of the disease is said to be 25.6-months. Early detection of elevated pulmonary artery pressure in childhood and appropriate intervention by optimization of anti-haemolytic therapy may prevent the progression of this complication. The current writes up is a review of literatures on pulmonary artery hypertension among children with sickle cell anaemia. This will give information which will aid early diagnosis and treatment of pulmonary artery hypertension among children with sickle cell anaemia. This will ultimately improve the quality of life of children with sickle cell anaemia and reduce morbidity and mortality from the disease in adults and children living with sickle cell anaemia.
Sickle cell anaemia; Pulmonary artery hypertension; Children.
Aggregate Professor of Cardiology Chief Interventional Cardiology Eastern Piedmont University C.so Mazzini 18, 28100 Novara, Italy
Assistant Professor of Pharmacology Department of Pharmaceutical Sciences College of PharmacyNova Southeastern University 3200 S. University Dr Health Professions Division (Terry) Bldg/Room 1338 Fort Lauderdale, FL 33328, USA
Consultant Interventional Cardiologist Department of Cardiology Danderyd University Hospital & Karolinska Institute Stockholm, Sweden
Director and Assistant Professor Structural Heart Research & Innovation Lab Division of Cardiothoracic Surgery Emory University 380B, Northyards Blvd Atlanta, GA 30313, USA
Associate Professor | Medical Imaging Discipline Department of Imaging and Applied Physics Curtin University GPO Box U1987 Perth WA 6845 Australia