The AngioVac system was invented in 2012 and was originally designed for the removal of thrombi from the venous system. It has been successfully used in the management of iliocaval and right endocardial thrombi but is reportedly less effective in the management of pulmonary emboli (PE). Since its advent, there has been interest in its application towards other medical situations. One of the most revolutionary uses thus far has been for percutaneous debridement of valvular and cardiac electronic device-associated vegetations. In most instances, the AngioVac device has been used to obviate the need for surgery in high-risk patients. Here, we describe a novel use of this device in the successful retrieval of a large, mobile, infected thrombus from the right ventricular outflow tract in a high surgical-risk patient.
There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA. Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA.
Renal artery calcifications can be associated with insufficient stent expansion and in-stent restenosis. Intravascular lithotripsy (IVL) uses shockwaves to disrupt calcium and treat calcific renal in-stent restenosis. Herein, the authors present a case to treat resistant reno-vascular hypertension and in-stent restenosis of an inadequately expanded renal stent in a patient with severe calcific renal artery stenosis. The patient was treated with IVL and stent dilation. The patient was followed subsequently, and her home blood pressure was well controlled on anti-hypertensive medications. In conclusion, IVL promises pronounced success in the modification of severely calcified renal artery lesions and can be used to treat renal artery stenosis even in the context of inadequately expanding renal artery stents.Extensive calcifications can contribute to the blockages of the arteries of the kidney. These can be associated with insufficient stent expansion in patients undergoing stent placement. Intravascular lithotripsy uses high-energy shockwaves to disrupt calcium deposits of renal arteries. Herein, the authors present a case of high blood pressure refractory to four blood pressure medications associated with blockage of previously placed stent of the artery of the left kidney. This case demonstrates that lithotripsy is an effective procedure to modify calcifications in order to facilitate expansion of the stent to restore blood flow to kidneys.
Results: Analysis of data for 24 patients revealed a significantly better P/F ratio during the first and second hour on HFPV, compared with a P/F ratio on CMV (420.0 ± 158.8, 459.2 ± 138.5, and 260.2 ± 98.5 respectively, p < 0.05), suggesting much better gas exchange on HFPV than on CMV.Hemodynamics were not affected by the mode of the ventilation.Conclusions: Improvement in gas exchange, reflected in a significantly improved P/F ratio, wasn't accompanied by worsening in hemodynamic parameters.The significant gains in the P/F ratio were lost when patients were switched to conventional ventilation.This data suggest that HFPV provides significantly better gas exchange compared with CMV and can be safely utilized in postoperative cardiac patients without any significant effect on hemodynamics.
Abstract Background There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among solid‐organ transplant recipients. Methods Temporal trends in hospitalizations for aortic valve replacement among solid‐organ transplant recipients were determined using the National Inpatient Sample database years 2012–2017. Propensity matching was conducted to compare admissions who underwent TAVR versus SAVR. The primary outcome was in‐hospital mortality. Results The analysis included 1,730 hospitalizations for isolated AVR; 920 (53.2%) underwent TAVR and 810 (46.7%) underwent SAVR. TAVR was increasingly utilized for solid‐organ transplant recipients (P trend = 0.01), while there was no change in the number of SAVR procedures (P trend = 0.20). The predictors of undergoing TAVR for solid‐organ transplant recipients included older age, diabetes, and prior coronary artery bypass surgery, while TAVR was less likely utilized in small‐sized hospitals. TAVR was associated with lower in‐hospital mortality after matching (0.9 vs. 4.7%, odds ratio [OR] 0.19; 95% confidence interval [CI] 0.11–0.35, p < .001) and after multivariable adjustment (OR 0.07; 95% CI 0.03–0.21, p < .001). TAVR was associated with lower rate of acute kidney injury, acute stroke, postoperative bleeding, blood transfusion, vascular complications, discharge to nursing facilities, and shorter median length of hospital stay. There was no difference between both groups in the use of mechanical circulatory support, hemodialysis, arrhythmias, or pacemaker insertion. Conclusion This contemporary observational nationwide analysis showed that TAVR is increasingly performed among solid‐organ transplant recipients. Compared with SAVR, TAVR was associated with lower in‐hospital mortality, complications, and shorter length of stay.
