Transcatheter aortic valve replacement (TAVR) has become one of the main treatments for severe aortic stenosis. However, percutaneous coronary intervention (PCI) is often required in elderly patients who combine with coronary artery disease. This paper reports a case of one-stop TAVR+PCI operation for a 71-year-old male patient with left main bifurcation lesions and severe aortic stenosis. During the procedure, first of all, the coronary arteries were assessed by angiography, and the pigtail catheter was implanted in the left ventricle after the straight guidewire transvalved successfully; then PCI was performed on the diseased coronary arteries; finally, the stenosis of aortic valve was treated with TAVR. After operation, the hemodynamics of the patient was stable and symptoms were significantly improved, showing a good clinical effect of one-stop operation of TAVR+PCI.
Objective To evaluate the clinical efficacy and safety of triple-antiplatelet treatment based on Cilostazol for restenosis after percutaneous coronary intervention. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2009), PubMed (1966 to 2009), EMbase (1974 to 2009), CNKI (1994 to 2009), CBM (1978 to Feb. 2009), VIP (1989 to Feb. 2009), and CMD Digital Periodicals (1998 to 2009). Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed using RevMan 5.0 software. Results Five randomized controlled trials (RCTs) involving 2 348 patients were included. The results of meta-analyses showed that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter (MD=0.31, 95%CI 0.11 to 0.51) and decrease restenosis rate (OR=0.49, 95%CI 0.37 to 0.65). In addition, it could decrease death rate (OR=0.52, 95%CI 0.31 to 0.88), but it could not change target-vessel revascularization, stroke rate, palpitation rate, and the rate of major adverse cardiac and cerebral events and major adverse cardiac events. Conclusion Evidence shows that triple-antiplatelet treatment based on Cilostazol could increase minimum lumen diameter and decrease restenosis rate and death rate. Their clinical application is worthy to be advocated.
Hybrid coronary revascularization (HCR) combining with coronary artery bypass grafting (CABG) has a long-term patency of left internal mammary artery to left anterior descending artery (LIMA-LAD) grafting, and the percutaneous coronary intervention (PCI) has a minimal invasiveness. It provides an alternative revascularization for patients with coronary heart disease. For patients who meet the HCR indications, most studies suggest that HCR can significantly reduce perioperative trauma, and offer favorable mid- and long-term prognosis, which is comparable with traditional revascularization strategies. Based on the major research results in this field in the past 10 years, we review the current application status and discuss the potential future direction of HCR in this paper.
As the indications for transcatheter aortic valve replacement (TAVR) expand to low-risk young patients, the number of patients undergoing percutaneous coronary intervention (PCI) after one or more TAVR may increase. The coronary access for PCI after TAVR has become a very practical and severe problem. Coronary re-intervention poses technical difficulties, and compared to balloon expandable valve, the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR. This article discusses the selection of appropriate valves before TAVR, the implementation of intraoperative commissural alignment technology, and the techniques for mastering the coronary access for PCI after TAVR, in order to improve the success rate of the coronary access for PCI after TAVR.
ObjectiveTo retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. MethodsClinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. ResultsFinally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. ConclusionIatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.
Objective To explore the effects of aggressive lipid lowering therapy and its influence on cardiovascular events using lipitor (20 mg daily) for Chinese people after percutaneous coronary intervention (PCI). Methods We did a double-blind and randomized controlled trial. From July 2005 to June 2006, 120 patients with PCI procedure who were discharged from the Shanghai Chest Hospital were randomly divided into aggressive lipid lowering group (atorvastatin 20 mg daily, n=60) and an ordinary lipid lowering group (atorvastatin 10 mg daily, n=60). The trial treatment was administered from the day of PCI to the third month after PCI. Atorvastatin at 10 mg daily was then used until one year after PCI. Blood biochemistry, cardiovascular events and drug adverse reactions were compared between the two groups. Results Among the 120 patients, 5 discontinued treatment and 4 more withdrew from the study. Therefore 115 and 111 were included in our main analyses [Comment from Mike: it is not ITT if the 5 who discontinued treatment are excluded] and a per-protocol (PP) analysis, respectively. Baseline clinical characteristics were comparable between the two groups. The reduction in TG and the increase in HDL-C were similar between the two groups (Pgt;0.05), but the reductions in LDL-C and TC were significantly different between the two groups (Plt;0.05). This was observed from the beginning of follow-up to the third month after PCI. In the PP analysis, the percentage of patients whose LDL-C met the predefined requirement at the third month in the 20 mg group was significantly higher than in the group receiving the lower dose (87.03% vs. 70.17%, P=0.031). A similar result was also obtained if the patients who withdrew were retained in the analysis (P=0.044). The change in C reaction protein (CRP) from baseline at the first and the third month was significantly different between the two groups (Plt;0.05), but become relatively stable at the sixth month (Pgt;0.05). The mean follow-up duration was 6.5±3.0 months in the higher dose group, with 1 case of recurring angina pectoris and 1 case of revascularization were identified. It was 7.2±3.6 months in the 10 mg daily group, with 3 cases of recurring angina pectoris, 1 case of nonfatal myocardial infarction, 2 cases of revascularization and 1 case of sudden cardiogenic death. The difference in the Kaplan-Meier event curves was of borderline statistical significance from the fourth month (P=0.048). Drug adverse reactions were mild and myopathy was not identified in any patients. Conclusions After PCI procedure, the use of atorvastatin 20 mg daily for aggressive lipid lowering was safe and effective.
ObjectiveTo investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD).MethodsA total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique.ResultsThere was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups.ConclusionHCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.
ObjectiveTo analyze systematic reviews (SRs) and meta-analyses on the efficacy of pharmacological interventions in the prevention of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). MethodsWe searched the PubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data, and VIP databases to identify SRs and meta-analyses on the pharmacological interventions aimed at preventing CI-AKI after PCI from inception of the databases to February 2022. Two researchers independently screened the literature and extracted data. The PRISMA statement, AMSTAR 2 tool, and GRADE system were adopted to evaluate the reporting quality, methodological quality, and evidence quality of the findings of the included SRs and meta-analyses. ResultsA total of 14 SRs and meta-analyses were identified. Among the drugs used were statins, N-acetylcysteine, sodium bicarbonate, Dan-hong injection, vitamins, salvianolate, adenosine antagonists, nicorandil, allopurinol, alprostadil, furosemide, trimetazidine, probucol, and brain natriuretic peptide. Most of the studies had relatively comprehensive coverage of the items, with the PRISMA scores ranging from 18 to 24.5. The main issues of reporting quality were protocol and registration, search, and funding. The methodological quality of the SRs and meta-analyses was generally low. Items 2 and 7 were the key items with poor scores, and the non-critical items with poor scores were items 3, 10, and 16. All drugs, except furosemide, decreased the incidence of CI-AKI. The quality of evidence ranged from medium to very low according to GRADE. Conclusion Most of the single drugs or drugs combined with hydration show the potential to prevent CI-AKI, however, the overall methodological quality of the included studies is relatively low, and the strength of evidence is generally low.