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Keywords = percutaneous structural heart intervention

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32 pages, 11062 KiB  
Review
Optical Coherence Tomography in Myocardial Infarction Management: Enhancing Precision in Percutaneous Coronary Intervention
by Angela Buonpane, Giancarlo Trimarchi, Marco Ciardetti, Michele Alessandro Coceani, Giulia Alagna, Giovanni Benedetti, Sergio Berti, Giuseppe Andò, Francesco Burzotta and Alberto Ranieri De Caterina
J. Clin. Med. 2024, 13(19), 5791; https://doi.org/10.3390/jcm13195791 - 28 Sep 2024
Cited by 9 | Viewed by 3070
Abstract
In acute myocardial infarction (AMI), the urgency of coronary revascularization through percutaneous coronary intervention (PCI) is paramount, offering notable advantages over pharmacologic treatment. However, the persistent risk of adverse events, including recurrent AMI and heart failure post-revascularization, underscores the necessity for enhanced strategies [...] Read more.
In acute myocardial infarction (AMI), the urgency of coronary revascularization through percutaneous coronary intervention (PCI) is paramount, offering notable advantages over pharmacologic treatment. However, the persistent risk of adverse events, including recurrent AMI and heart failure post-revascularization, underscores the necessity for enhanced strategies in managing coronary artery disease. Traditional angiography, while widely employed, presents significant limitations by providing only two-dimensional representations of complex three-dimensional vascular structures, hampering the accurate assessment of plaque characteristics and stenosis severity. Intravascular imaging, specifically optical coherence tomography (OCT), significantly addresses these limitations with superior spatial resolution compared to intravascular ultrasound (IVUS). Within the context of AMI, OCT serves dual purposes: as a diagnostic tool to accurately identify culprit lesions in ambiguous cases and as a guide for optimizing PCI procedures. Its capacity to differentiate between various mechanisms of acute coronary syndrome, such as plaque rupture and spontaneous coronary dissection, enhances its diagnostic potential. Furthermore, OCT facilitates precise lesion preparation, optimal stent sizing, and confirms stent deployment efficacy. Recent meta-analyses indicate that OCT-guided PCI markedly improves safety and efficacy in revascularization, subsequently decreasing the risks of mortality and complications. This review emphasizes the critical role of OCT in refining patient-specific therapeutic approaches, aligning with the principles of precision medicine to enhance clinical outcomes for individuals experiencing AMI. Full article
(This article belongs to the Special Issue Advancements in Myocardial Infarction Care: Strategies and Outcomes)
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30 pages, 625 KiB  
Review
Ventricular Tachycardia Catheter Ablation: Retrospective Analysis and Prospective Outlooks—A Comprehensive Review
by Laura Adina Stanciulescu and Radu Vatasescu
Biomedicines 2024, 12(2), 266; https://doi.org/10.3390/biomedicines12020266 - 24 Jan 2024
Cited by 5 | Viewed by 3326
Abstract
Ventricular tachycardia is a potentially life-threatening arrhythmia associated with an overall high morbi-mortality, particularly in patients with structural heart disease. Despite their pivotal role in preventing sudden cardiac death, implantable cardioverter-defibrillators, although a guideline-based class I recommendation, are unable to prevent arrhythmic episodes [...] Read more.
Ventricular tachycardia is a potentially life-threatening arrhythmia associated with an overall high morbi-mortality, particularly in patients with structural heart disease. Despite their pivotal role in preventing sudden cardiac death, implantable cardioverter-defibrillators, although a guideline-based class I recommendation, are unable to prevent arrhythmic episodes and significantly alter the quality of life by delivering recurrent therapies. From open-heart surgical ablation to the currently widely used percutaneous approach, catheter ablation is a safe and effective procedure able to target the responsible re-entry myocardial circuit from both the endocardium and the epicardium. There are four main mapping strategies, activation, entrainment, pace, and substrate mapping, each of them with their own advantages and limitations. The contemporary guideline-based recommendations for VT ablation primarily apply to patients experiencing antiarrhythmic drug ineffectiveness or those intolerant to the pharmacological treatment. Although highly effective in most cases of scar-related VTs, the traditional approach may sometimes be insufficient, especially in patients with nonischemic cardiomyopathies, where circuits may be unmappable using the classic techniques. Alternative methods have been proposed, such as stereotactic arrhythmia radioablation or radiotherapy ablation, surgical ablation, needle ablation, transarterial coronary ethanol ablation, and retrograde coronary venous ethanol ablation, with promising results. Further studies are needed in order to prove the overall efficacy of these methods in comparison to standard radiofrequency delivery. Nevertheless, as the field of cardiac electrophysiology continues to evolve, it is important to acknowledge the role of artificial intelligence in both the pre-procedural planning and the intervention itself. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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8 pages, 640 KiB  
Article
The “Woggle” Technique for Venous Access Site Management: An Old Technique for a New Need
by Gabriele Tumminello, Lucia Barbieri, Carlo Avallone, Nello Bellissimo, Luca Mircoli, Federico Colombo, Marco Vicenzi, Massimiliano Ruscica and Stefano Carugo
J. Clin. Med. 2023, 12(18), 6087; https://doi.org/10.3390/jcm12186087 - 20 Sep 2023
Cited by 1 | Viewed by 2913
Abstract
Background: Several closure devices are routinely used for percutaneous arterial access, while a relatively low number is available for the management of large bore venous accesses. The Woggle technique is a modification of the purse-string suture which was introduced several years ago in [...] Read more.
Background: Several closure devices are routinely used for percutaneous arterial access, while a relatively low number is available for the management of large bore venous accesses. The Woggle technique is a modification of the purse-string suture which was introduced several years ago in patients undergoing hemodialysis. Methods: A population of 45 patients who underwent transvenous femoral structural heart interventions was retrospectively evaluated. The Woggle technique consists of a purge string suture with a collar to maintain the tension as stable over time and a suture lock to tighten the suture. Results: Sheaths magnitude ranged from 8 French (F) to 14 F. A rapid post-procedural hemostasis was achieved in the whole population, and in 95% of cases, definite hemostasis was obtained after the first single release; the mean time of release was 302 ± 83 min. Although no relevant bleedings were reported, a significant reduction in hemoglobin levels was found in the whole population. This decrement was statistically significant only in the group with sheaths higher than 12 F. A single mild local hematoma was recorded in the group in which smaller sheaths were used. Seventy-two percent of patients were pre-treated with a dual antiplatelet therapy. Conclusions: The Woggle technique has shown to be a simple, effective, and safe approach for the management of large bore venous in percutaneous structural heart interventions. Full article
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32 pages, 7857 KiB  
Review
Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease
by Xinyue Zhang, Jordan Gosnell, Varatharajan Nainamalai, Savannah Page, Sihong Huang, Marcus Haw, Bo Peng, Joseph Vettukattil and Jingfeng Jiang
Diagnostics 2023, 13(18), 2981; https://doi.org/10.3390/diagnostics13182981 - 18 Sep 2023
Cited by 1 | Viewed by 2276
Abstract
Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the [...] Read more.
Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the last decade, three-dimensional (3D) transesophageal echocardiography (TEE) has become one of the most accessed imaging methods for structural interventions. Although 3D-TEE can assess cardiac structures and functions in real-time, its limitations (e.g., limited field of view, image quality at a large depth, etc.) must be addressed for its universal adaptation, as well as to improve the quality of its imaging and interventions. This review aims to present the role of TEE in the intraprocedural guidance of percutaneous structural interventions. We also focus on the current and future developments required in a multimodal image integration process when using TEE to enhance the management of congenital and SHD treatments. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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23 pages, 2477 KiB  
Review
Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review
by George Koulaouzidis, Dafni Charisopoulou, Piotr Bomba, Jaroslaw Stachura, Pawel Gasior, Jan Harpula, John Zarifis, Wojciech Marlicz, Damian Hudziak and Tomasz Jadczyk
J. Cardiovasc. Dev. Dis. 2023, 10(9), 399; https://doi.org/10.3390/jcdd10090399 - 18 Sep 2023
Cited by 10 | Viewed by 4151
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive [...] Read more.
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems. Full article
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21 pages, 9013 KiB  
Review
Three-Dimensional Transesophageal Echocardiography in Percutaneous Catheter-Based Cardiac Interventions
by Juan M. Farina, Timothy Barry, Reza Arsanjani, Chadi Ayoub and Tasneem Z. Naqvi
J. Clin. Med. 2023, 12(17), 5664; https://doi.org/10.3390/jcm12175664 - 31 Aug 2023
Cited by 2 | Viewed by 2484
Abstract
Cardiac structural and valve interventions have remained surgical procedures for several decades. The ability to directly visualize the region of interest during surgery made imaging of these structures pre- and postsurgery a secondary tool to compliment surgical visualization. The last two decades, however, [...] Read more.
Cardiac structural and valve interventions have remained surgical procedures for several decades. The ability to directly visualize the region of interest during surgery made imaging of these structures pre- and postsurgery a secondary tool to compliment surgical visualization. The last two decades, however, have seen rapid advances in catheter-based percutaneous structural heart interventions (SHIs). Due to the “blind” nature of these interventions, imaging plays a crucial role in the success of these procedures. Fluoroscopy is used universally in all percutaneous cardiac SHIs and helps primarily in the visualization of catheters and devices. However, success of these procedures requires visualization of intracardiac soft tissue structures. Due to its portable nature and rapid ability to show cardiac structures online, transesophageal echocardiography (TEE) has become an integral tool for guidance for all percutaneous SHI. Transcatheter aortic valve replacement—one of the earliest catheter-based procedures—while initially dependent on TEE, has largely been replaced by preprocedural cardiac CT for accurate assessment of valve sizing. Developments in echocardiography now allow live three-dimensional (3D) visualization of cardiac structures mimicking surgical anatomy during TEE. Besides showing actual 3D intracardiac structures, 3D-TEE allows visualization of the interaction of intracardiac catheters and devices with soft tissue cardiac structures, thereby becoming a “second pair of eyes” for the operator. Real-time 3D-TEE now plays an important role complementing multiplane two dimensional and biplane TEE during such interventions. In this review, we discuss the incremental role of 3D-TEE during various SHIs performed today. Full article
(This article belongs to the Section Cardiovascular Medicine)
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Graphical abstract

13 pages, 830 KiB  
Review
Structural Interventions in Heart Failure: Mending a Broken Heart
by David Katzianer and Chonyang Albert
J. Clin. Med. 2023, 12(9), 3243; https://doi.org/10.3390/jcm12093243 - 1 May 2023
Viewed by 1944
Abstract
Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and [...] Read more.
Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and preserved ejection fraction who are at an elevated surgical risk for perioperative events. This review highlights a subset of the interventions available in clinical practice or in development for the treatment of these valvular and structural alterations. Full article
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16 pages, 360 KiB  
Review
Cardiac Drugs in ACHD Cardiovascular Medicine
by Magalie Ladouceur, Estibaliz Valdeolmillos, Clément Karsenty, Sébastien Hascoet, Pamela Moceri and Laurianne Le Gloan
J. Cardiovasc. Dev. Dis. 2023, 10(5), 190; https://doi.org/10.3390/jcdd10050190 - 24 Apr 2023
Cited by 3 | Viewed by 2901
Abstract
Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines [...] Read more.
Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines on drug therapy are currently lacking. The aging ACHD population has led to an increase in late cardiovascular complications such as heart failure, arrhythmias, and pulmonary hypertension. Pharmacotherapy, with few exceptions, in ACHD is largely supportive, whereas significant structural abnormalities usually require interventional, surgical, or percutaneous treatment. Recent advances in ACHD have prolonged survival for these patients, but further research is needed to determine the most effective treatment options for these patients. A better understanding of the use of cardiac drugs in ACHD patients could lead to improved treatment outcomes and a better quality of life for these patients. This review aims to provide an overview of the current status of cardiac drugs in ACHD cardiovascular medicine, including the rationale, limited current evidence, and knowledge gaps in this growing area. Full article
12 pages, 849 KiB  
Article
Renal Insufficiency Increases the Combined Risk of Left Ventricular Hypertrophy and Dysfunction in Patients at High Risk of Cardiovascular Diseases
by Xiaozhao Lu, Qiang Li, Jingru Deng, Yu Kang, Guoxiao Liang, Linxiao Deng, Lei Guo, Haodong Ruan, Zibi Peng, Jiaxi Li, Ning Tan, Jiyan Chen, Jin Liu, Amanda Y. Wang and Yong Liu
J. Clin. Med. 2023, 12(5), 1818; https://doi.org/10.3390/jcm12051818 - 24 Feb 2023
Cited by 3 | Viewed by 2267
Abstract
Background: The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in [...] Read more.
Background: The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in patients at high risk of cardiovascular diseases (CVD). Methods: Patients undergoing coronary angiography and/or percutaneous coronary interventions were enrolled from the Cardiorenal ImprovemeNt II (CIN-II) cohort study, and their echocardiography and renal function were assessed at admission. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR). Our outcomes were LV hypertrophy and LV systolic and diastolic dysfunction. Multivariable logistic regression analyses were conducted to investigate the associations of eGFR with LV hypertrophy and LV systolic and diastolic dysfunction. Results: A total of 5610 patients (mean age: 61.6 ± 10.6 years; 27.3% female) were included in the final analysis. The prevalence of LV hypertrophy assessed by echocardiography was 29.0%, 34.8%, 51.9%, 66.7%, and 74.3% for the eGFR categories >90, 61–90, 31–60, 16–30, and ≤15 mL/min per 1.73 m2 or for patients needing dialysis, respectively. Multivariate logistic regression analysis showed that subjects with eGFR levels of ≤15 mL/min per 1.73 m2 or needing dialysis (OR: 4.66, 95% CI: 2.96–7.54), as well as those with eGFR levels of 16–30 (OR: 3.87, 95% CI: 2.43–6.24), 31–60 (OR: 2.00, 95% CI: 1.64–2.45), and 61–90 (OR: 1.23, 95% CI: 1.07–1.42), were significantly associated with LV hypertrophy. This reduction in renal function was also significantly associated with LV systolic and diastolic dysfunction (all P for trend <0.001). In addition, a per one unit decrease in eGFR was associated with a 2% heightened combined risk of LV hypertrophy and systolic and diastolic dysfunction. Conclusions: Among patients at high risk of CVD, poor renal function was strongly associated with cardiac structural and functional abnormalities. In addition, the presence or absence of CAD did not change the associations. The results may have implications for the pathophysiology behind cardiorenal syndrome. Full article
(This article belongs to the Section Nephrology & Urology)
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10 pages, 2635 KiB  
Article
Trends in Coronary and Structural Heart Interventions in Switzerland over the Last 16 Years and Impact of COVID-19: Insights from the National Swiss PCI Survey
by Max Wagener, Jasper Boeddinghaus, Oliver Gaemperli, Lorenz Räber, Fabian Nietlispach, Pascal Meier, Olivier Muller, Daniel Weilenmann and Raban Jeger
J. Clin. Med. 2022, 11(24), 7459; https://doi.org/10.3390/jcm11247459 - 15 Dec 2022
Cited by 5 | Viewed by 3334
Abstract
Background: Considering the global burden of cardiovascular disease, we analysed trends in interventional coronary and structural procedures over the past 16 years (2005–2021), using continuous data from the Swiss national registry. Methods: Based on a standardised questionnaire, data on coronary and structural interventions [...] Read more.
Background: Considering the global burden of cardiovascular disease, we analysed trends in interventional coronary and structural procedures over the past 16 years (2005–2021), using continuous data from the Swiss national registry. Methods: Based on a standardised questionnaire, data on coronary and structural interventions in Switzerland were assessed by the Working Group Interventional Cardiology of the Swiss Society of Cardiology (SSC). Here, we analysed the trend of annually performed interventions from 2005 to 2021 in Switzerland and the impact of the COVID-19 pandemic. Results: We observed a constant increase in the total number of cases (including coronary angiographies (CA) and percutaneous coronary interventions (PCI)) from 36,436 cases in 2005 to 56,555 cases in 2021 (+55%). With 18 cases in 2007, TAVI procedures have increased to 2004 cases in 2021. During the early phase of the COVID-19 pandemic in 2020, a slight decrease in CAs and PCIs of 9.15% was observed. In contrast, we did not observe an impact of the COVID-19 pandemic on the number of no TAVI procedures. Most importantly, all cause in-hospital mortality for coronary interventions before and during the peak of the COVID-19 pandemic was comparable (1.4% vs. 1.3%). Conclusion: Over a 16-year period, we observed an upward trend in diagnostic and therapeutic procedures for coronary as well as structural heart disease, with only a small short-term impact of the COVID-19 pandemic on interventions and a similar procedure-related in-hospital-mortality in Switzerland. Full article
(This article belongs to the Section Cardiovascular Medicine)
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16 pages, 5339 KiB  
Article
A Study of the Fluid–Structure Interaction of the Plaque Circumferential Distribution in the Left Coronary Artery
by Yepeng Du, Lili Zhang, Zhanju Hou and Jian Liu
Appl. Sci. 2022, 12(12), 6200; https://doi.org/10.3390/app12126200 - 18 Jun 2022
Cited by 2 | Viewed by 2172
Abstract
Atherosclerotic plaques within the coronary arteries can prevent blood from flowing to downstream tissues, causing coronary heart disease and a myocardial infarction over time. The degree of stenosis is an important reference point during percutaneous coronary intervention (PCI). However, clinically, patients with the [...] Read more.
Atherosclerotic plaques within the coronary arteries can prevent blood from flowing to downstream tissues, causing coronary heart disease and a myocardial infarction over time. The degree of stenosis is an important reference point during percutaneous coronary intervention (PCI). However, clinically, patients with the same degree of stenosis exhibit different degrees of disease severity. To investigate the connection between this phenomenon and the plaque circumferential distribution, in this paper, four models with different plaque circumferential locations were made based on the CT data. The blood in the coronary arteries was simulated using the fluid–structure interaction method in ANSYS Workbench software. The results showed that the risk of plaque rupture was less affected by the circumferential distribution of plaque, and the distribution of blood in each branch was affected by the circumferential distribution of plaque. Low TAWSS areas were found posterior to the plaque, and the TAWSS < 0.4 Pa area was ranked from highest to lowest in each model species: plaque on the side away from the left circumflex branch, plaque on the side away from the heart; plaque on the side close to the heart; and plaque on the side close to the left circumflex branch. The same trend was also found in the OSI. It was concluded that the circumferential distribution of plaques affects their further development. This finding will be useful for clinical treatment. Full article
(This article belongs to the Section Biomedical Engineering)
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18 pages, 8303 KiB  
Systematic Review
Multimodality Imaging of the Anatomy of the Aortic Root
by Vera Lucia Paiocchi, Francesco F. Faletra, Enrico Ferrari, Susanne Anna Schlossbauer, Laura Anna Leo and Francesco Maisano
J. Cardiovasc. Dev. Dis. 2021, 8(5), 51; https://doi.org/10.3390/jcdd8050051 - 4 May 2021
Cited by 9 | Viewed by 4403
Abstract
The aortic root has long been considered an inert unidirectional conduit between the left ventricle and the ascending aorta. In the classical definition, the aortic valve leaflets (similar to what is perceived for the atrioventricular valves) have also been considered inactive structures, and [...] Read more.
The aortic root has long been considered an inert unidirectional conduit between the left ventricle and the ascending aorta. In the classical definition, the aortic valve leaflets (similar to what is perceived for the atrioventricular valves) have also been considered inactive structures, and their motion was thought to be entirely passive—just driven by the fluctuations of ventricular–aortic gradients. It was not until the advent of aortic valve–sparing surgery and of transcatheter aortic valve implantation that the interest on the anatomy of the aortic root again took momentum. These new procedures require a systematic and thorough analysis of the fine anatomical details of the components of the so-called aortic valve apparatus. Although holding and dissecting cadaveric heart specimens remains an excellent method to appreciate the complex “three-dimensional” nature of the aortic root, nowadays, echocardiography, computed tomography, and cardiac magnetic resonance provide excellent images of cardiac anatomy both in two- and three-dimensional format. Indeed, modern imaging techniques depict the aortic root as it is properly situated within the thorax in an attitudinally correct cardiac orientation, showing a sort of “dynamic anatomy”, which admirably joins structure and function. Finally, they are extensively used before, during, and after percutaneous structural heart disease interventions. This review focuses on the anatomy of the aortic root as revealed by non-invasive imaging techniques. Full article
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33 pages, 2553 KiB  
Review
Antithrombotic Therapy for Percutaneous Cardiovascular Interventions: From Coronary Artery Disease to Structural Heart Interventions
by Alessandro Caracciolo, Paolo Mazzone, Giulia Laterra, Victoria Garcia-Ruiz, Alberto Polimeni, Salvatore Galasso, Francesco Saporito, Scipione Carerj, Fabrizio D’Ascenzo, Guillaume Marquis-Gravel, Gennaro Giustino and Francesco Costa
J. Clin. Med. 2019, 8(11), 2016; https://doi.org/10.3390/jcm8112016 - 19 Nov 2019
Cited by 8 | Viewed by 6427
Abstract
Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of [...] Read more.
Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy. Full article
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