J G Webb

..Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass...

..Transcatheter aortic valve implantation is an alternative to open heart surgery in patients with aortic stenosis. However, long-term data on a programmatic approach to aortic valve implantation remain sparse...

..Further evolution of this technology will involve lower-profile devices with design features that facilitate vascular delivery, visualization, positioning, deployment, and valvular function...

..The objective of this study was to evaluate, in a blinded, randomized, placebo-controlled fashion, whether intravenous NAC reduced CIN in the setting of cardiac catheterization in patients with preexisting renal insufficiency...

..Although such systems are often effective, distal protection does have limitations. We report a novel proximal embolic protection and rinsing system intended to overcome some of these limitations...

..We describe in a patient with severe aortic prosthetic paravalvular leak the use of an Amplatzer duct occluder device resulting in effective closure and symptomatic improvement...

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..We evaluated the safety and feasibility of a transvenous catheter-delivered implantable device to provide a percutaneous alternative to surgical mitral annuloplasty...

..Retrograde prosthetic aortic valve implantation via the femoral artery has potential advantages. Percutaneous prosthetic aortic valve implantation via the femoral arterial approach is described and the initial experience reported...

..Caution is prudent, however, in the future a more mature procedure might represent a viable alternative for a much broader range of patients...

..We describe procedural and clinical outcomes in a high-risk cohort undergoing transcatheter aortic valve replacement with early next-generation transcatheter valve and delivery systems...

..Nevertheless considerable work needs to be done before the indications for TAVI are expanded into lower risk groups. We review what is currently known about percutaneous transarterial implantation of the aortic valve...

..We describe the technique of, and our experience with, rapid ventricular burst pacing to facilitate transcatheter heart valve implantation...

..Procedural success rates and clinical outcomes continue to improve. Current studies suggest that morbidity and mortality are competitive in comparison to conventional surgery in selected high-risk patients...

..Uncertainty remains about outcomes, implications, durability, and the appropriate role for this new therapy. It appears likely that transcatheter valve implantation will become a more widely available and accepted therapeutic option...

..We examined the clinical, angiographic, and procedural characteristics determining survival after percutaneous coronary intervention (PCI) for cardiogenic shock...

..The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers...

..We sought to examine the implications of the timing of onset of cardiogenic shock (CS) after acute myocardial infarction (MI)...

..Circulatory arrest ensued. The thrombus was disrupted during cardiopulmonary resuscitation. Thrombolysis was administered and the patient recovered uneventfully...

..We describe how, when used for the prevention of distal embolization of atheromatous or thrombotic particles, this device may facilitate retention and retrieval of undeployed stents...

..Our objective was to define the outcomes of patients with cardiogenic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI)...

..We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI)...

..Transapical aortic valve implantation is a recent therapeutic advance for aortic valvular disease. We sought to identify complications--and the relevant technical and management considerations--from our learning curve with this procedure...

..We sought to evaluate the frequency of pulmonary congestion and associated clinical and hemodynamic findings in patients with suspected cardiogenic shock (CS)...

..To this end, we examined our experience during the developmental phases of transcatheter AVR and describe the causes and management of prosthetic valve malposition...

..Ultimately, improved understanding of the potential complications associated with TAVI might help improve outcomes and allow wider application of this therapy...

..Angiography can be performed at relatively low risk in shock patients. A window of opportunity is often available where revascularization may be of benefit...

..This study was designed to evaluate the composition and quantity of particulate debris resulting from vein graft intervention...

..Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR...

..Transcatheter pulmonary valve implantation improves conduit hemodynamics through a minimally invasive approach. We present data for 7 patients treated with the Edwards SAPIEN transcatheter heart valve (THV)...

..Implications of CAD and preprocedural revascularization in the setting of transcatheter aortic valve implantation (TAVI) are not known...

..The appearance of remote ST segment depression (RSTD) on an electrocardiogram (ECG) is associated with more extensive infarction and a worse clinical outcome than when RSTD is absent...

..We review current experimental percutaneous approaches to mitral annuloplasty...

..This study sought to describe a method of paravalvular leak closure using a purpose-specific occlusion device...

..Transcatheter heart valve implantation within a failed bioprosthesis, a "valve-in-valve" procedure, may offer a less invasive alternative...

..The purpose of this study was to determine whether immediate suture closure of 8F femoral arterial puncture sites can facilitate same-day discharge after coronary angioplasty...

..We present our initial experience with stenting of the left main coronary artery in the setting of allograft vasculopathy...

..Transcatheter aortic valve replacement (AVR) is a promising approach to aortic valve disease. The implications of this new therapy are not entirely known. We describe the potential for the development of new atrioventricular (AV) block...

..The purpose of this study was to assess whether the early discontinuation of eptifibatide infusion in nonemergent percutaneous coronary intervention (PCI) is associated with a higher frequency of periprocedural ischemic myonecrosis...

..Transcatheter valve and valve delivery systems are undergoing rapid evolution. We describe the current generation balloon-expandable valve and delivery systems...

..To construct a calculator to assess the risk of 30-day mortality following PCI...

..CONCLUSIONS: This initial experience suggests that transapical aortic valve implantation without cardiopulmonary bypass is feasible in selected patients with aortic stenosis...

..Currently, this procedure is an option only for symptomatic patients who are not appropriate candidates for surgical valve replacement...

..However, MSCT involves an additional contrast dye burden in patients often suffering from renal failure. In this study, the feasibility of direct-aortic-contrast-injection for MSCT was investigated, aiming to reduce total contrast load...

..Although short- and medium-term outcomes after transcatheter aortic valve implantation are encouraging, long-term data on valve function and clinical outcomes are limited...

..We now report clinical and echocardiographic outcomes of transapical aortic valve implantation in 71 patients...

..This is, to date, the longest follow-up of patients undergoing transapical aortic valve implantation...

..The transcatheter valve functioned properly postoperatively; however, the patient died of multiple organ dysfunction...

..CONCLUSION: TAVR is developing into an effective and reproducible therapy for aortic valve stenosis. We describe the important role of MDCT in planning and performing TAVR in a large transcatheter valve program...

..This study was designed to investigate the usefulness and limitations of echocardiography in optimizing the outcome of percutaneous aortic valve implantation...

..We sought to describe the frequency of fibrinolytic failure (rescue eligibility) as well as the patient characteristics associated with rescue eligibility, rescue referral, and PCI...

..Transcatheter transapical valve-in-valve aortic valve implantation is feasible and could be a viable approach for selected patients...

..We now report 6-month follow-up in our initial seven patients...

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..CONCLUSIONS: Percutaneous closure of PVLs is time-consuming but feasible in selected patients, with a reasonable degree of technical and clinical success. A second procedure may be necessary and a variety of complications can occur...

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..Few data exist describing the use of subcutaneous or intravenous enoxaparin as an anticoagulant in the highly thrombotic setting of primary percutaneous coronary intervention (PCI) for STEMI...

..There were no device-related complications. Percutaneous coronary intervention was successful in all patients. Our initial experience with the Venture wire control catheter has been favorable...

..This case highlights an unusual complication of fistula embolization and emphasizes the need for caution when occluding vessels which may supply the sinus node...

..Reports are few; success variable and techniques vary widely. We review the current considerations and techniques of percutaneous transcatheter closure of paravalvular leaks...

..The X-Sizer thrombectomy device improves TIMI flow but does not always prevent distal embolization. Care is needed when treating in-stent thrombosis...

..Endovascular occlusion may provide rapid control of hemorrhage and facilitate definitive therapy; yet, occlusion balloons are not commonly utilized in the cardiac catheterization laboratory...

..In this way, the implantation time of the filter was extended beyond the recommended period of 10 days. The filter was successfully retrieved 19 days later during percutaneous closure of the PFO...

..Reoperation may be associated with significant morbidity and mortality. We report successful percutaneous transcatheter closure of an anastomotic graft leak utilizing an occluder device...

..In those patients deemed unfit for surgery in whom no bleeding point can be identified, recurrent blood transfusions may offer some symptomatic relief...

..In cardiogenic shock (CS), conclusive data on serial hemodynamic measurements for treatment guidance and prognosis are lacking...

..032). CONCLUSIONS: Cardiac power is the strongest independent hemodynamic correlate of in-hospital mortality in patients with cardiogenic shock. Increasing age and female gender are independently associated with lower cardiac power...

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..We sought to determine the reason for this finding by examining the baseline characteristics and outcomes of the 2 treatment groups by age...

..The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial...

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..We assessed preliminary efficacy and safety of four doses of l-n-monomethyl-arginine (l-NMMA), a non-selective NOS inhibitor, in patients with AMI complicated by CS despite an open infarct-related artery...

..In addition, an update on the ongoing trials in percutaneous valve procedures is presented. Finally, the role of imaging in performing percutaneous valve procedures will be discussed...

..The aim of this study was to investigate the safety and efficacy of an innovative thrombectomy device, the Rinspiration System, which simultaneously "rinses" the vessel with turbulent flow and aspirates thrombus...

..Because of its simplicity, it has been applied in minimally invasive surgery, and recently, in the design of endovascular closed-heart devices...

..The purpose of the present statement is to summarize the available evidence relating to DES thrombosis and to provide practical recommendations regarding DES use and antiplatelet therapy...

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..The role of diabetes mellitus (DM) in cardiogenic shock (CS) complicating an acute myocardial infarction (AMI) is not well understood. Previous studies have reported an in-hospital mortality rate for patients with DM and CS of about 60%...

..In the rare, carefully selected patient, stents may represent an adjunct in the management of focal coronary artery spasm, although currently medical therapy remains the standard initial approach...

..We hypothesized that restrictive physiology plays a role in cardiogenic shock (CS)...