Advances in Cardiac Research

Rota-Cut Technique: A Simple Technique for Calcified Coronary Lesion

Sidhi Laksono — 2024-05-06

Background: Performing successful percutaneous coronary interventions (PCI) is extremely difficult when dealing with severely calcified coronary lesions. Among the alternatives for treating calcified lesions is the Rota-Cut technique. This technique combines using a rotablator and cutting balloon as one treatment.
Discussion: Coronary calcification may interfere with the placement of stents, leading to inadequate expansion and positioning, as well as causing direct harm to the stents. Performing PCI on calcified coronary artery disease (CAD) is linked to lower procedural success rates and increased risk of early and late complications. An ideal plaque modification equipment should be user-friendly, safe, efficient, and provide positive short- and long-term results. We can now safely and easily treat calcified lesions thanks to the development of the Rotablator and the cutting balloon, also known as the Rota-Cut technique. When combined, rotational atherectomy made a tunnel through calcium plaque which the cutting balloon can pass to complete the plaque modification after it has been inserted. Rota-Cut technique is a safe and efficient approach for calcified lesions.
Conclusion: The operator's skill in choosing a calcium-modification approach to reduce complexity before stent implantation is essential for diagnosing these lesions. Rotational atherectomy made a tunnel through calcium plaque that the cutting balloon can pass through to finish the plaque modification once it is in place.

Angiotensin Receptor Neprilysin Inhibition in Heart Failure: Clinical Benefits and Antiarrhythmic Actions

Sefik Gorkem Fatihoglu — 2024-05-06

Inhibition of renin– angiotensin–aldosterone system and sympathetic nervous system are crucial for the treatment of HF with reduced ejection fraction (HFrEF). Modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic peptides, neprilysin, has proven to be successful too. Sacubitril/valsartan (LCZ696) is a first-in-class medicine of angiotensin receptor neprilysin inhibitor (ARNI) that contains a neprilysin inhibitor (sacubitril) and an angiotensin receptor blocker (valsartan). PARADIGM-HF trial demonstrated that morbidity and mortality can be improved with the use of ARNI. Furthermore, recent studies revealed that ARNI reduces sudden death, implantable cardioverter defibrillator shocks, premature ventricular contractions and cardiovascular mortality. Despite the increase in understanding of how ARNI favorably affects the arrhythmic outcomes, several key aspects are still not fully understood. This review will overview mechanism of action and use of ARNI in HFrEF; summarize data regarding antiarrhythmic action and clinical implications.

UPDATE IN STROKE PREVENTION IN ATRIAL FIBRILLATION

Neryan Ozgul — 2024-05-06

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Ischemic stroke and systemic embolism are the most significant risks associated with AF, leading to increased morbidity and mortality. Therefore, stroke prevention is the cornerstone of managing AF. The standard of care for stroke prevention in AF is oral anticoagulation, which includes both vitamin K antagonists and non-vitamin K antagonist oral anticoagulants. However, there are still unmet needs regarding stroke prevention including bleeding, drug adherence and residual thrombotic risks. Percutaneous left atrial appendage closure (LAAC) and oral anticoagulants including Factor XIa inhibitors have emerged as alternatives for stroke prevention in AF patients. Several studies have demonstrated their effectiveness and safety in different contexts, raising their importance in daily clinical practice. Herein we aimed to review recent data regarding with stroke prevention in AF with specific emphasis on oral anticoagulation and LAAC.

Transcatheter Aortic Valve Implantation in a 60-Years-Old Chronic Lymphocytic Leukemia Patient with a Right Bundle Branch Block

Bilge Kara Cadir — 2024-05-06

Aortic stenosis (AS) is a prevalent condition in the elderly population that can have severe consequences. Transcatheter Aortic Valve Implantation (TAVI) has emerged as an effective alternative treatment for elderly individuals with symptomatic severe AS and high surgical risk. However, the efficacy of TAVI in the presence of malignancy remains controversial. This case report presents a TAVI procedure performed on a 60-year-old patient with chronic lymphocytic leukemia (CLL), right bundle branch block (RBBB), and symptomatic severe AS. The patient's condition, comorbidities, and life expectancy were thoroughly evaluated by a multidisciplinary team, leading to the decision to proceed with TAVI. The procedure was performed successfully without complications, and the patient's 30-day outcomes were uneventful.

Efficiency Redefined: TAVR meets LAA Closure in One Sitting

İlke Çelikkale — 2024-05-06

Atrial fibrillation (AF) is common in TAVR patients, increasing stroke and bleeding risk. We report an 88-year-old male with severe aortic stenosis, AF, CAD, and LAA thrombus who underwent a successful combined transcatheter approach. Coronary stenting was followed by a single session of LAA occlusion and TAVR, ensuring effective stroke prevention with minimized bleeding risk and valve replacement with no complications. This case demonstrates the safety and efficacy of a single-session strategy for high-risk patients with complex structural cardiovascular disease.