Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: A Multicenter Registry.

Background: Catheter-based percutaneous mechanical aspiration (PMA) is an emerging acute intervention for debulking infective vegetations in right-sided infective endocarditis (RSIE); however, its outcomes and safety remain undefined.

Objectives: The authors sought to assess early clinical outcomes and safety of PMA in patients with RSIE.

Methods: The CLEAR-IE (Cardiac Lesion Extraction and Aspiration Registry for Infective Endocarditis) is a large multicenter retrospective registry of consecutive patients with RSIE who have undergone PMA.

Novel Innovation Curriculum in Internal Medicine Residency Training.

Objective: Innovation in medicine places the needs of our patients first by developing new solutions to healthcare challenges; however, formal education in innovation has not been previously established in Internal Medicine (IM) residency training programs. A novel innovation curriculum was implemented in the IM residency training program at an academic medical institution in the southeastern United States during the academic year 2022-2023.

Methods: The innovation curriculum was divided into three phases: Inspire, Acquire, Apply.

Management of Single Leaflet Device Attachment in the Tricuspid Position.

Background: Single leaflet device attachment (SLDA) during transcatheter edge-to-edge repair (TEER) of the tricuspid valve is an uncommon but recognized complication. This case series presents 2 older adult patients with symptomatic severe tricuspid regurgitation who underwent tricuspid TEER and experienced SLDA during the procedure.

Case Series: The first patient was an 85-year-old man with liver cirrhosis and right-sided heart failure.

Percutaneous Mechanical Aspiration of an Aortic Root Thrombus Causing a Myocardial Infarction.

Background: Left ventricular assist devices (LVADs) are critical for patients with end-stage cardiomyopathy but complications, such as aortic root thrombus (ART), are present in up to 10% of cases. ART management is challenging, with limited therapeutic options.

Case Summary: A 54-year-old female with an LVAD presented with acute chest pain and a thrombus in the left coronary cusp.

Role of Biological Age in the Determination of Long-Term Cause-Specific Death Following Percutaneous Coronary Interventions.

Background: We tested whether biologic age, as estimated by deficits, functional impairments, or Age-Gap or their combination, provide improved estimation of cause-specific death as compared with chronological age.

Methods: Cardiovascular and noncardiovascular deficits, functional impairments, and Age-Gap were prospectively collected in 535 patients aged ≥55 years undergoing percutaneous coronary interventions between August 1, 2014, and March 31, 2018. Age-Gap was calculated as the difference between chronological age and age estimated by artificial intelligence ECG using a convolutional neural network.

Percutaneous Removal of Cardiac Papillary Fibroelastomas.

Papillary fibroelastomas (PFEs) are primary cardiac tumors associated with significant embolic risk. Surgical excision or medical therapy with antiplatelets and/or anticoagulants have been the treatment options for symptomatic patients. This paper reports our early experiences of percutaneous removal of PFE using mechanical aspiration techniques.

Percutaneous Mechanical Aspiration for Infective Endocarditis: Proceedings From an Inaugural Multidisciplinary Summit and Comprehensive Review.

The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments.

Percutaneous Mechanical Aspiration in Infective Endocarditis: Applications, Technical Considerations, and Future Directions.

In recent years, there has been a shift in the epidemiology of patients with infective endocarditis (IE). This has been characterized by an alarming increase in IE in patients who inject drugs, cardiac implantable electronic device-related IE, and those with comorbid conditions and high surgical risk. This unmet need has mandated a reevaluation of complex management strategies in these patients and introduction of unconventional approaches in treatment.

Chronic Right Ventricular Pacing Post-Transcatheter Aortic Valve Replacement Attenuates the Benefit on Left Ventricular Function.

Conduction abnormality post-transcatheter aortic valve implantation (TAVI) remains clinically significant and usually requires chronic pacing. The effect of right ventricular (RV) pacing post-TAVI on clinical outcomes warrants further studies. We identified 147 consecutive patients who required chronic RV pacing after a successful TAVI procedure and propensity-matched these patients according to the Society of Thoracic Surgeons (STS) risk score to a control group of patients that did not require RV pacing post-TAVI.

Invasive hemodynamic characteristics in patients with mitral annular calcification related mitral stenosis and chest radiation.

Quantification of invasive hemodynamics and mitral annular calcification-related mitral stenosis remains underexplored in patients exposed to chest radiation. We sought to explore invasive hemodynamic parameters via transseptal catheterization in patients with and without chest radiation who had a diagnosis of mitral annular calcification-related mitral stenosis. After excluding patients with more than moderate mitral regurgitation, we found that there was no difference in mitral valve area on hemodynamic testing in patients with and without radiation with an elevated baseline transmitral gradient on transthoracic echocardiography in the setting of mitral annular calcification-related mitral stenosis.

Exercise Cardiac Catheterization for Hemodynamic Evaluation of Paradoxical Low-Flow Low-Gradient Severe Aortic Stenosis.

Patients with paradoxical low-flow low-gradient aortic stenosis pose a diagnostic challenge when it comes to assessing the severity of aortic stenosis (AS) noninvasively. We describe 2 patients who underwent exercise cardiac catheterization to augment their cardiac output and assess the severity of AS invasively to allow differentiation of true severe AS from pseudo-severe AS.

Infliximab Limits Injury in Myocardial Infarction.

Background: The purpose of this study was to investigate a therapeutic approach targeting the inflammatory response and consequent remodeling from ischemic myocardial injury.

Methods And Results: Coronary thrombus aspirates were collected from patients at the time of ST-segment-elevation myocardial infarction and subjected to array-based proteome analysis. Clinically indistinguishable at myocardial infarction (MI), patients were stratified into vulnerable and resilient on the basis of 1-year left ventricular ejection fraction and death.

Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement.

Background: The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality.

Methods: All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated.

Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the national inpatient sample database-2016-2020.

Background: Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series.

Aims: The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort.

Mitral Annulus Calcium Score in Patients With Calcific Mitral Stenosis Undergoing Invasive Hemodynamic Assessment.

Background: Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown.

Methods And Results: This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization.

Transcatheter edge-to-edge repair for tricuspid valve regurgitation in apolipoprotein A-I-associated cardiac amyloidosis: case report.

Background: Amyloidosis is defined by abnormal protein folding and subsequent deposition in tissues. Cardiac involvement is usually related to misfolded monoclonal immunoglobulin light chains or misfolded transthyretin; however, apolipoprotein A-1-associated amyloidosis is a hereditary form of amyloidosis resulting from mutations in the AAPOA1 gene that can also result in cardiac amyloidosis. Although there have been advancements in noninvasive algorithms for the diagnosis of cardiac amyloidosis, endomyocardial biopsy (EMB) may still be warranted.

Percutaneous Removal of Left Atrial Myxoma: The FLORIDA Procedure.

Surgical resection has been the treatment of choice for cardiac myxomas, but older age and comorbidities relegate many patients to observation. Pure percutaneous removal of left atrial myxomas is both intriguing and challenging. We report a successful percutaneous technique for removal of left atrial cardiac myxoma in a nonsurgical candidate.

Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis.

Objective: To study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS).

Patients And Methods: Adults with moderate AS (aortic valve area, 1.0-1.