BACKGROUND: Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS: This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS: Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION: The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING: Isala Heart Centre and Medtronic.

• MeSH
• aortální stenóza * chirurgie   komplikace   MeSH
• chirurgická náhrada chlopně metody   MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární angioplastika * metody   MeSH
• koronární bypass * metody   MeSH
• lidé MeSH
• nemoci koronárních tepen * chirurgie   komplikace   terapie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transkatetrální implantace aortální chlopně * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

OBJECTIVE: The management of pelvic venous disorders (PeVD) remains controversial. Open surgical and endovascular methods are currently used for treatment, but there are few data in the literature on the morphology and histology of the ectatic ovarian vein (OV). This study aimed to explore the histomorphological changes in a dilated OV in patients with PeVD and compare it with a normal OV obtained post-mortem and a normal great saphenous vein (GSV). METHODS: Histology of the OV was studied in 16 patients who underwent surgery for PeVD, 10 control cadavers from whom fragments of the OV without visible gross changes were taken at autopsy, and nine control patients in whom the GSV was resected to be used for coronary artery bypass. RESULTS: The OV wall in patients with PeVD consisted of three layers: intima, media, and adventitia. The OV looked very similar to the GSV wall because of a clearly developed layer of smooth muscle fibres. The thickness of the normal OV was significantly different to the OV wall in PeVD (475.3 μm, IQR 370.7, 607.6 vs. 776.3 μm, IQR 668.9, 879.6, p < .001) and did not differ significantly from the thickness of a normal GSV wall (784.3 μm, IQR 722.2, 898.2). The intima-media complex of the OV was significantly thinner than the GSV in PeVD (118.9 μm, IQR 75.6, 159.6 vs. 415 μm, IQR 399.5, 520.0, р < .001); however, the adventitia of the OV was significantly thicker than in normal OV and GSV (599.6 μm, IQR 444.3, 749.7 vs. 373.5 μm, IQR 323.8, 482.0 vs. 308.4 μm, IQR 275.9, 338.2, p < .001). CONCLUSION: Dilatation of the OV in patients with PeVD was accompanied by a significant increase in the overall thickness of the vein wall, which brings it closer in structure to the GSV. This implies that the OV may be used safely for transposition into the inferior vena cava or iliac vein.

• MeSH
• koronární bypass MeSH
• lidé MeSH
• pánev MeSH
• varixy * chirurgie   MeSH
• vena cava inferior MeSH
• vena saphena chirurgie   MeSH
• žilní insuficience * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The clinical impact of a chronic total occlusion (CTO) in patients with 3-vessel coronary artery disease undergoing fractional flow reserve-guided percutaneous coronary intervention (PCI) with current-generation drug-eluting stents or coronary artery bypass grafting (CABG) is unclear. METHODS: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) compared fractional flow reserve-guided PCI with CABG in patients with 3-vessel coronary artery disease. The primary end point was major adverse cardiac and cerebrovascular events, a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. In this substudy, the 3-year outcomes were analyzed in patients with or without a CTO. RESULTS: Of the patients randomized to PCI or CABG in the FAME 3 trial, 305 (21%) had a CTO. In the PCI arm, revascularization of the CTO was attempted in 61% with a procedural success rate of 88%. The incidence of major adverse cardiac and cerebrovascular events at 3 years was not significantly different between those with or without a CTO in both the PCI (15.2% versus 20.1%; adjusted hazard ratio, 0.62 [95% CI, 0.38-1.03]; P=0.07) and the CABG (13.0% versus 12.9%; adjusted hazard ratio, 0.96 [95% CI, 0.55-1.66]; P=0.88) arms. In those without a CTO, PCI was associated with a significantly higher risk of major adverse cardiac and cerebrovascular events compared with CABG (adjusted hazard ratio, 1.61 [95% CI, 1.20-2.17]; P<0.01) but not in those with a CTO (adjusted hazard ratio, 1.21 [95% CI, 0.64-2.28]; P=0.56; Pinteraction=0.31). CONCLUSIONS: The presence of a CTO did not significantly impact the treatment effect of PCI versus CABG at 3 years in patients with 3-vessel coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02100722.

• MeSH
• časové faktory MeSH
• chronická nemoc MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární angiografie * MeSH
• koronární angioplastika * škodlivé účinky   mortalita   MeSH
• koronární bypass * škodlivé účinky   mortalita   MeSH
• koronární okluze * diagnostické zobrazování   mortalita   terapie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen terapie   mortalita   diagnostické zobrazování   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenty uvolňující léky * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

• MeSH
• infarkt myokardu s elevacemi ST úseků * mortalita   chirurgie   terapie   MeSH
• koronární angioplastika mortalita   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma * MeSH
• revaskularizace myokardu * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

The retrograde approach in chronic total occlusion (CTO) interventions often encounters significant challenges, particularly, when aligning the retrograde microcatheter (MC) with the antegrade system is difficult, complicating or even preventing standard externalization. To address these issues, techniques like the "tip-in" have proven to be effective backup strategies. We introduce the "Manual Microcatheter-tip Modification" (MMM) technique as an alternative when the "tip-in" method faces complications. We present a case of a left anterior descending CTO where MMM was successfully employed for the first time, enabling successful revascularization by manually modifying the MC tip to engage the retrograde guidewire. We explore the technical details within the framework of contemporary CTO PCI. This new technique could enhance the management of CTO interventions, offering innovative solutions when traditional externalization methods are problematic.

• MeSH
• balónková koronární angioplastika přístrojové vybavení   MeSH
• chronická nemoc MeSH
• design vybavení * MeSH
• koronární angiografie * MeSH
• koronární angioplastika přístrojové vybavení   MeSH
• koronární okluze * diagnostické zobrazování   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniaturizace * MeSH
• senioři MeSH
• srdeční katetrizace přístrojové vybavení   MeSH
• srdeční katétry * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. METHODS: Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. RESULTS: We analyzed 103 patients who underwent PRFCA 105 ± 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS). CONCLUSIONS: The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

• MeSH
• fibrilace síní * chirurgie   MeSH
• katetrizační ablace * metody   MeSH
• koronární bypass metody   MeSH
• kryochirurgie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• venae pulmonales * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Coronary artery perforation (CAP) is a rare, life-threatening complication of percutaneous coronary intervention (PCI). PTFE-coated stents are highly successful and lifesaving in the treatment of coronary perforation. The incidence of thrombosis and restenosis in the PTFE-covered stent is higher than in standard stents. The aim of this study was to evaluate the clinical outcomes of PTFE-covered stents for CAP. Materials and methods: We evaluated a total of 38 patients who were treated with PTFE-coated stents for coronary perforation from January 2012 to January 2022 at a single high-volume center, Medipol University Hospital in Turkey. The primary endpoint was the composite of major adverse cardiovascular events (MACEs). Results: The one-year outcomes of the patients who had PTFE-coated stents implanted after CAP were investigated. A total of 38 patients, 22 (58%) males and 16 (42%) females, were included. The mean age was 69.7±11.4 years. MACE developed in 37% of the population (14 patients) in the follow-up. The target vessel revascularization (TVR) rate at one year was 36.8% (14 patients), the target lesion revascularization (TLR) rate at one year was 21% (8 patients), the incidence of death was 10.5% (4 patients), of myocardial infarction 21.1% (8 patients). Conclusions: Today, although the majority of coronary perforation cases are successfully treated with PTFE-coated stents, the one-year outcome of MACE in CS implanted patients is high. These results showed that such patients should be closely monitored.

Perforace koronární tepny (coronary artery perforation, CAP) je vzácnou, život ohrožující komplikací perkutánní koronární intervence (PCI). Vysoce úspěšnou a život zachraňující metodou léčby CAP je implantace stentů potažených polytetrafluorethylenem (PTFE). Incidence trombózy a restenózy při použití stentů potažených PTFE je vyšší než při implantaci standardních stentů. Cílem této studie bylo zhodnotit klinické výsledky použití stentů potažených PTFE při řešení CAP. Materiály a metody: Analyzovali jsme údaje celkem 38 pacientů s implantací stentů potažených PTFE po CAP provedenou v období mezi lednem 2012 a lednem 2022 na jednom pracovišti s vysokým objemem těchto výkonů (Medipol University Hospital v tureckém Istanbulu). Primárním sledovaným parametrem byl souhrn závažných nežádoucích kardiovaskulárních příhod (major adverse cardiovascular event, MACE). Výsledky: Hodnotili jsme jednoroční výsledky pacientů s implantací stentů potažených PTFE po CAP. Do studie bylo zařazeno celkem 38 pacientů; 22 (58 %) mužů a 16 (42 %) žen průměrného věku 69,7 ± 11,4 roku. Během sledování došlo ke vzniku MACE u 37 % daného souboru (14 pacientů). Do jednoho roku byla revaskularizace cílové tepny (target vessel revascularization, TVR) provedena u 36,8 % (14 pacientů) a revaskularizace cílové léze (target lesion revascularization, TLR) u 21 % (8 pacientů), incidence úmrtí dosáhla 10,5 % (4 pacienti) a infarktu myokardu 21,1 % (8 pacientů). Závěry: I když se dnes většina případů perforace koronární tepny úspěšně řeší zavedením stentů potažených PTFE, je jednoroční incidence MACE u pacientů s implantací takových stentů vysoká. Naše výsledky tak prokázaly, že uvedené pacienty je nutno důsledně sledovat.

• MeSH
• balónková koronární angioplastika * metody   škodlivé účinky   MeSH
• iatrogenní nemoci MeSH
• klinická studie jako téma metody   MeSH
• koronární cévy * zranění   MeSH
• lidé MeSH
• polytetrafluoroethylen terapeutické užití   MeSH
• stenty trendy   MeSH
• Check Tag
• lidé MeSH

Srdeční infarkt je závažný stav definovaný jako nekróza části srdečních buněk (kardiomyocytů) s klinickými známkami akutní ischemie myokardu. Většinou je charakterizován rupturou aterosklerotického plátu, ulcerací, fisurou nebo erozí s výsledným intraluminálním trombem v jedné nebo více koronárních tepnách. Srdeční infarkt bývá spojován s vyšším věkem a u mladých pacientů se na tuto diagnózu často nemyslí. Cílem sdělení je poukázat na výskyt akutního infarktu myokardu (AIM) u mladých jedinců. Rádi bychom demonstrovali závažnost problematiky diagnostiky AIM u mladých nemocných na kazuistice muže věku 36 let s pozitivní rodinnou anamnézou. Na naše pracoviště byl přivezen za kontinuální resuscitace zevním masážním systémem Lucas pro refrakterní srdeční zástavu s obrazem bezpulzové aktivity. Resuscitace byla nakonec úspěšná, k obnově spontánního oběhu došlo v 85. minutě. Následně byl na EKG obraz infarktu myokardu s ST elevacemi přední stěny. Akutní koronarografie potvrdila proximální uzávěr ramus interventricularis anterior, byla provedena balónková angioplastika s implantací stentu. Tento mladý muž opustil naše oddělení po 21 dnech s malým neurologickým deficitem (porucha krátkodobé paměti). Prevalence srdečního infarktu stoupá s věkem, ale může se vyvinout a ohrožovat život i u mladých jedinců. Proto je třeba na tuto diagnózu myslet také u mladších pacientů s námahovými bolestmi na hrudi nebo v zádech.

A heart attack is a serious condition, defined as the death of a portion of cardiac muscle cells. It is typically caused by a sudden blockage or significant narrowing of a coronary artery that supplies the affected region. Although heart attacks are often associated with older individuals, they can also occur in the young. The aim of this paper is to shed light on the incidence of acute myocardial infarction (AMI) in younger populations. Through the case study of a 36year-old male with a familial history of heart conditions, we aim to highlight the critical nature of early AMI diagnosis in young individuals. He was admitted to our department while undergoing continuous resuscitation using the Lucas external chest compression system, following a refractory cardiac arrest characterized by pulseless electrical activity. Resuscitation proved successful, with spontaneous circulation restored after 85 minutes. A subsequent ECG revealed an ST elevation myocardial infarction of the anterior wall. Acute coronary angiography identified a proximal blockage in the ramus interventricularis anterior, which was then treated with balloon angioplasty and stent implantation. Twenty-one days later, the young patient was discharged with a mild impairment in short-term memory. While the prevalence of myocardial infarction increases with age, it is imperative to recognize that younger individuals are not immune. Therefore, healthcare professionals must consider AMI as a potential diagnosis in younger patients presenting with exertional chest or back pain.

• MeSH
• balónková koronární angioplastika MeSH
• dospělí MeSH
• echokardiografie MeSH
• infarkt myokardu přední stěny diagnóza   terapie   MeSH
• infarkt myokardu s elevacemi ST úseků diagnóza   terapie   MeSH
• infarkt myokardu * diagnóza   terapie   MeSH
• lidé MeSH
• mozková hypoxie a ischemie MeSH
• rehabilitace MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• akutní koronární syndrom * diagnóza   komplikace   prevence a kontrola   terapie   MeSH
• antihypertenziva aplikace a dávkování   terapeutické užití   MeSH
• antikoagulancia aplikace a dávkování   terapeutické užití   MeSH
• biologické markery krev   MeSH
• elektrokardiografie MeSH
• fibrinolýza MeSH
• infarkt myokardu diagnóza   komplikace   terapie   MeSH
• inhibitory agregace trombocytů aplikace a dávkování   terapeutické užití   MeSH
• koronární angioplastika metody   MeSH
• lidé MeSH
• revaskularizace myokardu metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

• MeSH
• balónková koronární angioplastika * metody   MeSH
• kongresy jako téma MeSH
• koronární restenóza terapie   MeSH
• lidé MeSH
• sirolimus aplikace a dávkování   MeSH
• stenty uvolňující léky MeSH
• Check Tag
• lidé MeSH