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Resumen Introduccion y objetivos Una profundidad mas alta del implante percutaneo de una valvula aortica autoexpandible minimiza el dano en el sistema de conduccion y puede reducir las tasas de marcapasos permanente a 30 dias. El objetivo es determinar la seguridad y la eficacia de modificar la tecnica de implante clasica para el reemplazo percutaneo de la valvula aortica a una tecnica de proyeccion de superposicion de cuspides (PSC) para lograr una profundidad mas alta del implante y reducir la necesidad de marcapasos permanente. Metodos Desde marzo de 2017 se incluyo a 226 pacientes consecutivos: 113 tratados con tecnica de implante PSC frente a 113 casos consecutivos previos con implante clasico. La profundidad del implante se evaluo mediante 3 metodos en todos los pacientes (cuspide no coronaria a valvula cardiaca percutanea (VCP); media de cuspide no coronaria y cuspide coronaria izquierda a VCP y el borde mas profundo de cuspide coronaria izquierda y cuspide no coronaria a VCP). Resultados El grupo de PSC presento una profundidad del implante menor que el del grupo de implante clasico (4,8 ± 2,2 frente a 5,7 ± 3,1 mm; p = 0,011; 5,8 ± 3,1 frente a 6,5 ± 2,4 mm; p = 0,095; 7,1 ± 2,8 frente a 7,4 ± 3,2 mm; p = 0,392). A los 30 dias de seguimiento, 40 pacientes (17,7%) requirieron el implante de marcapasos permanente, menos en el grupo de PSC (el 12,4 frente al 23%; p = 0,036). La tecnica de implante PSC protegio contra el evento principal (OR = 0,45; IC95%, 0,21-0,97; p = 0,043), con parecidos exito del procedimiento y complicaciones. Conclusiones La tecnica de implante PSC es una simple modificacion en el protocolo que proporciona una profundidad del implante mas alta de la protesis valvular autoexpandible con menores alteraciones de la conduccion y tasas de marcapasos permanente.

Resumen Introduccion y objetivos El tratamiento medico y las medidas de prevencion secundaria en el infarto agudo de miocardio con elevacion del segmento ST (IAMCEST) han experimentado una mejora progresiva en las ultimas decadas. A pesar de ello, los pacientes > 65 anos presentan un mayor riesgo de muerte tras un evento coronario. Nuestro objetivo fue evaluar si los pacientes Metodos Todos los pacientes que sufrieron un IAMCEST en los ultimos 6 anos en nuestro centro fueron incluidos en un estudio observacional (SurviSTEMI: survival in STEMI). Se calculo la supervivencia observada, la supervivencia esperada y el exceso de mortalidad. Se repitieron todos los analisis estratificando por grupo etario Resultados Para los pacientes Conclusiones Los supervivientes del IAMCEST presentan una esperanza de vida similar a la de la poblacion general de la misma edad, sexo y area geografica.

The aim of this study was to determine if modifying the classical implantation technique for self-expanding (SE) transcatheter aortic valve replacement to a novel cusp-overlapping projection (COP) technique results in a higher implantation depth (ID) and subsequently reduces the rate of permanent pacemaker implantation (PPMI).The COP technique presents the potential benefit of an optimized ID to reduce the rate of PPMI. However, only a few studies have compared clinical outcomes with those achieved using the standard technique. This is the first study to systematically evaluate this approach for SE transcatheter heart valves (THVs) in different populations METHODS: Beginning in February 2015, 444 patients were consecutively included. Propensity score matching was used to control baseline characteristics because of the observational nature of the study. In total, 161 pairs of patients were analyzed. Three methods were used to measure ID (noncoronary cusp [NCC] to the THV, mean of the NCC and the left coronary cusp [LCC] to the THV, and the deepest edge from the LCC and the NCC to the THV).ID was significantly higher in COP cases when measuring from the NCC (4.2 mm vs 5.3 mm; P 0.001) and the mean from the NCC and the LCC (5.3 mm vs 5.9 mm; P = 0.04), but not from the deepest edge. The PPMI rate was lower in the COP group: 19 (11.8%) vs 35 (21.7%) (P = 0.03; relative risk: 0.54; 95% CI: 0.32-0.91).The present study showed that the COP technique significantly reduces PPMI in SE THV implantation compared with the classical implantation technique, with similar rates of complications.

Introduction and objectives This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. Methods From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). Results The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm ± 2.2 vs 5.7 mm ± 3.1; P = .011; 5.8 mm ± 3.1 vs 6.5 mm ± 2.4; P = .095; 7.1 mm ± 2.8 vs 7.4 mm ± 3.2; P = .392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P = .036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P = .043), with similar procedural success rates and complications. Conclusions The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates.

INTRODUCTION AND OBJECTIVES In the last few decades, there has been a continuous process of improvement in medical treatment and secondary prevention measures after ST-segment elevation myocardial infarction (STEMI). Patients older than 65 years are at increased risk of death due to this event. Our aim was to determine whether patients aged less than 65 years and 65 years and older experiencing a STEMI can recover a life expectancy similar to that of the general population of the same age, sex, and geographical region. METHODS We included all patients experiencing a STEMI at our institution during a 6-year period in an observational-study (SurviSTEMI: survival in STEMI). We calculated their observed survival, expected survival, and excess mortality. We repeated all analyses for survivors of the acute event stratifying by 65 years. RESULTS For patients aged

Left Main Coronary Artery Aneurysm A 49-year-old man with hypertension was referred for evaluation of recurrent angina. Coronary angiography revealed a large aneurysm (shown in a video) in the left main coronary artery.

Right heart thrombus is a slightly detectable condition. In patients presenting with acute pulmonary embolism, the finding of thrombus in transit has been associated with high in-hospital mortality. We present a case of a 50-year-old male patient with acute pulmonary embolism and a thrombus in transit in the right atrium. We took the decision to perform fibrinolysis with tenecteplase, presenting significant improvement in the clinical condition, without any complications related to the therapy. Our case demonstrates the effectiveness of thrombolytic therapy in cases of pulmonary embolism and thrombus in transit in right chambers.