Research Spotlight

Kandzari, D.E., Kirtane, A.J., Windecker, S., Latib, A., Kedhi, E., Mehran, R., Price, M.J., Abizaid, A., Simon, D.I., Worthley, S.G., Zaman, A., Choi, J.W., Caputo, R., Kanitkar, M., McLaurin, B., Potluri, S., Smith, T., Spriggs, D., Tolleson, T., Nazif, T., Parke, M., Lee, L.C., Lung, T.H. and Stone, G.W. (2020). “One-Month Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention With Zotarolimus-Eluting Stents in High-Bleeding-Risk Patients.” Circ Cardiovasc Interv 13(11): e009565.

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BACKGROUND: Despite treatment guidance endorsing shortened dual antiplatelet therapy (DAPT) duration in high bleeding risk (HBR) patients after drug-eluting stents, limited evidence exists to support these recommendations. The present study was designed to examine the safety and effectiveness of 1-month DAPT duration following percutaneous coronary intervention with zotarolimus-eluting stents in HBR patients. METHODS: Onyx ONE Clear was a prospective, multicenter, nonrandomized study evaluating the safety and effectiveness of 1-month DAPT followed by single antiplatelet therapy in HBR patients undergoing percutaneous coronary intervention with Resolute Onyx drug-eluting stents. The primary analysis of cardiac death or myocardial infarction between 1 month and 1 year was performed in the prespecified one-month clear population of patients pooled from the Onyx ONE US/Japan study and Onyx ONE randomized controlled trial. One-month clear was defined as DAPT adherence and without major adverse events during the first month following percutaneous coronary intervention. RESULTS: Among patients enrolled in Onyx ONE US/Japan (n=752) and Onyx ONE randomized controlled trial (n=1018), 1506 patients fulfilled one-month clear criteria. Mean HBR characteristics per patient was 1.6 with 44.7% having multiple risks. By 2 months and 1 year, respectively, 96.9% and 89.3% of patients were taking single antiplatelet therapy. Between 1 month and 1 year, the rate of the primary end point was 7.0%. The 1-sided upper 97.5% CI was 8.4%, less than the performance goal of 9.7% (P<0.001). CONCLUSIONS: Among HBR patients who were event free before DAPT discontinuation at 1 month, favorable safety and effectiveness through 1 year support treatment with Resolute Onyx drug-eluting stents as part of an individualized strategy for shortened DAPT duration following percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov; Unique identifier NCT03647475.

Xenogiannis, I., Alaswad, K., Krestyaninov, O., Khelimskii, D., Khatri, J.J., Choi, J.W., Jaffer, F.A., Patel, M., Mahmud, E., Doing, A.H., Dattilo, P., Koutouzis, M., Tsiafoutis, I., Uretsky, B., Jefferson, B.K., Patel, T., Jaber, W., Samady, H., Sheikh, A.M., Yeh, R.W., Tamez, H., Elbaruny, B., Love, M.P., Abi Rafeh, N., Maalouf, A., Fadi, A.J., Toma, C., Shah, A.R., Chandwaney, R.H., Omer, M., Megaly, M.S., Vemmou, E., Nikolakopoulos, I., Rangan, B.V., Garcia, S., Abdullah, S., Banerjee, S., Burke, M.N., Karmpaliotis, D. and Brilakis, E.S. (2020). “Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion percutaneous coronary intervention.” Rev Esp Cardiol (Engl Ed) Nov 12;S1885-5857(20)30410-2. [Epub ahead of print.].

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INTRODUCTION AND OBJECTIVES: The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study. METHODS: We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry. RESULTS: The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P < .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P < .01) and higher overall technical success (88% vs 83%; P < .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P < .01). CONCLUSIONS: Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.

Brinkman, W.T. (2020). “The Details Matter in Open TAAA Surgery.” Ann Thorac Surg Dec 3;S0003-4975(20)32051-8. [Epub ahead of print.].

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Background: The present study was done to examine the incidence, predictors, and impact of early gastrointestinal complications (GICs) after open thoracoabdominal aortic aneurysm (TAAA) repair. Methods: We retrospectively analyzed data from 3,587 open TAAA repairs performed at our center during 1986-2019. We used univariate analyses and multivariable logistic regression to identify risk factors associated with GICs including bleeding, ischemia, obstruction, and acute pancreatitis. Adverse event was defined as operative death or persistent stroke, paraplegia, paraparesis, or renal failure necessitating dialysis. Results: GICs developed after 213 repairs (5.9%). GICs less often developed after extent I repair than after repairs that involved infrarenal abdominal aortic segments (ie, extent II-IV repairs; p = 0.003). Patients who developed GICs more often underwent endarterectomy, stenting, or bypass of visceral arteries (51.2% vs 42.2%; p = 0.01). Use of selective visceral perfusion did not differ between groups. Patients who developed GICs had higher rates of operative mortality (34.3% vs 6.6%) and adverse event (44.1% vs 13.2%) and had longer hospitalization (29 d vs 11 d) (p < 0.001 for all). Independent predictors of GICs included incidental splenectomy, rupture, non–extent I repair, older age, and longer aortic cross-clamp time. Short-, mid-, and long-term survival were poorer in patients who developed GICs (p < 0.001). Conclusions: Although uncommon, early GICs after open TAAA repair are associated with significant short- and long-term morbidity and mortality. Development of perioperative strategies to mitigate these complications is warranted.

Birkemeier, K.L. (2020). “Imaging of solid congenital abdominal masses: a review of the literature and practical approach to image interpretation.” Pediatr Radiol 50(13): 1907-1920.

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Fetal abdominal tumors are rare, usually benign, and cause a great deal of anxiety for expectant parents and the physicians counseling them. In this paper the author reviews the most common fetal abdominal tumors in the liver (hemangioma, mesenchymal hamartoma, hepatoblastoma, metastases) and the kidney (congenital mesoblastic nephroma, Wilms tumor, malignant rhabdoid tumor, and clear cell sarcoma), and suprarenal mass lesions (adrenal neuroblastoma, adrenal hemorrhage, and subdiaphragmatic extralobar pulmonary sequestration). The author describes the imaging approach, imaging appearance and differentiating features of tumors, and differences between fetal and childhood appearances of tumors.

Mostafavi, D., Methani, M.M., Piedra-Cascón, W., Zandinejad, A. and Revilla-León, M. (2020). “Influence of the Rinsing Post-Processing Procedures on the Manufacturing Accuracy of Vat-Polymerized Dental Model Material.” J Prosthodont Nov 17. [Epub ahead of print.].

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PURPOSE: To evaluate the influence of rinsing solvents namely isopropyl alcohol (IPA) and tripropylene glycol monomethyl ether (TPM) and rinsing times (5-, 7-, 9-, and 11-minutes) of the post-processing procedures on the manufacturing accuracy of an additively manufactured dental model resin material. MATERIAL AND METHODS: The standard tessellation language (STL file) of the digital design of a bar (15×4×3 mm) was obtained. A resin dental material (E-Model Light; Envisiontec, Dearborn, Michigan) and a 3D printer (VIDA HD; Envisiontec, Dearborn, Michigan) were selected to manufacture all the specimens using the STL file following the recommended printing parameters at a room temperature of 23 °C. Two groups were generated based on the rinsing solvent used on the post-processing procedures namely isopropyl alcohol (IPA-group) and tripropylene glycol monomethyl ether (TPM-group). Each group was further divided in 4 subgroups (IPA-1 to IPA-4 and TPM-1 to TPM-4) depending on the rinsing time performed (5-, 7-, 9-, and 11-minutes). Twenty specimens per subgroup were fabricated. The dimensions (length, width, and height) of all the specimens were measured using a low force digital caliper (Absolute Low Force Caliper Series 573; Mitutoyo, Takatsu-ku, Kawasaki, Kanagawa). Each measurement was performed 3 times and the mean value determined. The volume of each specimen was calculated using the formula V=l×w×h. Shapiro-Wilk test revealed that the data were not normally distributed. Data were analyzed using Kruskal-Wallis (α = .05), followed by pairwise Mann-Whitney U tests (α = .0018). RESULTS: The IPA groups obtained significantly lower trueness and precision values compared with TPM groups (P<0.0018). Among the IPA groups, IPA-1 subgroup obtained the highest trueness and precision values compared to the rest of IPA subgroups. The TPM-1 and TPM-2 subgroups obtained the highest trueness and prevision values among the TPM group and among all the groups tested. No significant difference was found between the TMP-1 and TPM-2 subgroups (P>0.0018). CONCLUSIONS: None of the manufacturing workflows tested was able to manufacture a perfect match of the bar virtual design dimensions. TPM solvent group obtained higher trueness and precision values compared to the IPA solvent group. The IPA-1 subgroup that replicated the manufacturer´s recommendations obtained the highest manufacturing accuracy among the IPA subgroup. TPM solvent used in a rinsing ultrasonic bath between 4 and 3 minutes followed by a second ultrasonic clean bath between 3 and 2 minutes of the just printed vat polymerized dental model specimens obtained the highest manufacturing accuracy values.