The feasibility, safety, and high technical success of robotically assisted percutaneous coronary intervention (PCI) for the treatment of both simple and complex coronary disease has been demonstrated. As the current generation robotic platform is limited to a rapid exchange system, orbital or rotational atherectomy cannot be performed robotically. However, excimer laser coronary atherectomy is performed with a rapid exchange catheter but its feasibility during robotically assisted PCI is unknown. We report the successful use of laser atherectomy during two complex robotically assisted PCI procedures using the CorPath GRX robotic system.
Background: Amiodarone is associated with heart block in patients with atrial fibrillation and heart failure. The safety of amiodarone use in patients with amyloid is unknown. We sought to identify the prevalence of heart block in patients with amyloid and heart failure who received amiodarone and compare them to those without amyloid in elderly patients. Methods: We searched Explorys (Explorys Inc, Cleveland, Ohio), a database that aggregates electronic health records of 45 million patients from 23 integrated health systems in the United States. We included patients who are at least 55 years of age who have heart failure and atrial fibrillation and receive amiodarone therapy. We compared those to age adjusted controls with heart failure and atrial fibrillation without amyloidosis. Results: We identified 640 patients with amyloid and 87280 patients without amyloid. Prevalence of block was higher in patients with amyloid on amiodarone (43.8% vs 30.0%, p!0.0001). When adjusted for age, odds ratio of block was as follows: 55-59 (1..0-1.8], p50.052), and 90+ (1.2 [0.9-1.7], p50.25), figure. Conclusion: Elderly patients with amyloidosis and heart failure who receive amiodarone are at higher risk of developing heart block. Amiodarone in this population should be used with caution and risk-benefit ratio should be addressed.Introduction: New onset heart failure (HF) in orthotopic liver transplant (OLT) patients has been described in the literature as a relatively uncommon but highly mortal condition. The pathophysiology remains unknown with many proposed theories. Current guidelines recommend against transplanting patients with heart failure. However, to date, there are no evidence-based screening algorithms to identify patients at risk for this clinical entity. Aims: We aimed to retrospectively explore the risk factors of both early and late HF in OLT and the utility of Dobutamine stress echocardiogram (DSE) in this regard. Methods: Medical records of 488 patient who received cadaveric OLT during the period of Jan.2001-Dec.2013 were reviewed. Echocardiographic and clinical parameters were examined as predictors of new HF using logistic regression analysis. HF was defined as either left ventricular (LV) ejection fraction of ! 45% or having diagnostic clinical features. 30 days post operatively was the cut off for early vs late HF. Echocardiographic assessment of diastolic function was not included in the analysis. Results: 262 patients had complete records including pre and post-OLT echocardiograms. 63% were males and 85% were Caucasians. History of ischemic heart disease was present in 5% and none had prior HF. Incidence of early HF was 6.9% (18 patients) and 9.9% (25 patients) for late HF. Median time to follow up echocardiogram was 251 days (interquartile range 46-1170 days). Pre-transplantation DSE was performed in 60% of analyzed cases and none of its parameters was associated with post-OLT HF. Independent predictors of developing HF were pre-OLT LV ejection fraction (MD -2.7%, P 0.001), LV systolic diameter (MD 1.6...
Objectives: To describe the outcome of primary meningeal sarcoma (PMS) in a pediatric population. Methods: We conducted a retrospective study on patients harbouring a PMS based on the French registry of paediatric tumours. Questionnaires were sent to all French paediatric oncologists. Data on patient characteristics and treatments were collected. Pathology and imaging were centrally reviewed. Results: Between August 1989 and May 2010, 12 patients from 6 French centres, aged 3 months to 14.5 years (mean: 3.3 years) were treated for a PMS. Mean follow-up was 12 years (range: 3 months to 24 years). Tumour locations were: frontal (3), parieto-occipital (2), parietal (1), temporal (1), occipital (1), thalamic (1), pontocerebellar angle (1), cerebellar tentorium (1), ambient cistern (1). No metastasis was observed. The firstline treatment was surgery in 10 cases, chemotherapy in 2. Resection was total in 6 cases, partial in 6. Central pathology review concluded to: high-grade undifferentiated sarcoma (8), chondrosarcoma (2), fibrosarcoma (1), myxoid desmoplastic tumour (1). Seven tumours were smaller than 5 cm in size. Eleven patients received 2 to 10 courses of chemotherapy (median: 5) but no response was observed. Four out of 6 patients for whom a total resection was performed were still alive at time of study, compared to 2 when only partial resection was possible. Four out of 6 patients who received radiotherapy are still alive, compared to 1 out of 4 patients without radiotherapy. The 5-year Event-Free Survival (EFS) and Overall Survival (OS) rates were 50%. The median EFS in case of total resection was 39 months versus 16 months in case of partial resection. Neither correlation was found between tumour size and location or between age at diagnosis and EFS/OS. Conclusions: We report the first multicentre case series describing clinical, radiological presentation and outcome of PMS in children. In this short series of very rare tumours, age and tumour size did not seem to be prognostic factors. Total resection and radiotherapy seem to be essential. The role of chemotherapy remains unclear.
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