Post-Closure Technique to Reduce Vascular Complications Related to Impella CP

BackgroundUse of percutaneous mechanical circulatory support has grown exponentially. Vascular complications remain a growing concern and best practices for device removal do not exist. We describe a novel post-closure technique for the next generation Impella CP removal and immediate hemostasis.MethodsThis study is a single center, retrospective, exploratory analysis of 11 consecutive patients receiving an Impella CP for either high-risk PCI or cardiogenic shock and then referred for post-closure compared to 20 patients receiving manual compression for Impella CP removal between 2017 and 2019.ResultsMean age range was 62.7–65.4 years and 50–65% male between groups. Average duration of Impella CP treatment ranged from 3.4 to 5.2 days. Patients referred for post-closure had significantly lower rates of all-cause adverse vascular events (0% versus 40%; n = 0/11 versus n = 8/20; p = 0.01). There was no significant difference in BARC 3 or greater bleeding, transfusion requirement, hospitalization duration or intensive care duration between removal strategies.ConclusionThe novel post-closure technique may significantly reduce vascular complications associated with device removal and may improve clinical outcomes for these critically ill patients.     

Echocardiographic Evaluation of Left and Right Ventricular Function in Patients with Coronary Slow Flow Syndrome: A Comparative Study

The Coronary Slow Flow Phenomenon is a syndrome of normal coronary anatomy and delayed progression of contrast medium through the coronary vessels. This research attempts to analyze and compare the systolic and diastolic function of the left and right ventricle in primary Slow Flow and Normal Coronary Flow.Two groups of primary Slow Coronary Flow (33 people) and Normal Coronary Flow (11 people) were included and the systolic and diastolic function of the ventricles was analyzed and compared between them.In the control group 18% of patients had mild and in the case group 24.2% mild, and 3.1% had moderate left ventricular diastolic dysfunction (P >0.05). The frequency distribution of the left and right ventricular systolic dysfunction was similar in the two groups.There was no statistically significant difference between two groups and in the association of cardiac dysfunction, it may be reasonable to investigate other causes.     

Rationale for a Clinical Trial That Compares Acute Stroke Rehabilitation at Inpatient Rehabilitation Facilities to Skilled Nursing Facilities: Challenges and Opportunities

In the United States, approximately 400,000 patients with acute stroke are discharged annually to inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs). Typically, IRFs provide time-intensive therapy for an average of 2-3 weeks, whereas SNFs provide more moderately intensive therapy for 4-5 weeks. The factors that influence discharge to an IRF or SNF are multifactorial and poorly understood. The complexity of these factors in combination with subjective clinical indications contributes to large variations in the use of IRFs and SNFs. This has significant financial implications for health care expenditure, given that stroke rehabilitation at IRFs costs approximately double that at SNFs. To control health care spending without compromising outcomes, the Institute of Medicine has stated that policy reforms that promote more efficient use of IRFs and SNFs are critically needed. A major barrier to the formulation of such policies is the highly variable and low-quality evidence for the comparative effectiveness of IRF- vs SNF-based stroke rehabilitation. The current evidence is limited by the inability of observational data to control for residual confounding, which contributes to substantial uncertainty around any magnitude of benefit for IRF- vs SNF-based care. Furthermore, it is unclear which specific patients would receive the most benefit from each setting. A randomized controlled trial addresses these issues, because random treatment allocation facilitates an equitable distribution of measured and unmeasured confounders. We discuss several measurement, practical, and ethical issues of a trial and provide our rationale for design suggestions that overcome some of these issues.