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Objective: This meta-analysis sought to evaluate the outcomes of absorb bioresorbable vascular scaffolds (BVS) compared with second-generation drug-eluting stents (DES) after 3 years, the approximate time of complete polymer bioresorption.Background: BVS were found to be inferior to second-generation DES in early and mid-term outcomes with a higher rate of target vessel myocardial infarction (TV-MI) and device thrombosis (DT). Improper implantation techniques and incomplete bioresorption of the poly-L-lactide (PLLA) polymer were sighted as possible reasons. Methods:We conducted an electronic database search for all randomized control trials that compared absorb BVS to second-generation DES and reported outcomes of interest after 3 years of absorb BVS implantation. Assuming interstudy heterogeneity, a random-effects analysis was conducted with odds ratio as the effect size of choice to compare the event rates between the two groups. Results: A total of four studies (n = 3,245, BVS = 2075, DES = 1,170) were included in the final analysis. Pooled analysis revealed that there was no difference between absorb BVS and second-generation DES with respect to target lesion failure (TLF) (OR = 1.23, 95% CI = 0.73-2.07, p = 0.44), TV-MI (OR = 1.03, 95% CI = 0.42-2.53, p = 0.95), target lesion revascularization (TLR) (OR = 1.61, 95% CI = 0.77-3.33, p = 0.20) and definite/probable DT (OR = 0.71, 95% CI = 0.10-5.07, p = 0.74). Also, there was no difference in cardiac mortality (OR = 0.66, 95% CI = 0.22-1.94, p = 0.45). Conclusions: Between 3 and 4 years of follow-up, patients receiving absorb BVS did not have significantly different outcomes, in terms of TLF, TV-MI, TLR, DT, and cardiac mortality, compared to DES. K E Y W O R D S absorb, bioresorbable vascular scaffolds, clinical outcomes, drug-eluting stents

Pacemaker or defibrillator placement is a common procedure done in more and more patients due to increased longevity and the prominence of cardiac disease. With more indications for cardiac implantable electrode devices, the devices themselves have evolved into more complex structures with more leads. The mechanical stress, risk of infection, and decreased blood flow through the superior vena cava (SVC) put patients at risk for SVC obstruction. Herein, we present a rare case of complete SVC obstruction secondary to fibrosis due to pacemaker leads which was treated with venoplasty and showed excellent long-term results. We also review the current literature on different approaches to treating SVC obstruction in this group of patients.

Objectives The objective of this study was to compare safety and efficacy of patent foramen ovale (PFO) closure compared with medical therapy in patients with cryptogenic stroke (CS). Background The role of PFO closure in preventing recurrent stroke in patients with prior CS has been controversial. Methods We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials that compared device closure with medical management and reported on subsequent stroke and adverse events. Event rates were compared using a forest plot of relative risk using a random-effects model assuming interstudy heterogeneity. Results A total of 6 studies ( n = 3747) were included in the final analysis. Mean follow-up ranged from 2 to 5.9 years. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (risk ratio [RR] = 0.41, 95% CI = 0.20–0.83, I 2 = 51%, P = 0.01). There was, however, a significant increase in atrial fibrillation with device therapy (RR = 5.29, 95% CI = 2.32–12.06, I 2 = 38%, P < 0.0001). No effect was observed on major bleeding ( P = 0.50) or mortality ( P = 0.42) with device therapy. Subgroup analyses showed that device closure significantly reduced the incidence of the composite primary end point among patients who had large shunt sizes (RR = 0.35, 95% CI = 0.18–0.68, I 2 = 27%, P = 0.002). The presence/absence of atrial septal aneurysm ( P = 0.52) had no effect on the outcome. Conclusion PFO closure is associated with a significant reduction in the risk of stroke compared to medical management. However, it causes an increased risk of atrial fibrillation.

The use of percutaneous left ventricular assist devices (VAD) may minimize the risk of hemodynamic compromise during such high-risk percutaneous coronary intervention (PCI) and allow complete revascularization, thus improving outcomes. A good understanding of cardiac hemodynamics is essential in making informed decisions during such cases. A 61-year-old male with an extensive surgical cardiac history including a modified Cabrol type anastomosis with saphenous vein (SVG) conduits to two coronary arteries presented to our hospital with severe substernal chest discomfort and was noted to have diffuse ST depressions along with subtle ST elevations in lead aVR suggestive of diffuse sub-endocardial ischemia. Diagnostic coronary angiography revealed significant stenosis in the Cabrol type SVG grafts and we opted for a protected PCI using Impella (Abiomed, Danvers, MA) support. A significant drop in the blood pressure was noted and despite trouble-shooting, the Impella arterial line tracing remained minimally pulsatile. A comprehensive understanding of circulatory support physiology was ultimately crucial in making an informed decision for a successful PCI outcome.