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Biomedical subjects

Jeffrey A Breall

Publications and source records attributed to Jeffrey A Breall.

7 recordsLinked to original sources
PubMed2005

Randomized evaluation of the TriActiv balloon-protection flush and extraction system for the treatment of saphenous vein graft disease.

OBJECTIVES: The Protection During Saphenous Vein Graft Intervention to Prevent Distal Embolization (PRIDE) study compared outcomes with the TriActiv System (Kensey Nash Corp., Exton, Pennsylvania), a balloon-protection flush and extraction device, with an embolic protection group during treatment of saphenous venous grafts (SVGs). BACKGROUND: Treatment of SVGs with embolic protection reduces adverse cardiac events. METHODS: We conducted a prospective trial randomizing 631 patients with coronary ischemia and lesions in SVGs to embolic protection with the TriActiv System or control group (Guardwire System [Medtronic AVE, Santa Rosa, California] or Filterwire EX [Boston Scientific Corp., Maple Grove, Minnesota]). RESULTS: The incidence of major adverse cardiac events at 30 days was 11.2% for the TriActiv group and 10.1% for the control group (relative risk = 1.1%; 95% confidence interval 0.67 to 1.76; p = 0.65; p = 0.02 for non-inferiority). Safety and efficacy end points were similar between groups except that patients randomized to the TriActiv System had more hemorrhagic complications (10.9% vs. 5.4%; p = 0.01). CONCLUSIONS: The TriActiv System was not inferior to approved embolic protection devices for the treatment of diseased SVGs.

Adult↗
PubMed2005

Percutaneous intervention through a Cabrol composite graft.

Similar to other surgical techniques, ascending thoracic aortic repair has evolved through a series of modifications, each with improvement in longevity, morbidity, and mortality. Until recently, most, if not all, aortic composite graft-coronary ostial anastamotic complications have been addressed with repeat surgery. Due to this, most interventional cardiologists have little to no experience in approaching postsurgical aortic composite graft-coronary ostial anastamotic lesions percutaneously when the anatomy is altered by a Cabrol interposition graft. Nevertheless, it is important that operators are aware of the various surgical techniques used to repair the ascending aorta and reimplant the coronary arteries. Furthermore, in the present era of addressing more and more stenotic lesions percutaneously, it is important to have knowledge into which type of lesion lends itself to a percutaneous approach. Our review of the literature reveals that there have been no reported cases of percutaneous interventions of the native coronary arteries through a Cabrol composite graft. We report the first case of percutaneous intervention of an unprotected left main anastamotic stenosis through a Cabrol composite graft.

Angioplasty, Balloon, Coronary↗
PubMed2003

Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention: results of the Coronary Revascularization Using Integrilin and Single bolus Enoxaparin Study.

OBJECTIVES: This study was designed to assess whether use of enoxaparin during percutaneous coronary intervention (PCI) increased bleeding compared with unfractionated heparin, in addition to background therapy with eptifibatide. BACKGROUND: Data supporting the benefits of enoxaparin and the glycoprotein IIb/IIIa inhibitor eptifibatide evolved in parallel. Information on combining these two classes of medications is limited. METHODS: A total of 261 patients undergoing elective or urgent PCI were randomized to either eptifibatide plus enoxaparin or eptifibatide plus unfractionated heparin. RESULTS: The primary end point of the study, the bleeding index (change in hemoglobin corrected for blood transfusions), was 0.8 in the patients randomized to enoxaparin and 1.1 in patients randomized to unfractionated heparin (p = 0.15). The rate of vascular access site complications was 9.3% in the enoxaparin arm versus 9.8% in the unfractionated heparin arm (p = NS). The rate of bleeding complications was not significantly different between the two arms of the study, including in those patients who received vascular closure devices. The rate of angiographic complications was 6.3% in the enoxaparin group and 6.2% in the unfractionated heparin group (p = NS). Similarly, there were no significant differences in the composite of death, myocardial infarction, or urgent target vessel revascularization at 48 h or 30 days. CONCLUSIONS: Compared with unfractionated heparin plus eptifibatide, the combination of enoxaparin plus eptifibatide is not associated with an excess of bleeding or vascular complications, including in those receiving closure devices. Despite no monitoring of anticoagulation activity with enoxaparin, there was no apparent increase in angiographic or clinical complications.

Adult↗
PubMed2003

Complete situs inversus and bicuspid aortic valve stenosis.

Patients with congenital heart disease are increasingly surviving to adulthood and present interesting challenges during cardiac catheterization. Situs inversus with dextrocardia is a type of cardiac malposition most likely to exist with a structurally normal heart. We present the case of a patient with complete situs inversus and bicuspid aortic valve stenosis, a hitherto unreported association. Prototypical findings in this cardiac malposition are illustrated for proper recognition with emphasis on technical tips for left and right heart catheterization.

Aortic Valve Stenosis↗
PubMed2002

Myocardial Bridge: a clinical review.

Human coronary arteries occasionally course intramyocardially--a condition termed Myocardial Bridge. We review the anatomic and pathophysiological basis of the Myocardial Bridge and discuss clinical presentations, prognoses and the current treatment options for this interesting coronary angiographic variant.

Cardiomyopathies↗
PubMed2002

Distal emboli protection in patients undergoing percutaneous coronary intervention after a recent myocardial infarction.

Devices to prevent distal atheroembolization are an important addition to the armamentarium of an interventional cardiologist. We report the use of PercuSurge, a distal balloon occlusion device, in two patients with recent myocardial infarction of differing etiologies. The first case is a patient with an old degenerated vein graft with thrombotic occlusion of greater than 48-hr duration and the second case is a patient with an embolic myocardial infarction in a native coronary artery. In both cases, significant thromboembolic debris was aspirated with technical success and no complications. These cases illustrate use of the PercuSurge device in patients after a recent myocardial infarction for preserving distal myocardial perfusion and microvascular integrity.

Angioplasty, Balloon, Coronary↗