Jim Stewart

• Auckland District Health Board

Background: As the indications for transcatheter aortic valve implantation (TAVI) have expanded, so to have the demands on interventionists to allow as many patients to access this technology as possible. Methods: We retrospectively reviewed our TAVI database for patients who had received a 29mm SAPIEN 3 valve despite having an annular area grea...

Aims: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in high-risk patients. We report the initial TAVI experience at Auckland City Hospital. Methods: The records of patients undergoing TAVI between 2011 and 2015 at Auckland City Hospital were reviewed. We report the procedural success...

Background: Radial arterial (RA) and femoral arterial (FA) access rates for invasive coronary angiography (ICA) vary widely internationally. The European Society of Cardiology (ESC) suggests default RA is feasible. We aim to investigate the variation in RA rates across all New Zealand public hospitals. Methods and results: Patient characteristic...

Background Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this ‘non-significant’ result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referr...

The Cardiac Society of Australia and New Zealand (CSANZ) and the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) have joined together to provide recommendations for institutions and individual operators to assess their ability to initiate and maintain a transcatheter valve program. Transcatheter aortic valve replacement...

Aims: To evaluate the long term safety and efficacy of the Elixir DESyneTM Novolimus-Eluting Coronary Stent System (CSS) compared to the Endeavor Zotarolimus-Eluting CSS through assessment of clinical, angiographic, and IVUS endpoints through 3 years. Method and results: 210 patients were randomized 2:1 either to the DESyne CSS loaded with 5mcg per...

Aims Primary percutaneous coronary intervention (PCI) is the optimal management for ST segment elevation myocardial infarction (STEMI) patients. We reviewed the largest primary PCI regional service in New Zealand: the Auckland/Northland service based at Auckland City Hospital, to assess patient management, in particular the door to reperfusion time...

Cardiac troponins are the preferred biomarkers for diagnosing myocardial infarction (MI). High-sensitivity troponin T (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis of infarction. We assessed the prognostic utility of admission hs-TnT to detect outcomes after primary angioplasty for ST-elevation/new left bundle branch bl...

Hypertension has a considerable worldwide burden and is a major risk factor for cardiovascular disease. Despite the use of lifestyle measures and medical therapy, a large proportion of patients remain treatment 'resistant and fail to have adequate control of blood pressure. This may adversely affect both future cardiovascular events and mortality....

To evaluate the outcome of cardiac resynchronisation therapy (CRT) in Auckland since its inception in 2000. Outcome measures were periprocedural events including procedure duration, fluoroscopic time, procedure success, complications, and echocardiographic markers of response. Retrospective review of those undergoing CRT implantation at Green Lane...

This study sought to perform clinical and imaging assessments of the DESolve Bioresorbable Coronary Scaffold (BCS). BCS, which is drug eluting, may have potential advantages compared with conventional metallic drug-eluting stents. The DESolve system, designed to provide vessel support and neointimal suppression, combines a poly-l-lactic acid-based...

This first-in-human multicenter study sought to examine prospectively the safety and efficacy of a new, cobalt chromium thin-strut, coronary absorbable polymer-coated, sirolimus-eluting stent. Bioabsorbable polymers on drug-eluting stents may lower the long-term risks of inflammation, delayed healing, and adverse events. We enrolled patients with s...

Purpose: Fully bioresorbable scaffolds (BS) provide temporary vascular scaffolding with drug delivery capability to prevent vessel recoil and minimize restenosis. By recovering several aspects related to vascular biology and physiology, BS has the potential to reduce late stent thrombosis and need for dual anti-platelet therapy. The DESolve is a PL...

Case summary: A frail 87 year-old lady presented with rest angina associated with widespread ECG change and troponin release. She failed attempts at medical therapy and therefore was referred for coronary intervention on the basis that she was not a surgical candidate. Investigation: Coronary angiography demonstrated heavily calcified coronary a...

Aims: Renal denervation using the point-by-point application of radiofrequency energy delivered by the first-generation Symplicity system is effective in lowering office blood pressure but may be time-consuming. The OneShot™ Renal Denervation System with a balloon-mounted spiral electrode potentially shortens and simplifies the procedure. This stud...

Background: The MiStent is a new drug-eluting stent characterized by the use of crystalline sirolimus and a fully absorbable PLGA polymer on a thin-strut (64 µm) cobalt-chromium stent. Prior preclinical studies showed the stent coating being eliminated in 45-60 days with full absorption of the polymer by 90 days. This clinical IVUS study aimed to a...

Background: The DESolve Bioresorbable Coronary Scaffold is a novel drug-eluting device combining a PLLA-based scaffold coated with a bioresorbable polylactide-based polymer and the drug Myolimus. Myolimus, a macrocyclic lactone mTOR inhibitor, has demonstrated potent anti-proliferative properties in two First-in-Man (FIM) trials using Elixir's meta...

Aims: Intravascular ultrasound (IVUS) is a proven and safe imaging modality used to guide percutaneous coronary intervention (PCI). The Volcano VIBE™ RX Vascular Imaging Balloon Catheter is a novel rapid exchange, 0.014" wire-compatible multi-lumen conventional balloon catheter modified with the addition of an IVUS transducer proximal to the ballo...

Percutaneous transcatheter renal sympathetic denervation (RDN) is a promising treatment for refractory hypertension (HT). RDN was found in one series of clinical studies to reduce systolic blood pressure (SBP) by as much as a mean of 30 mmHg with 85% of subjects experiencing sustained reductions of 10 mm or more out to two years after RDN. This deg...

Aims: To evaluate the clinical safety and effectiveness of the DESolve™ Myolimus-Eluting Bioresorbable Coronary Scaffold (DESolve) in patients with single de novo native coronary artery lesions through clinical endpoints and multiple imaging modalities. Methods and Results: Background: The DESolve Bioresorbable Scaffold is a novel drug eluting devi...

To the Editor We read with great interest the article titled ‘Contemporary clot busting in ST-elevation myocardial infarction: beware of the embolus’.1 Since the publication of the TAPAS trial2 in 2008 thrombus aspiration has become a useful part of the paradigm for treatment of ST elevation myocardial infarction. As demonstrated in the report by R...

Background: The DESolve Bioresorbable Coronary Scaffold is a novel drug-eluting device combining a PLLA-based scaffold coated with a bioresorbable polylactide-based polymer and the drug Myolimus. Myolimus, a macrocyclic lactone mTOR inhibitor, has demonstrated potent anti-proliferative properties in two First-in-Man (FIM) trials using Elixir's meta...

Delayed treatment of patients undergoing transfer for primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) may reduce treatment benefits compared with fibrinolysis at the referring institution. We evaluated the feasibility of helicopter transfer of Whangarei patients to Auckland City Hospital for PPCI. Cl...

Valvular heart disease is common in patients with end-stage renal disease and, if symptomatic, may lead to valve replacement surgery. However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality. Transcatheter aortic valve...

Transcatheter aortic valve implantation (TAVI) is an effective treatment for patients with severe aortic stenosis at high risk for surgical valve replacement. We present a case of successful, off-label transfemoral valve-in-valve implantation of the self-expandable Medtronic-CoreValve prosthesis in an inoperable elderly patient with structural dete...

This study sought to determine the accuracy of Doppler echocardiography and tissue Doppler imaging (TDI) measurements in detecting elevated left atrial pressure (LAP) in ambulant subjects with chronic heart failure using directly measured LAP as the reference. Echocardiographic indexes including the ratio of transmitral to annular early diastolic v...

Novolimus, a macrocyclic lactone with anti-proliferative properties, has a similar efficacy to currently available agents; however it requires a lower dose, and less polymer, and is therefore conceivably safer. The EXCELLA II study was a prospective, multicentre, single-blind, non-inferiority clinical trial which randomised 210 patients with a maxi...

Our aim was to assess whether a higher clopidogrel maintenance dose has a greater antiplatelet effect in CYP2C19*2 allele carriers compared with noncarriers. Clopidogrel is a prodrug that is biotransformed by the cytochrome P450 enzymes CYP2C19, 2C9, and 3A4, 2B6, 1A2. The CYPC219*2 loss of function variant has been associated with a reduced antipl...

The aim of this study was to determine the safety and efficacy of a novel pimecrolimus-eluting stent in a porcine coronary model and in a phase I clinical trial. Rapamycin- and paclitaxel-eluting stents reduce the need for repeat intervention by limiting neointimal hyperplasia but might cause delayed healing, pre-disposing patients to late stent th...

Limited data are available on the changes that occur at the dilated site many years after coronary balloon angioplasty. The development of bioabsorbable stents may increase the importance of understanding the long term changes that occur in an unscaffolded coronary artery following balloon-mediated injury. This study evaluated, by serial quantitati...

This study evaluated the antiplatelet effect of a higher loading and maintenance dose regimen of clopidogrel and a possible drug interaction with verapamil. Clopidogrel loading doses above 600 mg have not resulted in more rapid or complete platelet inhibition. Higher maintenance dosages may be more effective than 75 mg/day. A double-blind, randomiz...

This study assessed the effect of pharmacogenetics on the antiplatelet effect of clopidogrel. Variability in clopidogrel response might be influenced by polymorphisms in genes coding for drug metabolism enzymes (cytochrome P450 [CYP] family), transport proteins (P-glycoprotein) and/or target proteins for the drug (adenosine diphosphate-receptor P2Y...

Objectives This study assessed the effect of pharmacogenetics on the antiplatelet effect of clopidogrel. Background Variability in clopidogrel response might be influenced by polymorphisms in genes coding for drug metabolism enzymes (cytochrome P450 [CYP] family), transport proteins (P-glycoprotein) and/or target proteins for the drug (adenosine di...

Patients with large intracoronary thrombi represent a difficult management problem for the interventional cardiologist. We report 10 cases of challenging thrombi treated percutaneously using varying combinations of deep guide catheter engagement, guide aspiration, dedicated catheter aspiration and withdrawal of a distal filter vascular protection d...

This study provides insights into "crush" coronary bifurcation stenting through imaging of bench deployments. Although the strategy of provisional side-branch stenting is widely accepted for suitable bifurcation lesions, there is no consensus on the best option for elective stenting with 2 stents. The crush technique has the potential to scaffold a...

BACKGROUND There is considerable variation in use of pain relief for managing pain or discomfort of femoral sheath removal. Efficacy of pain relief to promote comfort during this procedure or to reduce the incidence of vascular and procedural complications has not been established. OBJECTIVES Assess efficacy of pain relief used to manage pain of fe...

We sought to define clinical and angiographic variables that may predict patients and lesions at increased risk for distal embolism during percutaneous intervention (PCI), as assessed by debris retrieval from a distal-protection filter device. Distal thrombo- and atheroembolism may contribute to periprocedural myocardial necrosis during PCI, which...

We describe a case of coronary artery perforation in a 76-year-old man, successfully treated by tris-acryl gelatin microsphere embolisation. This novel interventional embolic material is used in interventional radiology for arterial embolisation. We believe that this is the first report of its use for a coronary artery perforation.

Adrenaline is vital in the treatment of severe allergic reactions (anaphylaxis), however it is often underutilised or inappropriately administered. Adrenaline treatment is not without risk and most adverse reactions to adrenaline occur when it is given in overdose or as an intravenous bolus. We report a case of myocardial injury and hypotension fol...

Existing methods of venous access for permanent pacemaker leads have disadvantages. We documented learning times for ultrasound-guided lead implantation and compared them with cephalic venotomy technique. Two implanters learnt ultrasound-guided technique by implanting consecutive pacemaker patients. When procedural times stabilized, we reverted to...

We evaluated the effectiveness of manual pressure hemostasis after transfemoral coronary angiography in patients on therapeutic warfarin anticoagulation (international normalized ratio [INR] 2.0 to 3.0) compared with discontinuing warfarin > or =48 hours before the procedure (INR <2.0). There was a low incidence of small hematomas with either strat...

The objective of this study was to bench-test provisional bifurcation stenting strategies to provide insights on how best to perform these with drug-eluting stents (DESs). Bifurcation stenting with DESs reduces restenosis compared with bare metal stents (BMSs). Outcomes with a single DES are better than with two DESs but if the main branch is stent...