Archive for the ‘Medical Devices R&D and Inventions’ Category

Renowned Electrophysiologist Dr. Arthur Moss Died on February 14, 2018 at 86

Reporter: Aviva Lev-Ari, PhD, RN


— Stephen

Dr. Moss never lost the opportunity to get to know who an individual is by name, to complement one, to greet one, to teach one, to be available, and to show respect. His contributions to clinical medicine, patient care and physician education, along with pivotal research, is among the ver most notable of our era. I will miss him greatly and extend my most heartfelt gratitude to him and his family.

Stephen Winters, MD
Morristown Medical Center

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Renowned Cardiologist Arthur J. Moss, Pioneer of Research and Treatment in Sudden Death, Passes Away

Friday, February 16, 2018

Arthur J. Moss, M.D.

Arthur J. Moss, M.D.

Cardiologist Arthur J. Moss, whose research saved hundreds of thousands of lives and improved the standard of care for legions of people with heart disease, died on February 14, 2018. He was 86.

During a career spanning six decades, Moss made some of the most significant and long-lasting discoveries in the prevention and treatment of sudden cardiac death. His astounding accomplishments in scientific research and clinical care stemmed especially from his special devotion to patients; he understood the importance of listening, building trust and working together to bring about change. He was also a skilled leader, able to foster meaningful collaborations that led to some of the most productive clinical trials in all of cardiology.

“Arthur was a man of absolute integrity, both of science and of character, and an amazing visionary who could see where the field of electrophysiology was headed long before others,” said Wojciech Zareba, M.D., Ph.D.,director of the Heart Research Follow-up Program at the University of Rochester Medical Center, who worked closely with Moss for the past 26 years. “He was eternally optimistic in all aspects of his life; he brought a positive attitude to everything he did and didn’t worry about the small stuff, which helped him accomplish great things.”

In 1958, as an intern at Massachusetts General Hospital, Moss planned to pursue a career in hematology. That summer he was called to serve in the United States Navy. When he arrived in Pensacola, Fla., his commanding officers thought he was a cardiologist, for reasons unbeknownst to him. They asked Moss to teach flight surgeons electrocardiography, a test known as an EKG that checks the electrical activity of the heart. Undaunted, he read multiple books on the topic and taught them. The intricacy of the heart’s electrical activity captured Moss’ interest and he never looked back.

Moss spent the first half of his career figuring out which patients were at high risk of sudden cardiac death and the second half finding the best ways to treat them. He became an eminent authority on common arrhythmias that afflict hundreds of thousands of adults with heart disease and often lead to sudden death, as well as rare heart rhythm disorders that are smaller in number but no less deadly.

An unexpected patient visit in 1970 started what Moss called the most rewarding part of his career: his life-long quest to help individuals with Long QT syndrome (LQTS). Doctors could not understand why this patient – a woman in her 30s – would suddenly fall unconscious when she got excited while bowling. An unusual EKG led Moss, then a young cardiologist at URMC, to diagnose LQTS. An uncommon genetic condition caused by a glitch in the heart’s electrical system, LQTS puts patients at high risk of arrhythmias, fainting spells and sudden death.

Moss devised the first effective surgical treatment for the disorder and had the foresight to create the International Long QT Syndrome Registry in 1979, one of the first rare disease registries in the world. The registry allowed Moss and colleagues to identify risk factors that enable early diagnosis; develop multiple treatment options that have achieved an 80 percent reduction in life-threatening events; and contribute to the discovery of multiple genes associated with the disorder. The National Institutes of Health has supported the registry since its creation, and in 2014 Moss received a NIH grant to fund the registry and associated research projects through 2019.

“Not only was Arthur extraordinary in understanding the immediate problem, but he was also visionary in that long before we knew how to analyze genes he started the registry and preserved blood samples that could be used in the future,” said Mark B. Taubman, M.D., CEO of URMC and dean of the School of Medicine and Dentistry. “The registry has become one of the most important repositories in the world, helping prevent thousands of untimely deaths from Long QT and enabling the in-depth investigation of how genetics influence a form of heart disease. The impact of his work is unparalleled.”

Beginning in the 1990s, Moss led the MADIT (Multicenter Automatic Defibrillator Implantation Trial) series of clinical trials, which showed that the implantable cardioverter defibrillator or ICD – a device that detects arrhythmias and shocks the heart back into a normal rhythm – significantly reduces the risk of sudden death in patients who’ve experienced a heart attack. In the early 2000s these findings changed medical guidelines worldwide and led to the use of life-saving ICD therapy in hundreds of thousands of patients.

Later, in 2009, Moss completed the MADIT-CRT trial, which found that cardiac resynchronization therapy plus defibrillator – CRT-D therapy – prevents the progression of heart failure in patients living with mild forms of the disease. The device, which improves the mechanical pumping action of the heart and corrects fatal rhythms, was originally approved to treat patients with severe heart failure. Moss’ work opened the door for multitudes more patients to benefit and live longer, better lives.

“Arthur’s research was so successful and powerful because the results of his studies were usually strikingly positive or negative. This came from his rare ability to ask a simple question, and use a simple clinical trial design,” said Bradford C. Berk, M.D., Ph.D., professor of Medicine and Cardiology at URMC. “He did this so well because he was a superb clinician who had a remarkable insight into the underlying pathologic mechanisms of heart disease.”

Colleagues also credit Moss’ research success to his unique ability to bring people together, trigger discussion, and make all involved – from the highest-ranking physician to the newest graduate student or fellow – feel welcome and valued.

“I first met Art in 1976 and was at least three academic ranks lower than anyone else at the meeting,” said Henry (Hank) Greenberg, M.D., special lecturer of Epidemiology and Medicine at the Columbia University Medical Center. “Art sensed this and stated that everyone at the table contributed. This carried forward for four decades and was a reason why his trials were always superbly done. His ego did not get in the way.”

Moss was founding director of URMCs Heart Research Follow-up Program, a worldwide hub of international studies on medical interventions for sudden death, cardiac arrhythmias, heart attack and heart failure. He published more than 750 scientific papers, including a 1962 article – his first of many in the New England Journal of Medicine – highlighting the first three published cases of cardiopulmonary resuscitation (CPR), which included external chest massage followed by external defibrillation.

Charles J. Lowenstein, M.D., chief of Cardiology at URMC, said, “Arthur’s contributions to cardiac electrophysiology were vast and he was extremely well respected as a clinician and researcher. He also trained hundreds of medical students, residents, and fellows, and inspired many of us to dedicate our lives to medicine. This is his greatest legacy.”

Moss attended Yale as an undergraduate then Harvard Medical School. He interned at Massachusetts General Hospital and finished his residency in Rochester, where he also did a fellowship in cardiology. Moss joined the faculty at URMC in 1966 and stayed for the rest of his career, ultimately becoming  the Bradford C. Berk, M.D., Ph.D. Distinguished Professor in Cardiology. A valued member of the faculty, Moss received the Eastman Medal in 2012, the University of Rochester’s highest honor that recognizes individuals who, through their outstanding achievement and dedicated service, embody the high ideals for which the University stands.

On numerous other occasions, Moss was recognized locally, nationally and internationally for his tenacity and advancement of medical and cardiologic science. In 2008 he received the Glorney-Raisbeck Award in Cardiology, the highest honor of the New York Academy of Medicine. A year later he was awarded the prestigious Golden Lionel Award at the Venice International Cardiac Arrhythmias Meeting. The Heart Rhythm Society, the major international electrophysiology society, bestowed its top honor, the Distinguished Scientist Award, to Moss in 2011 and its Pioneer in Cardiac Pacing and EP Award to Moss in 2017.  

On November 11, 2017, just four months before his death, Moss was given the 2017 James B. Herrick Award at the American Heart Association’s Scientific Sessions. The award is given annually to a physician whose scientific achievements have contributed profoundly to the advancement and practice of clinical cardiology.

“Arthur’s passing is very sad news for the world of cardiology and clinical trials,” said David Cannom, director of Cardiology at Good Samaritan Hospital in Los Angeles. “There was no one quite like Arthur in terms of intelligence, judgement, leadership skills and thoughtful friendship. Plus good humor. An era is closing and he will be sorely missed.”  Other colleagues from around the world described him as a “true giant” in the field, a “role model,” and a “pioneer.”

Moss’s daughter Deborah, herself a physician, was always inspired by her dad’s curiosity, creativity and perseverance. “He paid close attention to his patients, their stories and their situations, and generated research questions that would make a difference not just for one patient, but for many patients. He was bold, never afraid to try something new, and wouldn’t stop until he solved a problem. Looking back on the entirety of his career, it was really incredible.”

Moss is survived by his wife Joy F. Moss, three children – Katherine M. Lowengrub, M.D., instructor in Psychiatry at the Sackler School of Medicine in Tel Aviv, Israel; Deborah R. Moss, M.D., M.P.H., associate professor of Pediatrics at the University of Pittsburgh Medical Center; and David A. Moss, Ph.D., professor at Harvard Business School – and nine grandchildren and two great-grandchildren. A memorial service will take place at Temple B’rith Kodesh on Elmwood Ave at 11 a.m. on Sunday, February 18. In lieu of flowers, donations may be sent to:

UR Heart Research Follow-Up Program

Alumni & Advancement Center

300 East River Rd. P.O. Box 270032

Rochester, NY 14627


His legacy is a career spanning more than 60 years that was marked by major contributions to cardiac electrophysiology, including the first surgical treatment for long QT syndrome and his leadership in the MADIT trials showing that an implantable cardioverter defibrillator could reduce the risk of sudden cardiac death.

Moss started his career in risk stratification studies and evaluating the potential of ventricular arrhythmias, according to longtime colleague Sanjeev Saksena, MD, past president of the North American Society of Pacing and Electrophysiology. Sakesna said that in 1983 Moss published “pivotal studies on risk stratification after myocardial infarction that led to his recognition as a leader in this field and was famously covered by TIME magazine for these contributions.”

Saksena also noted his early support of Michel Mirowski’s concept of an implanted standby defibrillator. This support, Saksena said “made him a lone voice arguing against the medical establishment more than 40 years ago for development of a therapy that is now a cornerstone of cardiovascular medicine.”

Douglas Zipes, MD, Past President, American College of Cardiology: “Wonderful man, scientist. He was the gold standard role model for the clinician investigator: he took care of patients and advanced the science of cardiology. A great loss, but his observations will live on.”

Robert Myerberg, MD, Professor of Medicine, University of Miami: “Art Moss had had an incredibly productive career. His dominant characteristic was a lack of fear of stepping into areas where there were gaps in our knowledge or untested hypotheses, and find a way to get us on to a path that would ultimately answer important and practical questions … His impact will continue to be felt long into the future. And on a personal level, his warmth and collegiality will be missed by his friends and colleagues.”

Bernard Gersh, MD, Professor of Medicine, Mayo Clinic: “Major contributions to our understanding of the long QT syndrome and the PI [principal investigator] of the major trials that established the clinical role of the ICD.”

Richard L. Page, MD, Chair, Department of Medicine, University of Wisconsin, School of Medicine & Public Health: “Arthur Moss was a consummate professional, gentleman, scholar, and physician. He was a role model for me and for a generation of cardiologists.”

Jagmeet P. Singh MD, Roman W. DeSanctis Endowed Chair in Cardiology, Massachusetts General Hospital Heart Center: “A huge loss for our community. He was my mentor.”


Eminent Cardiologist Arthur Moss Dies

Tributes to a giant in electrophysiology


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Tommy King Memorial Cardiovascular Symposium

Saturday CEUs in Boston, May 20

St. Elizabeth’s Medical Center

Boston, MA

May 20

7:30am – 3pm


07:30am | Registration & Continental Breakfast

08:00am | Hemodynamics; Faisal Khan, MD, St. Elizabeth’s Medical Center

09:00am | Radiation Protection; Satish Nair, PhD, F.X. Masse Associates

10:00am | Break & Exhibits

10:15am | Structural Heart – TAVR Updates and Watchman

Joseph Carrozza, MD, St. Elizabeth’s Medical Center

11:15am | Road to the Cath Lab — Triggers for STEMI Activation 

Lawrence Garcia, MD, St. Elizabeth’s Medical Center

12:15pm | Lunch

01:00pm | HF Program including Cardiomems

Lana Tsao, MD & Jaclyn Mayer, NP, St. Elizabeth’s Medical Center

02:00pm | Cath Lab Pharmacology

Mirembe Reed, Pharm.D, St. Elizabeth’s Medical Center

Register now »


From: <> on behalf of “Kurt, ACVP” <>

Reply-To: <>

Date: Monday, April 24, 2017 at 2:26 PM

To: Aviva Lev-Ari <>

Subject: cardiovascular symposium in Boston, May 20

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ACC 2017, 3/30/2017 – Poor Outcomes for Bioresorbable Stents in Small Coronary Arteries



Bioresorbable Stent Comparable to Xience at Two Years, With Concerns


Stephen Ellis, M.D., professor of medicine and director of interventional cardiology at Cleveland Clinic, discusses the two year outcomes of the ABSORB III trial of Absorb vs. Xience. The late-breaking trial was presented at ACC 2017. Read the article on the ABSORB III results.  Watch a VIDEO with Gregg Stone, M.D., “Poor Outcomes for Bioresorbable Stents in Small Coronary Arteries.”



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Reporter and Curator: Dr. Sudipta Saha, Ph.D.


Low sperm count and motility are markers for male infertility, a condition that is actually a neglected health issue worldwide, according to the World Health Organization. Researchers at Harvard Medical School have developed a very low cost device that can attach to a cell phone and provides a quick and easy semen analysis. The device is still under development, but a study of the machine’s capabilities concludes that it is just as accurate as the elaborate high cost computer-assisted semen analysis machines costing tens of thousands of dollars in measuring sperm concentration, sperm motility, total sperm count and total motile cells.


The Harvard team isn’t the first to develop an at-home fertility test for men, but they are the first to be able to determine sperm concentration as well as motility. The scientists compared the smart phone sperm tracker to current lab equipment by analyzing the same semen samples side by side. They analyzed over 350 semen samples of both infertile and fertile men. The smart phone system was able to identify abnormal sperm samples with 98 percent accuracy. The results of the study were published in the journal named Science Translational Medicine.


The device uses an optical attachment for magnification and a disposable microchip for handling the semen sample. With two lenses that require no manual focusing and an inexpensive battery, it slides onto the smart phone’s camera. Total cost for manufacturing the equipment: $4.45, including $3.59 for the optical attachment and 86 cents for the disposable micro-fluidic chip that contains the semen sample.


The software of the app is designed with a simple interface that guides the user through the test with onscreen prompts. After the sample is inserted, the app can photograph it, create a video and report the results in less than five seconds. The test results are stored on the phone so that semen quality can be monitored over time. The device is under consideration for approval from the Food and Drug Administration within the next two years.


With this device at home, a man can avoid the embarrassment and stress of providing a sample in a doctor’s clinic. The device could also be useful for men who get vasectomies, who are supposed to return to the urologist for semen analysis twice in the six months after the procedure. Compliance is typically poor, but with this device, a man could perform his own semen analysis at home and email the result to the urologist. This will make sperm analysis available in the privacy of our home and as easy as a home pregnancy test or blood sugar test.


The device costs about $5 to make in the lab and can be made available in the market at lower than $50 initially. This low cost could help provide much-needed infertility care in developing or underdeveloped nations, which often lack the resources for currently available diagnostics.




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Cheetah Medical Introduces New Algorithm for Fluid Management

Reporter: Lawrence J Mulligan, PhD


Cheetah Medical Advances the Science of Fluid Management

Cheetah Medical is the pioneer and leading global provider of 100% noninvasive hemodynamic monitoring technologies that are designed for use in critical care, OR and emergency department settings. The CHEETAH NICOM™ and STARLING™ SV technologies use a proprietary algorithm to calculate parameters related to the volume of blood and the functioning of patients’ circulatory systems. Medical professionals use this information to assess patients’ unique volume requirements, guide volume management decisions and maintain adequate organ perfusion. Cheetah Medical technologies are designed to enable more confident, informed therapy decisions that support clinical goals of improving patient outcomes and driving economic efficiencies.

NEWTON, Mass. –(BUSINESS WIRE)– Cheetah Medical announced today that its eighth abstract on fluid management will be presented at Society of Critical Care Medicine meeting in January. Building on previous work, this abstract demonstrates a strong association between large volume fluid administration in septic shock and increased risk of death in more than 23,000 patients.

Each year, millions of patients require hemodynamic monitoring to ensure optimal volume and perfusion management. While intravenous fluid is typical first-line therapy for many critical care situations, volume management has been a challenge for the healthcare community. It is often difficult for a clinician to know the right amount of fluid to administer to patients, and there are serious complications associated with both under and over resuscitation.

“Ever since we’ve been using intravenous fluid, clinicians have been asking, ‘What is the right amount?’” said Doug Hansell, MD and Cheetah’s Chief Physician Executive. “Today, with non-invasive Cheetah technology, we have new tools to answer this question, and we are learning that getting this question right is more important than ever.”

Cheetah Medical has been working with leading researchers using a large U.S. dataset to better understand the risks and benefits of fluid administration. During the past two years, researchers have now released eight clinical abstracts on the importance of fluid management.

  • FLUID ADMINISTRATION IN SEPSIS AND SEPTIC SHOCK – PATTERNS AND OUTCOMES: Sepsis and septic shock is a huge national priority, as it is the most expensive condition to treat, at $24 billion per year (AHRQ). This study identified a strong association between large fluid administration (more than five liters) and excess mortality in septic shock patients. As expected, sicker patients received more fluid. However, even after accounting for the severity of illness, these patients had an increased risk of dying. (Society of Critical Care Medicine Annual Conference, January 2017)
  • FLUID ADMINISTRATION IN OPEN AND LAPAROSCOPIC ABDOMINAL SURGERY: The study looked at the relationship between intraoperative fluid therapy and complications following abdominal surgery.Based on data from 18,633 patients, an increase in complications was found with day-of-surgery fluid use above five liters for open abdominal procedures. The study recommended individualized fluid therapy to reduce potentially negative effects from over/under resuscitation with intravenous fluids. (American Society of Anesthesiologists [ASA] 2016 Annual Meeting)
  • FLUID PRESCRIPTIONS IN HOSPITALIZED PATIENTS WITH RENAL FAILURE: The implication of volume resuscitation and potential complications among patients with acute kidney injuries (AKIs) has been widely debated. This study examined the relationship between fluid administration and outcomesamong 62,695 AKI patients. It found the potential for both under and over resuscitation in those who received treatments with vasopressors. A better understanding of individual fluid needs was seen for patients requiring pressor and mechanical ventilation support. (European Society of Intensive Care Medicine [ESICM] Annual Congress, 2016)
  • EFFECTS OF FLUIDS ADMINISTRATION IN PATIENTS WITH SEPTIC SHOCK WITH OR WITHOUT HEART FAILURE (HF): The study examined the relationship between indications of fluid overload in sepsis patients (with or without diastolic HF) and outcomes. For 29,098 patients, mortality was the highest among those who received the highest volumes of fluid. It also noted that patients with diagnosed diastolic HF received less fluids and exhibited a significantly lower mortality than predicted. These lower mortality rates could be a result of a more conservative fluid treatment strategy applied in patients known to be at risk for fluid overload. (American Thoracic Society [ATS] 2016 International Conference)
  • WIDE PRACTICE VARIABILITY IN FLUID RESUSCITATION OF CRITICALLY ILL PATIENTS WITH ARDS: The study looked at how variable fluid resuscitation testing and treatments impacted the outcomes of patients with acute respiratory distress syndrome (ARDS). An analysis of 1,052 patients highlighted a highly variable fluid resuscitation. The findings suggest a widespread variability in provider decision-making regarding fluid resuscitation, which may be detrimental to quality and costs, lowering the overall value of care. (American Thoracic Society [ATS] 2016 International Conference)
  • POTENTIAL HARM ASSOCIATED WITH SEVERITY-ADJUSTED TREATMENT VARIABILITY IN FLUID RESUSCITATION OF CRITICALLY ILL SEPTIC PATIENTS: The study set out to determine treatment variability for patients with severe sepsis and how it may impact mortality. Retrospectively analyzing 77,032 patients, a high degree of treatment variability was found for fluid resuscitation, with a range of 250 ml to more than 7L of fluid administered. For patients who received less fluid, there was no increased risk of mortality. In those who received the most fluid, there was a strong association with worse hospital mortality. (American Thoracic Society [ATS] 2016 International Conference)
  • ASSOCIATION OF FLUIDS AND OUTCOMES IN EMERGENCY DEPARTMENT PATIENTS HOSPITALIZED WITH COMMUNITY-ACQUIRED PNEUMONIA (CAP): Analyzing 192,806 CAP patients, the study looked at the correlation between fluid-volume overload, hospital mortality and ventilator-free days (VFDs). A significant association was found between the amount of fluid administered on day one, increased mortality and decreased VFDs. The study may have also identified a subset of CAP patients who could benefit from a more restrictive fluid strategy. (36thInternational Symposium on Intensive Care and Emergency Medicine)
  • FLUID ADMINISTRATION IN COMMUNITY-ACQUIRED SEPSISEXAMINATION OF A LARGE ADMINISTRATIVE DATABASE: The study looked at variation in fluid administration practices and compliance with “Surviving Sepsis” guidelines, which recommend a minimum initial fluid administration of 30cc/kg in sepsis-induced tissue hypoperfusion patients. It found that a substantial proportion of patients (47.4 %) with community-acquired sepsis received less than the recommended guidelines within the first 24 hours. (Society of Critical Care Medicine Annual Conference, 2016)

“We are very proud to have supported this work – we are advancing the science of fluid management and helping to improve our understanding of how better fluid management may improve patient outcomes,” said Chris Hutchison, CEO of Cheetah Medical.




Other related articles published in this Open Access On-line Scientific Journal includes the following:

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First U.S. TAVR Patients Treated With Temporary Pacing Lead (Tempo Lead)

Reporter: Aviva Lev-Ari, PhD, RN


UPDATED on 8/2/2017

Medtronic wins FDA nod, CE Mark for Avalus aortic valve




BioTrace Medical, Inc., a venture backed company based in San Carlos, Calif., is dedicated to reinventing temporary pacing to improve patient outcomes and reduce hospital costs.

For more information:


FDA Clears Temporary Pacing Technology for Transcatheter Aortic Valve and EP Procedures

The BioTrace Medical Tempo temporary pacing lead is designed to reduce complications and hospital length of stay

The Tempo Lead represents the first major advance in temporary pacing since the technology was introduced decades ago,” said Susheel Kodali, M.D., director of the Heart Valve Program at the Center for Interventional Vascular Therapy at Columbia University Medical Center in New York. “As a critical component of every TAVR procedure, temporary leads are integral to successful clinical outcomes for patients. I am excited about the potential of this technology and look forward to using it in my practice.”

Results of the first-in-human study of the technology will be presented at the annual Transcatheter Cardiac Therapeutics (TCT) conference in Washington, D.C. on Sunday, Oct. 30, at 10:59 a.m. eastern time in Room 209, Level 2.

“FDA clearance is an exciting milestone for BioTrace,” said Laura Dietch, CEO of BioTrace Medical. “We are pleased to bring this important innovation to the significant and growing number of patients needing better temporary pacing options to minimize risks and life-threatening complications. We look forward to launching in select U.S. centers in the coming weeks.”

For more information:


December 19, 2016 — BioTrace Medical Inc. announced the first commercial use of the company’s Tempo Temporary Pacing Lead since U.S. Food and Drug Administration (FDA) 510(k) clearance in October.

The first cases involved patients undergoing transcatheter aortic valve replacement (TAVR) procedures and were performed by James Harkness, M.D., interventional cardiologist, and Brian K. Whisenant, M.D., medical director of the Structural Heart Disease Program at Intermountain Medical Center in Salt Lake City, Utah, and Susheel Kodali, M.D., director of the Heart Valve Program at Columbia University Medical Center/New York Presbyterian Hospital.

BioTrace Medical’s Tempo Lead is for use in procedures in which

  • Temporary pacing is indicated, including
  • TAVR and
  • Electrophysiology (EP) procedures.

The lead is designed for secure and stable cardiac pacing with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

“The Tempo Lead is designed to alleviate the risks associated with lead dislodgement and inconsistent pacing, providing a safer option for patients.”

Temporary leads are used in more than 350,000 procedures each year, a number that is growing rapidly as the population ages and TAVR becomes increasingly common. The temporary pacing lead, a small catheter with two electrodes, is placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for several days.


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Advanced Peripheral Artery Disease (PAD): Axillary Artery PCI for Insertion and Removal of Impella Device

Reporter: Aviva Lev-Ari, PhD, RN



July 15, 2016

Rajiv Tayal, MD, MPH1,2;  Mihir Barvalia, MD, MHA1;  Zeshan Rana, MD2;  Benjamin LeSar, MD1;  Humayun Iftikhar, MD1;  Spas Kotev, MD1;  Marc Cohen, MD1;  Najam Wasty, MD1

Abstract: Traditionally, brachial and common femoral arteries have served as access sites of choice, with many operators recently converting to radial artery access for coronary angiography and percutaneous intervention due to literature suggesting reduced bleeding risk, better patient outcomes, and lower hospital-associated costs. However, radial access has limitations when percutaneous procedures requiring larger sheath sizes are performed. Six Fr sheaths are considered the limit for safe use with the radial artery given that the typical luminal diameter of the vessel is approximately 2 mm, while peripheral artery disease (PAD) may often limit use of the common femoral artery, particularly in patients with multiple co-morbid risk factors. Similarly, the brachial artery has fallen out of favor due to both thrombotic and bleeding risks, while also not safely and reliably accommodating sheaths larger than 7 Fr. Here we describe 3 cases of a new entirely percutaneous technique utilizing the axillary artery for delivery of Impella 2.5 (13.5 Fr) and CP (14 Fr) cardiac-assist devices for protected percutaneous coronary intervention in the setting of prohibitive PAD.

J INVASIVE CARDIOL 2016;28(9):374-380. 2016 July 15 (Epub ahead of print)

Key words: axillary artery, percutaneous access, high-risk PCI



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