Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA ...dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH‐DUAL (Watchman 2.5 Versus Watchman FLX in a Dual‐Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre‐ and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3‐dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 range, 72.0–83.0 years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43–64) days. The landing zone area (median, 446 range, 363–523 versus 290 222–366 mm 2 ; P <0.001) and minimal diameter (median, 23.0 range, 20.7–24.8 versus 16.7 14.7–19.4 mm; P <0.001) significantly increased after implantation. The absolute (median, 157 range, 98–220 versus 85 18–148 mm 2 , P <0.001) and relative (median, 50% range, 32%–79% versus 26% 4%–50%; P <0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
Abstract
Background
The ACURATE
neo
™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) is predominantly implanted via femoral access. Transcarotid use of this prothesis has ...never been reported.
Case presentation
We present the case of an 89-year-old woman referred to us for a transcatheter aortic valve replacement (TAVR). After apparatus imaging of the aortic annulus and the peripheral vascular pathway, the heart team was confronted with a triple challenge: (i) The preferable choice of a self-expanding valve because of a small aortic annulus in an obese woman. (ii) Gaining favorable access to the coronary ostia, considering multiple recent coronary stenting. (iii) Utilizing an alternative arterial access because of iliac and femoral severely calcified stenosis. Implanting the ACURATE
neo
™ transcatheter heart valve (THV) via carotidal access allowed us to overcome these challenges. The procedure was performed successfully without any short-term complications.
Conclusion
We report the first case of implantation of an ACURATE
neo
™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) via the right common carotid artery.
Objectives. The aim of this postmarket clinical study was to assess the safety and efficacy of the latest generation polymer-free sirolimus-eluting stents (PF-SES) in an all-comers population ...comparing outcomes in stable coronary artery disease (CAD) versus acute coronary syndrome (ACS) in France. Background. The efficacy and safety of the first-generation PF-SES have already been demonstrated by randomized controlled trials and “all-comers” observational studies. Methods. For this all-comers observational, prospective, multicenter study, 1456 patients were recruited in 22 French centers. The primary endpoint was target lesion revascularization (TLR) rate at 12 months and secondary endpoints included major adverse cardiac events (MACE) and bleeding. Results. 895 patients had stable CAD and 561 had ACS. At 12 months, 2% of patients had a TLR, with similar rates between stable CAD and ACS (1.9% vs 2.2%, p = 0.7). The overall MACE rate was 5.2% with an expected higher rate in patients with ACS as compared to those with stable CAD (7.3% vs 3.9%, p = 0.007). The overall bleeding event rate was 4.5%, with similar rates in stable CAD as compared to ACS patients (3.8% vs 5.6%, p = 0.3). Dual antiplatelet therapy (DAPT) interruptions prior to the recommended duration occurred in 41.7% of patients with no increase in MACE rates as compared to patients who did not prematurely interrupt DAPT (3.9% vs 6.1%, p = 0.073). Conclusions. The latest generation PF-SES is associated with low clinical event rates in these all-comers patients. There was a high rate of prematurely terminated DAPT, without any effect on MACE at 12 months. This trial is registered with NCT03809715.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular graft implantation. We ...report the short- and long-term outcomes of the procedure. (Level of Difficulty: Advanced.)
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An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular…
Background
Vascular complications increase morbidity and mortality in transcatheter aortic valve replacement (TAVR). Data involving suture‐based percutaneous vascular closure devices (VCDs) have been ...extensive. Although promising, data regarding the efficacy and safety of the MANTA VCD (Teleflex) are scarce. We sought to assess the safety and effectiveness of the MANTA device in a real‐life unselected cohort of patients undergoing transfemoral‐TAVR (TF‐TAVR).
Methods
This single‐center retrospective observational study included a cohort of consecutive patients with severe aortic stenosis (AS) treated by our team using TAVR between January 2020 to December 2022. The primary outcome measure was access‐related major and minor vascular complications according to the Valve Academic Research Consortium (VARC‐3) definition criteria.
Results
From January 2020 to December 2022, a total of 347 patients underwent TF‐TAVR were treated using the MANTA 18 Fr VCD system for vascular closure. Mean age was 82.4 ± 6.1 years (56–98 years). There were no significant differences in preoperative and procedural characteristics between patients with and without VCD‐related major vascular complications. Access site‐related major and minor vascular complications occurred in 20 of 347 patients (5.7%). Overall, major vascular complications occurred in 5 patients (1.4%) and device failure was seen in 17 patients (4.9%).
Conclusion
This French real world evaluation of large‐bore arteriotomy closure in TF‐TAVR indicated that MANTA VCD is a feasible alternative with an acceptable low rate of access‐site‐related complications.
No studies have compared Watchman 2.5 (W2.5) with Watchman FLX (FLX) devices to date. We aimed at comparing the FLX with W2.5 devices with respect to clinical outcomes, left atrial appendage (LAA) ...sealing properties and device-related thrombus (DRT).
All consecutive left atrial appendage closure (LAAC) procedures performed at two European centres between November 2017 and February 2021 were included. Procedure-related complications and net adverse cardiovascular events (NACE) at 6 months after LAAC were recorded. At 45-day computed tomography (CT) follow-up, intra- (IDL) and peri- (PDL) device leak, residual patent neck area (RPNA), and DRT were assessed by a Corelab. Out of 144 LAAC consecutive procedures, 71 and 73 interventions were performed using W2.5 and FLX devices, respectively. There were no differences in terms of procedure-related complications (4.2% vs. 2.7%, P = 0.626). At 45-day CT, the FLX was associated with lower frequency of IDL 21.3% vs. 40.0%; P = 0.032; odds ratio (OR): 0.375; 95% confidence interval (CI): 0.160-0.876; P = 0.024, similar rate of PDL (29.5% vs. 42.0%; P = 0.170), and smaller RPNA 6 (0-36) vs. 40 (6-115) mm2; P = 0.001; OR: 0.240; 95% CI: 0.100-0.577; P = 0.001 compared with the W2.5 group. At 45 days, rate of DRT as detected by CT and/or transoesophageal echocardiography (TOE), was higher with W2.5 (6.0% vs. 0%, P = 0.045). At 6-month follow-up, NACE did not differ between groups.
In this cohort of consecutive LAACs, FLX as compared to W2.5, was associated with similar procedure-related complications and 6-month NACE, but with improved LAA neck coverage, and lower IDL and DRT.
Les calcifications coronaires sont fréquemment identifiées au sein des lésions coronaires et leur incidence augmente avec l’âge et les facteurs de risque cardiovasculaires. Leur localisation peut ...être superficielle ou profonde, correspondant à des physiopathologies différentes. Dans tous les cas, la présence de calcifications au sein de la paroi vasculaire est un facteur de mauvais pronostic clinique et d’évolution défavorable après revascularisation percutanée. Les calcifications coronaires peuvent être analysées par angiographie, scanner ou imagerie endocoronaire (IVUS ou OCT) avec des performances variables. L'angiographie est la méthode la plus utilisée mais est peu sensible (sensibilité proche de 50 %) et insuffisante pour leur quantification précise. Le scanner est une méthode non invasive plus efficace permettant une bonne analyse de la lésion avant coronarographie. L'IVUS et l'OCT sont, grâce à leur résolution spatiale, les méthodes les plus sensibles pour l'identification des calcifications (présents dans près de 75–80 % des lésions) et leur quantification. Ces deux dernières techniques offrent des perspectives intéressantes pour l'identification des lésions les plus à risque de mauvais pronostic post revascularisation, la planification des procédures d'angioplastie (dont le choix des outils de préparation de plaque), le monitorage de leur exécution et l’évaluation du résultat post-stenting immédiat.
Coronary calcifications are frequently identified within coronary lesions as their incidence increases with age and cardiovascular risk factors. Their location can be superficial or deep, according to different pathological process. In all cases, the presence of calcifications within the vascular wall predicts poor clinical prognosis and unfavorable evolution after percutaneous revascularization. Coronary calcifications can be analyzed by angiography, CT or intracoronary imaging (IVUS or OCT) with variable accuracies. Angiography is the most frequently used method but is not very sensitive (sensitivity close to 50%) and insufficient for their precise quantification. The CT scan is a more effective non-invasive method leading to an accurate analysis of the lesion before coronary angiography. IVUS and OCT have an excellent spatial resolution and are the most sensitive methods for the identification (present in nearly 75–80% of lesions) and quantification of calcifications. These intracoronary imaging techniques offer interesting perspectives for identification of the highest-risk lesions, PCI procedures planning (including the choice of an optimal dedicated plaque preparation devices), the monitoring of their execution and the evaluation of the immediate post-stenting results.
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