To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals.
...We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach.
We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation SD
±
8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD
±
16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7
mmHg (SD
±
21.5) to 15.8
mmHg (SD
±
5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD
±
3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%).
The axillary approach for transcatheter aortic valve implantation using the CoreValve
® and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality.
Validar el acceso axilar como una opción eficaz y segura para el implante percutáneo de válvula aórtica percutánea CoreValve
®, en pacientes con contraindicación para el acceso femoral, en tres hospitales españoles.
Incluimos a pacientes con estenosis aórtica severa sintomática y alto riesgo quirúrgico o contraindicación para cirugía, seleccionados por un equipo multidisciplinario para implante percutáneo de válvula aórtica; además, los pacientes tenían contraindicación para el abordaje arterial femoral.
Incluimos a 19 de los 186 pacientes (10,2%) a los que se implantó una válvula percutánea entre noviembre de 2008 y marzo de 2010. La media de edad era 78,3
±
8,65 años y el 73,7% eran varones. El EuroSCORE logístico medio de la muestra fue del 28,7%
±
16,3%. La tasa de éxito de implante fue del 100%. Tras el implante, el gradiente transvalvular máximo pasó de 81,7
±
21,5 a 15,8
±
5,5 mmHg, y ningún paciente presentó insuficiencia aórtica residual > 2. La mortalidad total, con un seguimiento medio de 9,2
±
3,2 meses, fue del 10,5%, con nula mortalidad intraoperatoria y a los 30 días. La incidencia total de complicaciones mayores atribuibles al procedimiento fue del 15,7%. Se implantó marcapasos definitivo por bloqueo auriculoventricular en 8 pacientes (44,4%).
El uso del acceso axilar en pacientes seleccionados para implante percutáneo de válvula aórtica CoreValve
® con contraindicación para el acceso femoral es seguro y eficaz y proporciona excelentes resultados en términos de éxito del implante y mortalidad, tanto intrahospitalaria como a los 30 días.
An association has been reported between direct stenting in primary angioplasty and low incidences of the no-reflow phenomenon and distal embolization. The aims of this study were to determine the ...proportion of patients who can be treated by direct stent implantation and to identify factors that establish when the technique should be used in acute myocardial infarction in clinical practice.
This prospective descriptive and multicenter study (DISCO 3) included 189 patients. Angiographic reperfusion parameters were recorded and resolution of the ST-segment elevation was monitored. Adverse clinical events, such as death, non-fatal reinfarction and repeat revascularization of the culprit vessel, were recorded at discharge, and after 1 and 6 months.
Direct stenting was performed in 56% of patients, and stenting after predilatation in 44%. The main predictors of direct stenting were short postinfarction delay, non-zero initial TIMI flow, and preinfarction angina. The most common reasons for balloon predilatation were TIMI flow zero on traversing the lesion with a guidewire (92%), involvement of a major bifurcation or tortuous vessel, and severe calcification. Indices of myocardial reperfusion were better with direct stenting: TIMI myocardial perfusion grade 2–3 flow was present in 84% vs 69% (
P=.005), and >70% ST-segment resolution occurred in 66% vs 42% (
P=.003). No difference in adverse clinical events was found.
Direct stenting is feasible for treating acute myocardial infarction in more than half of patients. The lesions should not be severely calcified nor involve tortuous vessels, and there should be sufficient flow following passage of a guidewire to define the lesion's characteristics.
El implante directo del
stent en la angioplastia primaria se ha asociado con una menor incidencia de no reflujo y embolización distal. El objetivo de este estudio fue evaluar la proporción de pacientes que puede ser tratada y los factores que determinan la implantación directa del
stent en el infarto agudo de miocardio en la práctica habitual.
Se incluyó a 189 pacientes en este estudio descriptivo, prospectivo y multicéntrico (DISCO 3). Se analizaron los resultados angiográficos y de resolución de la elevación del segmento ST. Se registraron los acontecimientos clínicos (muerte, reinfarto no mortal y nueva revascularización del vaso causante) en el momento del alta, al mes y a los 6 meses.
Se trató con
stent directo (SD) al 56% de los pacientes y con
stent tras predilatación (SP) al 44%. Los mejores predictores de SD fueron: menor tiempo de evolución del infarto, flujo TIMI inicial distinto de 0 y presencia de angina preinfarto. Los motivos para la predilatación fueron: presencia de un flujo TIMI 0 tras cruzar la lesión (92%), bifurcación mayor, calcificación y tortuosidad severas. Los índices de reperfusión miocárdica fueron mejores en el grupo de SD, con un grado de perfusión miocárdica TIMI 2–3 (el 84 frente al 69%; p = 0,005) y una resolución del segmento ST > 70% (el 66 frente al 42%; p = 0,003). No hubo diferencias significativas en la presencia de eventos clínicos adversos en el seguimiento.
El uso del SD en el tratamiento del infarto agudo de miocardio de menos de 12 h de evolución es factible en más de la mitad de los casos, cuando las lesiones no presentan calcificación y/o tortuosidad severas, y cuando se consigue, tras el paso de la guía, un flujo mínimo que permita definir las características de la lesión.
INTRODUCTION AND OBJECTIVESPercutaneous aortic valve implantation for patients with severe symptomatic aortic stenosis and a high surgical risk is currently well established. We report our experience ...in terms of safety and effectiveness of transcatheter aortic valve implantation in other clinical context like the degenerated aortic homografts.METHODSWe report our initial experience in four hospitals and five patients with degenerated aortic homograft and severe aortic regurgitation, refused for surgery for a heart team, that underwent percutaneous implantation of CoreValve(®) aortic prosthesis.RESULTSWe included three males and two females. The mean age was 70 (3.5) years. All patients were symptomatic in New York Heart Association class III or IV. Procedures were performed through one of the femoral arteries in all patients and under sedation in three patients. The implant was successfully carried out in all cases. There were no major complications during the procedure or admission and the valvular defect was solved in all cases. In-hospital and 30-days mortality was 0. All patients had clinical improvement during follow-up with a reduction in at less two grades in the New York Heart Association functional scale.CONCLUSIONSIn our experience the treatment of degenerated aortic homografts and aortic insufficiency with transcatheter aortic valve implantation showed to be safe and effective. The current challenge is to convey the good results of transcatheter aortic valve implantation in symptomatic aortic stenosis and high surgical risk to others disorders of the aortic valve. In the future, it is possible that transcatheter aortic valve implantation will expand its indications to majority of aortic valve disorders and patients with less surgical risk.
Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique Galvão Braga, Carlos; Ocaranza-Sánchez, Raymundo; Gestal, Santiago ...
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology,
11/2016, Letnik:
35, Številka:
11
Report
Optical coherence tomography images of three different overlapping stents Abellás-Sequeiros, Rosa Alba; Ocaranza-Sánchez, Raymundo; Trillo-Nouche, Ramiro ...
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology,
07/2016, Letnik:
35, Številka:
7-8
Report
PDF