REC Interventional Cardiology最新文献

Introduction and objectives: Multi-fenestrated atrial septal defects (mASD) pose both diagnostic and therapeutic challenges. This study aimed to compare the outcomes of transcatheter closure in patients with mASD vs those with a single ASD at our center.

Methods: We conducted a retrospective, single-center study including adult patients who underwent transcatheter ASD closure from October 2014 through October 2024. Demographic, echocardiographic, and hemodynamic data were collected, with a the 6-month follow-up.

Results: A total of 67 patients were included, 12 of whom (18%) exhibited mASD. Patients with mASD were younger (42 vs 54 years) and more frequently presented with an interatrial septal aneurysm (91% vs 27%; P = .001). The use of multiple occlusion devices was more common in patients with mASD (34% vs 4%; P = .008). Complications were rare (5.9%) and none occurred in the mASD group. Procedural outcomes, including residual shunt and right ventricular remodeling at the follow-up, were comparable between groups.

Conclusions: Transcatheter closure of mASD is both a safe and feasible procedure, with clinical outcomes similar to those observed in patients with a single ASD.

Introduction and objectives: Ultrasound renal denervation (uRDN) has emerged as an innovative therapeutic approach for the treatment of hypertension. However, its efficacy compared to medication remains uncertain. We aimed to assess the efficacy profile of uRDN vs sham groups focusing on its impact on daytime ambulatory blood pressure, 24-hour blood pressure, home blood pressure and office blood pressure.

Methods: We conducted a systematic search across Embase, PubMed, and Cochrane Library databases from their inception up 1 November 2024 to identify randomized controlled trials evaluating the efficacy of uRDN. Statistical analyses were performed using RevMan 6.3 software, utilizing the mean and standard deviation method to calculate mean differences with a 95% confidence interval (95%CI).

Results: A total of 4 studies were included in the final analysis with 642 patients. uRDN significantly reduced daytime ambulatory systolic blood pressure (SBP) (-5.12 mmHg; 95%CI, -6.07 to -4.16; P ≤ .00001), 24-h SBP (-4.87 mmHg; 95%CI, -6.53 to -3.21]; P ≤ .00001), office SBP (-5.03 mmHg; 95%CI, -6.27 to -3.79; P ≤ .00001) and showed a decrease in patient medication 6 months after the procedure.

Conclusions: Using uRDN leads to a lower blood pressure in patients within 2 months following the procedure. Additionally, after 6 months a significant decrease in drug use is observed.This meta-analysis protocol was registered on PROSPERO on 7 July 2024 (CRD42024562852).

Introduction and objectives: Although early discharge protocols after transcatheter aortic valve implantation (TAVI) have demonstrated to be safe in various studies, they are usually applied in high-experience centers. This study analyzes the length of stay of the first 100 patients undergoing TAVI in a center without on-site cardiac surgery, differentiating between very early (< 24 hours), early (24-48 hours), and late discharge (> 48 hours). Furthermore, the study evaluates the feasibility of an early discharge protocol during the team's learning curve.

Methods: We conducted a prospective observational study from April 2022 through January 2024. A pre- and postoperative management protocol was implemented, including assessments in the Valvular Heart Disease Clinic, admission to the cardiac surgery intensive care unit with electrocardiographic monitoring, and specific discharge criteria in full compliance with an established protocol for the management of conduction disorders. Early follow-up evaluations were performed in the outpatiently after discharge.

Results: A total of 100 patients (50% women) were included, with a mean age of 82.4 ± 5.3 years and a EuroSCORE II score of 4.38 ± 5.1%. The median length of stay was 2 days (range, 1-19). A total of 27.27% of patients were discharged in < 24 hours, 48.49% within the 24-48 hours following implantation, and 24.24% 48 hours later. The 30-day cardiovascular mortality rate was 1%. A total of 6 patients were readmitted with procedural complications within the first 30 days.

Conclusions: The implementation of a standardized care protocol allows for early and safe discharge in most patients, even during the team's learning cuve.

Introduction and objectives: Because of the potential need for permanent pacemaker implantation, patients are frequently monitored for days after transcatheter aortic valve implantation (TAVI), particularly when using self-expanding valves. We sought to determine whether the appearance and management of conduction disturbances after TAVI can be improved by combining the cusp overlap projection (COP) and a rapid atrial pacing (RAP) protocol to detect the need for pacemaker implantation.

Methods: We consecutively studied a total of 273 patients who underwent TAVI with self-expanding valves from 2018 through 2022 (134 undergoing standard implantations and 139 COP + RAP). Assessment included the 90-day follow-up.

Results: Complete heart block was reported in 25.4% and 14.4% in the standard-of-care and COP + RAP group, with a marked decrease in transient atrioventricular block (12.8% vs 2.9%, respectively; P = .007). The absence of the Wenckebach phenomenon during RAP had a negative predictive value of 97% (95%CI, 91-99) for pacemaker implantation at the follow-up, which significantly decreased the need for 24-hour temporary pacemaker monitoring in the COP + RAP group (91.8% vs 28.1%; P < .0001) and the median [IQR] length of stay (5.0 [4-8] days vs 2.0 [1-4] days; P < .0001). At the 90-day follow-up, COP + RAP reduced pacemaker implantation (OR, 0.48; 95%CI, 0.24-0.92; P = .031), as well as the risk of infection-related readmissions significantly (OR, 0.35; 95%CI, 0.12-0.89; P = .036).

Conclusions: The combination of COP + RAP during self-expanding TAVI improves postoperative screening for conduction disturbances, thus reducing the need for cardiac rhythm monitoring, and the length stay. The COP + RAP strategy improves the short-term clinical outcomes of self-expanding TAVI due to fewer infection-related readmissions.