Pub Date : 2023-04-26DOI: 10.24875/recice.m23000371
Alba Abril Molina, M. Fernández Quero, Rosa M. Cardenal Piris, A. Guisado Rasco, Rocío Rodríguez Delgado, J. Peña Mellado, Manuel Villa Gil Ortega, and José F. Díaz Fernández
Introduction and objectives: Rapid ventricular pacing reduces cardiac output by providing stability during transcatheter aortic valve implantation (TAVI). Our objective is to assess the efficacy and safety profile of left ventricular pacing through the high-support guidewire used for implantation and a guidewire located in the right atrium (RA) functioning as an anode. Methods : Left ventricular pacing is performed by connecting the external end of a Safari 2 pre-shaped guidewire located in the left ventricle to the cathode of a temporary pacemaker, and the anode to the body of an Emerald guidewire inserted into the RA using a diagnostic Judkins Right catheter (via ultrasound-guided femoral venous access). Pacemaker was programmed with maximum output (20 V) and null sensitivity. Results: A total of 62 selected patients (median 79.4 ± 6.5 years old) underwent transfemoral TAVI using the pacing technique described (25 patients the SAPIEN 3 Ultra; 13 the Navitor, 9 the ACURATE neo2, 14 the Evolut PRO+, and 1 patient the Myvalve). Procedure was successful in all cases (there was 1 capture failure due to pacemaker programming). Two patients required a temporary and permanent pacemaker due to high-grade atrioventricular block. No vascular complications from venous access were documented, not even from the RA guidewire. Procedural time did not increase significantly, and the median length of stay after implantation was 2 days. Conclusions: In our series, left ventricular pacing using the RA-positioned wire as the anode proved to be effective and safe without increasing procedural time significantly. This procedure also provides the advantage of being able to use the central venous access for possible emergency temporary pacemaker implantation.
简介和目的:快速心室起搏通过提供经导管主动脉瓣植入(TAVI)期间的稳定性来减少心输出量。我们的目的是评估通过用于植入的高支撑导丝和位于右心房(RA)作为阳极的导丝进行左心室起搏的有效性和安全性。方法:左心室起搏是通过将位于左心室的Safari 2预成型导丝的外端连接到临时起搏器的阴极，阳极连接到使用诊断性Judkins右导管插入RA的Emerald导丝体(通过超声引导的股静脉通道)。起搏器被编程为最大输出(20 V)和零灵敏度。结果:共有62例患者(中位年龄79.4±6.5岁)采用上述起搏技术行经股动脉TAVI(25例患者采用SAPIEN 3 Ultra;Navitor, accurate ne2, Evolut PRO+， 1例Myvalve)。手术在所有病例中都是成功的(由于起搏器编程，有1例捕获失败)。2例患者由于高度房室传导阻滞需要临时和永久起搏器。静脉通路没有血管并发症，甚至RA导丝也没有。手术时间无明显增加，植入后中位住院时间为2天。结论:在我们的研究中，使用ra定位导线作为阳极的左心室起搏被证明是有效和安全的，而不会显著增加手术时间。该手术还提供了能够使用中心静脉通道进行可能的紧急临时起搏器植入的优势。
{"title":"Right atrium: a good ally in left ventricular pacing during transcatheter aortic valve implantation","authors":"Alba Abril Molina, M. Fernández Quero, Rosa M. Cardenal Piris, A. Guisado Rasco, Rocío Rodríguez Delgado, J. Peña Mellado, Manuel Villa Gil Ortega, and José F. Díaz Fernández","doi":"10.24875/recice.m23000371","DOIUrl":"https://doi.org/10.24875/recice.m23000371","url":null,"abstract":"Introduction and objectives: Rapid ventricular pacing reduces cardiac output by providing stability during transcatheter aortic valve implantation (TAVI). Our objective is to assess the efficacy and safety profile of left ventricular pacing through the high-support guidewire used for implantation and a guidewire located in the right atrium (RA) functioning as an anode. Methods : Left ventricular pacing is performed by connecting the external end of a Safari 2 pre-shaped guidewire located in the left ventricle to the cathode of a temporary pacemaker, and the anode to the body of an Emerald guidewire inserted into the RA using a diagnostic Judkins Right catheter (via ultrasound-guided femoral venous access). Pacemaker was programmed with maximum output (20 V) and null sensitivity. Results: A total of 62 selected patients (median 79.4 ± 6.5 years old) underwent transfemoral TAVI using the pacing technique described (25 patients the SAPIEN 3 Ultra; 13 the Navitor, 9 the ACURATE neo2, 14 the Evolut PRO+, and 1 patient the Myvalve). Procedure was successful in all cases (there was 1 capture failure due to pacemaker programming). Two patients required a temporary and permanent pacemaker due to high-grade atrioventricular block. No vascular complications from venous access were documented, not even from the RA guidewire. Procedural time did not increase significantly, and the median length of stay after implantation was 2 days. Conclusions: In our series, left ventricular pacing using the RA-positioned wire as the anode proved to be effective and safe without increasing procedural time significantly. This procedure also provides the advantage of being able to use the central venous access for possible emergency temporary pacemaker implantation.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45368935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-26DOI: 10.24875/recice.m23000373
M. Álvarez-Fuente, M. Toledano, I. Hernandez, E. Garrido-Lestache, N. Rivero, I. Sánchez, I. Molina, Itziar García OrmazÁbal, and María Jesús del Cerro
Introduction and objectives: Percutaneous pulmonary valve implantation is currently a common procedure in patients with congenital heart disease with a dysfunctional right ventricular outflow tract. Until April 2022, there were only balloon-expandable valves available in Europe, which did not cover the needs of the different anatomies of the right ventricular outflow tract. Since that date we have available the self-expandible Venus P-valve (Venus MedTech, China). We present the initial experience with this new percutaneous pulmonary valve in our center. Methods: Description of the valve implants with the new self-expandible valve performed between September and November 2022. Results: Eight valve implants have been performed, all successful and without severe complications during the procedure. All patients had severe pulmonary regurgitation with a dilated right ventricle and severe dilatation of the pulmonary trunk and were not good candidates for percutaneous balloon-expandable valves. Five patients had a tetralogy of Fallot. In 7 patients, the implant was performed through the femoral vein and in one through jugular access. As a safety measure, all valves were implanted through a DrySeal sheath (Gore, W.L. Gore & Associates, Inc., United States). The mean hospital stay was 3-day. Conclusions: Valve implantation with the new self-expandible Venus P-valve was, in our preliminary experience, a safe and feasible procedure, allowing us to treat very dilated right outflow tracts, not suitable for the current balloon-expandable valves.
{"title":"Initial experience with the new percutaneous pulmonary self-expandable Venus P-valve","authors":"M. Álvarez-Fuente, M. Toledano, I. Hernandez, E. Garrido-Lestache, N. Rivero, I. Sánchez, I. Molina, Itziar García OrmazÁbal, and María Jesús del Cerro","doi":"10.24875/recice.m23000373","DOIUrl":"https://doi.org/10.24875/recice.m23000373","url":null,"abstract":"Introduction and objectives: Percutaneous pulmonary valve implantation is currently a common procedure in patients with congenital heart disease with a dysfunctional right ventricular outflow tract. Until April 2022, there were only balloon-expandable valves available in Europe, which did not cover the needs of the different anatomies of the right ventricular outflow tract. Since that date we have available the self-expandible Venus P-valve (Venus MedTech, China). We present the initial experience with this new percutaneous pulmonary valve in our center. Methods: Description of the valve implants with the new self-expandible valve performed between September and November 2022. Results: Eight valve implants have been performed, all successful and without severe complications during the procedure. All patients had severe pulmonary regurgitation with a dilated right ventricle and severe dilatation of the pulmonary trunk and were not good candidates for percutaneous balloon-expandable valves. Five patients had a tetralogy of Fallot. In 7 patients, the implant was performed through the femoral vein and in one through jugular access. As a safety measure, all valves were implanted through a DrySeal sheath (Gore, W.L. Gore & Associates, Inc., United States). The mean hospital stay was 3-day. Conclusions: Valve implantation with the new self-expandible Venus P-valve was, in our preliminary experience, a safe and feasible procedure, allowing us to treat very dilated right outflow tracts, not suitable for the current balloon-expandable valves.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49014786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-11DOI: 10.24875/recice.m23000368
Sofia Gonzalez Lizarbe, Teresa Borderias Villarroel, C. Ruisanchez Villar, J. M. Navasa Melado, I. Pulitani, and Dae-Hyun Lee Hwang
Aortic pseudoaneurysm is a rare and serious complications after surgical aortic valve replacement. Its appearance in the reimplantation region of coronary arteries has been documented on very few occasions. This is the case of a 53-year-old man with a Stanford type A acute aortic dissection. The aortic root and ascending aorta were replaced with coronary artery reimplantation (modified Bentall-Bono technique) with favorable early disease progression. The thoracoabdominal computed tomography scan performed 25 days after surgery to study an incidental renal mass revealed the presence of a 14 mm x 10 mm hyperdense nodular image in the arterial phase of posterior location with respect to the left main coronary artery ostium consistent with a postoperative pseudoaneurysm (figure 1A,C, circle). A 3D transesophageal echocardiography confirmed the presence of a pseudoaneurysm surrounding the aortic root with flow inside stemming from the suture of the left main
{"title":"Percutaneous closure of coronary ostial anastomoses pseudoaneurysm after Bentall","authors":"Sofia Gonzalez Lizarbe, Teresa Borderias Villarroel, C. Ruisanchez Villar, J. M. Navasa Melado, I. Pulitani, and Dae-Hyun Lee Hwang","doi":"10.24875/recice.m23000368","DOIUrl":"https://doi.org/10.24875/recice.m23000368","url":null,"abstract":"Aortic pseudoaneurysm is a rare and serious complications after surgical aortic valve replacement. Its appearance in the reimplantation region of coronary arteries has been documented on very few occasions. This is the case of a 53-year-old man with a Stanford type A acute aortic dissection. The aortic root and ascending aorta were replaced with coronary artery reimplantation (modified Bentall-Bono technique) with favorable early disease progression. The thoracoabdominal computed tomography scan performed 25 days after surgery to study an incidental renal mass revealed the presence of a 14 mm x 10 mm hyperdense nodular image in the arterial phase of posterior location with respect to the left main coronary artery ostium consistent with a postoperative pseudoaneurysm (figure 1A,C, circle). A 3D transesophageal echocardiography confirmed the presence of a pseudoaneurysm surrounding the aortic root with flow inside stemming from the suture of the left main","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48563574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-11DOI: 10.24875/recice.m23000366
F. Ballesteros Tejerizo, Félix Coserría Sánchez, X. Freixa, I. Amat-Santos, E. B. Balbacid Domingo, P. Betrián Blasco, Roberto Blanco Mata, José Ignacio Carrasco, M. J. C. Cerro Marín, Marta Flores Fernández, A. Gómez Jaume, B. Insa Albert, M. N. Navalón Pérez, S. Ojeda Pineda, F. Rueda Núñez, Joaquín Sánchez Gila, R. Sanz-Ruiz, and Juan Ignacio Zabala Argüelles
Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated—15 public and 1 private—including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.
{"title":"Spanish cardiac catheterization in congenital heart diseases registry. Second official report from the ACI-SEC and the GTH-SECPCC (2021)","authors":"F. Ballesteros Tejerizo, Félix Coserría Sánchez, X. Freixa, I. Amat-Santos, E. B. Balbacid Domingo, P. Betrián Blasco, Roberto Blanco Mata, José Ignacio Carrasco, M. J. C. Cerro Marín, Marta Flores Fernández, A. Gómez Jaume, B. Insa Albert, M. N. Navalón Pérez, S. Ojeda Pineda, F. Rueda Núñez, Joaquín Sánchez Gila, R. Sanz-Ruiz, and Juan Ignacio Zabala Argüelles","doi":"10.24875/recice.m23000366","DOIUrl":"https://doi.org/10.24875/recice.m23000366","url":null,"abstract":"Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated—15 public and 1 private—including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69049013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-17DOI: 10.24875/recice.m22000294
Ana Pardo Sanz, Luisa Salido Tahoces, José Luis Mestre Barcelo, María Abellás Sequeiros, José Luis Zamorano Gómez, and, Ángel Sánchez-Recalde
{"title":"Left main coronary artery embolization after transcatheter paravalvular leak closure","authors":"Ana Pardo Sanz, Luisa Salido Tahoces, José Luis Mestre Barcelo, María Abellás Sequeiros, José Luis Zamorano Gómez, and, Ángel Sánchez-Recalde","doi":"10.24875/recice.m22000294","DOIUrl":"https://doi.org/10.24875/recice.m22000294","url":null,"abstract":"","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135295439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-13DOI: 10.24875/recice.m23000365
J. Gómez-Lara
Answer: The publications of the COMPLETE and FLOWER MI clinical trials has changed the management of nonculprit lesions tremendously in patients with ACS jeopardizing the role of the pressure guidewire guiding the revascularization of these lesions.1,2 In the COMPLETE trial, angiography-guided complete revascularization reduced the rates of death and infarction compared to the optimal medical therapy (OMT).1 We should mention that over 80% of the lesions included had an angiographic percent diameter stenosis ≥ 70%.1 In the FLOWER MI trial that included less severe nonculprit lesions, pressure guidewire-guided complete revascularization reduced the number of lesions treated (45% fewer lesions) compared to angiography-guided complete revascularization with a similar rate of events in both strategies.2 However, a subanalysis of the group of patients treated with pressure guidewire guidance revealed that patients with fractional flow reserve (FFR) values ≤ 0.80 (stented according to protocol) had fewer events compared to patients with FFR values > 0.80 (treated with OMT).3 This has aroused controversy regarding the utility of the pressure guidewire in this context. Probably the reason why the FFR has such a low negative predictive value is the lack of information on the composition of the plaque of the target lesion. In a subanalysis of the COMPLETE trial where nonculprit lesions were treated with OCT, it was reported that > 35% of the lesions with stenosis ≥ 70% were classified as vulnerable plaques compared to 25% of intermediate lesions (stenosis between 50% and 69%).4
{"title":"Debate. Revascularization of nonculprit lesions in ACS: physiology or OCT-guided or both? Perspective from imaging","authors":"J. Gómez-Lara","doi":"10.24875/recice.m23000365","DOIUrl":"https://doi.org/10.24875/recice.m23000365","url":null,"abstract":"Answer: The publications of the COMPLETE and FLOWER MI clinical trials has changed the management of nonculprit lesions tremendously in patients with ACS jeopardizing the role of the pressure guidewire guiding the revascularization of these lesions.1,2 In the COMPLETE trial, angiography-guided complete revascularization reduced the rates of death and infarction compared to the optimal medical therapy (OMT).1 We should mention that over 80% of the lesions included had an angiographic percent diameter stenosis ≥ 70%.1 In the FLOWER MI trial that included less severe nonculprit lesions, pressure guidewire-guided complete revascularization reduced the number of lesions treated (45% fewer lesions) compared to angiography-guided complete revascularization with a similar rate of events in both strategies.2 However, a subanalysis of the group of patients treated with pressure guidewire guidance revealed that patients with fractional flow reserve (FFR) values ≤ 0.80 (stented according to protocol) had fewer events compared to patients with FFR values > 0.80 (treated with OMT).3 This has aroused controversy regarding the utility of the pressure guidewire in this context. Probably the reason why the FFR has such a low negative predictive value is the lack of information on the composition of the plaque of the target lesion. In a subanalysis of the COMPLETE trial where nonculprit lesions were treated with OCT, it was reported that > 35% of the lesions with stenosis ≥ 70% were classified as vulnerable plaques compared to 25% of intermediate lesions (stenosis between 50% and 69%).4","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45864942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-13DOI: 10.24875/recice.m22000359
M. Echavarría-Pinto
Answer: I would like to start by contextualizing the change of paradigm we’ve been experiencing regarding myocardial revascularization. In controlled clinical trials of stable coronary artery disease, compared to optimal medical therapy, unfortunately, myocardial revascularization—the percutaneous one (PCI) in particular—has not been able to reduce clinical events whether angiography-guided (COURAGE and BARI 2D trials) or guided by non-invasive ischemia detection studies (ISCHEMIA trial).1 1It is hard to believe that although there is a significant correlation between the degree of ischemia documented non-invasively and the risk of adverse events, revascularization based on the information that, as interventional cardiologists, we collecrt from non-invasive studies doesn’t lead to better clinical outcomes compared to non-revascularizing the patient leaving him with ischemia and on optimal medical therapy. Here’s where the use of the pressure guidewire (PG) during the procedure (and possibly its angiographic alternatives) seems to lead to a different outcome. Currently, 3 randomized clinical trials are being conducted—2 of them in patients with acute coronary syndrome (ACS)—comparing the clinical events associated with PGand optimal medical therapy-guided myocardial revascularization alone. A recent metanalysis revealed that, compared to optimal medical therapy, PG-guided myocardial revascularization reduces the risk of cardiac death an infarction significantly at 5 years.2 We should mention that this is a high-quality metanalysis that only included randomized clinical trials and «hard» events in its primary outcome. Also, unlike the ISCHEMIA trial that reported more early events associated with revascularization, fewer events were also documented in the PG arm from the beginning of follow-up and, as years went by, this event difference has grown favorable to revascularization. This and other information suggest that the PG allows us to select more accurately compared to angiography the segments of epicardial arteries where the benefits of PCI exceed risks.3,4 This evidence has changed the clinical practice guidelines that now recommend the use of the PG for the lack of previous evidence of ischemia and when the use of revascularization is under consideration. However, although this recommendation has been effective for years, the clinical use of PG is still low worldwide.
{"title":"Debate: Revascularization of non-culprit lesions in ACS: physiology, OCT-guided or both? Perspective from physiology","authors":"M. Echavarría-Pinto","doi":"10.24875/recice.m22000359","DOIUrl":"https://doi.org/10.24875/recice.m22000359","url":null,"abstract":"Answer: I would like to start by contextualizing the change of paradigm we’ve been experiencing regarding myocardial revascularization. In controlled clinical trials of stable coronary artery disease, compared to optimal medical therapy, unfortunately, myocardial revascularization—the percutaneous one (PCI) in particular—has not been able to reduce clinical events whether angiography-guided (COURAGE and BARI 2D trials) or guided by non-invasive ischemia detection studies (ISCHEMIA trial).1 1It is hard to believe that although there is a significant correlation between the degree of ischemia documented non-invasively and the risk of adverse events, revascularization based on the information that, as interventional cardiologists, we collecrt from non-invasive studies doesn’t lead to better clinical outcomes compared to non-revascularizing the patient leaving him with ischemia and on optimal medical therapy. Here’s where the use of the pressure guidewire (PG) during the procedure (and possibly its angiographic alternatives) seems to lead to a different outcome. Currently, 3 randomized clinical trials are being conducted—2 of them in patients with acute coronary syndrome (ACS)—comparing the clinical events associated with PGand optimal medical therapy-guided myocardial revascularization alone. A recent metanalysis revealed that, compared to optimal medical therapy, PG-guided myocardial revascularization reduces the risk of cardiac death an infarction significantly at 5 years.2 We should mention that this is a high-quality metanalysis that only included randomized clinical trials and «hard» events in its primary outcome. Also, unlike the ISCHEMIA trial that reported more early events associated with revascularization, fewer events were also documented in the PG arm from the beginning of follow-up and, as years went by, this event difference has grown favorable to revascularization. This and other information suggest that the PG allows us to select more accurately compared to angiography the segments of epicardial arteries where the benefits of PCI exceed risks.3,4 This evidence has changed the clinical practice guidelines that now recommend the use of the PG for the lack of previous evidence of ischemia and when the use of revascularization is under consideration. However, although this recommendation has been effective for years, the clinical use of PG is still low worldwide.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44536158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.24875/recice.m22000324
Federico Liberman, Nicolás Zaderenko, G. Pacheco, Juan Pablo Casas and, J. Lugones
{"title":"Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula","authors":"Federico Liberman, Nicolás Zaderenko, G. Pacheco, Juan Pablo Casas and, J. Lugones","doi":"10.24875/recice.m22000324","DOIUrl":"https://doi.org/10.24875/recice.m22000324","url":null,"abstract":"","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41435624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.24875/recice.m22000326
Federico Liberman, Nicolás Zaderenko, Guillermo Pacheco, Juan Pablo Casas and, José Lugones
{"title":"Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. Case resolution","authors":"Federico Liberman, Nicolás Zaderenko, Guillermo Pacheco, Juan Pablo Casas and, José Lugones","doi":"10.24875/recice.m22000326","DOIUrl":"https://doi.org/10.24875/recice.m22000326","url":null,"abstract":"","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136130897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.24875/recice.m22000325
Javier Portales Fernández
{"title":"Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. How would I approach it?","authors":"Javier Portales Fernández","doi":"10.24875/recice.m22000325","DOIUrl":"https://doi.org/10.24875/recice.m22000325","url":null,"abstract":"","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46844480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：