Pub Date : 2023-03-10DOI: 10.24875/recice.m23000367
H. Alvarez-Covarrubias, M. Kasel, Jonathan M. Michel, S. Cassese, S. Kufner, C. Duesmann, Constanza Pellegrini, T. Rheude, N. Patrick Mayr, H. Schunkert, A. Kastrati, E. Xhepa, Gabriela Borrayo-Sánchez, and, M. Joner
Introduction and objectives: Coronary computed tomography angiography (CCTA) has become the gold standard to measure the size of the aortic annulus and better select the size of transcatheter heart valves (THV) in patients undergoing transcatheter aortic valve implantation (TAVI). However, in selected cases, CCTA may not be feasible. Angiographic aortic annulus (AAA) measurements during TAVI may be an alternative and should be evaluated for precision regarding the proper selection of THV sizes. We sought to investigate the correlation between AAA and CCTA measurements for the proper selection of balloon-expandable valve (BEV) sizes in patients undergoing TAVI. Methods: Patients undergoing TAVI with BEV and high-quality CCTA were included. AAA measurements were obtained in the standard 3-cusp view after aortic root aortography. Angiographic distance between non-and left coronary cusps were compared to CCTA annulus measurements. Endpoints were diagnostic tests and correlations between angiographic and CCTA measurements, and the composite endpoint of the VARC-3-defined efficacy (technical success, correct position, and intended performance), and safety profile (multiple valves, valve embolization, pacemaker implantation, and more than moderate valvular regurgitation). Results: Regarding the Sapien family of THV, aortography-based distance measurements showed a correlation of 0.528 ( P < .01), 0.451 ( P < .01), and 0.579 ( P < .01) for 23 mm, 26 mm, and 29 mm valves with CCTA-based distance measurements. No difference was seen regarding the VARC-3-defined efficacy (94.2% vs 96.0%; P = .60) and safety profile (90.9% vs 91.9%; P = .84) among cases showing discordant and concordant pairs of measurements. Conclusions: AAA measurement showed a moderate diagnostic test and Spearman’s correlation coefficient compared to CCTA-based annulus assessment for perioperative THV size selection. This strategy could potentially enable TAVI in patients in whom access to preoperative CCTA is not available.
{"title":"Fluoroscopic and tomographic correlation for aortic annulus measurements in transcatheter aortic valve implantation: �follow the right cusp� rule","authors":"H. Alvarez-Covarrubias, M. Kasel, Jonathan M. Michel, S. Cassese, S. Kufner, C. Duesmann, Constanza Pellegrini, T. Rheude, N. Patrick Mayr, H. Schunkert, A. Kastrati, E. Xhepa, Gabriela Borrayo-Sánchez, and, M. Joner","doi":"10.24875/recice.m23000367","DOIUrl":"https://doi.org/10.24875/recice.m23000367","url":null,"abstract":"Introduction and objectives: Coronary computed tomography angiography (CCTA) has become the gold standard to measure the size of the aortic annulus and better select the size of transcatheter heart valves (THV) in patients undergoing transcatheter aortic valve implantation (TAVI). However, in selected cases, CCTA may not be feasible. Angiographic aortic annulus (AAA) measurements during TAVI may be an alternative and should be evaluated for precision regarding the proper selection of THV sizes. We sought to investigate the correlation between AAA and CCTA measurements for the proper selection of balloon-expandable valve (BEV) sizes in patients undergoing TAVI. Methods: Patients undergoing TAVI with BEV and high-quality CCTA were included. AAA measurements were obtained in the standard 3-cusp view after aortic root aortography. Angiographic distance between non-and left coronary cusps were compared to CCTA annulus measurements. Endpoints were diagnostic tests and correlations between angiographic and CCTA measurements, and the composite endpoint of the VARC-3-defined efficacy (technical success, correct position, and intended performance), and safety profile (multiple valves, valve embolization, pacemaker implantation, and more than moderate valvular regurgitation). Results: Regarding the Sapien family of THV, aortography-based distance measurements showed a correlation of 0.528 ( P < .01), 0.451 ( P < .01), and 0.579 ( P < .01) for 23 mm, 26 mm, and 29 mm valves with CCTA-based distance measurements. No difference was seen regarding the VARC-3-defined efficacy (94.2% vs 96.0%; P = .60) and safety profile (90.9% vs 91.9%; P = .84) among cases showing discordant and concordant pairs of measurements. Conclusions: AAA measurement showed a moderate diagnostic test and Spearman’s correlation coefficient compared to CCTA-based annulus assessment for perioperative THV size selection. This strategy could potentially enable TAVI in patients in whom access to preoperative CCTA is not available.","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":"49049105","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 : 2023-03-03DOI: 10.24875/recice.m23000369
M. García-Guimarães, D. van Ginkel, Benno J. Rensing, J. T. ten Berg, U. Sonker, Thomas L. de Kroon, Robin H. Heijmen, Martin J. Swaans and, L. Timmers
Introduction and objectives: Moderate or severe paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. Aortic valve (AV) calcification is a strong predictor of PVL. ACURATE neo (Boston Scientific Corporation, United States) is a self-expanding transcatheter heart valve to treat degenerative aortic stenosis. We evaluated PVL after ACURATE neo and neo2 implantation, and the role of AV calcification. Methods: We analyzed patients referred for TAVI with ACURATE neo and neo2 from a large volume tertiary center. All cardiac computed tomography scans were analyzed using 3Mensio Structural Heart software (Pie Medical Imaging, The Netherlands). The volume of AV calcium was quantified using contrast-enhanced cardiac computed tomography series. The 30-day clinical and echocardiographic data were prospectively recorded. Results: We included 165 patients referred for TAVI with ACURATE (neo = 87; neo2 = 78). Median age was 82 years-old, 65% were women with a median EuroSCORE II of 4.7 [IQR, 2.4-6.1]. Patients in the neo group showed a larger amount of total AV calcium (320 mm 3 vs 200 mm 3 ; P = .0305). We found no significant inter-group differences regarding clinical outcomes both in-hospital or at 30-days. At 30-days, the rate of PVL ≥ mild (61% vs 34%; P < .001) and ≥ moderate (15.9% vs 5.4%; P = .0365) were higher in the neo group. After propensity score matching adjusted by the total amount of AV calcium, neo2 was associated with a lower risk of PVL ≥ mild (OR, 0.35, 95%CI, 0.18-0.69; P = .003), and ≥ moderate (OR, 0.16; 95%CI, 0.03-0.74; P = .019). Conclusions : TAVI with ACURATE neo2 vs neo is associated with a lower risk of any degree of PVL and a reduced risk of PVL ≥ moderate. After adjusting for AV calcium volume, ACURATE neo2 was still associated with a lower risk of PVL.
简介和目的:经导管主动脉瓣植入术(TAVI)后中度或重度瓣旁漏(PVL)与较差的预后相关。主动脉瓣钙化是PVL的重要预测指标。accurate neo(波士顿科学公司，美国)是一种自我扩张的经导管心脏瓣膜，用于治疗退行性主动脉瓣狭窄。我们评估了acate neo和neo2植入后的PVL，以及房室钙化的作用。方法:我们分析来自大容量三级中心的acatate neo和neo2转诊TAVI的患者。所有心脏计算机断层扫描使用3Mensio心脏结构软件(Pie Medical Imaging, The Netherlands)进行分析。采用增强心脏计算机断层扫描系列定量测定房室钙的体积。前瞻性记录30天临床及超声心动图资料。结果:我们纳入了165例使用accurate进行TAVI转诊的患者(neo = 87;Neo2 = 78)。年龄中位数为82岁，65%为女性，EuroSCORE II中位数为4.7 [IQR, 2.4-6.1]。neo组患者的总房室钙含量更高(320 mm 3 vs 200 mm 3;P = .0305)。我们发现，在住院或30天的临床结果方面，组间没有显著差异。在30天，PVL≥轻度发生率(61% vs 34%;P < 0.001)和≥中度(15.9% vs 5.4%;P = 0.0365)。经房室钙总量调整的倾向评分匹配后，neo2与PVL≥轻度的风险降低相关(OR, 0.35, 95%CI, 0.18-0.69;P = 0.003)，≥中度(OR, 0.16;95%置信区间,0.03 - -0.74;P = .019)。结论:TAVI与accurate neo2 vs neo可降低任何程度PVL的风险，降低PVL≥中度的风险。在调整房室钙容量后，accurate neo2仍与PVL风险降低相关。
{"title":"Paravalvular leak with ACURATE neo and neo2: a comparative study with calcium quantification","authors":"M. García-Guimarães, D. van Ginkel, Benno J. Rensing, J. T. ten Berg, U. Sonker, Thomas L. de Kroon, Robin H. Heijmen, Martin J. Swaans and, L. Timmers","doi":"10.24875/recice.m23000369","DOIUrl":"https://doi.org/10.24875/recice.m23000369","url":null,"abstract":"Introduction and objectives: Moderate or severe paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. Aortic valve (AV) calcification is a strong predictor of PVL. ACURATE neo (Boston Scientific Corporation, United States) is a self-expanding transcatheter heart valve to treat degenerative aortic stenosis. We evaluated PVL after ACURATE neo and neo2 implantation, and the role of AV calcification. Methods: We analyzed patients referred for TAVI with ACURATE neo and neo2 from a large volume tertiary center. All cardiac computed tomography scans were analyzed using 3Mensio Structural Heart software (Pie Medical Imaging, The Netherlands). The volume of AV calcium was quantified using contrast-enhanced cardiac computed tomography series. The 30-day clinical and echocardiographic data were prospectively recorded. Results: We included 165 patients referred for TAVI with ACURATE (neo = 87; neo2 = 78). Median age was 82 years-old, 65% were women with a median EuroSCORE II of 4.7 [IQR, 2.4-6.1]. Patients in the neo group showed a larger amount of total AV calcium (320 mm 3 vs 200 mm 3 ; P = .0305). We found no significant inter-group differences regarding clinical outcomes both in-hospital or at 30-days. At 30-days, the rate of PVL ≥ mild (61% vs 34%; P < .001) and ≥ moderate (15.9% vs 5.4%; P = .0365) were higher in the neo group. After propensity score matching adjusted by the total amount of AV calcium, neo2 was associated with a lower risk of PVL ≥ mild (OR, 0.35, 95%CI, 0.18-0.69; P = .003), and ≥ moderate (OR, 0.16; 95%CI, 0.03-0.74; P = .019). Conclusions : TAVI with ACURATE neo2 vs neo is associated with a lower risk of any degree of PVL and a reduced risk of PVL ≥ moderate. After adjusting for AV calcium volume, ACURATE neo2 was still associated with a lower risk of PVL.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69049083","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 : 2023-03-02DOI: 10.24875/recice.m23000370
A. Fernández-Cisnal, B. Silla, José María Ramón, E. Valero, S. García-Blas, J. Núñez, V. Bodí, Juan Sanchis, and, G. Miñana
Introduction and objectives: Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) are long procedures where many patients suffer moderate-to-high level anxiety and pain. Virtual reality (VR) has proven capable of reducing procedural pain and anxiety in many medical procedures. The objective of this study is to demonstrate that the use of VR during CTO PCI reduces anxiety and pain compared to conventional routine clinical practice. Methods: Randomized, controlled, open-label, superiority trial clinical trial with 2 parallel arms including 58 patients with a scheduled CTO PCI randomized on a 1:1 ratio to VR during the procedure or conventional management. In both arms, the administration of anxiolytic drugs will be left to the lead operator’s discretion and based on the degree of anxiety o pain perceived. The remaining actions for the management of pre-and perioperative anxiety will be identical in both arms. The primary endpoint will be the maximum level of anxiety perceived by the patient. Secondary endpoints will be the level of patient-perceived pain, the need for intraoperative anxiolytic drug therapy, dose of drug administered, and satisfaction with the VR goggles. Results: The results of this study will add significant knowledge on the utility of VR regarding anxiety reduction in CTO PCIs. Conclusions: The ReViCTO trial is the first randomized clinical trial to use VR during a PCI CTO. Its results will show the utility of this technology to reduce anxiety and pain in PCIs performed on CTOs. Trial design registered at ClinicalTrials.gov (Identifier: NCT05458999).
{"title":"Efficacy of virtual reality reducing anxiety during CTO revascularization: the ReViCTO trial design","authors":"A. Fernández-Cisnal, B. Silla, José María Ramón, E. Valero, S. García-Blas, J. Núñez, V. Bodí, Juan Sanchis, and, G. Miñana","doi":"10.24875/recice.m23000370","DOIUrl":"https://doi.org/10.24875/recice.m23000370","url":null,"abstract":"Introduction and objectives: Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) are long procedures where many patients suffer moderate-to-high level anxiety and pain. Virtual reality (VR) has proven capable of reducing procedural pain and anxiety in many medical procedures. The objective of this study is to demonstrate that the use of VR during CTO PCI reduces anxiety and pain compared to conventional routine clinical practice. Methods: Randomized, controlled, open-label, superiority trial clinical trial with 2 parallel arms including 58 patients with a scheduled CTO PCI randomized on a 1:1 ratio to VR during the procedure or conventional management. In both arms, the administration of anxiolytic drugs will be left to the lead operator’s discretion and based on the degree of anxiety o pain perceived. The remaining actions for the management of pre-and perioperative anxiety will be identical in both arms. The primary endpoint will be the maximum level of anxiety perceived by the patient. Secondary endpoints will be the level of patient-perceived pain, the need for intraoperative anxiolytic drug therapy, dose of drug administered, and satisfaction with the VR goggles. Results: The results of this study will add significant knowledge on the utility of VR regarding anxiety reduction in CTO PCIs. Conclusions: The ReViCTO trial is the first randomized clinical trial to use VR during a PCI CTO. Its results will show the utility of this technology to reduce anxiety and pain in PCIs performed on CTOs. Trial design registered at ClinicalTrials.gov (Identifier: NCT05458999).","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45485781","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 : 2023-02-27DOI: 10.24875/recice.m23000362
Marc Figueras Coll, Andrea Fidalgo García, G. Aguasca, and, P. Betrián Blasco
Introduction and objectives: Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare but serious cyanotic congenital heart disease. Depending on the patient’s anatomy, different therapeutic strategies—surgical or trancatheter—can be planned. The objective of this study was to describe the results of transcatheter pulmonary valve perforation in patients with PA/IVS in a single tertiary center, and compare transjugular to transfemoral approach. The need for additional source of pulmonary flow (ductal stenting or systemic-to-pulmonary artery fistula) at follow-up was reviewed to identify possible risk factors associated with this reintervention. Methods: patients with PA/IVS referred for transcatheter pulmonary valve perforation as first-line therapy from February 2004 through May 2022 were included. Technical procedural details, total procedural and fluoroscopy times, and demographic and echocardiographic data were studied. Results: A total of 22 patients were included. Procedure was successful in 20 cases (91%). The rate of complications was 2/22 (9%). No deaths were reported. The transjugular and transfemoral approaches were equally safe and effective. The total median procedural (n = 20) and fluoroscopy times (n = 16), however, were shorter in the transjugular compared to the transfemoral approach (85 min vs 156 min, and 31 min vs 62 min, respectively), which reached statistical significance. At follow-up, 8/20 (40%) patients needed additional flow (4 ductal stenting, 4 systemic-to-pulmonary artery shunts). No significant risk factors regarding this reintervention were reported. Conclusions: Transcatheter mechanical pulmonary valve perforation may be feasible in expert hands and properly selected patients being an attractive alternative to surgery. In our own experience, transjugular approach seems to simplify the procedure, and reduces procedural and fluoroscopy times.
{"title":"Neonatal transcatheter pulmonary valve perforation. Evolution from transfemoral to transjugular approach","authors":"Marc Figueras Coll, Andrea Fidalgo García, G. Aguasca, and, P. Betrián Blasco","doi":"10.24875/recice.m23000362","DOIUrl":"https://doi.org/10.24875/recice.m23000362","url":null,"abstract":"Introduction and objectives: Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare but serious cyanotic congenital heart disease. Depending on the patient’s anatomy, different therapeutic strategies—surgical or trancatheter—can be planned. The objective of this study was to describe the results of transcatheter pulmonary valve perforation in patients with PA/IVS in a single tertiary center, and compare transjugular to transfemoral approach. The need for additional source of pulmonary flow (ductal stenting or systemic-to-pulmonary artery fistula) at follow-up was reviewed to identify possible risk factors associated with this reintervention. Methods: patients with PA/IVS referred for transcatheter pulmonary valve perforation as first-line therapy from February 2004 through May 2022 were included. Technical procedural details, total procedural and fluoroscopy times, and demographic and echocardiographic data were studied. Results: A total of 22 patients were included. Procedure was successful in 20 cases (91%). The rate of complications was 2/22 (9%). No deaths were reported. The transjugular and transfemoral approaches were equally safe and effective. The total median procedural (n = 20) and fluoroscopy times (n = 16), however, were shorter in the transjugular compared to the transfemoral approach (85 min vs 156 min, and 31 min vs 62 min, respectively), which reached statistical significance. At follow-up, 8/20 (40%) patients needed additional flow (4 ductal stenting, 4 systemic-to-pulmonary artery shunts). No significant risk factors regarding this reintervention were reported. Conclusions: Transcatheter mechanical pulmonary valve perforation may be feasible in expert hands and properly selected patients being an attractive alternative to surgery. In our own experience, transjugular approach seems to simplify the procedure, and reduces procedural and fluoroscopy times.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42986411","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 : 2023-02-27DOI: 10.24875/recice.m22000360
O. Rodriguez-Leor, A. B. Cid-Álvarez, Raúl Moreno, X. Rosselló, S. Ojeda, A. Serrador, R. López-Palop, J. Martín‐Moreiras, J. Ramón Rumoroso, Á. Cequier, Borja Ibanez, I. Cruz-González, R. Romaguera, Sergio Raposeiras and, Armando Pérez de Prado
. ABSTRACT Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC ( P < .0001), as was gender ( P = .003) and the prevalence of cardiovascular risk factors ( P < .0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis (range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences ( P < .001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network.
{"title":"Regional differences in STEMI care in Spain. Data from the ACI-SEC Infarction Code Registry","authors":"O. Rodriguez-Leor, A. B. Cid-Álvarez, Raúl Moreno, X. Rosselló, S. Ojeda, A. Serrador, R. López-Palop, J. Martín‐Moreiras, J. Ramón Rumoroso, Á. Cequier, Borja Ibanez, I. Cruz-González, R. Romaguera, Sergio Raposeiras and, Armando Pérez de Prado","doi":"10.24875/recice.m22000360","DOIUrl":"https://doi.org/10.24875/recice.m22000360","url":null,"abstract":". ABSTRACT Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC ( P < .0001), as was gender ( P = .003) and the prevalence of cardiovascular risk factors ( P < .0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis (range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences ( P < .001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45677925","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 : 2023-02-27DOI: 10.24875/recice.m23000363
E. Pinar, J. D. de Lara, J. Hurtado, M. Robles, Gunnar Leithold, Belén Martí-Sánchez, P. González, Kim Rand, and, J. Cuervo
Introduction and objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used procedure to treat severe aortic stenosis (AS) that should be monitored in the real-world routine clinical practice. We assessed TAVI outcomes (SAPIEN 3) in terms of the patient’s health-related quality of life (HRQoL), clinical endpoints, and resource utilization considering a valid risk score. Methods: This was an observational prospective study including all consecutive patients with severe AS treated with TAVI (Edwards SAPIEN 3, transfemoral access) conducted during the calendar year of 2018. A systematic assessment of the patients’ HRQoL (EQ-5D-5L, the 36-item Short Form Health Survey, and the Kansas City Cardiomyopathy Questionnaire), clinical endpoints, and resource utilization (length of stay at the hospital/intensive care unit setting) was implemented. Assessment was scheduled before the procedure (baseline), at discharge, and 1, 6, and 12 months after implantation. Multivariate regression models were applied to test outcomes while controlling the patients’ risk (eg, Society of Thoracic Surgeons risk score). Results: A total of 76 patients (50% female) with a mean age of 82.05 ± 4.76 years, and 55% with intermediate-high risk were included. The rates of successful impantation and cardiac death were 97.37% and 2.63%, respectively, at 1 year. Significant reductions in mean and maximum gradients were achieved and maintained at follow-up. The mean length of stay at the hospital (5.2 6 ± 4.05) and intensive care unit setting (0.22 ± 0.64) was short. Significant improvements (all adjusted P < .05) were detected in the Kansas City Cardiomyopathy Questionnaire overall summary scores, EQ-5D-5L, and the 36-item Short Form (physical component summary). Conclusions: This research highlights how positive clinical outcomes translated into significant improvements in relation to the patients’ HRQoL. Use of resources —generally low— was based on the Society of Thoracic Surgeons risk score. (SARU Study; code: 2017-01, Murcia, Spain).
{"title":"Prospective assessment of clinical outcomes of transcatheter aortic valve implantation in a cohort of patients based on their risk profile","authors":"E. Pinar, J. D. de Lara, J. Hurtado, M. Robles, Gunnar Leithold, Belén Martí-Sánchez, P. González, Kim Rand, and, J. Cuervo","doi":"10.24875/recice.m23000363","DOIUrl":"https://doi.org/10.24875/recice.m23000363","url":null,"abstract":"Introduction and objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used procedure to treat severe aortic stenosis (AS) that should be monitored in the real-world routine clinical practice. We assessed TAVI outcomes (SAPIEN 3) in terms of the patient’s health-related quality of life (HRQoL), clinical endpoints, and resource utilization considering a valid risk score. Methods: This was an observational prospective study including all consecutive patients with severe AS treated with TAVI (Edwards SAPIEN 3, transfemoral access) conducted during the calendar year of 2018. A systematic assessment of the patients’ HRQoL (EQ-5D-5L, the 36-item Short Form Health Survey, and the Kansas City Cardiomyopathy Questionnaire), clinical endpoints, and resource utilization (length of stay at the hospital/intensive care unit setting) was implemented. Assessment was scheduled before the procedure (baseline), at discharge, and 1, 6, and 12 months after implantation. Multivariate regression models were applied to test outcomes while controlling the patients’ risk (eg, Society of Thoracic Surgeons risk score). Results: A total of 76 patients (50% female) with a mean age of 82.05 ± 4.76 years, and 55% with intermediate-high risk were included. The rates of successful impantation and cardiac death were 97.37% and 2.63%, respectively, at 1 year. Significant reductions in mean and maximum gradients were achieved and maintained at follow-up. The mean length of stay at the hospital (5.2 6 ± 4.05) and intensive care unit setting (0.22 ± 0.64) was short. Significant improvements (all adjusted P < .05) were detected in the Kansas City Cardiomyopathy Questionnaire overall summary scores, EQ-5D-5L, and the 36-item Short Form (physical component summary). Conclusions: This research highlights how positive clinical outcomes translated into significant improvements in relation to the patients’ HRQoL. Use of resources —generally low— was based on the Society of Thoracic Surgeons risk score. (SARU Study; code: 2017-01, Murcia, Spain).","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49258428","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 : 2023-02-16DOI: 10.24875/recice.m23000364
D. Martí Sánchez, Alfonso Suárez Cuervo, J. Duarte Torres, Diego Rodríguez Torres, Miguel Ángel Sastre Perona and, Noelia Alonso Gómez
20 mg. Due to severe worsening of his neurological status, he was admitted for further evaluation. After careful clinical evaluation, diagnosis of cerebellar and pyramidal syndrome in the neurosyphilis setting was achieved. Penicillin was started. During hospitalization, cerebral magnetic resonance imaging revealed the presence of a massive hernia at C4-C5 causing significant spinal cord compression. Decompressive surgery was advised. During hospitalization, he complained of chest pain. The ECG showed signs of sinus rhythm with sustained diffuse ST-segment depression and ST-segment elevation in aVR and V1. The transthoracic echocardiography showed a severely impaired left ventricular ejection fraction with severe hypokinesia of the apex, anterior, posterior, and lateral walls. The aortic root was mildly enlarged, but no flaps were seen. Due to refractory chest pain and progressively worsening hypotension, the patient was given unfractionated heparin (5000 IU) and underwent an emergency coronary angiography that revealed the presence of critical left main coronary artery ostial stenosis (videos 1 and 2 of the supplementary data). No further lesions were identified. Due to the complexity of the lesion, percutaneous angioplasty under left ventricular assist device was advised. It was necessary to make a multidisciplinary decision due to the patient’s condition.
{"title":"Complex venous disease in transcatheter left atrial appendage closure","authors":"D. Martí Sánchez, Alfonso Suárez Cuervo, J. Duarte Torres, Diego Rodríguez Torres, Miguel Ángel Sastre Perona and, Noelia Alonso Gómez","doi":"10.24875/recice.m23000364","DOIUrl":"https://doi.org/10.24875/recice.m23000364","url":null,"abstract":"20 mg. Due to severe worsening of his neurological status, he was admitted for further evaluation. After careful clinical evaluation, diagnosis of cerebellar and pyramidal syndrome in the neurosyphilis setting was achieved. Penicillin was started. During hospitalization, cerebral magnetic resonance imaging revealed the presence of a massive hernia at C4-C5 causing significant spinal cord compression. Decompressive surgery was advised. During hospitalization, he complained of chest pain. The ECG showed signs of sinus rhythm with sustained diffuse ST-segment depression and ST-segment elevation in aVR and V1. The transthoracic echocardiography showed a severely impaired left ventricular ejection fraction with severe hypokinesia of the apex, anterior, posterior, and lateral walls. The aortic root was mildly enlarged, but no flaps were seen. Due to refractory chest pain and progressively worsening hypotension, the patient was given unfractionated heparin (5000 IU) and underwent an emergency coronary angiography that revealed the presence of critical left main coronary artery ostial stenosis (videos 1 and 2 of the supplementary data). No further lesions were identified. Due to the complexity of the lesion, percutaneous angioplasty under left ventricular assist device was advised. It was necessary to make a multidisciplinary decision due to the patient’s condition.","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69048960","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 : 2023-02-09DOI: 10.24875/recice.m22000358
Cristóbal A. Urbano-Carrillo
Introduction and objectives: Advances made in transcatheter aortic valve implantation (TAVI) valvular technology have resulted in better outcomes and fewer complications compared with older generations. We studied the rate and determinants of paravalvular leak (PVL) using Evolut PRO vs SAPIEN 3 valves as well as other perioperative and in-hospital outcomes. Methods: A total of 110 consecutive patients with severe aortic stenosis scheduled for transfemoral TAVI were randomly selected to receive the SAPIEN 3 (N = 59) or the Evolut PRO valve (N = 51). Annular dimensions were determined by transesophageal echocardiography guided balloon sizing. The following postoperative and in-hospital endpoints were assessed: PVL, conduction defects, valve embolization, need for a second valve, annular rupture, stroke, vascular complications, acute kidney injury, and in-hospital mortality. We also studied the possible anatomical determinants of PVL. Results: There were no relevant baseline differences between the 2 groups regarding clinical and echocardiographic characteristics. In-hospital complications were comparable between both valves apart from a significantly higher rate of immediate postoperative PVL and at discharge (≥ grade II) between the Evolut PRO and the SAPIEN 3 valves (19.6% vs 6.8%) and (5.9% vs 1.7%), respectively. Of the anatomical variables described, the left ventricular outflow tract/ascending aorta angle, aortic angulation, and calcification had a significant impact on PVL in the Evolut PRO valves. The left ventricular outflow tract/ascending aorta angle revealed a negative correlation with implantation depth in the Evolut PRO valves but not in the SAPIEN 3 ones. Conclusions: Both valves demonstrated favorable comparable outcomes except for a significantly higher rate of PVL in patients implanted with Evolut PRO valves. REC Interv Cardiol. 2023;5(2):94-101 https://doi.org/10.24875/RECICE.M22000351
{"title":"Class effect in TAVI: the time has come to know if they are all the same","authors":"Cristóbal A. Urbano-Carrillo","doi":"10.24875/recice.m22000358","DOIUrl":"https://doi.org/10.24875/recice.m22000358","url":null,"abstract":"Introduction and objectives: Advances made in transcatheter aortic valve implantation (TAVI) valvular technology have resulted in better outcomes and fewer complications compared with older generations. We studied the rate and determinants of paravalvular leak (PVL) using Evolut PRO vs SAPIEN 3 valves as well as other perioperative and in-hospital outcomes. Methods: A total of 110 consecutive patients with severe aortic stenosis scheduled for transfemoral TAVI were randomly selected to receive the SAPIEN 3 (N = 59) or the Evolut PRO valve (N = 51). Annular dimensions were determined by transesophageal echocardiography guided balloon sizing. The following postoperative and in-hospital endpoints were assessed: PVL, conduction defects, valve embolization, need for a second valve, annular rupture, stroke, vascular complications, acute kidney injury, and in-hospital mortality. We also studied the possible anatomical determinants of PVL. Results: There were no relevant baseline differences between the 2 groups regarding clinical and echocardiographic characteristics. In-hospital complications were comparable between both valves apart from a significantly higher rate of immediate postoperative PVL and at discharge (≥ grade II) between the Evolut PRO and the SAPIEN 3 valves (19.6% vs 6.8%) and (5.9% vs 1.7%), respectively. Of the anatomical variables described, the left ventricular outflow tract/ascending aorta angle, aortic angulation, and calcification had a significant impact on PVL in the Evolut PRO valves. The left ventricular outflow tract/ascending aorta angle revealed a negative correlation with implantation depth in the Evolut PRO valves but not in the SAPIEN 3 ones. Conclusions: Both valves demonstrated favorable comparable outcomes except for a significantly higher rate of PVL in patients implanted with Evolut PRO valves. REC Interv Cardiol. 2023;5(2):94-101 https://doi.org/10.24875/RECICE.M22000351","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44945734","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 : 2023-02-09DOI: 10.24875/recice.m22000357
J. Valencia, Francisco Torres-Saura, Fernando Torres-Mezcua, P. Bordes, Javier Pineda, and, J. Ruiz-Nodar
{"title":"Role of drug-coated balloon in the management of very late stent thrombosis","authors":"J. Valencia, Francisco Torres-Saura, Fernando Torres-Mezcua, P. Bordes, Javier Pineda, and, J. Ruiz-Nodar","doi":"10.24875/recice.m22000357","DOIUrl":"https://doi.org/10.24875/recice.m22000357","url":null,"abstract":"","PeriodicalId":34613,"journal":{"name":"REC Interventional Cardiology English Ed","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44293181","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：