Journal of the Society for Cardiovascular Angiography & Interventions最新文献

Background: Three-dimensional rotational angiography (3DRA) is a promising advancement to guide cardiac catheterizations. It is used with restraint in critically ill infants with congenital heart disease (CHD) due to the lack of research conducted within this patient group.

Methods: Data of all infants with CHD and a body weight <5 kg who underwent cardiac catheterization with the use of 3DRA between November 2011 and April 2021 were retrospectively analyzed. Primary outcome measures were 3DRA-related periprocedural deaths or major adverse events (MAEs). Secondary outcome measures were 3DRA-related minor adverse events (MiAEs), the amount of radiation exposure and contrast agent, and whether 3DRA led to important new findings. The case-based workflow of 3DRA in vulnerable infants is explained.

Results: Eighty-six patients underwent 109 cardiac catheterizations in which 132 3DRA scans were performed. Median age and weight were 50.0 days (IQR, 20.0-98.5) and 3.8 kg (IQR, 3.2-4.5). There were no periprocedural deaths or MiAEs, and only 2 MAEs occurred, both concerning ventricular fibrillation. The median radiation exposure was 160.0 cGy⋅cm² (IQR, 81.3-257.5), of which 28.0 cGy⋅cm² (IQR, 19.4-43.0) was derived from 3DRA. The mean amount of contrast agent used was 4.8 ± 1.6 mL/kg. In 70.6%, 3DRA imaging led to important new findings. Multivariate binary logistic regression analysis showed the presence of comorbidity to be associated with a lower odds of receiving a 3DRA-derived radiation dose ≥15 cGy⋅cm² (P = .01). Additionally, the interval between surgery and cardiac catheterization was significantly associated with higher odds of a contrast dye consumption ≥6 mL/kg (P = .046).

Conclusions: 3DRA proved to be safe in vulnerable infants with CHD weighing <5 kg, enabling visualization of anatomical substrates often invisible in conventional angiography. However, when an advanced computed tomography scanner is available, the diagnostic purposes for 3DRA are few. The greatest benefit of 3DRA usage is interventional guidance (3D roadmap).

The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments. After conceptualizing the 3 major roles of PMA as a bridge to decision, destination therapy, and adjunctive therapy, we then review the clinical scenarios in which PMA might be considered by IE subtype. We discuss patient selection, the rationale for intervention, and the most recent evidence for each. Next, we consider PMA for IE in the larger context of our health care system across 3 domains: clinical collaboration, financial considerations, and academic innovation, emphasizing the importance of interdisciplinary teams and cross-organizational partnerships, reimbursement models, and the need for high-quality research. Finally, we outline what we determined to be the most pressing outstanding questions in this space. In doing so, we propose a national consortium to help organize efforts to move this field forward and share our progress in these endeavors to date. PMA for IE has great promise, but significant work remains if we are to fully realize its potential to safely and effectively improve outcomes for modern endocarditis patients.