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1.
J Card Surg ; 36(7): 2533-2535, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33821488

RESUMEN

Alternative accesses for transcatheter aortic valve replacement (TAVR) are needed in a certain number of patients, who present contraindications to the standard transfemoral access. We present the transcervical approach, which allows to access the aortic valve via supra-aortic vessels, namely, the brachiocephalic trunk, carotid artery, or subclavian artery. This approach is interesting because it avoids thoracotomy, which is necessary with some other alternative approaches for TAVR, such as the transaortic or transapical ones. Although some points still need clarification, such as the best anesthesia modality (general or local) or the optimal side for vessel access, data suggest the transcervical access might yield similar periprocedural and 30-day outcomes compared with the transfemoral access. Herein, we describe the surgical technique that was developed in our institution for transcervical access.


Asunto(s)
Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Aorta , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Humanos , Factores de Riesgo , Resultado del Tratamiento
2.
Front Cardiovasc Med ; 8: 687168, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34124210

RESUMEN

Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10-15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR. Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted. Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02-1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25-0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02-2.55, p = 0.040). Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.

3.
Interact Cardiovasc Thorac Surg ; 31(6): 781-788, 2020 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-33051655

RESUMEN

OBJECTIVES: Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS: All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS: TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5-101.0] vs 93 [IQR 80.0-120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0-0.0) vs 1.0 (IQR 1.0-3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0-9.5) vs 14.0 (IQR 10.0-22.0) days, P < 0.001]. CONCLUSIONS: The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
4.
JACC Cardiovasc Imaging ; 11(6): 813-825, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-28823746

RESUMEN

OBJECTIVES: This study sought to investigate whether early post-infarction cardiac magnetic resonance (CMR) parameters provide additional long-term prognostic value beyond traditional outcome predictors in ST-segment elevation myocardial infarction (STEMI) patients. BACKGROUND: Long-term prognostic significance of CMR in STEMI patients has not been assessed yet. METHODS: This was a longitudinal study from a multicenter registry that prospectively included STEMI patients undergoing CMR after infarction. Between May 2003 and August 2015, 810 revascularized STEMI patients were included. CMR was performed at a median of 4 days after STEMI. Infarct size, microvascular obstruction (MVO), and left ventricular (LV) volumes and function were measured. Primary endpoint was a composite of all death and decompensated heart failure (HF). RESULTS: During median follow-up of 5.5 years (range 1.0 to 13.1 years), primary endpoint occurred in 99 patients (39 deaths and 60 HF hospitalization). MVO was a strong predictor of the composite endpoint after correction for important clinical, CMR, and angiographic parameters, including age, LV systolic function, and infarct size. The independent prognostic value of MVO was confirmed in all multivariate models irrespective of whether it was included as a dichotomous (presence of MVO, hazard ratio [HR]: 1.985 to 1.995), continuous (MVO extent as % LV, HR: 1.095 to 1.097), or optimal cutoff value (MVO extent ≥2.6% of LV; HR: 3.185 to 3.199; p < 0.05 for all). MVO extent ≥2.6% of LV was a strong independent predictor of all death (HR: 2.055; 95% confidence interval: 1.076 to 3.925; p = 0.029) and HF hospitalization (HR: 5.999; 95% confidence interval: 3.251 to 11.069; p < 0.001). Finally, MVO extent ≥2.6% of LV provided incremental prognostic value over traditional outcome predictors (net reclassification improvement index: 0.16 to 0.30; p < 0.05 for all models). CONCLUSIONS: Early post-infarction CMR-based MVO is a strong independent prognosticator in revascularized STEMI patients. Remarkably, MVO extent ≥2.6% of LV improved long-term risk stratification over traditional outcome predictors.


Asunto(s)
Imagen por Resonancia Cinemagnética , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Anciano , Progresión de la Enfermedad , Europa (Continente) , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Supervivencia sin Progresión , Estudios Prospectivos , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Factores de Tiempo
5.
Rev Med Suisse ; 3(118): 1696-701, 2007 Jul 04.
Artículo en Francés | MEDLINE | ID: mdl-17726905

RESUMEN

Intracardiac echocardiography is a new technique based on the use of ultrasonic diagnostic catheter, which can be introduced through the femoral vein up of the right atrium. Intracardiac echocardiography provides bidimensional views, coupled to colour and pulsed Doppler. This review summarizes multiple applications of intracardiac echocardiography in the field of interventional cardiology, particularly during percutaneous closure of patent foramen ovale or atrial septal defect. A major advantage of intracardiac echocardiography is the possibility of avoiding general anaesthesia as well as providing equivalent information to the reference technique of transoesophageal echocardiography.


Asunto(s)
Cateterismo Cardíaco , Ecocardiografía/métodos , Ultrasonografía Intervencional , Ecocardiografía/instrumentación , Diseño de Equipo , Humanos
6.
J Invasive Cardiol ; 17(3): 125-8, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15867437

RESUMEN

Elective left main (LM) stenting is increasingly performed as a valuable alternative to coronary artery bypass grafting. Nevertheless, clinical data are limited to registries, and randomized trials have not been published. Intravascular ultrasound (IVUS) has been recognized as an accurate tool for assessing optimal stent deployment. We hereby report the usefulness of IVUS in defining the interventional strategy in four consecutive patients presenting with severe, symptomatic ostial LM disease, and this in the era of drug-eluting stents. The first two patients were treated by a short drug-eluting stent for a critical LM stenosis as IVUS demonstrated a reference diameter < 3.7 mm. The third patient had a larger reference diameter and was treated with conventional stenting with optimization of the result by IVUS. IVUS was particularly helpful in all patients to confirm accurate stent placement in relation to the LM ostium and bifurcation. In another patient, based on IVUS findings, surgery was preferred. This patient with diabetes as a risk factor presented with comparable angiographic features. IVUS, however, showed diffuse disease without any healthy reference segment in the LM. All stented patients are asymptomatic at 15 +/- 7 months follow-up with negative stress testing. The present observation indicates that IVUS is an essential tool for strategic selection and to optimize percutaneous coronary intervention for LM disease.


Asunto(s)
Estenosis Coronaria/terapia , Stents , Ultrasonografía Intervencional , Adulto , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Diabetes Mellitus Tipo 1 , Diagnóstico Diferencial , Femenino , Humanos , Hipertensión , Persona de Mediana Edad
7.
J Invasive Cardiol ; 15(12): 706-9, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14660823

RESUMEN

At present, vascular brachytherapy is the only efficient therapy for in-stent restenosis. Nevertheless, edge restenosis often related to geographical miss has been identified as a major limitation of the technique. The non-slippery cutting balloon has the potential to limit vascular barotraumas, which, together with low-dose irradiation at both ends of the radioactive source, are the prerequisite for geographical miss. This prospective study aimed to examine the efficacy of combining cutting balloon angioplasty and brachytherapy for in-stent restenosis. The Radiation in Europe NOvoste (RENO) registry prospectively tracked all patients who had been treated by coronary beta-radiation with the Beta-Cath System (Novoste Corporation, Brussels, Belgium) but were not included in a randomized radiation trial. A subgroup of patients with in-stent restenosis treated by cutting balloon angioplasty and coronary beta-radiation (group 1, n = 166) was prospectively defined, and clinical outcomes of patients at 6 months were compared with those of patients treated by conventional angioplasty and coronary beta-radiation (group 2, n = 712). At 6-month follow-up, there was a significant difference between groups 1 and 2 in target vessel revascularization (10.2% versus 16.6% respectively; p = 0.04) and in the incidence of major adverse clinical events (MACE) including death, myocardial infarction, and revascularization (10.8% versus 19.2%; p = 0.01). This observation was confirmed by a multivariate analysis indicating a lower risk for MACE at 6 months (odds ratio: 0.49; confidence intervals: 0.27 0.88; p = 0.02). Compared to conventional angioplasty, cutting balloon angioplasty prior to coronary beta-radiation with the Beta-Cath System seems to improve the 6-month clinical outcome in patients with in-stent restenosis.


Asunto(s)
Angioplastia Coronaria con Balón , Braquiterapia , Reestenosis Coronaria/terapia , Anciano , Partículas beta/uso terapéutico , Terapia Combinada , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/epidemiología , Europa (Continente) , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Resultado del Tratamiento
10.
Catheter Cardiovasc Interv ; 55(2): 233-6, 2002 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11835654

RESUMEN

More than 70% of percutaneous coronary interventions are followed by a stent implantation. In-stent restenosis still occurs in 20-30% of patients and remains a therapeutic challenge. At present only vascular brachytherapy has been shown to be an effective treatment option. We report here one case of recurrent in-stent restenosis after vascular brachytherapy that was successfully treated by a second beta radiation treatment.


Asunto(s)
Partículas beta , Braquiterapia , Reestenosis Coronaria/etiología , Reestenosis Coronaria/radioterapia , Stents , Anciano , Implantación de Prótesis Vascular/instrumentación , Femenino , Humanos , Recurrencia
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