RESUMEN
INTRODUCTION AND OBJECTIVES: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.
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Cardiología , Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Humanos , Cateterismo Cardíaco , Sistema de RegistrosRESUMEN
BACKGROUND: There is little information available on agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in left main coronary artery (LMCA) intermediate stenosis. Besides, several meta-analyses support the use of FFR to guide LMCA revascularization, but limited information is available on iFR in this setting. Our aims were to establish the concordance between FFR and iFR in intermediate LMCA lesions, to evaluate with intravascular ultrasound (IVUS) in cases of FFR/iFR discordance, and to prospectively validate the safety of deferring revascularization based on a hybrid decision-making strategy combining iFR and IVUS. METHODS: Prospective, observational, multicenter registry with 300 consecutive patients with intermediate LMCA stenosis who underwent FFR and iFR and, in case of discordance, IVUS and minimal lumen area measurements. Primary clinical end point was a composite of cardiovascular death, LMCA lesion-related nonfatal myocardial infarction, or unplanned LMCA revascularization. RESULTS: FFR and iFR had an agreement of 80% (both positive in 67 and both negative in 167 patients); in case of disagreement (31 FFR+/iFR- and 29 FFR-/iFR+) minimal lumen area was ≥6 mm2 in 8.7% of patients with FFR+ and 14.6% with iFR+. Among the 300 patients, 105 (35%) underwent revascularization and 181 (60%) were deferred according to iFR and IVUS. At a median follow-up of 20 months, major adverse cardiac events incidence was 8.3% in the defer group and 13.3% in the revascularization group (hazard ratio, 0.71 [95% CI 0.30-1.72]; P=0.45). CONCLUSIONS: In patients with intermediate LMCA stenosis, a physiology-guided treatment decision is feasible either with FFR or iFR with moderate concordance between both indices. In case of disagreement, the use of IVUS may be useful to indicate revascularization. Deferral of revascularization based on iFR appears to be safe in terms of major adverse cardiac events. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03767621.
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Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Pronóstico , Angiografía Coronaria , Estudios Prospectivos , Constricción Patológica , Resultado del Tratamiento , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/terapia , Vasos Coronarios/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Ultrasonografía Intervencional , Valor Predictivo de las Pruebas , Cateterismo CardíacoRESUMEN
Iodinated contrast media (CM) are the leading cause of acute renal failure of toxic origin. Between 21% and 50% of patients that receive them develop contrast-induced nephropathy (CIN). All prophylactic measures used so far have failed to provide effective prevention. Since oxidative stress is involved in the damage, a possible preventive strategy could be the administration of antioxidant substances, such as quercetin. This compound has shown renoprotective effects in experimental studies. The aim of this study was to evaluate whether quercetin may be helpful in preventing CIN in patients undergoing coronary catheterization. A clinical phase II study was conducted. Patients were distributed in two groups, namely, CM (patients who only received contrast media) and CM+Q (patients who were pretreated with quercetin orally for 3-5 days). Results showed less incidence of CIN in the CM+Q group, possibly due to glomerular protection, evidenced by a lower increase in serum creatinine and albuminuria; and a lower decrease in the glomerular filtration rate (GFR). Furthermore, in this group, the relative risk of developing CIN observed in patients that received a high dose of contrast media was inferior. In conclusion, this is the first study that demonstrates that quercetin is a promising safe candidate in preventing CIN.
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Medios de Contraste/efectos adversos , Enfermedades Renales/etiología , Enfermedades Renales/prevención & control , Sustancias Protectoras/farmacología , Quercetina/farmacología , Anciano , Biomarcadores , Medios de Contraste/administración & dosificación , Medios de Contraste/clasificación , Creatinina/metabolismo , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/metabolismo , Masculino , Sustancias Protectoras/uso terapéutico , Quercetina/uso terapéuticoRESUMEN
Introducción y objetivos: Muchos pacientes con fibrilación auricular no valvular tienen contraindicados los anticoagulantes orales. El objetivo es estimar la incidencia de eventos tromboembólicos y hemorrágicos en pacientes con fibrilación auricular no valvular y cierre de la orejuela izquierda con seguimiento a largo plazo, y determinar los factores asociados con mayor mortalidad a largo plazo. Métodos: Cohorte prospectiva de pacientes reclutados desde 2009 a 2015. Se compararon los eventos tromboembólicos y hemorrágicos con los esperados según las escalas CHA2DS2-VASc y HAS-BLED. Se realizó un análisis multivariable para determinar las variables asociadas con la mortalidad. Resultados: Se reclutó a 598 pacientes (1.093 pacientes-año) con contraindicación de anticoagulantes (mediana de edad, 75,4 años). La tasa de éxito del cierre de la orejuela izquierda fue del 95,8%; 30 pacientes (5%) presentaron complicaciones. Las tasas de eventos (cada 100 pacientes-año) durante el seguimiento (media, 22,9 meses; mediana, 16,1 meses) fueron: muerte, 7,0%; ictus isquémico, 1,6% (frente al 8,5% esperado según CHA2DS2-VASc; p < 0,001); hemorragia intracraneal, 0,8%; hemorragia gastrointestinal, 3,2%, y hemorragia grave, 3,9% (frente al 6,3% esperado por HAS-BLED; p = 0,002). Estos resultados incluso mejoraron en el subgrupo de 176 pacientes con seguimiento > 24 meses (media, 46,6 meses; 683 pacientes-año) para las hemorragias graves, el 2,6% (frente al 6,3% esperado por HAS-BLED; p < 0,033). La edad (HR = 1,1), las hemorragias intracraneales (HR = 6,8) y el ictus (HR = 2,7) se asociaron con mayor mortalidad. Conclusiones: El cierre de la orejuela izquierda redujo significativamente las incidencias de ictus y de eventos hemorrágicos graves y el beneficio se mantuvo. La edad, las hemorragias intracraneales y el ictus se asociaron con mayor mortalidad
Introduction and objectives: Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality. Methods: Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up. Results: A total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA2DS2-VASc; P < .001); intracranial hemorrhage 0.8%; gastrointestinal bleeding 3.2%; severe bleeding 3.9% (vs 6.3% expected by HAS-BLED, P = .002). These results were improved in the subgroup of 176 patients with follow-up > 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P < .033). The factors significantly associated with higher mortality were age (HR, 1.1), intracranial hemorrhage (HR, 6.8), and stroke during follow-up (HR, 2.7). Conclusions: Left atrial appendage closure significantly reduced the incidence of stroke and bleeding events and the benefit was maintained. Intracranial hemorrhage, age and stroke were associated with higher mortality
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Humanos , Masculino , Femenino , Anciano , Apéndice Atrial/cirugía , Dispositivos de Cierre Vascular/estadística & datos numéricos , Defectos del Tabique Interatrial/cirugía , Fibrilación Atrial/complicaciones , Efectos Adversos a Largo Plazo/prevención & control , Registros de Enfermedades/estadística & datos numéricos , Fibrilación Atrial/tratamiento farmacológico , Anticoagulantes/efectos adversos , Estudios Prospectivos , Tromboembolia/epidemiología , Hemorragia/epidemiología , Accidente Cerebrovascular/prevención & control , Indicadores de Morbimortalidad , Contraindicaciones de los MedicamentosRESUMEN
INTRODUCTION AND OBJECTIVES: Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality. METHODS: Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up. RESULTS: A total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA2DS2-VASc; P < .001); intracranial hemorrhage 0.8%; gastrointestinal bleeding 3.2%; severe bleeding 3.9% (vs 6.3% expected by HAS-BLED, P = .002). These results were improved in the subgroup of 176 patients with follow-up > 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P < .033). The factors significantly associated with higher mortality were age (HR, 1.1), intracranial hemorrhage (HR, 6.8), and stroke during follow-up (HR, 2.7). CONCLUSIONS: Left atrial appendage closure significantly reduced the incidence of stroke and bleeding events and the benefit was maintained. Intracranial hemorrhage, age and stroke were associated with higher mortality.
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Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Sistema de Registros , Dispositivo Oclusor Septal , Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Portugal/epidemiología , Estudios Prospectivos , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The aims of this registry were to determine the incidence, predictors, and prognostic value of periprocedural acute kidney injury (AKI) after left atrial appendage closure (LAAC). BACKGROUND: No data exist on the occurrence of AKI after LAAC. METHODS: A total of 355 patients undergoing LAAC were included in the study. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or ≥50%, respectively, after the procedure or the need for hemodialysis during index hospitalization. RESULTS: The incidence of AKI was 9%, and patients with worse baseline renal function were at higher risk for developing AKI (odds ratio: 1.32; 95% confidence interval [CI]: 1.09 to 1.61; p = 0.004 for each 10 ml/min decrease in glomerular filtration rate). In-hospital bleeding events occurred more frequently in the AKI group (5.3% vs. 15.6%; p = 0.037). After a median follow-up period of 18 months, patients in the AKI group had higher mortality (hazard ratio [HR]: 2.59; 95% CI: 1.36 to 4.92; p = 0.004), more embolic events (HR: 6.14; 95% CI: 2.23 to 16.92; p = 0.001) and major bleeding events (HR: 2.36; 95% CI: 0.89 to 6.24; p = 0.083). The occurrence of AKI was an independent predictor of midterm mortality (HR: 2.00; 95% CI: 1.02 to 3.91; p = 0.044). CONCLUSIONS: The occurrence of AKI was relatively frequent following LAAC, and patients with lower renal glomerular filtration rates were at high risk for developing this complication. AKI identified a group of patients with worse midterm outcomes, highlighting the importance of further preventive strategies in this population.
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Lesión Renal Aguda/epidemiología , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Anciano , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/mortalidad , Canadá/epidemiología , Cateterismo Cardíaco/mortalidad , Femenino , Tasa de Filtración Glomerular , Humanos , Incidencia , Riñón/fisiopatología , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation. METHODS: Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included. RESULTS: A total of 101 patients (median age 76 [IQR 69-80] years, 48% women, mean CHA2DS2-VASc 5 ± 2; HAS-BLED 4 ± 1) were included. Eighty-six (85.1%) patients received an Amplatzer Cardiac Plug/Amulet device and 15 (14.9%) patients a Watchman device. The mean follow-up period was 4 ± 1 years. During 358.6 patient-years of follow-up, 7 (6.9%) patients suffered a major stroke (2 cases per 100 person-years; expected rate: 6.2 cases per 100 person-years), and 20 (19.8%) patients experienced at least one episode of major bleeding (6.4 cases per 100 person-years; expected rate: 9.0 cases per 100 person-years). There were no cases of late adverse events related to the device. A total of 34 (33.7%) patients died during follow-up (9.5 cases per 100 person-years). Older age, male sex, low ejection fraction, and chronic kidney disease were identified as predictive factors of late mortality. CONCLUSIONS: Percutaneous LAA closure is safe and effective in the long term in patients with AF with contraindications to anticoagulation. However, a high long-term mortality rate was observed in this high-risk population. Comprehensive patient assessment prior to undergoing LAA closure should identify patients in whose comorbidities limit their overall prognosis.
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Apéndice Atrial/cirugía , Fibrilación Atrial/mortalidad , Fibrilación Atrial/cirugía , Seguridad del Paciente , Dispositivo Oclusor Septal/estadística & datos numéricos , Administración Oral , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Fibrilación Atrial/diagnóstico por imagen , Cateterismo Cardíaco/instrumentación , Estudios de Cohortes , Contraindicaciones , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Selección de Paciente , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Tasa de Supervivencia , Tiempo , Resultado del TratamientoRESUMEN
We present the case of a patient with a high-output fistula between the right superficial femoral artery and femoral vein after left atrial appendage closure successfully treated with a PK-Papyrus covered coronary stent using a 6F guiding catheter. To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting.
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Fístula Arteriovenosa/cirugía , Arteria Femoral/cirugía , Vena Femoral/cirugía , Complicaciones Posoperatorias/cirugía , Stents , Anciano de 80 o más Años , Fístula Arteriovenosa/etiología , Femenino , Humanos , Enfermedad Iatrogénica , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Vasculares/métodosAsunto(s)
Aorta Torácica/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis/complicaciones , Fístula/cirugía , Cardiopatías/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Anciano de 80 o más Años , Aorta Torácica/cirugía , Ecocardiografía , Endocarditis/diagnóstico , Fístula/diagnóstico , Fístula/etiología , Cardiopatías/etiología , Cardiopatías/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
No disponible
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Apéndice Atrial/cirugía , Apéndice Atrial , Dispositivos de Cierre Vascular/tendencias , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento , Evaluación de Eficacia-Efectividad de IntervencionesRESUMEN
Pulmonary vein (PV) stenosis (PVS) is a known complication of PV isolation procedures for AF (atrial fibrillation). PV angioplasty and stenting have been used as an effective therapy for PVS, yet high rates of restenosis are common. Experience with intravascular ultrasound (IVUS) in evaluating the PVS morphological characteristics and appropriate stent deployment is very limited. Furthermore, the use of IVUS could minimise the risk of restenosis. We describe the case of a patient with sub-occlusion of the left superior PV and total occlusion of the left inferior PV following catheter ablation for AF treated by stenting with IVUS guidance.
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Ablación por Catéter , Procedimientos Endovasculares , Enfermedad Veno-Oclusiva Pulmonar , Stents , Ultrasonografía Intervencional , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Veno-Oclusiva Pulmonar/diagnóstico por imagen , Enfermedad Veno-Oclusiva Pulmonar/cirugíaAsunto(s)
Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Dispositivo Oclusor Septal , Anciano , Fibrilación Atrial/diagnóstico , Ecocardiografía , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Anuloplastia de la Válvula Mitral/instrumentación , Insuficiencia de la Válvula Mitral/terapia , Válvula Mitral/cirugía , Falla de Prótesis , Anciano , Cateterismo Cardíaco/instrumentación , Ecocardiografía Doppler en Color , Ecocardiografía Tridimensional , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Anuloplastia de la Válvula Mitral/efectos adversos , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Diseño de Prótesis , Punciones , Recurrencia , Resultado del TratamientoRESUMEN
The most common etiology of tricuspid stenosis is rheumatic, and in most cases it is associated with valvular regurgitation. Interestingly, there have been reports of tricuspid stenosis without associated valvular regurgitation, mostly related to pacemaker leads. Percutaneous tricuspid valvuloplasty may be a therapeutic alternative to surgery in cases of pure tricuspid stenosis without other concomitant valvulopathies. We report the case of a 52-year-old woman with pacemaker lead-related tricuspid stenosis successfully treated with percutaneous valvuloplasty guided by 3D echocardiography.
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Ecocardiografía Tridimensional , Marcapaso Artificial/efectos adversos , Cirugía Asistida por Computador , Estenosis de la Válvula Tricúspide/etiología , Estenosis de la Válvula Tricúspide/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Femenino , Humanos , Persona de Mediana Edad , Inducción de Remisión , Estenosis de la Válvula Tricúspide/diagnóstico por imagenRESUMEN
Introducción y objetivos: El cierre percutáneo de las fugas periprotésicas presenta tasas de éxito variables, la falta de dispositivos específicamente diseñados para este procedimiento ha limitado sus resultados. El Amplatzer Vascular Plug III, por sus características, parece un dispositivo ideal para este procedimiento, pero los datos disponibles se limitan a casos aislados o pequeñas series. El propósito de este estudio es analizar la factibilidad y la eficacia del cierre percutáneo de fugas periprotésicas con este dispositivo. Métodos: Se analizan resultados de seguridad y eficacia durante el procedimiento y a 90 días de las fugas periprotésicas mitrales y aórticas cerradas percutáneamente con este dispositivo en nuestro centro. Resultados: Se trataron 34 fugas periprotésicas, 7 a nivel aórtico y 27 a nivel mitral, correspondientes a 33 pacientes. El éxito técnico fue del 93,9% (en 2 pacientes se realizó un segundo procedimiento programado) y el éxito del procedimiento (reducción ≥ 1 grado de regurgitación) en el 90,9%. En 4 pacientes se observaron complicaciones relacionadas con el procedimiento (transfusión en 3 pacientes y cirugía por interferencia con los discos en 1 paciente). No se observó ningún caso de muerte, infarto de miocardio o accidente cerebrovascular periprocedimiento. A 90 días la supervivencia fue del 100%, y en el 90,3% de los pacientes mejoró la clase funcional; 4 pacientes sufrieron complicaciones vasculares (seudoaneurisma) en el seguimiento. Conclusiones: El cierre percutáneo de la fugas periprotésicas con el Amplatzer Vascular Plug III es un procedimiento factible, seguro y con elevadas tasas de éxito clínico y ecocardiográfico
Introduction and objectives: Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. Methods: The immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. Results: Percutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). Conclusions: Mitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates
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Humanos , Endofuga/cirugía , Dispositivos de Cierre Vascular , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Tricúspide/epidemiología , Complicaciones PosoperatoriasRESUMEN
Fully bioresorbable vascular scaffolds (BVS) are a new approach to the percutaneous treatment of coronary artery disease. The BVS have not yet been fully tested in complex lesions, including chronic total occlusion (CTO). We report a CTO case successfully treated with a second-generation bioabsorbable drug-eluting scaffold.
RESUMEN
INTRODUCTION AND OBJECTIVES: Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. METHODS: The immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. RESULTS: Percutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). CONCLUSIONS: Mitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates.
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Insuficiencia de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/instrumentación , Prótesis Valvulares Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Dispositivo Oclusor Septal , Anciano , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica/métodos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Falla de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
AIMS: Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of ISR between first and second generation DES. METHODS AND RESULTS: OCT was performed in 66 DES-ISR, defined as > 50% angiographic diameter stenosis within the stented segment. Patients with ISR of first generation sirolimus-eluting stents (SES), paclitaxel eluting stents (PES) and second generation zotarolimus-eluting stents (ZES), everolimus-eluting stents (EES) and biolimus-eluting stents (BES) were enrolled. Quantitative and qualitative ISR tissue analysis was performed at 1-mm intervals along the entire stent, and categorised as homogeneous, heterogeneous and neo-atherosclerosis. The presence of microvessels and peri-strut low intensity area (PSLIA) was determined in all ISR. Neoatherosclerosis was identified by lipid, calcium and thin-cap fibro-atheroma (TCFA) like lesions. We compared the two DES generations at both early (< 1 year) and late (> 1 year) follow-ups.In second generation DES a heterogeneous pattern was prevalent both before and after 1 year (57.1% and 58.6% respectively). Neo-atherosclerosis was more common in the early period in first generation DES (19.4% vs 11.7%, p < 0.01), but after one year was more prevalent in second generation DES (7.0% vs 19.3%, p < 0.01). Similar prevalence of TCFAs was observed in both groups in all comparisons. CONCLUSIONS: When ISR restenosis occurs in second generation DES, the current data suggest a different time course and different morphological characteristics from first generation. Future prospective studies should evaluate the relationship between ISR morphology, time course and clinical events.