Catheterization Laboratory Research Articles

Survival After Extracorporeal Cardiopulmonary Resuscitation Based on In-Hospital Cardiac Arrest and Cannulation Location: An Analysis of the Extracorporeal Life Support Organization Registry.

Explore whether extracorporeal cardiopulmonary resuscitation (ECPR) mortality differs by in-hospital cardiac arrest location and whether moving patients for cannulation impacts outcome. Retrospective cohort study. ECPR hospitals that report data to the Extracorporeal Life Support Organization (ELSO). Patients having ECPR for in-hospital cardiac arrest between 2020 and 2023 with data in the ELSO registry. None. Patient demographics, comorbidities, pre-cardiac arrest conditions, pre-ECPR vasopressor use, cardiac arrest details, ECPR cannulation information, major complications, and in-hospital mortality were recorded. Multivariable logistic regression model was used to examine the associations between in-hospital mortality and 1) cardiac arrest location and 2) moving a patient for ECPR cannulation. A total of 2515 patients met enrollment criteria. The adjusted odds ratio (aOR) for mortality was increased in patients who had a cardiac arrest in the ICU (aOR, 1.85; 95% CI, 1.45-2.38; p < 0.001) and in patients who had a cardiac arrest in an acute care bed (aOR, 1.68; 95% CI, 1.09-2.58; p = 0.02) compared with the cardiac catheterization laboratory. Moving a patient for cannulation had no association with mortality (aOR, 0.70; 95% CI, 0.18-2.81; p = 0.62). Advanced patient age was associated with increased mortality. Specifically, patients 60-69 and patients 70 years old or older were more likely to die compared with patients younger than 30 years old (aOR, 1.71; 95% CI, 1.17-2.50; p = 0.006 and aOR, 2.27; 95% CI, 1.49-3.48; p < 0.001, respectively). ECPR patients who experienced cardiac arrest in the ICU and in acute care hospital beds had increased odds of mortality compared with other locations. Moving patients for ECPR cannulation was not associated with improved outcomes.

Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA)

BackgroundDiscrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia. MethodsObservational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ​≥ ​50 ​% at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80. ResultsThe study population consisted of 192 patients, of whom 224 vessels (61 ​% LAD, 19 ​% LCX, 20 ​% RCA) had lesions with DS ​≥ ​50 ​% interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 ​% vs 43.2 ​% and 44.2 ​%, respectively, p ​= ​0.018). A significant correlation between DS and FFR was observed only in LAD (p ​= ​0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 ​%) for LAD, non-calcified plaque volume (threshold >130 ​mm3) for LCX, and lumen volume (threshold <844 ​mm3) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76–0.80). ConclusionsIntegrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients’ referral to the catheterization laboratory.

A high-fidelity personalised 3d printed simulator for the left atrial appendage occlusion procedure

Purpose This study aims to develop a realistic 3D printing-based simulator for the training and planning of the left atrial appendage occlusion (LAAO) to be used in the cath lab. Design/methodology/approach Starting from a pre-operative computed tomography dataset of a patient already treated with LAAO, the model was obtained, consisting in the right and left heart, opportunely assembled to replicate the position and orientation of the patient's anatomy while lying on the cath lab table. Different 3D printing techniques and materials were used to mimic the interaction between the cardiac tissue and the clinical instrumentation. The simulator was tested in the cath lab under proper image guidance by three LAAO expert operators. The clinicians were required to assign a score in terms of realism to each material used to fabricate the fossa ovalis and the LAA. Findings The simulated interventions were successfully performed by the operators, who were able to navigate in the system and release the occluder device as during a real procedure. The intraoperative images acquired during the simulations were highly comparable with data from a real intervention, with a mean percentage difference below 10%. Originality/value This study demonstrated the feasibility of the proposed simulator to faithfully replicate the LAAO procedure and its potentiality to be used for multiple purposes, including the training of the young clinicians, the evaluation of the most complicated cases and the design of novel occluder devices, in a fully realistic setting.

Diagnostic performance of fully automatic coronary CT angiography-based quantitative flow ratio

BackgroundMurray-law based quantitative flow ratio, namely μFR, was recently validated to compute fractional flow reserve (FFR) from coronary angiographic images in the cath lab. Recently, the μFR algorithm was applied to coronary computed tomography angiography (CCTA) and a semi-automated computed μFR (CT-μFR) showed good accuracy in identifying flow-limiting coronary lesions prior to referral of patients to the cath lab. We aimed to evaluate the diagnostic accuracy of an artificial intelligence-powered method for fully automatic CCTA reconstruction and CT-μFR computation, using cath lab physiology as reference standard. MethodsThis was a post-hoc blinded analysis of the prospective CAREER trial (NCT04665817). Patients who underwent CCTA, coronary angiography including FFR within 30 days were included. Cath lab physiology standard for determining hemodynamically significant coronary stenosis was defined as FFR≤0.80, or μFR≤0.80 when FFR was not available. ResultsAutomatic CCTA reconstruction and CT-μFR computation was successfully achieved in 657 vessels from 242 patients. CT-μFR showed good correlation (r ​= ​0.62, p ​< ​0.001) and agreement (mean difference ​= ​−0.01 ​± ​0.10, p ​< ​0.001) with cath lab physiology standard. Patient-level diagnostic accuracy for CT-μFR to identify patients with hemodynamically significant stenosis was 83.0 ​% (95%CI: 78.3%–87.8 ​%), with sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of 84.2 ​%, 81.9 ​%, 82.1 ​%, 84.0 ​%, 4.7 and 0.2, respectively. Average analysis time for CT-μFR was 1.60 ​± ​0.34 ​min per patient. ConclusionThe fully automatic CT-μFR yielded high feasibility and good diagnostic performance in identifying patients with hemodynamically significant stenosis prior to referral of patients to the cath lab.

Comparing Virtual Reality and Traditional Training in Radiation Safety Practices Over Three Years Among Cardiologists and Scrub Nurses

PurposeThis study evaluated the effectiveness of virtual reality (VR) training versus traditional methods in enhancing radiation safety practices among cardiologists and scrub nurses. Developed by Virtual Medical Coaching, VR training simulates radiation safety scenarios in cardiac catheterization laboratories (Cath Labs). MethodsA three-year crossover study was conducted with 150 healthcare professionals (in this study, healthcare professionals are defined as cardiologists and scrub nurses who work in Cath Labs) at five urban hospitals. These professionals are key personnel in fluoroscopy-guided interventional procedures, where radiation safety is a critical concern.Participants, stratified by profession, were randomly assigned to initially receive either VR (virtual medical coaching) or traditional training, followed by a year-long washout period before switching training modalities. Primary outcomes measured changes in radiation exposure via dosimeters, whereas secondary outcomes assessed knowledge retention. ResultsVR training significantly reduced radiation exposure, resulting in a 30% greater decrease in radiation dose than traditional methods do. Cardiologists in Group A (VR training) experienced a mean reduction of 3.37 (p < 0.001), whereas scrub nurses experienced a mean reduction of 2.89 (p < 0.001). In contrast, participants in Group B (traditional training) exhibited a smaller reduction of 1.75 for cardiologists (p < 0.001) and 1.49 for scrub nurses (p < 0.001). The participants transitioning from traditional to VR training demonstrated enhanced retention and application of safety protocols, as reflected by improved knowledge and observed structured clinical examinations (OSCE) scores. The integration of VR into training notably improved procedural knowledge and skills without the risk of radiation exposure, making VR an effective tool for radiation safety education. ConclusionThis study highlights the superiority of VR training in reducing radiation exposure and enhancing practical skills among medical professionals. Virtual medical coaching’s specialized VR modules effectively simulate real-world scenarios, making them valuable components in radiation safety training. The findings advocate the integration of VR into medical education curricula to improve safety standards and training efficacy.

The invisible gorilla in the cath lab: can we fly away from it?

The invisible gorilla in the cath lab: can we fly away from it?

346 - A critical analysis of personal radiation protection in the catheterization laboratory: A systematic review

346 - A critical analysis of personal radiation protection in the catheterization laboratory: A systematic review

TCT-934 Early Administration of Heparin at First Medical Contact Versus in the Cath Lab for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention (HELP-PCI): A Multicenter, Randomized Trial

TCT-934 Early Administration of Heparin at First Medical Contact Versus in the Cath Lab for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention (HELP-PCI): A Multicenter, Randomized Trial

TCT-249 Cath Lab Mortality Evaluation and the MMC-QI Nexus in Improving Quality and Outcomes: A Methodical Approach in Accordance With Contemporary Best Practices at the World’s Largest Primary PCI Center

TCT-249 Cath Lab Mortality Evaluation and the MMC-QI Nexus in Improving Quality and Outcomes: A Methodical Approach in Accordance With Contemporary Best Practices at the World’s Largest Primary PCI Center

TCT-731 Setting the Stage: Comparative Analysis of Pulmonary Embolism Intervention in the Cath Lab Versus Operating Room

TCT-731 Setting the Stage: Comparative Analysis of Pulmonary Embolism Intervention in the Cath Lab Versus Operating Room

TCT-331 Use of Automated Contrast Injector Versus Manifold in Cardiac Catheterization Laboratory Procedures Is Not Associated With Reduced Procedural Contrast Volumes or Rates of Acute Kidney Injury

TCT-331 Use of Automated Contrast Injector Versus Manifold in Cardiac Catheterization Laboratory Procedures Is Not Associated With Reduced Procedural Contrast Volumes or Rates of Acute Kidney Injury

363 - Evaluation of radiation protection and catheterization laboratory safety in Nepal

363 - Evaluation of radiation protection and catheterization laboratory safety in Nepal

TCT-301 Impact of Implementing Solid Waste Management in Health Care Services: A Case Study in a Catheterization Laboratory Center

TCT-301 Impact of Implementing Solid Waste Management in Health Care Services: A Case Study in a Catheterization Laboratory Center

Assessment of chronical total occlusions management in France: The ENCOCHE Registry, a prospective, multicentric study

BackgroundCoronary chronic total occlusions (CTO) are frequent, and coronary angioplasty has been increasingly used in recent years for lesion revascularisation. However, to date, no dedicated multicentric prospective study is available in France. AimTo describe the characteristics of CTO patients and to assess current treatment strategies in French catheterisation laboratory practice. MethodsPatients presenting with CTOs were included from 16/09/2021 to 13/12/2021 over two consecutive prospective phases. In phase I (one month), data were collected to include all patients presenting CTO at diagnostic angiography. In phase II (two months), data were collected focusing on patients who underwent CTO-PCI. ResultsA total of 1303 patients (1460 CTOs) were included in 68 French centres. The mean age was 67.7±10.7 years and 84.3% of the patients were men. The prevalence of prior PCI (44.6%), and diabetes mellitus (35.6%) was high. In phase I, multivessel coronary artery disease was detected in two-thirds of cases, and most of them (88.5%) had a single CTO. The mean J-CTO score was 1.9±1.2, with a proportion of difficult and very difficult CTO (J CTO score ≥2) of 61.1%. The selected treatment was medical therapy in 57% of cases, coronary angioplasty in 30% and bypass surgery in 13%. In phase II, 528 patients were included with a mean J-CTO score of 1.8±1.2. Successful guidewire crossing through CTO lesion was obtained with an antegrade access in 89% of patients. Procedural success rate of CTO-PCI was 80%, with a rate of major in-hospital complications of 1% (death: 0.4%, MI: 0.2%, stroke: 0.2%, emergency CABG: 0.2%). ConclusionThis prospective study provides a snapshot of CTOs prevalence and CTO treatment strategies in France in 2021.

Fusion mixed reality: a novel approach to merge the physical and virtual cath lab.

Fusion mixed reality: a novel approach to merge the physical and virtual cath lab.

Guidewire Entrapment During Percutaneous Intervention for Chronic Total Occlusion: A Rare Case Report

Iatrogenic complications occur in approximately 0.21% of percutaneous coronary interventions (PCI), which are critical for diagnosing and treating acute coronary syndrome. This case report details a rare complication involving guidewire entrapment during a PCI procedure for chronic total occlusion (CTO). A 71-year-old male with a diagnosis of myocardial infarction (MI) was admitted to the catheterization laboratory, where imaging revealed total occlusion of the Left Anterior Descending (LAD) artery. During the intervention, a balloon shaft breakage prevented the stent balloon from being withdrawn, necessitating an emergency surgical intervention. The guidewire was successfully removed, and urgent revascularization was performed through coronary artery bypass grafting (CABG). The patient experienced a stable recovery, being discharged after one week of intensive care unit monitoring and five days of ward observation. This case highlights the potential for severe complications in CTO interventions and suggests that pre-intervention consultation between cardiology and cardiovascular surgery teams could mitigate such risks and improve outcomes.

Clinical profile and management of patients with acute myocardial infarction admitted to cardiac care units: The EYESHOT-2 registry

BackgroundThe clinical governance of patients with acute myocardial infarction (AMI) has markedly changed in the last few years. We sought to assess the contemporary in-hospital management patterns of patients with AMI at a country level. MethodsEYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units)-2 was a nationwide, prospective registry aimed to evaluate the current management of patients admitted to intensive cardiac care units (CCUs) for an AMI in Italy. ResultsOver a 4-week period (February 1st-29th, 2024), 183 CCUs enrolled 2806 consecutive patients: 52.6 % with non-ST elevation myocardial infarction (NSTEMI) and 47.4 % with ST-elevation myocardial infarction (STEMI). The median time from hospital admission to angiography in NSTEMI was 22.3 h (IQR 10.9–46.1), while for STEMI was 1.1 h (IQR 0.5–2.2) with significant difference between hospitals with and without catheterization laboratories. In both NSTEMI and STEMI patients, percutaneous coronary intervention (PCI) was the preferred management strategy (73.3 % and 94.2 %, respectively). An optimal secondary prevention therapy, including dual antiplatelet therapy, inhibition of the renin-angiotensin system, a beta-blocker and a high-intensity statin was prescribed at discharge in more than 75 % of patients with AMI. In-hospital major bleedings occurred in 2.0 % and 2.3 % (p = 0.58), while death in 1.8 % and 2.8 % (p = 0.09) of NSTEMI and STEMI patients, respectively. ConclusionsThe EYESHOT-2 registry shows the current management strategies and outcome of AMI patients admitted to Italian CCUs and provides insights to improve the clinical care of such patients.Clinical Trial Registration. URL: http://www.clinicaltrials.gov. Unique identifier: NCT06316128.

Features and Limitations of Robotically Assisted Percutaneous Coronary Intervention (R-PCI): A Systematic Review of R-PCI.

Background: Ischaemic heart disease is one of the major drivers of cardiovascular death in Europe. Since the first percutaneous coronary intervention (PCI) in 1977, developments and innovations in cardiology have made PCI the treatment of choice for stenotic coronary artery disease. To address the occupational hazards related to chronic exposure to radiation and wear and tear from heavy lead-based radioprotective aprons, the concept of robotically assisted PCI (R-PCI) was introduced in 2005. Aim: To explore the features and limitations of R-PCI, we first discuss the concept and evolution of R-PCI platforms and then systematically review the available clinical data. Methods: A systematic review has been performed across the Pubmed, Embase and Cochrane databases in order to assess the efficacy and safety of R-PCI. Secondary endpoints, such as operator and patient exposure to radiation, contrast volume used and procedural time, were assessed when available. Results: In selected patients, R-PCI provides high technical and clinical success rates, ranging from 81 to 98.8% and from 93.3 to 100%, respectively. In-hospital and 1-year MACE rates ranged from 0 to 10.4% and 4.8 to 10.5%, respectively. R-PCI is able to significantly reduce the operator's exposure to radiation. Further research analysing the patient's and cath lab staff's exposure to radiation is needed. Therapy escalation with R-PCI seems to be limited to complex lesions. R-PCI procedures add approximately 10 min to the procedural time. Conclusions: The efficacy and safety of R-PCI have been proven, and R-PCI is able to significantly reduce occupational hazards for the first operator. The lack of adoption in the community of interventional cardiologists may be explained by the fact that current generations of R-PCI platforms are limited by their incompatibility with advanced interventional devices and techniques needed for escalation in complex interventions.

A Novel Shielding Device for Cardiac Cath Labs

Abstract This research evaluates the effectiveness of a large specialized cardiac catheterization laboratory shielding device (SCCLSD) placed perpendicular to the patient compared to traditional shielding methods in reducing occupational exposure to scattered x rays, contributing to the ongoing enhancement of radiation safety in the cardiac catheterization laboratory (CCL) setting. An experimental setup involving an anthropomorphic phantom on the catheterization table simulated radiation scatter from a patient. Measurements were taken systematically at various grid points and heights in the CCL using a Fluke 451P ion chamber while mimicking a real interventional scenario. In-air peak exposure rates were analyzed at head, chest, and waist heights in the anteroposterior (AP) position. Results demonstrated that the SCCLSD provided a superior radiation shadow and effective whole-body radiation exposure reduction compared to conventional shielding devices. Considering that conventional shielding requires staff to wear lead aprons, an effective dose equivalent correction factor was applied for exposure measurements without the SCCLSD. Even after the correction factor, the SCCLSD continued outperforming lead aprons and offered whole-body protection, including the head and arms, which is typically neglected with conventional shielding. The SCCLSD also reduces exposure to the eyes, aligning with lower occupational exposure recommendations from ICRP and NCRP. However, proper CCL staff positioning is important in maximizing the effectiveness of the SCCLSD. Future research avenues may explore exposure rates at different C-arm angles to more completely assess the SCCLSD’s impact on occupational exposure.

Hepatic and splenic venous access tract closure using the VASCADE vascular closure system following percutaneous intervention in patients with CHD.

Hepatic and splenic venous access are specialised techniques used to perform diagnostic and interventional procedures in the cardiac catheterisation laboratory. Bleeding events are the most commonly reported complication following hepatic or splenic venous access. The VASCADE Vascular Closure System (Cardiva Medical Inc. Santa Barbara, CA) is an approved device for closure of femoral vascular access tracts in patients ≥18 years of age. We report our experience using VASCADE to close the hepatic or splenic venous access site in the cardiac catheterisation laboratory. This is a single centre retrospective review of all patients who had percutaneous hepatic or splenic venous access obtained in the cardiac catheterisation laboratory from March 1, 2022 through October 30, 2023 and underwent tract closure with VASCADE. Ten patients (six male) underwent 16 procedures (median age and weight 3.5 years and 12.5 kg) with 15 hepatic and two splenic veins accessed. Successful closure of the access tracts with VASCADE was performed in all patients. There were no major adverse events related to closure of the access sites with VASCADE. VASCADE can be used following transhepatic and trans-splenic venous access in the cardiac catheterisation laboratory to safely close the access tract and potentially reduce the risk of post-procedural bleeding complications. Further evaluation in a larger cohort of patients is needed to ensure VASCADE is safe for use and provides adequate haemostasis following hepatic or splenic venous access, particularly in children.