High Procedural Success Rate Research Articles

Safety and Efficacy of Atrial Fibrillation Ablation in Young Patients.

Background: Outcome of catheter ablation of atrial fibrillation (AF) in young patients has not been widely reported. This study describes the safety and efficacy of radiofrequency catheter ablation (RFA) for atrial fibrillation in patients forty years or younger. Methods and Results: Forty consecutive patients who underwent fifty-two RFA procedures for symptomatic, drug-refractory paroxysmal or non-paroxysmal AF were included in the study. The mean (SD) age of the patients at time of initial procedure was 34.1 (5.6) years. Twenty-five (62.5%) patients had paroxysmal AF, 6 (15%) patients had persistent AF, and 9 (22.5%) patients had longstanding persistent AF. Procedural safety and efficacy were assessed based on patient status > 1 year after initial ablation procedure. After a mean (SD) follow-up of 3.8 (2.9) years, 25 (62.5%) patients were free of AF without antiarrhythmic drugs (AAD) and 40 (100%) patients experienced > 95% reduction of AF burden on or off AADs. No major complications or adverse events occurred during the study. Conclusions: Catheter ablation of AF is a favorable therapeutic option for patients 40 years or younger, resulting in high rates of procedural success with a low risk of major complications.

Single Centre Experience of Transcatheter Aortic Valve Implantation (TAVI) for High-Risk Patients with Severe Aortic Stenosis: Patient Characteristics and Complications

OP-081 Transcatheter aortic valve implantation (TAVI) has been a reliable treatment modality for high risk patients with severe aortic stenosis (AS). TAVI has high procedural success rates however some complications can occur during the procedure. In this study, our aim is to present our experience

TCT-685 High Procedure Success Rate in Device Closure of Atrial Septal Defect with Multiple Rim Deficiencies

Adequate septal rim is an important factor for device closure of atrial septal defect (ASD). As little is known about the procedural completion in ASD patients with multiple rim deficiencies, we aimed to evaluate the validity of device closure for these patients. Between September 2007 and May 2013

Long‐term clinical outcomes following drug‐eluting stent implantation for unprotected distal trifurcation left main disease: The Milan‐New Tokyo (MITO) registry

Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri-procedural complications and adverse events at follow-up especially when the main branch and the side branches are concomitantly diseased. A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation in order to assess the technical feasibility and long-term outcomes according to the disease distribution in the trifurcation branches (true vs. non-true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow-up. Eighty-four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non-true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3-years follow-up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non-true ULMT (HR 2.801 [confidence interval; CI 1.164-7.896], P = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164-7.896], P = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true-ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006-5.461], P = 0.049). PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow-up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR.

The percutaneous treatment of Patent Foramen Ovale, an effective and safe therapeutic choice

Abstract

Impact of preoperative mitral regurgitation on outcome after Transcatheter Aortic Valve Implantation: results of the German TAVI registry

Objective: Mitral Regurgitation (MR) is a common finding in non-surgical patients with severe Aortic Stenosis (AS). Herein, we assessed the impact of preoperative MR on outcome in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) based upon data of the German Aortic Valve Interventions Registry. Methods and results: Between January 2009 and June 2010, a total of 1385 patients (pts) undergoing TAVI were included in this registry (mean age 81.7±6.1, 41.9% males). 468 (33.8%) pts presented with MR ≥ grade 2, in 917 (66.2%) pts none or minor MR was observed. Pts in the MR-subgroup had a significantly lower ejection fraction (49.0±14.8% vs. 54.7±14.4%; p<0.001) and a higher EuroSCORE (22.3±15.1 vs. 19.4±12.4; p<0.01) compared to non-MR pts. In both subgroups the majority of procedures was performed transfemorally (MR: 85.7% vs. non-MR: 88.3%; p=0.16) with a high procedural success rate (MR: 97.0% vs. non-MR: 97.6%; p=0.51). In the MR-group, a significantly higher proportion of pts was treated with the Edwards SAPIEN device (MR: 25.1% vs. non-MR: 15.7%; p<0.0001). Thus, pts with MR≥grade 2 less frequently required postoperative pacemaker implantation (MR: 31.3% vs. non-MR: 36.8%, p<0.05). Pts with MR ≥ grade 2 more frequently developed postoperative low cardiac output (9.1% vs. 5.6%, p<0.05). Functional NYHA class and survival at 30 days demonstrated comparable outcome in both groups (30-day survival MR: 90.0% vs. non-MR: 92.8%; p=0.07). In contrast, mortality at 1 year was significantly higher in the MR-subgroup (26.6% vs. 16.6%, p<0.0001). After TAVI both groups experienced a significant improvement of self-assessed quality-of-life, resulting in similar EuroQol5d-scoring at 30 days and 1 year (0.68±0.24 vs. 0.69±0.23; p=0.35 and 0.67±0.27 vs. 0.69±0.24; p=0.27). Conclusion: Despite a high procedural success rate and comparable mortality at 30-days, long-term survival at 1 year is significantly lower in patients with MR≥grade 2. However, despite a moderately increased likelyhood of postprocedural complications patients with concomitant MR ≥ grade 2 benefit from TAVI with a similar and sustained improvement in quality-of-life at 30 days and 1 year.

Long term outcome after rotablation for bail-out in severely calcified coronary lesions

Background: Rotablation is mostly used to enable stent implantation in severely calcified coronary lesions. There is a lack of long term data regarding the outcome after rotablation in severe calcified lesions with either failed balloon crossing or in case of failed balloon expansion. Methods: To assess the 1-year outcome of rotabloation in this setting, we analyzed 210 consecutive patients undergoing rotablation required for preparation of stent implantation in severely calcified coronary lesions. Complete 1-year follow-up data was available for all patients. Results: Patients were on average 71 years old. The reasons for rotablation were in 42% inability to cross the lesion with the balloon and in 58% inability to expand the balloon in severe calcified lesion. Sixteen % of patients needed rotablation during PCI for acute coronary syndrom (ACS). The procedural success was 99,5%. Drug eluting stents (DES) were implanted in 88%. The majority of patients received initial rotablation with 1,5 mm burr. Elevated troponin a day post rotablation was measured in 38% of patients and elevated creatine kinase (CK) in 12%. Target vessel revascularisation (TVR) after 1 year post index PCI was performed in 13,2% of patients. The combined endpoint of death and myocardial infarction (MI) as marker for safety was reached by 14,4%. Death during 1-year follow-up occurred in 10,4%. Conclusions: Rotablation as a part of lesion preparation for stent implantation in otherwise untreatable severe calcified coronary lesions is associated with high procedural success rate. One-year event rates, however, indicate that patients in need for bail-out rotablation represent a high risk subset.

GW24-e2224 Long-term clinical outcome of rotational atherectomy followed by long drug-eluting stent implantation in diffuse calcified coronary lesions

ObjectivesTo assess long-term outcome after rotational atherectomy (RA) is followed by long drug-eluting stent (DES) implantation in diffuse calcified coronary lesions.MethodsPatients with diffuse calcified coronary lesions treated with RA following...

Comparison of Short- and Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions Between Patients Aged ≥75 Years and Those Aged

Few reports are available on the safety and efficacy of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in older patients. In the present study, 284 patients who underwent PCI for CTOs were retrospectively evaluated by comparing the characteristics of 67 patients aged ≥75 years (the older group) and 217 patients aged <75 years (the younger group). Technical success was achieved in 77% of the patients in the older group and 79% of those in the younger group (p = 0.66). No significant differences were observed between the 2 groups in terms of the incidence of procedural complications. In the older group, a comparison between the patients with successful and failed PCI revealed significantly superior 3-year cardiac survival (97.6% vs 76.9%, p = 0.005). The 3-year cardiac survival of those with successful PCI was similar to that observed in the younger group. On multivariate analysis, successful PCI was found to be associated with a lower incidence of cardiac death in the older group (hazard ratio 0.09, 95% confidence interval 0.01 to 0.91, p = 0.042). In conclusion, this single-center, observational study suggests that PCI for CTOs can be performed with a high rate of procedural success and acceptably low mortality and morbidity in older patients, resulting in improved cardiac survival. Thus, PCI for CTO lesions should be included among the treatment strategies for older patients.

Propofol for Procedural Sedation and Analgesia Reduced Dedicated Emergency Nursing Time While Maintaining Safety in a Community Emergency Department

Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P < 0.001) and higher rates of procedural success (propofol 98%; midazolam 92%; P = 0.02). There were no significant differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile.

060 CORONARY ROTATIONAL ATHERECTOMY USING BURR-TO-ARTERY RATIOS OF LESS THAN 0.5 IS ASSOCIATED WITH LOW LEVELS OF COMPLICATIONS, HIGH PROCEDURAL SUCCESS RATES AND FAVOURABLE 12-MONTH OUTCOMES

<h3>Background</h3> Rotational atherectomy (RA) is an established treatment of heavily-calcified coronary stenoses. Previous data suggest higher procedural complication rates when Burr-to-Artery (BTA) ratios exceed 0.7; the manufacturer-recommended BTA being 0.6. Little contemporary data exists regarding safe and optimal burr sizing, which may be important when considering RA via the radial approach with lower-caliber guiding catheters. <h3>Methods</h3> Single-centre retrospective review of patients undergoing elective RA between 2004 and 2011. Procedural success was defined as successful stent deployment with residual stenosis &lt;30%, and complications defined as death, pericardial effusion/tamponade, coronary dissection/perforation and emergent CABG. Demographic and outcome data were obtained from local/national databases and casenote review. Quantitative coronary angiographic analysis was performed on archived films. <h3>Results</h3> Elective RA was successful in 197/220 cases (89.5%) with 72% of cases male and 22% diabetic (mean age 71.1±8.9 years). Target vessel was LAD (50.9%), RCA (35.0%), LCx (10.9%) and LMS (3.2%). Mean reference diameter was 3.45±0.6 mm and mean diameter stenosis (DS) 71.9±12.9%. Maximum burr size/case ranged from 1.25–2 mm (mode 1.5 mm) with mean BTA 0.43±0.08. 10 procedural complications occurred (4.5%); one wire fracture, two dissections, three perforations, two emergency CABG, one unretractable burr and one death. No difference in mean BTA was observed between procedures with/without complications (0.38±0.03 vs 0.43±0.08; p=0.33), but residual DS was higher in those with complications (12.3±21.2 vs 58.8±31.2; p&lt;0.01). No correlation was observed between maximum burr size and age, sex, DS or minimum luminal diameter. At 36-month follow-up mortality was 11.7% and target vessel revascularisation (TVR) 22.8%. <h3>Conclusions</h3> Elective RA with low BTA is associated with high procedural success and low complication rates. These data imply that elective RA with a lower BTA than recommended is both safe and effective and need not preclude a transradial approach.

Clinical and angiographic outcomes of drug eluting stents in native Ostial coronary lesions

Objectives The study was designed to evaluate the efficacy and safety of drug eluting stents (DESs) in ostial coronary artery lesions, in terms of early and late restenosis rate. Also, the study was aimed to compare the results of implantation of DES to that of bare metal stents. Background The safety and effectiveness of DESs for the treatment of ostial lesions. Methods We included 177 patients with symptoms subjective of angina pectoris or objective evidence of myocardial ischemia; who underwent percutaneous coronary interventions in 189 ostial lesions using DES. The patients were divided into two groups based on the site of ostial lesion. The incidence of MACE, including death, myocardial infarction (MI), need for repeated revascularization (CABG or angioplasty), were recorded in-hospital and at 12 month. Results The initial procedure was successful in 175 patients (98.8%) in the DES arm. There were no significant major in-hospital complications in the DES group, compared to BMS group which showed 4 cases of in-hospital deaths ( p = 0.017). During follow-up, MACE were significantly less frequent in the DES group compared to the BMS group, including death (0.8% vs. 6.4%, p = 0.004) and need for CABG (1.7% vs. 10%, p = 0.012). Conclusions The main finding of our study is that, implantation of the DES in aorto-ostial lesions appears safe and effective. It is associated with high procedural success rate, low immediate and in-hospital complication rate, and favourable long-term clinical and angiographic outcomes compared to bare metal stents.

Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery

BackgroundPercutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending coronary artery (LAD) specifically is associated with improved long-term 5years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity.We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. Patients and methodsThe study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators’ initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire (GW) as a simple technique. ResultsA total of 30 patients with 30 LAD CTO lesions (100%) were recorded. Mean age was 71.6+15years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients.Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions (83% of total cases), while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction (MI), stent thrombosis, stroke, emergency coronary artery bypass graft (CABG), major bleeding, radiation dermatitis, cardiac tamponade or clinical perforation requiring any hemostatic maneuvers did not occur. There was a post-procedural Troponin rise of 3x normal levels in 30% of patients, and contrast induced nephropathy in 7%. Intra-aortic balloon counterpulsation (IABCP) was used in 3% of patients and cardiac death occurred in 3% of patients. ConclusionSingle wiring and radial access as initial strategies in PCI for LAD-CTO lesions in either approaches antegrade or retrograde are associated with a high procedural success rate and an acceptable incidences of adverse events.

Revascularización carotídea con stent: implicaciones clínicas y para el procedimiento de la presencia de una lesión suboclusiva

Introduction and objectivesThe advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. MethodsWe included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). ResultsNo differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). ConclusionsStent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.

Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review

Reliable closure is a prerequisite for conventional and innovative endoscopic procedures, such as NOTES. The purpose of this study is the systematic evaluation of the procedural and clinical success rates in closure of iatrogenic gastrointestinal perforations and acute anastomotic leaks by means of the over-the-scope-clip system (OTSC(®)). PubMed and other sources were searched systematically for clinical and preclinical research on the evaluation of the OTSC System for closure of gastrointestinal perforations and leaks. Appraisal of studies for inclusion and data extraction was performed independently by two reviewers using an a priori determined data extraction grid. Major endpoints to be extracted were data on procedural success (successful clip application) and clinical access (durable closure of defect without secondary adjunct therapy). A total of 17 clinical research articles/abstracts and 22 preclinical research articles/abstracts were identified. The examined clinical studies comprised case series and clinical single-arm studies. The reviewed studies revealed a consistently high mean rate of procedural success of 80-100 % and durable clinical success of 57-100 %. An identified major drawback preventing successful clip application was occurrence of fibrotic or inflamed lesion edges. Usage of the OTSC System was accompanied by neither major clip-related nor application-related complication. In experimental settings, closure of larger perforations and gastric access sites of NOTES or endoscopic full-thickness resection were achieved with high rates of success. Because randomized, clinical trials are not available in this field of indication, the evaluation is based on small case series. Nevertheless, by pooling all experience gained, we conclude that endoscopic closure of iatrogenic gastrointestinal perforations and acute anastomotic leaks by means of the OTSC System is a safe and effective method.

An 8-year single-centre experience of cardiac resynchronisation therapy: procedural success, early and late complications, and left ventricular lead performance

Despite the increasing number of device implants worldwide, little is known about the early and late complications of cardiac resynchronisation therapy (CRT) or the incidence of these complications in patients with different heart failure aetiologies. We aim to determine procedural success and early and late complications in CRT patients. All early (<90 days) and late (>90 days) complications occurring over 490 consecutive CRT procedures in 402 patients, from a large single-centre registry between 2000 and 2009 were analysed. Mean follow-up duration was 1012 ± 610 days. In addition, procedural data and long-term left ventricular (LV) lead performance were examined. The mean age of patients was 65 ± 15 years, 31% were female. The majority of devices (70%) were CRT-defibrillators. Left ventricular lead implantation was achieved after one or more than one attempt in 96.7% of patients (first procedure was successful in 95.1%). The incidence of early and late complications was 9.4% and 6.1% respectively. Infection and lead displacement were the most common complications. Dilated cardiomyopathy (DCM) was associated with significantly more complications than ischaemic cardiomyopathy (P = 0.01) and these occurred later in the DCM population. Long-term LV lead performance was comparable with that of right atrial and ventricular leads. Transvenous implantation of the LV lead is safe and achievable for CRT with high procedural success rates. For the first time we describe the late complications from CRT in different heart failure populations. This group of patients must be kept under surveillance, not only for heart failure events but also for device-related issues. The reasons for higher complication rates in DCM patients require further evaluation.

Percutaneous Coronary Intervention using Transradial Access in Elderly vs. Non-Elderly Patients

Radial access is the object of increasing interest for interventional cardiologists, providing several advantages, including a reduction of bleeding and major adverse cardiovascular event (MACE) rates. However, even though elderly patients have a greater risk of access site bleedings, the use of the radial approach is controversial, due to the greater anatomical complexity of these patients. Retrospective study including patients undergoing percutaneous coronary intervention (PCIs) using the radial access divided into an elderly (> 65 years) and a non-elderly (< 65 years) group. Clinical, angiographic and procedural characteristics as well as early and late follow-up outcomes were analyzed. The elderly group included 131 patients (145 PCIs) and the non-elderly group, 149 patients (176 PCIs). The elderly group presented lower body mass index and fewer smokers and higher rates of chronic renal failure, peripheral arterial disease, stable coronary artery disease, multivessel disease and calcified lesions. There was no difference in the rate of access-site crossover (4.8% vs. 3.4%), fluoroscopy time (15.3 ± 10.3 minutes vs. 16.1 ± 10.3 minutes), procedure time (40.6 ± 26.4 minutes vs 46.4 ± 53.6 minutes), angiographic (96.3% vs 97.5%) and clinical (94.5% vs 95.4%) success, MACE (3.4% vs 3.4%) and bleedings (0.21% vs 0.6%) during hospitalization. In the late follow-up there was no difference in the MACE rates (9.6% vs 11%). Despite the greater clinical and angiographic complexity, PCI using the radial access is safe and effective, with a high procedural success rate and low in-hospital and late follow-up complication rates. Intervenção Coronária Percutânea por Acesso Transradial em Pacientes Idosos vs. Não-Idosos A via radial é objeto de interesse crescente de cardiologistas intervencionistas, por oferecer diversas vantagens, entre elas a redução da taxa de sangramento e eventos cardíacos adversos maiores (ECAM). Entretanto, apesar de os idosos apresentarem maior risco de sangramento da via de acesso, a utilização da via radial é motivo de controvérsias, pela maior complexidade anatômica desses pacientes. Estudo retrospectivo, que incluiu pacientes submetidos a intervenção coronária percutânea (ICP) por via radial, divididos nos grupos idoso (≥ 65 anos) e não-idoso (< 65 anos). Foram analisados os perfis clínico, angiográfico e do procedimento, além da evolução tanto inicial como tardia. No grupo idoso foram incluídos 131 pacientes (145 ICPs) e no grupo não-idoso, 149 pacientes (176 ICPs). O grupo idoso apresentou mais frequentemente menor índice de massa corporal e de tabagistas, e maiores taxas de insuficiência renal crônica, doença arterial periférica, quadros clínicos estáveis, doença multiarterial e lesões calcificadas. Não houve diferença nas taxas de troca de via de acesso (4,8% vs. 3,4%), tempo de fluoroscopia (15,3 ± 10,3 minutos vs. 16,1 ± 10,3 minutos), tempo do procedimento (40,6 ± 26,4 minutos vs. 46,4 ± 53,6 minutos), sucesso tanto angiográfico (96,3% vs. 97,5%) como clínico (94,5% vs. 95,4%), ECAM (3,4% vs. 3,4%) e sangramentos (0,21% vs. 0,6%) na fase hospitalar. No seguimento tardio também não houve diferença nas taxas de ECAM (9,6% vs. 11%). Apesar da maior complexidade tanto clínica como angiográfica, a realização de ICP por via radial em idosos é segura e eficaz, com elevado índice de sucesso do procedimento e baixa taxa de complicações hospitalares e tardias.

Procedural Outcomes of Watchman® Left Atrial Appendage Occluder Device Implantation and Longitudinal Toe Follow-Up of Peri-Device Leaks

Background: We describe our procedural outcomes and technical success rates of Watchman® LAA closure devices from our centre with a focus on peri-device leaks. Results: Fifty-three patients aged 65.5 ± 7.3 years (range 43–82 years, 72% male, CHADS2 score 1.94 ± 0.9, CHADSVASC score 2.8 ± 1.0) underwent successful implantation of a Watchman® LAA occluder device in our centre since Nov 2009. Forty-four patients had concomitant pulmonary vein isolation (44/53). The average device size was 24 ± 3 mm (range 21–30 mm). No acute procedural complications occurred. Post implant transoesophageal echocardiogram (TOE) was performed at six weeks, and again at six months if any persistent peri-device leaks seen at initial follow up. At implant, 4/53 patients had a small peri-device leak detected on colour flow Doppler by TOE ≤ 3 mm. At six week TOE, 12 patients had a peri-device leak (nine new, three persistent), with four of these showing persistent small leaks at six month TOE (two present since implant). There was no significant age or sex distribution of patients who developed new peri-device leaks, however all patients who demonstrated leaks at implant were male. At six week follow up, the interatrial septal puncture sites had healed in all but 12 patients, with no age or sex distribution observed. Conclusion: Despite high procedural success rates and low incidence of peri-device leaks at implant, we have observed development of small leaks at first TOE follow-up in approximately 17% of patients which then tend to close again. This may reflect a period of “seating” with the device.

Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease

Objectives: The study was designed to evaluate the efficacy and safety of drug eluting stents (DESs) in aorto-ostial (A-O) coronary artery lesions, in terms of early and late restenosis rate; including clinical assessment, non-invasive stress testing and angiographic follow-up. Also, the study was aimed to compare the results of implantation of drug eluting stents (DES) to that of bare metal stents (BMS) in aortoostial lesions done over a previous 5 years in Royal Brompton Hospital. Background: The safety and effectiveness of DESs for the treatment of aortoostial lesions. Methods: We included 161 consecutive patients with symptoms subjective of angina pectoris or objective evidence of myocardial ischemia; who underwent percutaneous coronary interventions (PCI) in coronary ostial lesions using DES. The patients were divided into two groups based on the site of ostial lesion. The control group consisted of 125 consecutive patients who underwent percutaneous coronary intervention for ostial lesions using bare metal stents (BMS) implantation in the period immediately before the introduction of DES. The incidence of major adverse cardiac events (MACE), including death or Q-wave myocardial infarction (MI), need for repeated revascularization procedure CABG or angioplasty, were recorded in-hospital and at twelve months ± 3 months. Follow-up angiography was only performed in case of recurrent symptoms subjective of myocardial ischemia or if there was objective evidence of myocardial ischemia by stress testing. Results: The initial procedure was successful in 149 patients (92.5%) in the DES arm. There were no statistically significant major in-hospital complications in the DES group, compared to BMS group which showed 4 cases of in-hospital deaths (p = 0.017). At Twelve months ± 3 months follow-up, MACE were significantly less frequent in the DES group compared to the BMS group, including death (0.8% vs. 6.4%, p = 0.004) and need for CABG (1.7% vs. 10%, p = 0.012). Conclusions: The main finding of our study is that, compared to the BMS, implantation of the DES in coronary ostial lesions appears safe and effective. It is associated with high procedural success rate, low immediate and in-hospital complication rate, infrequent late adverse events and favourable long-term clinical and angiographic outcomes compared with bare metal stents implantation at 12-month follow-up. Advanced age, previous myocardial infarction and acute coronary syndromes at presentation were all found to be independent positive predictors for clinical events after drug eluting stent implantation in ostial lesions.

Incidence and Predictors of Radial Artery Occlusion Associated Transradial Catheterization

In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3rd h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24th h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.