Percutaneous Cardiac Catheterization Research Articles

Clinical Outcome of Surgical Treatment of Giant Femoral Artery Pseudoaneurysms

Femoral artery was used as an access site for cardiovascular procedures and by IV drug abusers, Femoral Artery Pseudoaneurysm (FAP) was a common complication associated with these procedures. Objective: To evaluate clinical outcome of surgical repair of femoral artery pseudoaneurysms. Methods: The prospective study was conducted in Doctors Hospital, Lahore from October 2022 to October 2023. The study included patients with giant femoral artery pseudoaneurysms who required surgical intervention. Data from a total of 50 patients were included in whom both peripheral vascular interventions and percutaneous cardiac catheterization was performed. Patients were followed up at 1-, 3-, 6- and 12 months postoperatively. SPSS version 23.0 was used for data analysis. Results: All patients underwent open surgical treatment. Of 50 patients, 25 (50%) had SFA pseudoaneurysm, 20 (40%) had CFA pseudoaneurysm and 5 (10%) had PFA pseudoaneurysm. The mean duration of clinical manifestations was 16.30 ± 7.74 days. Surgical repair was successful in all 50 (100%) patients and distal ischemia was fully resolved. There was no case of limb loss or post-operative mortality. One patient had an infection in the groin wound and had raised Total leucocyte count (TLC), which was resolved by early drainage and antibiotic treatment. Patients were followed up at 1, 3, 6, and 12 months and there were no signs of clinical or angiographic evidence of post-operative complications and changes in distal pulse. Conclusion: Surgical repair was first-line treatment for giant FAP. It was clinically feasible and has a high success rate and low complication rate.

Radial Artery Occlusion After Transradial Access for Coronary Interventions.

Background Transradial access (TRA) is a medical procedure primarily used for percutaneous coronary interventions (PCI) and cardiac catheterization. Based on the recently published Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX (MATRIX) trial, TRA is being used more frequently than transfemoral access (TFA) since it has reduced rates of bleeding and fatality. A structural complication of TRA is radial artery occlusion (RAO), which may cause temporary pain to limit TRA in the future. Objective This study aimed to investigate the onset andrisk factors of RAO following TRA for coronary interventions. Material and methods An observational study was conducted at Fauji Foundation Hospital in Peshawar, Pakistan. The study included 1,680 patients recruited between April 2021 to December 2023. Fifty-eight patients were lost to follow-up, while another 95 patients did not come for a visit within the study period. The final study, therefore, included 1,527 patients. Results The mean age of patients was 58.09 ± 8.07 years. Patients were divided into two age groups (greater or less than 60 years). Diagnostic angiograms were completed for 955 patients, while 572 also underwent PCI. The overall RAO onset was 81 (5.3%). There was a significantly higher RAO onset in patients over 60 years old(7.1 vs 3.8%, p = 0.003). Conclusion Overall, the risk of RAO is low following TRA. The risk of RAO is significantly higher in people aged over 60 years.

Predictors of Post-catheterization Femoral Artery Pseudoaneurysm

Objectives: To compare the affected patients with the age- and sex-matched patients in the control group. Materials and Methods: All patients who had undergone PCI, left heart catheterization, or coronary angiography between July and November 2022 were prospectively recruited. We included 247 patients in our study who underwent cardiac catheterization via femoral access. Results: The incidence of FAP after a diagnostic catheterization was 5.97% and 8.69% after an interventional procedure. The mean age of the patients with FAP was 54.06 ± 15.04 years and 62.5% patients were females in the affected group. In FAP group, 14 patients (87.5%) had hypertension, 8 patients (50%) had diabetes, and 37.5% were had obesity. The systolic blood pressure was 145.38 ± 29.99 mmHg, while the diastolic blood pressure was 86 ± 14.59 mmHg. Data obtained from computed tomography scanning showed that the arterial wall of the CFA was healthy in 11 patients (68.5%), while diffuse atherosclerosis was detected in 5 (31.5%) patients. In 69% of the patients, FAPs were connected to the CFA and in 31% patients to the superficial femoral artery (SFA). In 38% (6) patients partial thrombosis of the pseudoaneurysm sac observed. Conclusion: FAP is a common vascular complication after a diagnostic procedure or percutaneous cardiac catheterization, and its prevalence is likely to rise.

A total closed chest swine model of acute myocardial infarction-related cardiogenic shock: A critical double coronary sub-occlusion approach

The management of acute myocardial infarction-related cardiogenic shock (AMICS) represents a significant challenge, with mortality rates remaining high (40–60%), despite recent advances. Current animal models of myocardial infarction are either associated with a very high rate of per-procedure malignant arrhythmia, or with very low impairment of hemodynamic parameters, or with the inability to have complete coronary reperfusion. We sought to develop a closed chest and clinically relevant large animal model of severe AMICS, with high survival rate. Adult pigs were anaesthetized and mechanically ventilated. Percutaneous cardiac catheterization was performed under fluoroscopy. Advanced left ventricular dysfunction was induced by 120 minutes of critical sub-occlusion of the proximal left anterior descending coronary artery and the mid circumflex artery. A thorough hemodynamic assessment was obtained by invasive and non-invasive monitoring devices. Repeated blood samples were obtained to determine blood gas parameters, lactate, and haemoglobin concentration. After death, the heart was retrieved for further histological analyses. All animals (n = 12) developed significant circulatory failure associated with AMICS upon reperfusion and beyond. No animal died during the ischemia process. However, all animals that did not benefited from vasopressor support (“sham” group, n = 4) spontaneously died within 30 minutes of reperfusion, confirming the severity of the model. Cardiogenic shock was characterized by a drop in mean arterial pressure below 60 mmHg (58 ± 5 mmHg at 120 min of ischemia), a significant decrease in mean cardiac output (−44% from 5.7 ± 0.4 at baseline to 3.2 ± 0.4 at 120 minutes of ischemia) and SvO2 (−32% from 57 ± 8 at baseline to 39 ± 6 at 120 minutes of ischemia) and a significant increase in left ventricle end-diastolic pressure (LVEDP) (+110% from 10 ± 3 at baseline to 21 ± 3 at 120 minutes of ischemia). CO2 gap and coronary sinus venous oxygen saturation increased significantly upon ischemia and reperfusion and remained elevated throughout (P ≤ 0.001 for all comparisons). Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. We present, for the first time, a stable and clinically relevant model of severe AMICS obtained by critical double coronary sub-occlusion. The greater severity of the model did not lead to an increase in the frequency of malignant arrythmias and per-procedure mortality.

FREQUENCY OF RADIAL ARTERY OCCLUSION IN PATIENTS UNDERGOING PERCUTANEOUS CARDIAC CATHETERIZATION BY RADIAL ACCESS

Objectives: To assess the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Methodology: A descriptive cross sectional study was carried out at cardiology department Jinnah hospital, Lahore from April – October 2018. One hundred thirty one consecutive patients who had undergone percutaneous cardiac catheterization via the trans-radial approach were enrolled in the study. Post procedure patients were followed in the ward and after 24 hours, Allen’s test was used for checking the patency of the radial artery. Color Doppler USG was performed in the patients with absent radial artery and RAO was confirmed. Data was entered and analysed in SPSS version 21.0. Results: Out of 131 patients who had undergone for percutaneous cardiac catheterization 63.4% were male and 36.6% were female. Among these cases radial artery occlusion was detected in 52 (39.7%) patients. No statistically significant difference was found with effect modifiers like age, gender, duration of procedure and type of intervention statistically insignificant difference was observed (P>0.05). Conclusion: A considerable number of patients were observed with radial artery occlusion with trans-radial approach thought statistically insignificant difference was noted among all ages, gender or type of intervention suggesting a detailed evaluation of radial artery patency should be done before hospital discharge.

Frequency of Radial Artery Occlusion (RAO) in Patients undergoing Percutaneous Cardiac Catheterization

Objective: The aim of this study was to determine the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Study Design: Prospective study Place and Duration: The study was conducted at cardiology department of Cat A Hospital Batkhela and Fauji Foundation Hospital Peshawar for six months duration from January 2021 to June 2021. Methods: Total one hundred and forty patients of both genders were included in this study. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. Patients who underwent percutaneous cardiac catheterization were presented in this study. Hypertension, diabetes mellitus and smoking history were analyzed. Frequency of radial artery occlusion (RAO) was measured by Barbeau test. Chi square test and fisher test was used to measure prevalence of RAO with respect to comorbidities. Complete data was analyzed by SPSS 23.0 version. Results: There were 100 (71.4%) male patients and 40 (28.6%) patients were females. Mean age of the patients was 53.7±8.44 years with mean BMI 28.6±9.51 kg/m2. Mean height of the patients 167.5 ± 5.11 cm with mean weight 75.9±11.14 kg. Most common risk factor was hypertension found in 90 (64.3%) cases, followed by smokers 80 (57.14%) and diabetes mellitus 75 (53.6%). Prevalence of radial artery occlusion (RAO) was found among 25 (17.9%) cases, most of them were females. Prevalence of RAO was most common among smokers 20 (80%) followed by diabetes mellitus 17 (68%) and hypertension 14 (56%). Conclusion: We concluded in this study that frequency of radial artery occlusion (RAO) was 17.9% among patients undergoing percutaneous cardiac catheterization. Hypertension, smoking and diabetes were the most common risk factors among all these cases. To achieve long-term patency of the radial artery in patients with high predictors of RAO, meticulous management and close follow-up are essential. Keywords: Cardiac Catheterization, Radial Artery Occlusion (RAO), DM, HTN, Smoking

Percutaneous Common Carotid Artery Access for Cardiac Interventions in Infants Does Not Acutely Change Cerebral Perfusion.

Pediatric cardiac interventions via percutaneous common carotid artery (CCA) access have been shown to be safe and effective. However, the impact of placement of a sheath in the carotid artery for interventions on cerebral perfusion is unknown. In this study we used cerebral near-infrared spectroscopy (NIRS) to analyze the effects of percutaneous CCA access for cardiac interventions on cerebral perfusion. This study is a retrospective chart review carried out at a tertiary care center on all pediatric patients who underwent percutaneous cardiac catheterization via carotid artery access from January 2010 to January 2020. All patients who had ipsilateral NIRS recorded on the side of carotid artery access were included. Patients with only partial or no ipsilateral NIRS data were excluded. The primary outcome measure was the change in NIRS upon CCA access; the mean NIRS for 15min before obtaining access was compared to the mean NIRS during the procedure and to the mean NIRS 15min after removal of the CCA sheath. We hypothesized that there would be a significant drop in NIRS values on the side of CCA access. There were 48 catheterizations in the study period where percutaneous CCA was accessed. Of those, 21 catheterizations had complete data and were included in the study. 13 (62%) were of males. The median age was 23days (IQR 7-79). The indications for CCA access were patent ductus arteriosus stent implantation (n = 13; 62%), aortic valvuloplasty (n = 5; 24%), balloon angioplasty of coarctation of aorta (n = 2; 10%), and renal artery angioplasty (n = 1; 4%). In 16 patients (72%), the left common carotid artery was accessed. The median weight of the patients was 3.3kg (IQR 2.8-2.9). The most common sheath size used was 4F, in 16 patients (72%). The mean NIRS prior to the procedure was 67 ± 15%, during the procedure was 68 ± 20%, and after removal of sheath was 68 ± 21%. Paired t test of cerebral NIRS before, during, and after the procedure showed no significant change with CCA access (P = 0.08). No patient in the series had a documented neurologic deficit following the procedure. Percutaneous CCA access was not associated with a decrease in NIRS on the side of the access during the procedure, suggesting there was no significant acute change in cerebral perfusion with CCA access.

Abstract 12602: Poor Quality of Life in Patients With and Without Frailty: Co-prevalence and Prognostic Implications in Patients Undergoing Percutaneous Coronary Interventions and Cardiac Catheterization

Introduction: Relationship of QOL and frailty are poorly defined. Hypothesis: To study the prevalence and prognosis of poor QOL in frail patients. Methods: Predismissal standardized tests for frailty and QOL in 2 cohorts were administered. In cohort 1, 629 patients ≥ 65 years underwent percutaneous coronary intervention (PCI) from 2005-2008, frailty (Fried) and QOL [SF-36 and SAQ] were ascertained. Cohort 2 [921 patients, 535 PCI, ≥55 years] underwent cardiac catheterization from 2014-18, frailty (Rockwood) and QOL (Likert) were determined. Results: In cohort 1, 19%; and 20% in cohort 2 were frail. Lower median SAQ (58.9 vs. 82.2); physical (29.5 vs. 43.9) and mental (49.2 vs. 57.4) scores of SF-36 in cohort 1 higher rates of fair/poor health (56% vs 18%) in cohort 2 (all comparisons, p<0.001) was seen in frail patients. As compared to without, frail patients were 5 times more likely (59% vs. 11%, p<0.001) in cohort 1 and 7 times more likely (56% vs. 8%) in cohort 2 to have poor QOL. Adjusted three year all-cause death and death/myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [HR (95% CI) death, 4.20 (2.63, 6.68) and death or MI HR 2.72 (1.91, 3.87), p<0.001) and with poor QOL [HR death 2.47 (1.59, 3.84) and death or MI 1.61 (1.16, 2.24) p<0.001). There was no significant interaction between frailty and QOL (p=0.64) indicating their independent prognostic influence. Conclusions: Poor QOL is commonly seen with frailty. Both frailty and poor QOL had significant and independent association with long-term survival.

Poor quality of life in patients with and without frailty: co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization.

We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis. Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence. In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.

Safety and efficacy study of the wound care 360° SiteSeal® vascular closure device in percutaneous cardiac catheterization procedures

Vascular access site complications after percutaneous transfemoral cardiovascular procedures remain a common cause of morbidity and mortality. We evaluated the SiteSeal® VCD for achieving hemostasis following diagnostic cardiac catheterization. We conducted a prospective case control single center study to assess the safety and efficacy of SiteSeal® VCD compared to standard manual compression following diagnostic cardiac catheterization. Forty patients were enrolled in study to receive either SiteSeal® device or manual compression (20 in each group). Patients in the SiteSeal® group achieved hemostasis in a significantly shorter time (4 ± 2.4 vs. 19 ± 2.4 min, P < 0.001), had shorter time from hemostasis to ambulation (95 ± 44 vs. 388 ± 63 min, P < 0.001) and significantly earlier device deployment to discharge time compared to the manual compression group (4.7 ± 1.1 vs. 8.9 ± 4.8 h, P = 0.001). There was one non-major bleeding event in the SiteSeal® group which occurred >24 h after discharge from the hospital and was managed conservatively. In the remaining device patients, there was no clinical or Doppler ultrasound evidence of major or minor vascular complication with good overall patient comfort at discharge, 7 days and 30 days follow-up. In this first clinical experience, the SiteSeal® VCD achieved safe and efficient hemostasis, allowed for earlier ambulation and faster discharge compared to manual compression.

Echocardiographic guidance of interventions in adults with congenital heart defects.

Cardiac catheterization procedures have revolutionized the treatment of adults with congenital heart disease over the past six decades. Patients who previously would have required open heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures to close intracardiac shunts, relieve obstructive valvular lesions, stent stenotic vessels, or even replace and repair dysfunctional valves. As the complexity of percutaneous cardiac catheterization procedures has increased, so has the use of echocardiography for interventional guidance in adults with congenital heart disease. Transthoracic, transesophageal, intracardiac, and three-dimensional echocardiography have all become part and parcel of the catheterization laboratory experience. In this review, we aim to describe the different echocardiographic techniques and their role in various cardiac catheterization interventions specific to adults with congenital heart disease.

Evaluation of the rate of marginal ulcer formation after bariatric surgery using the MBSAQIP database.

Marginal ulcer (MU) formation is a known problem after gastric bypass. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database contains data from all US and Canadian Centers of Excellence including complication rates. We hypothesized that the short-term rate of ulceration is low. We queried the MBSAQIP database for the year 2015. We searched patients with primary gastric bypass who developed MU. We then compared preoperative, operative, and postoperative characteristics with patients who did not develop MU. The incidence of MU in the entire cohort of GB patients was 155 of 44,379 (0.35%, 95% CI 0.297%, 0.409%). Among the 155 patients with an ulcer, 88 (57%) patients had only one procedure, 69 had an intervention (therapeutic or diagnostic endoscopy), 16 had readmission, and 3 had reoperation. 65 patients (42%) had two procedures with the majority having both readmissions and endoscopy (n = 59); and two patients (1%) had three procedures. Ulcer formation was most common in the intervention group (11.4%). The occurrence of ulcer formation was associated with unplanned ICU admissions (6.45%), transfusions (5.16%), postoperative UTI (3.87%), sepsis (1.94%), and myocardial infarction (0.65%). Death occurred in 76 patients with no related cases to MUs. The risk of ulcer was associated with increased BMI (OR 1.02, p = 0.01), presence of percutaneous transluminal cardiac catheterization (PTC) (2.17, p = 0.038), histories of DVT (1.72, p = 0.085), and pulmonary embolism (2.84, p = 0.002). In a nationally reported database, symptomatic MUs rarely occur in the first month. The large majority are diagnosed and treated endoscopically with minimal need for surgical intervention. The risk of anastomotic ulcer was increased with increased BMI, need for PTC, and history of DVT/PE.

Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta-analysis.

Trans-radial access has rapidly become the standard for percutaneous coronary procedures in the last decade. As proceduralists overcome the learning curve and become more competent in trans-radial access, alternative safe access sites such as the ulnar artery have been increasingly used for emergent and elective procedures. The aim of this study was to synthesize the best available evidence of the impact on major adverse cardiac events (MACE) of ulnar artery compared to radial artery cardiac catheterization. This review considered randomized controlled trials that included adult patients who had a percutaneous coronary procedure via the radial or ulnar artery. The intervention of interest was the use of ulnar compared to radial artery for cardiac catheterization. An extensive search was undertaken for published and unpublished trials up to May 2017. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Data were analyzed using Review Manager. A total of six trials were included in the review. There was no statistically significant difference in the incidence of MACE between patients who underwent trans-ulnar or trans-radial artery catheterization (OR 0.90; 95% CI 0.65-1.25). Complications associated with access including hematoma formation, (n = 6 trials) pseudo-aneurysm, and arterio-venous fistulae formation (n = 5 trials), were investigated in a total of 5,276 patients, with no difference in these complications noted between the two groups. There were no differences in arterial access time, fluoroscopy time, and contrast load between the two groups. There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization.

Safety and Efficacy of Ulnar Artery Approach for Percutaneous Cardiac Catheterisation: Systematic Review and Meta-Analysis

Safety and Efficacy of Ulnar Artery Approach for Percutaneous Cardiac Catheterisation: Systematic Review and Meta-Analysis

Is a cardiac catheterization procedure at hospitals without on-site surgical backup safe?

Percutaneous cardiac catheterization procedures have now become an established and preferable method. Initially, these procedures were performed at clinical sites with surgical backup as complication rates and need of urgent surgery were high. With the improvement in catheter technique, experienced operators and the development of new devices, overall complication rates of catheterization are low and emergency cardiac surgery has become an increasingly rare event. The aim of the study was to evaluate the procedural outcomes for cardiac interventions in a tertiary-level hospital without onsite cardiac surgery backup. This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous cardiac interventions, including both diagnostic as well as therapeutic interventions, between September 2013 and August 2015 were included in this study. Total 692 percutaneous cardiac interventions were performed. The mean age was 61.9 ± 18.3 years. 439(63.52%) procedures were carried out in men. PCI was done in 189(27 .31%). Percuteneous transvenous mitral comissurotomy was done in 49(7.08%) cases, coronary angiogram was done in 395(57.08%), permanent pacemaker insertion in 29(4.20%), peripheral angiogram in 16(2.30%), pericardiocentesis in 14(2 .02%).Primary PCI was done in 62(32.88%). The most frequent indication for PCI was STEMI 106(56.16%). Complications like Post-procedural cardiogenic shock in 4 (2.11%) cases, arrhythmias and minor complications in 7 (3.70%), and death in 4 (2.11%) patients was witnessed. Similarly, periprocedural MI and contrast induced nephropathy (CIN) requiring dialysis stroke or transient ischemic attack were not noted.Cardiac tamponade was observed in 1 (2.02%) patient during PTMC. There was no need of emergency cardiac surgery Percutaneous cardiac intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup.

Is a cardiac catheterization procedure at hospitals without on-site surgical backup safe?

&lt;p&gt;Percutaneous cardiac catheterization procedures have now become an established and preferable method. Initially, these procedures were performed at clinical sites with surgical backup as complication rates and need of urgent surgery were high. With the improvement in catheter technique, experienced operators and the development of new devices, overall complication rates of catheterization are low and emergency cardiac surgery has become an increasingly rare event. The aim of the study was to evaluate the procedural outcomes for cardiac interventions in a tertiary-level hospital without onsite cardiac surgery backup. This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous cardiac interventions, including both diagnostic as well as therapeutic interventions, between September 2013 and August 2015 were included in this study. Total 692 percutaneous cardiac interventions were performed. The mean age was 61.9 ± 18.3 years. 439(63.52%) procedures were carried out in men. PCI was done in 189(27 .31%). Percuteneous transvenous mitral comissurotomy was done in 49(7.08%) cases, coronary angiogram was done in 395(57.08%), permanent pacemaker insertion in 29(4.20%), peripheral angiogram in 16(2.30%), pericardiocentesis in 14(2 .02%).Primary PCI was done in 62(32.88%). The most frequent indication for PCI was STEMI 106(56.16%). Complications like Post-procedural cardiogenic shock in 4 (2.11%) cases, arrhythmias and minor complications in 7 (3.70%), and death in 4 (2.11%) patients was witnessed. Similarly, periprocedural MI and contrast induced nephropathy (CIN) requiring dialysis stroke or transient ischemic attack were not noted.Cardiac tamponade was observed in 1 (2.02%) patient during PTMC. There was no need of emergency cardiac surgery Percutaneous cardiac intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup.&lt;/p&gt;

Percutaneous fetal cardiac catheterization technique for stenting the foramen ovale in a midgestation lamb model.

Intact or highly restricted intra-atrial septum can be reliably diagnosed in the human fetus as early as 22 to 24 weeks of gestation. Fetal interventions targeting the atrial septum have used a direct approach through the atrial wall. Here, we report stenting of the foramen ovale with a large, open-cell stent via percutaneous access through the fetal hepatic vein in a sheep model. In 5 fetal sheep of 109 to 111 days of gestation (term, 147 days), the fetal hepatic vein was punctured percutaneously under ultrasound guidance and a 13.3-cm 14-gauge intravenous catheter was inserted. After catheterization of the inferior vena cava, right atrium, foramen ovale, and left atrium with a guidewire and 1.8F to 2.6F tapered catheter, a self-expandable, 8×12-mm flexible open-cell stent was positioned in an unrestricted foramen ovale. Flow and fetal well-being were documented for 45 minutes after the procedure. Access to the left atrium was achieved in all 5 animals and all survived. In 4 animals, the stent was successfully positioned in the foramen ovale. One fetus was born at term and euthanized on day 3: postmortem examination confirmed the patency of the stent. The other 3 fetuses were well after being monitored by ultrasound for 45 minutes. In 1 animal, the stent dislodged immediately after release obstructing the mitral valve. This fetus developed ascites and was euthanized after 4 days. It is feasible to safely advance a large diameter, self-expandable, open-cell design stent into the fetal atrial septum via a percutaneous access route through the fetal hepatic vein.

Evaluation of a Structured Training Program for Arterial Femoral Sheath Removal After Percutaneous Arterial Catheter Procedures by Assistant Personnel

After cardiac catheterization procedures, arterial closure can be achieved by manual compression (MC), using external mechanical compression devices, or by applying vascular closure devices (VCDs) with comparable vascular access site-related complication rates. The aim of the present study was to assess vascular access site-related complications during the implementation of structured sheath removal and MC by paramedics after catheterization procedures. After an observational phase of 3 months to assess the baseline complication rate, a structured 4-level training program was implemented to train assistant personnel, in this case paramedics, in the management of sheath removal by MC. Access site-related complication rates after sheath removal were assessed prospectively and MC by paramedics compared with MC by physicians and application of VCDs. To account for imbalances in procedure- and patient-related risk factors of access-site complications, propensity score-based matching analysis was performed (ClinicalTrials.gov identifier NCT00825331). All consecutive percutaneous transfemoral arterial cardiac catheterization procedures were prospectively assessed over a period of 8 months (n = 3,503). MC was performed in 2,315 cases, of which 180 were performed by paramedics and 2,135 by physicians; VCDs were applied in 1,188 procedures. Rates of access site-related complications were significantly lower for paramedics compared with physicians (p = 0.03) and similar between paramedics and VCDs (p = 0.77). In conclusion a structured program for paramedics to be trained in sheath removal after percutaneous cardiac catheterization procedures can be readily implemented during clinical routine with low in-hospital complication rates.

Pre-procedural fasting for coronary interventions: is it time to change practice?

IntroductionTraditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice.ObjectivesTo demonstrate that percutaneous cardiac catheterisation...

First human experience of thermal arterial closure

This study was designed to evaluate the efficacy and safety of the CardioDex arterial closure device, which is a novel femoral artery closure device used following percutaneous cardiac catheterization. Current devices utilized to achieve hemostasis of the femoral artery following percutaneous cardiac catheterization include collagen plug and suture mediated devices, but are associated with significant vascular complications. The CardioDex closure device utilizes thermal energy to cause collagen shrinking and swelling and thereby, achieve hemostasis. The device was evaluated in a prospective nonrandomized single-center trial with patients undergoing 6F invasive cardiac procedures. Femoral artery puncture closure was performed immediately at completion of the procedure, followed by 3-4 minutes of manual compression. Time to hemostasis (TTH), time to ambulation (TTA), and short-term clinical follow-up data were collected. A total of 34 patients including 21 diagnostic and 13 interventional cases were evaluated. The median TTH was 3 min in diagnostic and 4 min in interventional cases. TTH was independent of activated clotting time (ACT). The median TTA was 2.75 hr and 3.37 hr in diagnostic and interventional groups, respectively. There were no major adverse events identified at 1 week and 30 day follow up. This first in human clinical experience with the CardioDex closure device demonstrates that in the small cohort studied, it is safe and effective in diagnostic cardiac catheterization and also in interventional cases on mild anticoagulation (mean ACT = 188 sec). It has the advantage of leaving no foreign material in the body following use.