Giulia Laterra, Giorgio Sacchetta, Giombattista Barrano, Claudia Artale, Silvia Motta, Paolo Mazzone, Giovanni Ruscica, Serena Costa, Marco Barbanti, Marco Contarini
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引用次数: 0
Abstract
Objectives: This study sought to compare intracardiac echocardiography (ICE) probe via the esophageal route (TE-ICE) and transesophageal echocardiography (TEE) guidance for the LAAO procedure.
Background: Intraprocedural imaging guidance is recommended for all LAAO procedures. Currently, both femoral-ICE-guided and TEE-guided LAAO demonstrated similar outcomes. TE-ICE may serve as a potential alternative imaging modality in LAAO. This approach avoids general anesthesia and its potential complications, while maintaining a favorable learning curve, as it is highly similar to standard transesophageal echocardiography, with whose imaging operators are generally more familiar.
Methods: A pooled analysis of the FLXiEST and DIONISIO registries was conducted. For the purposes of this study, TE-ICE patients were compared to TEE patients. All TE-ICE procedures were performed using a 2D ICE catheter introduced via the transesophageal route. One-to-one propensity score matching was applied to compare the TE-ICE technique with the gold standard TEE in guiding LAAO. Technical success and procedural success were defined as the primary outcomes of the study.
Results: A total of 282 patients were included in the present study. After adjustment for clinical and echocardiographic characteristics, 99 matched-pair treated with LAAO using TE-ICE and TEE were compared. The technical success did not differ between TE-ICE and TEE patients (98 % vs 96 %; p = 0.6827). The procedural success, defined as technical success in the absence of in- hospital device or procedure-related clinical events, was comparable between the two groups (93 % vs 92 %; p = 0.7673). No statistically significant differences were found for all procedural complications assessed: death, stroke, TIA, pericardial effusion, device embolization, systemic arteria embolization and major bleeding.
Conclusions: The present pooled analysis of the DIONISO and the FLXiEST demonstrated that LAAO procedure guidance can be performed with equivalent outcomes using either TE-ICE and TEE. Indeed, the use of TE-ICE technique could be particularly advantageous in high-volume centers to reduce the need for anesthesia, especially in fragile and elderly patients. This approach offers significant organizational benefits by potentially eliminating the requirement for an anesthesiologist in the cath lab, thereby streamlining workflow and improving resource allocation.
目的:本研究旨在比较经食管超声心动图(TE-ICE)和经食管超声心动图(TEE)指导的LAAO手术的心内超声心动图(ICE)探头。背景:所有LAAO手术均推荐术中影像学指导。目前,股骨ice引导和tee引导的LAAO结果相似。TE-ICE可能作为LAAO的潜在替代成像方式。这种方法避免了全身麻醉及其潜在的并发症,同时保持了良好的学习曲线,因为它与标准的经食管超声心动图非常相似,其成像操作员通常更熟悉。方法:对FLXiEST和DIONISIO登记进行汇总分析。为了本研究的目的,TE-ICE患者与TEE患者进行比较。所有TE-ICE手术均使用经食管路径引入的2D ICE导管进行。采用一对一倾向评分匹配比较TE-ICE技术与金标准TEE在指导LAAO中的作用。技术成功和手术成功被定义为研究的主要结果。结果:本研究共纳入282例患者。在调整临床和超声心动图特征后,比较TE-ICE和TEE治疗LAAO的99对配对患者。TE-ICE和TEE患者的技术成功率没有差异(98% vs 96%; p = 0.6827)。手术成功,定义为在没有院内设备或手术相关临床事件的情况下的技术成功,两组之间具有可比性(93%对92%;p = 0.7673)。所有评估的程序性并发症:死亡、卒中、TIA、心包积液、器械栓塞、全身动脉栓塞和大出血均无统计学差异。结论:目前对DIONISO和FLXiEST的汇总分析表明,使用TE-ICE和TEE进行LAAO程序指导可以获得相同的结果。事实上,TE-ICE技术在大容量中心的使用尤其有利,可以减少麻醉的需要,特别是在脆弱和老年患者中。这种方法通过潜在地消除对导管室麻醉师的需求,从而简化工作流程并改善资源分配,为组织提供了显著的好处。
期刊介绍:
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.