Postepy w kardiologii interwencyjnej = Advances in interventional cardiology最新文献

{"title":"Balloon aortic valvuloplasty, Impella insertion and complex coronary intervention: is this all feasible fully percutaneously via upper limb access?","authors":"Jerzy Sacha, Krzysztof Krawczyk, Maciej Gawor, Joanna Płonka, Marek Gierlotka","doi":"10.5114/aic.2021.104783","DOIUrl":"https://doi.org/10.5114/aic.2021.104783","url":null,"abstract":"Corresponding author: Jerzy Sacha MD, PhD, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 76 Prószkowska St, 45-758 Opole, Poland, phone: +48 77 452 08 72, e-mail: sacha@op.pl Received: 27.10.2020, accepted: 26.11.2020. Balloon aortic valvuloplasty, Impella insertion and complex coronary intervention: is this all feasible fully percutaneously via upper limb access?","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"126-128"},"PeriodicalIF":1.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/fe/PWKI-17-43652.PMC8039925.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutting balloon to treat post-stenting intramural hematoma during ST elevation myocardial infarction.","authors":"Clément Servoz, Jacques Monségu, Mohamed Abdellaoui, Benjamin Faurie","doi":"10.5114/aic.2021.104779","DOIUrl":"https://doi.org/10.5114/aic.2021.104779","url":null,"abstract":"A 71-year-old woman was admitted to our institution for an ongoing inferior ST-elevation myocardial infarction (STEMI). TIMI 3 flow of a mid-right coronary artery (RCA) thrombotic occlusion was restituted with balloon angioplasty (Sapphire II NC 3 × 15 mm, OrbusNech) and stenting at 9 atm (Ultimaster Tansei 3.5 × 28 mm, TERUMO) (Figure 1 A). Post-stenting angiogram revealed a distal stent edge stenosis which was not restituted after intracoronary nitroglycerin excluding vasospasm (Figure 1 B). Moreover, this lesion was evolutive: the stenosis aspect and degree became worse. As the dissection mechanism was suspected, we treated this lesion with a second stent. While stenting, we observed a distal migration of the sub-intimal contrast dye that made us think about a probable iatrogenic hematoma extension. A tight distal RCA stenosis was revealed on angiogram with clear subintimal dye trapping and extraluminal compression while the patient had recurrence of chest pain and inferior ST-segment elevation (Figure 1 C). The diagnosis of iatrogenic subintimal hematoma defined as blood accumulation in the medial space without distinguishable entry or exit points was considered [1]. We thought that additional stenting could worsen the situation by moving forward the hematoma and jeopardize the RCA crux and its distal flow. Intracoronary imaging would have confirmed the diagnosis but was not performed in the context of emergency so as not to delay revascularization. Hence, we decided to fenestrate this hematoma with a cutting balloon (CB) angioplasty in order to evacuate blood from the subintimal space as previously described for spontaneous hematoma [2]. At the site of hematoma, three CB (Wolverine 3 × 10 mm, Boston Scientific) incremental inflations at 6, 8 then 11 atm were required to obtain the awaited effect and recover a good flow without subintimal contrast trapping anymore. Chest pain and ST elevation disappeared immediately; nevertheless, we stented this fenestrated area (Ultimaster Tansei 3.5 × 28 mm, TERUMO) (Figure 1 D). Ultra-sensitive troponin maximum level was 237 594 ng/l and the patient was discharged from hospital after 5 days with a limited inferior wall akinesia on echocardiography. Frequently, after stent implantation when stenosis appears at the stent edge, diagnosis and management of such an issue is difficult. In some exceptional situations when true lumen compression leads to ischemia, cutting balloon angioplasty at the site induces a fenestration between the true lumen and hematoma. This situation has been described in cases of spontaneous coronary artery dissection or during chronic total occlusion revascularization [3, 4]. In the context of ventricular arrhythmias or clinical instability as in our case, diagnosis should be confirmed by intracoronary imaging: intravascular ultrasound (IVUS) or optical coherence tomography (OCT), even though OCT risk is a distal propagation of the hematoma. To fenestrate the hematoma while minimizing","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"114-115"},"PeriodicalIF":1.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/94/PWKI-17-43648.PMC8039918.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study.","authors":"Shelly Meron Grossman,&nbsp;Nili Schamroth Pravda,&nbsp;Katia Orvin,&nbsp;Ashraf Hamdan,&nbsp;Mordehay Vaturi,&nbsp;Tuvia Bengal,&nbsp;Ran Kornowski,&nbsp;Adaya Weissler-Snir","doi":"10.5114/aic.2021.104770","DOIUrl":"https://doi.org/10.5114/aic.2021.104770","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited data on the long-term follow-up of patients with myocarditis.</p><p><strong>Aim: </strong>To investigate the long-term follow-up of patients with myocarditis.</p><p><strong>Material and methods: </strong>We performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis.</p><p><strong>Results: </strong>Between May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4-38.9). The median follow-up period was 56.9 months (interquartile range 25.3-87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05-1.16, <i>p</i> < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18-18, <i>p</i> = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07-0.56, <i>p</i> = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, <i>p</i> = 0.005).</p><p><strong>Conclusions: </strong>The overall prognosis of patients with myocarditis is good - in terms of both survival and recovery without residual left ventricular dysfunction.</p>","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"60-67"},"PeriodicalIF":1.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/7f/PWKI-17-43639.PMC8039934.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term safety and efficacy of transcarotid transcatheter aortic valve implantation with balloon-expandable vs. self-expandable valves.","authors":"Damian Hudziak,&nbsp;Wojciech Wańha,&nbsp;Radosław Gocoł,&nbsp;Radosław Parma,&nbsp;Andrzej Ochała,&nbsp;Grzegorz Smolka,&nbsp;Joanna Ciosek,&nbsp;Tomasz Darocha,&nbsp;Marek A Deja,&nbsp;Wojciech Wojakowski","doi":"10.5114/aic.2021.104772","DOIUrl":"https://doi.org/10.5114/aic.2021.104772","url":null,"abstract":"<p><strong>Introduction: </strong>Transfemoral access (TF) is the preferred access for transcatheter aortic valve implantation (TAVI). Transcarotid TAVI (TC-TAVI) is an alternative for patients in whom TF-TAVI is impossible. Two types of valves - balloon-expandable (BE) and self-expandable (SE) - can be used in TC-TAVI procedures.</p><p><strong>Aim: </strong>Comparison of the short-term results of patients treated with TC-TAVI using BE and SE valves.</p><p><strong>Material and methods: </strong>The retrospective registry included 39 patients in whom the TC-TAVI procedure was performed between 2017 and 2020 (BE-TAVI; <i>n</i> = 10, SE-TAVI; <i>n</i> = 29). Preoperative characteristics, operative and postoperative results, and 30-days mortality were compared.</p><p><strong>Results: </strong>Patients from the BE-TAVI group had higher surgical risk (EuroSCORE) (10.8% (6.2-14.0) vs. 5.5% (4.3-8.7); <i>p</i> = 0.027). The incidence of chronic obstructive pulmonary disease (COPD) was higher in the SE-TAVI group (34.5% vs. 0%; <i>p</i> = 0.040). In terms of other comorbidities, demographics, preprocedural laboratory results, transthoracic echocardiography (TTE), and multislice computed tomography (MSCT), the two groups were comparable. In both groups, we observed 100% procedural success. The median valve size was larger in the SE-TAVI group (29.0 (26.0-29.0) vs. 26.0 (23.0-26.0); <i>p</i> < 0.001). The hospitalization time was shorter in the BE-TAVI group vs. SE-TAVI (5.8 ±0.6 vs. 6.4 ±0.9; <i>p</i> = 0.043). We did not observe statistically significant differences between BE-TAVI and SE-TAVI in periprocedural and 30-day mortality, or the number of strokes/TIA. Also TTE parameters and NYHA class showed similar improvement at 30 days in both groups.</p><p><strong>Conclusions: </strong>TC-TAVI using balloon-expandable and self-expandable valves showed similar safety and efficacy in 30 days follow-up.</p>","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"75-81"},"PeriodicalIF":1.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/87/PWKI-17-43641.PMC8039933.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid treatment of a tight aortic stenosis with critical calcified left main disease in a patient with poor left ventricular function.","authors":"Piotr Kübler,&nbsp;Grzegorz Onisk,&nbsp;Maciej Rachwalik,&nbsp;Roman Przybylski,&nbsp;Krzysztof Reczuch,&nbsp;Marcin Protasiewicz","doi":"10.5114/aic.2021.104781","DOIUrl":"https://doi.org/10.5114/aic.2021.104781","url":null,"abstract":"","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"122-123"},"PeriodicalIF":1.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/c8/PWKI-17-43650.PMC8039928.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-fluoroscopic radiofrequency catheter ablation of right- and left-sided ventricular arrhythmias.","authors":"Grzegorz Karkowski,&nbsp;Marcin Kuniewicz,&nbsp;Edward Koźluk,&nbsp;Tomasz Chyży,&nbsp;Andrzej Ząbek,&nbsp;Michał Dusza,&nbsp;Jacek Lelakowski","doi":"10.5114/aic.2020.99268","DOIUrl":"https://doi.org/10.5114/aic.2020.99268","url":null,"abstract":"<p><strong>Introduction: </strong>Radiofrequency catheter ablation (RFCA) is an important method of treatment of ventricular arrhythmias (VAs). In the majority of RFCA, fluoroscopy is used, exposing patients and medical staff to all related side effects. Current experience of non-fluoroscopic (NF)-RFCA in VAs from the left side is limited.</p><p><strong>Aim: </strong>Analysis of safety and effectiveness of NF-RFCA of VAs from left- and right-sided cardiac chambers.</p><p><strong>Material and methods: </strong>From 2014 to 2018, a group of 128 patients who underwent RFCA of VAs were retrospectively divided into two groups: NF-RFCA and fluoroscopic (F)-RFCA. Patients in each group were then subsequently subdivided into two groups based on VAs localization - left- (LS-Va) and right-sided (RS-Va) VAs. In all patients the CARTO Biosense Webster mapping system was used.</p><p><strong>Results: </strong>In group 1 (NF-RFCA <i>n</i> = 88) 66 (75%) patients underwent RFCA of RS-Va and 22 (25%) of LS-Va. Early success was achieved in 89.8% (<i>n</i> = 79) and long term success in 81.8% (<i>n</i> = 72). In group 2 (F-RFCA <i>n</i> = 40) 19 patients (47.5%) had RFCA of RS-Va and 21 (52.5%) patients of LS-Va. Acute procedural success rate was 80% (<i>n</i> = 32) and long-term success 72.5% (<i>n</i> = 29). There were 4 (4.6%) perioperative complications in NF-RFCA and 2 (5%) in F-RFCA. Success rate, procedure time and complications were not significantly different between groups and subgroups in follow-up.</p><p><strong>Conclusions: </strong>NF-RFCA in VAs from the right and left cardiac chamber is safe and equally effective as F-RFCA, and it should be implemented as often as possible for protection of patients and electrophysiology staff.</p>","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"321-329"},"PeriodicalIF":1.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/86/PWKI-16-41854.PMC7863801.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute circumflex artery total occlusion during ablation of septal premature ventricular contraction with radiofrequency energy.","authors":"Myrda Krzysztof,&nbsp;Krzysztof Wilczek,&nbsp;Mariusz Gąsior","doi":"10.5114/aic.2020.99276","DOIUrl":"https://doi.org/10.5114/aic.2020.99276","url":null,"abstract":"The 28-year-old female patient was admitted to our clinic with symptomatic, frequent, drug-refractory (β-blocker/propafenone) premature ventricular contraction (PVC) (Figure 1 A). Both echocardiography and cardiac magnetic resonance showed normal values of cardiac chamber size and function, without valvular dysfunction. Using an electroanatomical 3D system (Carto 3 UniVu) and ablation catheter (Thermocool SmartTouch) (Biosense Webster, Diamond Bar, CA, USA), activation maps of both the right and left ventricles and the coronary sinus (CS), respectively, were created. Despite delivery of radiofrequency (RF) energy with 30–40 W to the interventricular septum from the left and right side the ablation was unsuccessful. Thus, based on the local signals, fluoroscopy view and 3D map, RF energy application was performed within the coronary sinus in the proximity of the posterior cardiac vein (MCV) (Figures 1 A–C). In the 60th s of the successful RF application with 20 W, signs of ischemia were present in the 12-lead electrocardiogram. Urgent coronarography showed acute occlusion of the distal circumflex artery (LCx) (Figure 1 D). Successful wire crossing and recanalization were achieved with the coronary guide wire. Prolonged inflation with a 2.25 × 12 mm semi-compliant balloon demonstrated a suboptimal result and therefore a 2.5 × 15 mm sirolimus-eluting stent (Orsiro, Biotronic AG, Büllach, Switzerland) was implanted, with an optimal angiographic result (Figure 1 E). At discharge and in 6 months’ follow-up, there was no evidence of recurrence of ventricular extra beats in 24-hour Holter monitoring. Based on the medical history, physical examination and the results of the additional tests, no signs of coronary artery disease were found. Coronary artery occlusion is a rare complication of RF catheter ablation reported previously, with an incidence rate less than 0.2% [1]. Acute injury at this particular location is most commonly related to RF application during ablation of the accessory pathway in postero-septal localization or in proximity of the posterior interventricular vein (MCV) [2]. Most reports and a large group of studies describe occlusion of the right coronary artery (RCA) [2]. In the present case acute occlusion affected a branch of the left coronary artery – LCx – the dominant artery in this anatomical variant. Selection of ablation catheters and RF application settings in CS most often results from local experience. However, limiting power and duration of RF application, as well as choosing a different energy source (cryo), might decrease the risk of coronary artery injury. In conclusion, we would like to emphasize that RF ablation in the ostial part of the coronary sinus/MCV is associated with a very small risk of occlusion/injury of RCA or CX depending on the coronary artery dominance.","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"352-353"},"PeriodicalIF":1.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/c9/PWKI-16-41862.PMC7863806.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of transcatheter bronchial artery embolization in five patients with bronchial artery aneurysm.","authors":"Fu Le-Jun,&nbsp;Yu Sun,&nbsp;Yong Fan,&nbsp;Song Jin","doi":"10.5114/aic.2020.99269","DOIUrl":"https://doi.org/10.5114/aic.2020.99269","url":null,"abstract":"<p><strong>Introduction: </strong>Due to its rarity and the lack of animal models for this disease, the etiology of bronchial artery aneurysm (BAA) is poorly understood.</p><p><strong>Aim: </strong>To investigate the effect of transcatheter artery embolization (TAE) with coils, spherical polyvinyl alcohol (PVA), and gel foam in patients with BAA.</p><p><strong>Material and methods: </strong>From June 2015 to November 2018, 5 patients diagnosed with BAA with massive hemoptysis after undergoing bronchial arteriography and receiving TAE therapy in the Department of Interventional Radiology were enrolled in this study. Post-embolization angiography was used to demonstrate total occlusion of the BAAs and bronchiectatic engorged vessels. The patients' follow-up was conducted 1-16 months after TAE.</p><p><strong>Results: </strong>All 5 patients were cured by the TAE treatment, during which PVA, coils, and gel foam were applied. The patients also received successful TAE via a microcatheter. Hemoptysis disappeared in all patients. No special or severe complications occurred, and no patient experienced a recurrence during the follow-up.</p><p><strong>Conclusions: </strong>Overall, TAE is the best choice for patients with hemoptysis and BAA due to its effectivity and reliability. Thorough and complete embolization of the bleeding arteries is the key to successful treatment. Though PVA and coils are the most common materials for embolization, gel foam strips can also be applied.</p>","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"330-335"},"PeriodicalIF":1.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/f1/PWKI-16-41856.PMC7863811.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of protamine sulfate during transfemoral transcatheter aortic valve implantation - a preliminary assessment of administration rate and impact on complications.","authors":"Karol Zbroński,&nbsp;Kajetan Grodecki,&nbsp;Roksana Gozdowska,&nbsp;Szymon Jędrzejczyk,&nbsp;Ewa Ostrowska,&nbsp;Julia Wysińska,&nbsp;Bartosz Rymuza,&nbsp;Piotr Scisło,&nbsp;Radosław Wilimski,&nbsp;Janusz Kochman,&nbsp;Krzysztof J Filipiak,&nbsp;Grzegorz Opolski,&nbsp;Zenon Huczek","doi":"10.5114/aic.2020.99266","DOIUrl":"https://doi.org/10.5114/aic.2020.99266","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding complications after transcatheter aortic valve implantation (TAVI) are an important issue and negatively affect survival. The rate and impact of protamine sulfate (PS) administration on bleeding complications after TAVI remain unclear.</p><p><strong>Aim: </strong>To assess the impact of PS on bleeding complications after TAVI.</p><p><strong>Material and methods: </strong>Between March 2010 and November 2016 two hundred fifty-eight patients qualified for TAVI in one academic center were screened. Baseline, procedural and follow-up data up to 30 days were collected and analyzed. The primary endpoint (PE) was major bleeding according to the Valve Academic Research Consortium up to 48 h after the procedure.</p><p><strong>Results: </strong>Overall, 186 patients (96 females, mean age: 80 years) met the inclusion criteria. Thirty-nine (21%) subjects received PS. PE occurred in 24.7% of the study population. There were no significant differences in terms of the PE rate between the groups (25.6% in the PS group and 24.7% in the remaining cohort, <i>p</i> = 0.9, odds ratio (OR) = 1.05, confidence interval (CI): 0.47-2.4, <i>p</i> = 0.9). Multivariate analysis identified female gender (OR = 2.2, CI: 1.08-4.4, <i>p</i> = 0.03) as an independent predictor of PE occurrence. Similarly, female gender (OR = 2, CI: 1.06-3.84, <i>p</i> = 0.03) as well as general anesthesia (GA, OR = 2.23, CI: 1.13-4.63, <i>p</i> = 0.02) and dose of unfractionated heparin per kilogram (UFH/kg, OR = 1.02, CI: 1-1.03 per 1 IU increment, <i>p</i> = 0.02) predicted the occurrence of a composite of major and minor bleeding.</p><p><strong>Conclusions: </strong>In this analysis, PS administration did not decrease the PE rate. Female gender predicted PE occurrence. Randomized, placebo-controlled trials are required to accurately assess the impact of PS.</p>","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"306-314"},"PeriodicalIF":1.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/20/PWKI-16-41852.PMC7863803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical circulatory support during high-risk percutaneous coronary intervention in a young male patient.","authors":"Pawlik Artur,&nbsp;Paweł Kleczyński,&nbsp;Dariusz Dudek,&nbsp;Artur Dziewierz,&nbsp;Stanisław Bartuś","doi":"10.5114/aic.2020.99274","DOIUrl":"https://doi.org/10.5114/aic.2020.99274","url":null,"abstract":"A 58-year-old man, with a history of myocardial infarction, hypercholesterolemia, smoking, arterial hypertension, chronic obstructive pulmonary disease, paroxysmal atrial fibrillation, and stroke, was transferred from another hospital to our department to undergo high-risk percutaneous coronary intervention (PCI). Previously performed coronary angiography revealed a multi-vessel disease with significant stenosis of the left main (LM) and left ascending coronary artery (LAD), as well as occlusions of the right coronary artery and circumflex artery (Figure 1 A). Due to severely depressed left ventricular (LV) function (ejection fraction of 25%) and the need for complex PCI of the last remaining vessel, after the discussion with the heart team, he was scheduled for PCI with the support of a percutaneous left ventricular assist device (pLVAD) – so-called ‘protected PCI’ [1]. After the initial peripheral angiography confirming eligibility for using pLVAD, a 14 Fr sheath was inserted into the right femoral artery. The Impella CP system (Abiomed Inc., Danvers MA, USA) was delivered to the LV and started providing a cardiac output of 3.4 l/min. Subsequently, intravascular ultrasound (IVUS) guided PCI using the right transradial approach was started. During each balloon inflation, the curve of blood pressure measured in the ascending aorta was flattened (Figure 1 B), which meant that cardiac output was provided only by pLVAD. Eventually, a 3.5 × 48 mm drug-eluting stent was successfully implanted in the LM/LAD (Figures 1 C, D). The femoral artery was closed with the Perclose ProGlide closure system (Abbott Cardiovascular, Santa Clara, CA, USA). Further hospitalization was uncomplicated, and after 3 days, the patient was discharged home. The Impella CP provides up to 4 l/min cardiac output covering 70–100% of the heart contractile function [2]. Therefore, the arterial pressure drops during the described procedure did not manifest themselves either as severe cardiac arrhythmias or cardiac arrest. The operator was able to continue the intervention, prepare highly calcified and complex lesions, and apply advanced percutaneous techniques, resulting in good stent apposition. As the introduction of Impella CP is relatively easy and safe, we assume that this device should be used more often in carefully selected patients, especially since the national healthcare system in Poland reimburses its use during high-risk PCIs [3]. The heart team consultation should help in choosing patients who will benefit from this technology the most.","PeriodicalId":520756,"journal":{"name":"Postepy w kardiologii interwencyjnej = Advances in interventional cardiology","volume":" ","pages":"347-348"},"PeriodicalIF":1.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/91/PWKI-16-41860.PMC7863813.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25377038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}