- MeSH
- aortální insuficience diagnostické zobrazování MeSH
- aortální stenóza chirurgie diagnostické zobrazování patofyziologie patologie MeSH
- diagnostické techniky kardiovaskulární MeSH
- echokardiografie MeSH
- fyzikální vyšetření MeSH
- hemodynamické monitorování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mitrální insuficience chirurgie diagnostické zobrazování patologie MeSH
- mitrální stenóza diagnóza patofyziologie MeSH
- nemoci srdečních chlopní * chirurgie diagnostické zobrazování klasifikace patologie MeSH
- srdeční chlopně umělé klasifikace MeSH
- stupeň závažnosti nemoci MeSH
- trikuspidální insuficience diagnostické zobrazování terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- cévy anatomie a histologie MeSH
- hemodynamické monitorování * metody škodlivé účinky MeSH
- kardiovaskulární fyziologické jevy * MeSH
- koronární cévy anatomie a histologie diagnostické zobrazování fyziologie MeSH
- lidé MeSH
- srdce anatomie a histologie fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Transcatheter aortic valve implantation (TAVI) has become a high-volume procedure with increasing demands on hospital resources. Local anaesthesia with sedation supervised by an anaesthesiology team is the current standard of care. We aimed to describe our experience with a simplified, nurse-led sedation (NLS) protocol. This study enrolled 128 consecutive patients who underwent transfemoral TAVI with self-expandable Evolut R prosthesis between November 2019 and April 2021. Operators selected 50% of patients for NLS based on the clinical expectation of lower risk of procedural difficulties. Nurse-led sedation protocol demanded only mild to moderate levels of sedation. The clinical outcomes were determined from the local TAVI registry and the national mortality database. Baseline patient characteristics were similar in the NLS (n = 64) and anaesthesiologist-led sedation (ALS) (n = 64) groups except higher prevalence of diabetes mellitus (48.4% vs. 31.3%, P = 0.035) and peripheral vascular disease (20.3% vs. 7.8%, P = 0.036) in the ALS group. There was a trend for the larger prostheses used in the ALS group (P = 0.058). The procedural results did not differ, and coronary care team backup was rarely needed in the NLS group (6% of patients). The in-hospital outcomes were identical from both clinical and echocardiography perspectives, and 30-day mortality was low in both groups (1.5%). For the NLS group, preparation in the catheterization laboratory was quicker by 6.4 min (P = 0.01), and intensive care unit stay was shorter (2.03 vs. 3.48 days, P = 0.001). In conclusion, the NLS for the selected transfemoral TAVI population seems safe.
- Publikační typ
- časopisecké články MeSH
Cardiac computed tomography (CT) is vital for safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to determine the accuracy of fully automated CT analysis of aortic root anatomy before TAVI by Philips HeartNavigator software. This prospective, academic, single-centre study enrolled 128 consecutive patients with native aortic valve stenosis considered for TAVI. Automated HeartNavigator software was compared to the standard manual CT analysis by experienced operators using FluoroCT software. The sizing of the aortic annulus by perimeter and area significantly differed between both methods: mean perimeter was 76.43 mm vs. 77.52 mm (P < 0.0001) using manual FluoroCT vs. automated HeartNavigator software; mean area was 465 mm2 vs. 476 mm2 (P < 0.0001). Interindividual variability testing revealed mean differences between the two operators were 1.21 mm for the aortic annulus perimeter and 9 mm2 for the aortic annulus area. The hypothetical self-expandable transcatheter prosthesis sizing resulted in 80% agreement in 80% of cases. The time required to perform the automated CT analysis was significantly shorter than the time required for manual analysis (mean 17.8 min vs. 2.1 min, P < 0.0001). Philips HeartNavigator fully automated software for pre-TAVI CT analysis is a promising technology. Differences detected in aortic annulus dimensions are small and similar to the variability of manual CT analysis. Automated prediction of optimal fluoroscopic viewing angles is accurate. Correct transcatheter prosthesis sizing requires clinical oversight.
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data. BACKGROUND: Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators. METHODS: In this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions. RESULTS: The average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°). CONCLUSIONS: CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.
BACKGROUND: Bioresorbable scaffold (BRS) AbsorbTM clinical use has been stopped due to higher rate of device thrombosis. Scaffold struts persist longer than 2 years in the vessel wall. Second generation devices are being developed. This study evaluates long-term invasive imaging in STEMI patients. METHODS: PRAGUE-19 study is an academic study enrolling consecutive STEMI patients with intention to implant AbsorbTM BRS. A total of 83 STEMI patients between December 2012 and March 2014 fulfilled entry criteria. Coronary angiography and optical coherence tomography at 5 year follow-up was performed in 25 patients. RESULTS: Primary combined clinical endpoint (death, myocardial infarction or target vessel revascularization) occurred in 12.6% during the five-year follow-up with overall mortality 6.3%. Definite scaffold thrombosis occurred in 2 patients in the early phase after BRS implantation. Quantitative coronary angiography after 5 years demonstrated low late lumen loss of 0.11 ± 0.35 mm with binary restenosis rate of 0%. Optical coherence tomography demonstrated complete resorption of scaffold struts and mean lumen diameter of 3.25 ± 0.30 and 3.22 ± 0.49 (P = 0.73) at baseline and after 5 years, respectively. Three patients developed small coronary artery aneurysm in the treated segment. CONCLUSION: Invasive imaging results 5 years after BRS implantation in STEMI showed complete resorption of scaffold struts and stable lumen vessel diameter. Trial registration ISRCTN43696201 (retrospectivelly registred, June 7th, 2019). https://www.isrctn.com/ISRCTN43696201.
- MeSH
- infarkt myokardu s elevacemi ST úseků * diagnostické zobrazování chirurgie MeSH
- koronární angiografie MeSH
- koronární angioplastika * MeSH
- lidé MeSH
- protézy - design MeSH
- stenty uvolňující léky * MeSH
- vstřebatelné implantáty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Vstřebatelné stenty by v současnosti neměly být používány v rutinní klinické praxi, neboť existují pochybnosti o jejich bezpečnosti. Tato skutečnost by však neměla stát v cestě dalšímu vývoji této intuitivně správné myšlenky, neboť dlouhodobá data po implantaci permanentních kovových stentů ukazují trvale rostoucí výskyt klinických příhod. V budoucnosti lze očekávat lepší techniku implantace vstřebatelných stentů a technologický vývoj je také velmi nadějný. Autor shrnuje několik potenciálních výhod absence permanentního cizího tělesa ve věnčité tepně. Rutinní použití vstřebatelných stentů můžeme v budoucnosti zvážit, pokud se podaří prokázat bezpečnost a efektivitu této technologie v okamžiku kompletní resorpce.
Currently, absorbable stents should not be used in routine clinical practice since their safety has been questioned. This fact, however,should not stand in the way of further development of this intuitively correct concept since long-term data after implantation ofpermanent metal stents show a constantly increasing incidence of clinical events. In the future, a better technique of implantationof absorbable stents can be expected and technological progress is also very promising. The author summarizes several potentialadvantages of the absence of a permanent foreign body in a coronary artery. The routine use of absorbable stents can be consideredin the future if we manage to demonstrate the safety and efficacy of this technology at the point of complete resorption.
- Klíčová slova
- studie ABSORB II, trombóza stentu, vstřebatelné stenty,
- MeSH
- klinická studie jako téma MeSH
- koronární angioplastika * metody MeSH
- kovy MeSH
- lidé MeSH
- polymery MeSH
- stenty uvolňující léky * škodlivé účinky trendy MeSH
- stenty * škodlivé účinky trendy MeSH
- trombóza MeSH
- vstřebatelné implantáty * škodlivé účinky trendy MeSH
- Check Tag
- lidé MeSH
