Prezentujeme málo častou možnost využití mechanické srdeční podpory Impella CP Smart Assist (Abiomed) zavedené přes biologickou aortální náhradu Evolut (Medtronic). Mezi absolutní kontraindikace zavedení Impelly se řadí mj. i přítomnost mechanické protézy aortální chlopně, ne však bioprotéza v aortální pozici. Před zaváděním Impelly přes bioprotézu Evolut však varuje americká FDA z důvodu rizika interakcí mezi in-flow a out-flow Impelly a okrajem stentu s možností poškození funkce pumpy. Přesto může být zavedení této podpory i u pacientů s implantovanou stentovanou chlopní někdy nezbytné, především při vysoce rizikové PCI nebo v případě kardiogenního šoku, kdy není vhodné nebo možné použít jinou oběhovou nebo levokomorovou podporu. V článku jsou popsány některé praktické tipy, jak lze postupovat v případě, že je nutno Impellu do těchto stentovaných chlopní, zavést a prezentujeme naši zkušenost na konkrétním případu.
We present the rare possibility of using the mechanical heart support Impella CP Smart Assist (Abiomed) introduced through the biological aortic replacement Evolut (Medtronic). Among the absolute contraindications for the introduction of Impella is the presence of a mechanical aortic valve prosthesis but not that of a bioprosthesis in the aortic position. However, the US FDA warns against the introduction of Impella through the Evolut bioprosthesis due to the risk of interactions between the in-flow and out-flow of the Impella and the edge of the stent, with the possibility of damage to the pump function. Nevertheless, the insertion of this support even in patients with an implanted stented valve may sometimes be necessary, particularly in the case of high-risk PCI or in the case of cardiogenic shock if it is not appropriate or feasible to use another circulatory or left ventricular support device. The article presents some practical advice on how to proceed in the case that Impella has to be introduced into these stented valves, as well as our experience in a specific case.
- MeSH
- akutní koronární syndrom * terapie MeSH
- chirurgická náhrada chlopně MeSH
- dialýza ledvin MeSH
- kardiovaskulární chirurgické výkony metody MeSH
- komorbidita MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
The aim of this study was to evaluate the patency of the proximal and distal radial artery after coronary procedures performed via the distal radial artery (DRA). Ultrasound (US) as the most reliable method was used to diagnose radial artery occlusions (RAO). We evaluated 115 patients who underwent catheterization via distal radial access (dTRA). Following the procedure and after successful hemostasis (80 ± 36 min), arterial patency and diameter at conventional transradial access (cTRA) and distal puncture sites (either in the anatomical snuffbox or the dorsal distal RA) were assessed. No RAO were found in the proximal or distal RA and there were no significant other complications. The mean diameter of the radial artery at conventional puncture site was 2.86 ± 0.49 mm and at distal puncture site 2.31 ± 0.47 mm (p < 0.001). Postprocedural compression time of dTRA was very short. In conclusion distal radial access was associated with the absence of early arterial occlusion, significant local bleeding and other relevant complications.
Cíl: Jednoroční analýza výkonů provedených v režimu jednodenních koronárních katetrizací, intervencí a přístrojových výměn v době pandemie covidu-19 v Komplexním kardiovaskulárním centru FN Plzeň.
Background: One-year analysis of same-day discharge (SDD) coronary catheterizations, interventions and device replacement procedures during the covid-19 pandemic at the Complex Cardiovascular Center of the University Hospital in Pilsen. Methods: In 2021, 53 to 87 patients were admitted monthly and 817 in total to the SDD specialized Radial Lounge at the Department of Cardiology. Coronary angiography (CAG) was performed in 729 patients and percutaneous coronary intervention (PCI) in 176 (24%). Fifty-five patients were admitted for permanent pacemaker exchange and in 33 of them an implantable cardioverter-defibrillator exchange. Results: Out of 729 transradial CAGs 621 were performed by using the conventional proximal radial approach and 108 (15%) via the distal radial approach, 90 % of all procedures (n = 655), were performed from the nondominant left hand. Only one asymptomatic postprocedural radial artery occlusion was diagnosed by the reverse Barbeau test on the wrist (1/729 = 0.1%). No other relevant complications occured. The distal radial approach was associated with a shorter compression with time in comparison to the proximal puncture site at the wrist - 75 ± 26 min vs. 92 ± 24 (p < 0.05) and there were only four superficial hematomas smaller than 2 cm. In the proximal radial approach subcutaneous hematomas also did not require any specific treatment. Of the total of 817 patients, 90% (n = 732) were discharged home on the same day of admission in the afternoon and none of them was readmitted within the next 24 hours. The remaining 10% of the patients (n = 85) were hospitalized after the procedure, mostly because of severe findings on the coronary arteries. Conclusions: Coronary catheterizations and interventions together with device replacement procedures in the SDD program at the University Hospital in Pilsen were associated with a one-year saving of more than 700 overnight stays, minimal complications, and 99.9% radial artery patency rate after transradial procedures.
OBJECTIVES: Impaired glucose metabolism represents one the most important cardiovascular risk factors, with steeply raising prevalence in overall population. We aimed to compare mortality risk of impaired fasting glycaemia (IFG) and overt diabetes mellitus (DM) in patients with coronary heart disease (CHD). STUDY DESIGN: prospective cohort study METHODS: A total of 1685 patients, 6-24 months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. Overt DM was defined as fasting glucose ≥ 7 mmol/L and/or use of antidiabetic treatment, while IFG as fasting glucose 5.6-6.99 mmol/L, but no antidiabetic medication. The main outcomes were total and cardiovascular mortality during 5 years of follow-up. RESULTS: During follow-up of 1826 days, 172 patients (10.2%) deceased, and of them 122 (7.2%) from a cardiovascular cause. Both exposures, overt DM (n=623, 37.0% of the whole sample) and IFG (n=436, 25.9%) were associated with an independent increase of 5-year total mortality, compared to normoglycemic subjects [fully adjusted hazard risk ratio (HRR) 1.63 (95%CI: 1.01-2.61)]; p=0.043 and 2.25 (95%CI: 1.45-3.50); p<0.0001, respectively]. In contrast, comparing both glucose disorders one with each other, no significant differences were found for total mortality [HRR 0.82 (0.53-1.28); p=0.33]. Taking 5-years cardiovascular mortality as outcome, similar pattern was observed [HRR 1.96 (95%CI: 1.06-3.63) and 3.84 (95%CI: 2.19-6.73) for overt DM and IFG, respectively, with HRR 0.63 (95%CI: 0.37-1.07) for comparison of both disorders]. CONCLUSIONS: Impaired fasting glycaemia adversely increases mortality of CHD patients in the same extent as overt DM.
- MeSH
- diabetes mellitus krev diagnóza farmakoterapie mortalita MeSH
- komorbidita MeSH
- krevní glukóza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nemoci koronárních tepen krev mortalita MeSH
- omezení příjmu potravy krev MeSH
- prediabetes krev mortalita MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The transradial approach is recommended as a first choice in coronary catheterizations and interventions, for among other reasons, the reduction in the number of local complications. A head-to-head comparison of the reverse Barbeau test (RBT) and duplex ultrasonography (DUSG) for the detection of post-procedural radial artery patency and occlusion has not yet been evaluated. In 500 patients from our same-day discharge program (age 65 ± 9.4 years, 148 women), radial artery patency and occlusion, compression time, haematomas, and other local complications were evaluated. Radial artery patency was confirmed in 495 patients (99.0%), and complete radial artery occlusion (RAO) was detected in 2 (0.4%) patients using both methods. In 3 patients (0.6%), the RBT was negative, while incomplete RAO was detected by DUSG. Superficial haematomas (˃ 5 but ≤10 cm) were found in 27 (5.4%) patients. There were no other local complications. Detection of radial artery patency and occlusion using the RBT and DUSG was comparable. The incidence of RAO in our study was extremely low. Thanks to its simplicity, the RBT has the potential to be used as the first method of detection of radial occlusion after coronary catheterizations.
- Publikační typ
- časopisecké články MeSH
Standardní radiální přístup z pravého či levého zápěstí se stal dominantní přístupovou cestou ke koronárním katetrizacím a intervencím s doporučením IA dle posledních guidelines Evropské kardiologické společnosti pro revaskularizaci myokardu z roku 2018. Od té doby bylo publikováno několik článků o možnosti provádět intervenční výkony na koronárních tepnách z tzv. distálního radiálního přístupu. Tento článek popisuje naše první zkušenosti s tímto novým přístupem.
Standard radial approach from the right or left wrist has become a dominant arterial approach for coronary catheterizations and interventions with IA recommendation in 2018 Guidelines for myocardial revascularization of European Society of Cardiology. Since that time several articles has been published about distal radial approach. This article describes our first experience with this new approach.
- Klíčová slova
- distální radiální přístup,
- MeSH
- arteria radialis * chirurgie MeSH
- koronární angiografie * metody statistika a číselné údaje MeSH
- koronární angioplastika metody statistika a číselné údaje MeSH
- koronární cévy diagnostické zobrazování MeSH
- koronární nemoc diagnostické zobrazování terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- periferní katetrizace metody statistika a číselné údaje MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- hodnotící studie MeSH
Osoby s asymptomaticky zvýšeným rizikem kardiovaskulárního onemocnění (KVO) jsou prioritou pro prevenci ihned po pacientech s manifestní KVO. Pokusili jsme se stanovit prevalenci asymptomatických vysokorizikových subjektů v náhodné vzorku obecné populace a posoudit jejich adherenci k cílovým hodnotám pro primární prevenci. Ve studii bylo vyšetřeno celkem 616 osob (o průměrném věku 47,2 let) jako náhodný populační vzorek. Individuální absolutní riziko fatální vaskulární příhody v příštích letech bylo stanoveno pomocí SCORE funkce, lokalizované pro českou populaci. Celkem 24,8 % osob vykazovalo v našem souboru riziko SCORE ? 5 %, či bylo již léčeno kardioprotektivní medikací (antihypertenzívem či hypolipidemikem). Pokud bylo použito projekce aktuálního riziko na 60. rok věku, vzrostla prevalence vysokorizikových osob na 46,9 %. Kromě toho, 8,5% osob již prodělalo manifestaci KVO nebo mělo diabetes. Mezi asymptomatickými vysokorizikovými subjekty, 29,4 % bylo obézních, 52,2% vykazovalo zvětšený obvod pasu a 51,6% bylo aktivními kuřáky. Zastoupení pacientu se zvýšeným krevním tlakem činilo 37,4%, zatímco proporce hypercholesterolemie 70,9 %; navíc 11,8 % mělo zvýšenou glykemii nalačno. Souhrnně, v našem vzorku obecné populace jsme zjistili vysokou prevalenci asymptomaticky zvýšeného rizika KVO, zatímco kontrola rizikového profilu k doporučeným hodnotám má daleko k optimu.
Asymptomatic individuals with increased risk of cardiovascular disease (CVD) are a priority for prevention immediately after patients with established CVD. We aimed to establish the prevalence of asymptomatic high-risk subjects in the Czech population and to evaluate the adherence to primary prevention targets. The study looked at a general population based sample of 616 subjects (mean age 47.2 years). The overall 10 years absolute risk of a fatal vascular event was estimated using SCORE function localized for Czech population. In total, 24.8 % of the subjects were at high-risk because of SCORE ? 5 % or were already treated with cardiovascular medication (antihypertensives or lipid-lowering drugs). Using a projection of current risk into 60 years of age, the prevalence of high-risk individuals increased to 46.9 %. In addition, 8.5 % reported a manifestation of CVD or were diabetic. In asymptomatic high-risk individuals, 29.4 % were obese, 52.2 % had increased waist circumference and 51.6 % were active smokers. The proportion of patients with raised blood pressure was 37.4 %, while 70.9 % had hypercholesterolemia; 11.8 % of subjects showed increased fasting glycaemia. In conclusion, in our study we found a high prevalence of asymptomatic individuals with increased risk of CVD, and that the therapeutic control of individual risk factors is far from optimal.
- MeSH
- financování organizované MeSH
- kardiovaskulární nemoci mortalita prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhlá srdeční smrt MeSH
- primární prevence MeSH
- riziko MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- statistika jako téma MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
