Procedure planning and device positioning for left atrial appendage occlusion: insights from multi detector-row computed tomography with 3D fusion.

To compare planned and achieved device position in patients undergoing left atrial appendage occlusion (LAAO). It is unclear how devices used for LAAO position themselves compared to what is planned. All patients undergoing LAAO at our institution had pre- and post-procedural multi detector-row computed tomography (MDCT) at 3 months (N = 52). Using dedicated software, both datasets were fused to superimpose the left atria in all planes. The effective device position was traced on the post-procedural MDCT and then imported in the pre-procedural dataset to allow comparisons. Planned and effective landing zones were compared with respect to size, location and orientation. The device's final position was in a significantly larger landing zone than planned (452 ± 174 vs. 351 ± 112 mm2 for effective and planned landing zones, respectively, paired t-test: p < 0.0001), resulting in significantly less-than-intended area oversizing (41 ± 31 vs. 12 ± 28%, p < 0.0001). In terms of device orientation, there was a difference of 19.7° between the planned and effective landing zones (p < 0.0001). The Amplatzer device had a shallower-than-planned position in 70% of cases, whereas the Watchman device had a deeper-than-planned position in 75% of cases (p = 0.04). Incomplete occlusion was found in 17 patients (33%). In a multivariable model, oversizing at the effective landing zone was the only MDCT independent predictor of incomplete occlusion (OR: 0.96 per 1% increment, 95% CI 0.95-0.98, p = 0.009). MDCT fusion showed that LAAO device position and orientation are different than planned, and this is associated with incomplete occlusion of the LAA.

Implementation of the transradial approach as an alternative vascular access for transcatheter aortic valve replacement guidance: Experience from a high-volume center.

OBJECTIVE: This study sought to assess the potential benefits of the transradial approach (TRA) as an alternative vascular access to the classical contralateral femoral approach for transcatheter aortic valve replacement (TAVR). BACKGROUND: Vascular and bleeding complications in TAVR have gradually decreased owing to operator experience and downsizing of the delivery system. However, about 1/4 of vascular access site complications are related to the transfemoral (TF) secondary access. METHODS: We compared the outcomes at 30 days according to VARC-2 after TAVR of a prospective cohort of 217 consecutive patients undergoing right or left TRA as the second vascular access (TRA-TF TAVR) and a retrospective cohort of 194 consecutive patients undergoing TF approach as a second vascular access (TF-TF TAVR). RESULTS: Baseline clinical characteristics and risk scores were well matched in both groups. Procedural success rate was 99.7%. Fluoro time was significantly lower in the TF-TF TAVR group (16.9 ± 7.2 vs. 19.1 ± 7.8 min, P = 0.003); however, there was no significant difference in x-ray exposure, procedure time or amount of contrast used. In the TRA-TF TAVR group, there were no complications related to the TRA access and there were less vascular and bleeding complications (18.0% vs. 9.7%, P = 0.014; 17.0% vs. 9.2%, P = 0.026, respectively), although blood transfusion requirement or hospitalization duration stay were similar in both groups. CONCLUSIONS: TRA approach as alternative secondary vascular access in TAVR is safe and feasible and is associated with a significant decrease in vascular and bleeding complications. Further, large-scale studies are warranted to confirm the potential benefit of this approach.

Seudoaneurisma ventricular derecho tras implante valve-in-valve tricuspídeo / Right ventricular pseudoaneurysm after percutaneous tricuspid valve-in-valve implantation

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Cirugía de la regurgitación tricuspídea grave: resultados a corto y largo plazo / Short- and long-term outcomes of surgery for severe tricuspid regurgitation

Introducción y objetivos. En nuestro medio hay pocos datos sobre los resultados del tratamiento quirúrgico de la insuficiencia tricuspídea grave. Nuestro objetivo es analizar los resultados clínicos y ecocardiográficos de nuestra población con insuficiencia tricuspídea grave sometida a cirugía comparándolos según el tipo de reparación o de sustitución valvular. Métodos. Realizamos un estudio retrospectivo incluyendo a 119 pacientes consecutivos con insuficiencia tricuspídea grave sometidos a cirugía de dicha válvula entre abril de 1996 y febrero de 2010. Resultados. Se realizaron 61 anuloplastias sin anillo y 23 con anillo, y se implantaron 11 prótesis biológicas y 24 mecánicas. La mortalidad perioperatoria fue del 18,5%, y se asociaron a ella la edad y el tiempo de circulación extracorpórea. Durante el seguimiento clínico (mediana, 41 [intervalo intercuartílico, 24-89] meses), el grupo anuloplastia con anillo precisó dos reoperaciones, al igual que el grupo de prótesis mecánica, en el que se diagnosticó trombosis protésica a 4 pacientes. La mortalidad total tras seguimiento fue del 29,9%, y se asociaron a ella la edad > 70 años y el tiempo de circulación extracorpórea. La aparición de nueva insuficiencia tricuspídea grave se asoció a la edad y la anuloplastia sin anillo (p = 0,04). Conclusiones. La reparación sin anillo se asoció significativamente con recurrencia de insuficiencia tricuspídea grave. El implante de prótesis mecánica se asoció a una elevada tasa de trombosis en el seguimiento. No se encontraron diferencias significativas en la mortalidad perioperatoria o total según el tipo de reparación o sustitución valvular (AU)

Introduction and objectives: There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Methods: Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. Results: A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). Conclusions: Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement (AU)

Short- and long-term outcomes of surgery for severe tricuspid regurgitation.

INTRODUCTION AND OBJECTIVES: There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. METHODS: Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. RESULTS: A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). CONCLUSIONS: Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.