New severity criteria for tricuspid regurgitation in a broad population of "real life" patients: Prevalence and prognostic impact.

Introduction Our objective was to determine, in "real life" patients, the prevalence of massive and torrential regurgitation among patients diagnosed with severe tricuspid regurgitation (TR), as well as its impact on long-term prognosis. Methods In a single-center retrospective study, all patients with an echocardiographic diagnosis of severe TR attended at a tertiary care hospital of an European country from January 2008 to December 2017 were recruited. Images were analysed off-line to measure the maximum vena contracta (VC) and TR was classified into three groups: severe (VC ≥ 7 mm), massive (VC 14-20 mm), and torrential (VC ≥ 21 mm). The impact of this classification on the combined event of heart failure (HF) admission and all-cause death in follow-up was investigated. Results A total of 614 patients (70 ± 13 years, 72 % women) were included. 81.4 % had severe TR, 15.8 % massive TR, and 2.8 % torrential TR. The 5-year HF-free survival  was 42 %, 43 %, and 12 % (p = 0.001), for the different subgroups of severe TR, respectively. After adjusting for baseline characteristics, TR severity was an independent predictor of survival free of the combined end-point: HR 0.91 [95 % CI 0.70-1.18] p = 0.46, for massive TR; and HR 2.5 [95 % CI 1.49-4.21] p = 0.001, for torrential TR considering severe TR as reference. Conclusions The prevalence of massive and torrential TR is not negligible among patients with severe TR in real life. The prognosis is significantly worse for patients with torrential TR measured by the maximum VC.

A novel approach for venous occlusion after endocavitary leads. The balloon-assisted tracking technique.

The balloon-assisted tracking technique can be useful in short venous occlusions that conventional venoplasty fails. This technique could be feasible and with an expected low complication rate.

Spanish registry of percutaneous VSD closure with NitOcclud Lê VSD Coil device: lessons learned after more than a hundred implants.

INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.

Supervivencia a largo plazo de una población española con cardiopatía isquémica estable: el registro CICCOR / Long-term survival in a Spanish population with stable ischemic heart disease. The CICCOR registry

Introducción y objetivos: La información sobre el pronóstico de la cardiopatía isquémica crónica (CIC) es escasa. El objetivo es analizar los predictores de la mortalidad y la supervivencia a largo plazo de estos pacientes. Métodos: Estudio de cohortes prospectivo y monocéntrico que reclutó a 1.268 pacientes con CIC desde enero de 2000 hasta febrero de 2004. Se registraron los fallecimientos durante el seguimiento. Se compararon las tasas de mortalidad total y cardiovascular ajustadas con la población española. Se investigó la asociación de variables basales con la mortalidad. Resultados: La media de edad fue 68+/-10 años; el 73% eran varones. Tras 17 años de seguimiento máximo (mediana, 11 años), murieron 629 pacientes (50%). La edad (HR=1,08; IC95%, 1,07-1,11; p<0,001), la diabetes (HR=1,36; IC95%, 1,14-1,63; p <0,001), la frecuencia cardiaca (HR=1,01; IC95%, 1,00-1,02; p <0,001), la fibrilación auricular (HR=1,61; IC95%, 1,22-2,14); p=0,001), las alteraciones electrocardiográficas (HR=1,23; IC95%, 1,02-1,49; p=0,02) y el tabaquismo (HR=1,85; IC95%, 1,31-2,80; p=0,001) han resultado predictores independientes de la mortalidad total. La tasa de mortalidad total fue mayor que en la población española (47,81 frente a 36,29/1.000 pacientes/año; razón de mortalidad estandarizada=1,31; IC95%, 1,21-1,41). La tasa de mortalidad cardiovascular fue 15,25 frente a 6,94/1.000 pacientes/año de la población general (razón de mortalidad estandarizada=2,19; IC95%, 1,88-2,50). Conclusiones: En esta muestra de pacientes con CIC, la tasa de mortalidad fue significativamente mayor que en la población general. Las variables clínicas identifican a los pacientes con mayor riesgo de muerte en el seguimiento

Introduction and objectives: Data are lacking on the long-term prognosis of stable ischemic heart disease (SIHD). Our aim was to analyze long-term survival in patients with SIHD and to identify predictors of mortality. Methods: A total of 1268 outpatients with SIHD were recruited in this single-center prospective cohort study from January 2000 to February 2004. Cardiovascular and all-cause death during follow-up were registered. All-cause and cardiovascular mortality rates were compared with those in the Spanish population adjusted by age, sex, and year. Predictors of these events were investigated. Results: The mean age was 68+/-10 years and 73% of the patients were male. After a follow-up lasting up to 17 years (median 11 years), 629 (50%) patients died. Independent predictors of all-cause mortality were age (HR, 1.08; 95%CI, 1.07-1.11; P <.001), diabetes (HR, 1.36; 95%CI, 1.14-1.63; P <.001), resting heart rate (HR, 1.01; 95%CI, 1.00-1.02; P <.001), atrial fibrillation (HR, 1.61; 95%CI, 1.22-2.14; P=.001), electrocardiographic changes (HR, 1.23; 95%CI, 1.02-1.49; P=.02) and active smoking (HR, 1.85; 95%CI, 1.31-2.80; P=.001). All-cause mortality and cardiovascular mortality rates were significantly higher in the sample than in the general Spanish population (47.81/1000 patients/y vs 36.29/1000 patients/y (standardized mortality rate, 1.31; 95%CI, 1.21-1.41) and 15.25/1000 patients/y vs 6.94/1000 patients/y (standardized mortality rate, 2.19; 95%CI, 1.88-2.50, respectively). Conclusions: The mortality rate was higher in this sample of patients with SIHD than in the general population. Several clinical variables can identify patients at higher risk of death during follow-up

Prosthesis-patient mismatch after transcatheter aortic valve replacement: prevalence and medium term prognostic impact.

Prosthesis-patient mismatch (PPM) occurs when the effective orifice area of the prosthesis is too small in relation to the patient's body surface area. There are few data available on the frequency and prognostic impact of PPM after transcatheter aortic valve implantation (TAVI). Our aim was to determine the prevalence of PPM and to investigate its association with medium-term clinical course of patients undergoing TAVI. We included 185 patients undergoing TAVI (79 ± 5 years, 49% male, 98% CoreValve) between April-2008 and December-2014. The effective orifice area (EOA) was determined by transthoracic echocardiography prior and after the procedure. We defined PPM as indexed EOA ≤ 0.85 cm2/m2 (severe PPM if ≤ 0.65 cm2/m2). All cause death, stroke and hospitalization for heart failure were considered as major clinical events. 45 patients (24%) showed PPM (severe 11 patients, 6%). PPM was associated with a higher EuroSCORE (OR 1.06, IC 95% 1.01-1.12, p = 0.03), body surface area ≥ 1.72 m2 (OR 3.58, IC 95% 1.30-9.87, p = 0.01) and small aortic annulus (OR 0.73, IC 95% 0.55-0.92, p = 0.03); and severe PPM with small prostheses size (OR 17.79, IC 95% 1.87-169.78, p = 0.012). The mean event-free survival was 34 ± 26 months. Patients with severe PPM showed lower rates of event free survival than the rest of the series (52% vs. 84%, p = 0.04) at 34 months follow up. In our series, PPM was present in a quarter of the patients after TAVI. Higher EuroSCORE, smaller prosthesis size, larger body surface area and smaller aortic annulus diameter were associated with PPM. Severe PPM was an independent factor associated with major events at medium-term follow up.

Long-term Survival in a Spanish Population With Stable Ischemic Heart Disease. The CICCOR Registry.

INTRODUCTION AND OBJECTIVES: Data are lacking on the long-term prognosis of stable ischemic heart disease (SIHD). Our aim was to analyze long-term survival in patients with SIHD and to identify predictors of mortality. METHODS: A total of 1268 outpatients with SIHD were recruited in this single-center prospective cohort study from January 2000 to February 2004. Cardiovascular and all-cause death during follow-up were registered. All-cause and cardiovascular mortality rates were compared with those in the Spanish population adjusted by age, sex, and year. Predictors of these events were investigated. RESULTS: The mean age was 68±10 years and 73% of the patients were male. After a follow-up lasting up to 17 years (median 11 years), 629 (50%) patients died. Independent predictors of all-cause mortality were age (HR, 1.08; 95%CI, 1.07-1.11; P <.001), diabetes (HR, 1.36; 95%CI, 1.14-1.63; P <.001), resting heart rate (HR, 1.01; 95%CI, 1.00-1.02; P <.001), atrial fibrillation (HR, 1.61; 95%CI, 1.22-2.14; P=.001), electrocardiographic changes (HR, 1.23; 95%CI, 1.02-1.49; P=.02) and active smoking (HR, 1.85; 95%CI, 1.31-2.80; P=.001). All-cause mortality and cardiovascular mortality rates were significantly higher in the sample than in the general Spanish population (47.81/1000 patients/y vs 36.29/1000 patients/y (standardized mortality rate, 1.31; 95%CI, 1.21-1.41) and 15.25/1000 patients/y vs 6.94/1000 patients/y (standardized mortality rate, 2.19; 95%CI, 1.88-2.50, respectively). CONCLUSIONS: The mortality rate was higher in this sample of patients with SIHD than in the general population. Several clinical variables can identify patients at higher risk of death during follow-up.

Cierre percutáneo de seudoaneurisma tras cirugía de Rastelli / Percutaneous closure of pseudoaneurysm after Rastelli surgery

No disponible

Reserva coronaria y función ventricular izquierda tras la terapia regenerativa en pacientes con infarto anterior agudo revascularizado / Coronary flow reserve and ventricular function following regenerative treatment in patients with revascularized acute anterior myocardial infarction

Introducción y objetivos: Las células madre de médula ósea pueden regenerar el miocardio infartado por distintos mecanismos. La relación entre la recuperación de la función muscular y microvascular después del tratamiento regenerativo ha sido poco estudiada. El objetivo es analizar la relación entre los cambios en función ventricular y función microvascular en pacientes con infarto agudo que reciben la terapia. Métodos: Se analizó a 88 pacientes con infarto anterior revascularizado incluidos en 2 ensayos clínicos y 1 estudio piloto que evaluaban la eficacia de la terapia celular. El estudio de la reserva coronaria y la función ventricular se analizaron con la misma metodología en todos ellos. Se administraron células mononucleares derivadas de médula ósea autóloga (n = 40), factor estimulante de colonias granulocíticas (n = 14) o la combinación de ambos (n = 10). Hubo un grupo control (n = 24) que solo recibió revascularización convencional. Resultados: La media de fracción de eyección se incrementó del 37 ± 8% al 46 ± 12% (p < 0,05). La media de incremento de la reserva de flujo coronario fue de 1,6 ± 0,5 a 2,3 ± 0,9 (p < 0,05). No hubo correlación entre los parámetros de función muscular y los parámetros de función microvascular al seguimiento. Conclusiones: Hay cambios favorables en el miocardio tras el tratamiento con terapia regenerativa después de un infarto, aunque no se ha encontrado correlación entre los cambios de función muscular y microvascular

Introduction and objectives: Bone marrow stem cells may reconstruct infarcted myocardium through distinct mechanisms. However, little is known on the relationship between recovery of muscular and microvascular function after regenerative treatments. Our objective was to analyze the relationship between changes in left ventricular and microvascular function in patients with anterior acute myocardial infarction receiving regenerative treatment. Methods: We performed a pooled analysis of 2 clinical trials and a pilot study evaluating stem cell therapy in 88 patients with revascularized acute anterior myocardial infarction. Coronary flow reserve and left ventricular function were analyzed with identical methods in all patients. Patients treated with regenerative treatment received intracoronary bone¿marrow-derived mononuclear cell transplant (n = 40), subcutaneous administration of granulocyte colony-stimulating factor (n = 14), or a combination of both (n = 10). A control group of 24 patients was treated with conventional revascularization. Results: Mean ejection fraction increased from 37% 8% to 46% ± 12%, (P < .05). Mean coronary flow reserve increased from 1.6 0.5 to 2.3 0.9 (P < .05). However, there was no correlation between parameters of left ventricular function and microvascular parameters at follow-up. Conclusions: Left ventricular function shows favorable changes after regenerative treatment of infarction. However, no correlation was found between changes in microvascular and myocardial function after regenerative therapy

One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry.

INTRODUCTION AND OBJECTIVES: There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. METHODS: Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. RESULTS: Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. CONCLUSIONS: Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.

Registro Español de Hemodinámica y Cardiología Intervencionista. XXVI Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2016) / Spanish Cardiac Catheterization and Coronary Intervention Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2016)

Introducción y objetivos: La Sección de Hemodinámica y Cardiología Intervencionista presenta su informe anual con los datos del registro de actividad correspondiente a 2016. Métodos: Todos los centros españoles con laboratorio de hemodinámica están invitados a aportar voluntariamente sus datos de actividad. La información se introduce online y una empresa independiente analiza la mayor parte. Resultados: En 2016 han participado en el registro nacional 106 centros, de los cuales 80 son públicos. Se realizaron 154.362 estudios diagnósticos; de ellos, 135.332 son coronariografías, un 14% más que años anteriores. La media española de diagnósticos totales por millón de habitantes fue de 3.322 (3.127 en 2015). El número de procedimientos intervencionistas coronarios fue un 7% superior al del año anterior: 68.695 (67.671 en 2015) y, aunque se registró una disminución en el tratamiento de la enfermedad multivaso del 3%, hubo un incremento del intervencionismo del tronco no protegido del 9,4%. Se implantaron en total 104.628 stents, entre ellos 88.344 farmacoactivos (el 84,4%, un 10% más que el año anterior) y 1.610 plataformas reabsorbibles. Se realizaron en total 20.588 procedimientos intervencionistas en el infarto agudo de miocardio (un crecimiento del 10% respecto a 2015), de los que el 83,7% fueron angioplastias primarias. Se utilizó el acceso radial en el 74,2% de los procedimientos diagnósticos, muy similar al año anterior, y el 82,6% de los intervencionistas (un 7% superior). El número de implantes transcatéter de prótesis valvular aórtica continúa incrementándose (aumento del 28%, n = 2.026), al igual que el número de procedimientos de reparación percutánea de la válvula mitral (MitraClip) (45%, n = 232) y cierres de orejuela: 496, lo que supone un incremento del 48,5% respecto a 2015. Conclusiones: En el año 2016 se registra un incremento de los procedimientos diagnósticos y terapéuticos en el seno del infarto. Sigue incrementándose el uso de abordaje radial y stents farmacoactivos en los procedimientos terapéuticos. El implante transcatéter de prótesis aórtica, la reparación con MitraClip y el cierre de orejuela izquierda continúan con el aumento progresivo observado en años anteriores (AU)

Introduction and objectives: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the activity data for 2016. Methods: All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and was analyzed mainly by an independent company. Results: In 2016, 106 centers participated in the national registry; 80 of these centers are public. A total of 154 362 diagnostic studies were carried out, of which 135 332 were coronary angiograms. These figures are 14% higher than in previous years. The Spanish average of total diagnostic procedures per million population was 3322 (3.127 in 2015). The number of coronary interventional procedures was 7% higher than in the previous year: 68 695 (67 671 in 2015) and, although multivessel treatment decreased by 3%, unprotected left main trunk treatment increased by 9.4%. A total of 104 628 stents were implanted, of which 88 344 (84.4%) were drug-eluting stents (10% higher than in 2015) and 1610 were bioresorbable scaffolds. A total of 20 588 interventional procedures were performed in the acute myocardial infarction setting (10% increase), of which 83.7% were primary angioplasties. The radial approach was used in 74.2% of the diagnostic procedures, similar to the previous year, and in 82.6% of interventional procedures (7% increase). The number of transcatheter aortic valve implantations continued to increase (28% increase, n = 2026), as did the number of percutaneous mitral valve repair procedures (MitraClip) (45% increase, n = 232) and left atrial appendage closures (48.5% increase, n = 496). Conclusions: The number of diagnostic and therapeutic procedures in acute myocardial infarction increased in 2016. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The growing trend observed in previous years continued for the use of transcatheter aortic prosthesis, the MitraClip device, and left atrial appendage closure (AU)

Spanish Cardiac Catheterization and Coronary Intervention Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2016).

INTRODUCTION AND OBJECTIVES: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the activity data for 2016. METHODS: All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and was analyzed mainly by an independent company. RESULTS: In 2016, 106 centers participated in the national registry; 80 of these centers are public. A total of 154 362 diagnostic studies were carried out, of which 135 332 were coronary angiograms. These figures are 14% higher than in previous years. The Spanish average of total diagnostic procedures per million population was 3322 (3.127 in 2015). The number of coronary interventional procedures was 7% higher than in the previous year: 68 695 (67 671 in 2015) and, although multivessel treatment decreased by 3%, unprotected left main trunk treatment increased by 9.4%. A total of 104 628 stents were implanted, of which 88 344 (84.4%) were drug-eluting stents (10% higher than in 2015) and 1610 were bioresorbable scaffolds. A total of 20 588 interventional procedures were performed in the acute myocardial infarction setting (10% increase), of which 83.7% were primary angioplasties. The radial approach was used in 74.2% of the diagnostic procedures, similar to the previous year, and in 82.6% of interventional procedures (7% increase). The number of transcatheter aortic valve implantations continued to increase (28% increase, n = 2026), as did the number of percutaneous mitral valve repair procedures (MitraClip) (45% increase, n = 232) and left atrial appendage closures (48.5% increase, n = 496). CONCLUSIONS: The number of diagnostic and therapeutic procedures in acute myocardial infarction increased in 2016. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The growing trend observed in previous years continued for the use of transcatheter aortic prosthesis, the MitraClip device, and left atrial appendage closure.

Effect of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation (CoreValve) on Mortality, Frequency of Re-Hospitalization, and Need for Pacemaker.

New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n = 80), those with persistent new-onset LBBB, and group 2 (n = 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32 ± 22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p = 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p = 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p = 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.

Modificación de la conducción auriculoventricular tras el implante de prótesis aórtica Core Valve / Atrioventricular conduction changes after corevalve transcatheter aortic valve implantation

Introducción y objetivos: Con frecuencia se producen alteraciones en la conducción tras el implante de una prótesis CoreValve. Se pretende analizar qué cambios se producen en la conducción cardiaca de pacientes con estenosis aórtica tratados con este tipo de prótesis. Métodos: Desde abril de 2008 hasta diciembre de 2013, se seleccionó a 181 pacientes con estenosis aórtica grave tratados con esta prótesis y estudiados mediante electrocardiograma. Se estudió a un subgrupo de 137 pacientes consecutivos (75,7%) mediante electrocardiogramas intracavitarios antes y tras implante protésico. El objetivo principal del estudio es la necesidad de marcapasos definitivo en las primeras 72 h tras el implante protésico. Se analizaron numerosas variables para predecir esta eventualidad. Resultados: Tras el implante, los intervalos PR y QRS se incrementaron de 173 ± 47 a 190 ± 52 ms (p < 0,01) y de 98 ± 22 a 129 ± 24 ms (p < 0,01), mientras que los intervalos AH y HV se alargaron de 95 ± 39 a 108 ± 41 ms (p < 0,01) y de 54 ± 10 a 66 ± 23 ms (p < 0,01). En total, 89 pacientes (49%) presentaron bloqueo de rama izquierda de novo y 33 (25%) precisaron marcapasos en las primeras 72 h. Los predictores independientes de marcapasos fueron el bloqueo de rama derecha basal y la profundidad protésica. Los intervalos intracavitarios carecieron de valor predictivo. Además, 13 pacientes requirieron marcapasos después de las 72 h. Conclusiones: El implante de prótesis CoreValve produce alta incidencia de alteraciones de la conducción; la más frecuente es el bloqueo de rama izquierda; el 25% de los pacientes precisaron marcapasos definitivo. La necesidad de marcapasos se relacionó con el bloqueo de rama derecha basal y la profundidad protésica (AU)

Introduction and objectives: Conduction disturbances often occur after CoreValve transcatheter aortic valve implantation. The aim was to analyze which cardiac conduction changes occur in patients with aortic stenosis treated with this type of prosthesis. Methods: A total of 181 patients with severe aortic stenosis treated with this prosthesis and studied by electrocardiography between April 2008 and December 2013 were selected. A subgroup of 137 (75.7%) consecutive patients was studied by intracardiac electrocardiogram before and after prosthesis implantation. The primary endpoint of the study was the need for a permanent pacemaker within 72 hours after prosthesis implantation. Numerous variables to predict this possibility were analyzed. Results: Following implantation, PR and QRS intervals were increased from 173 ± 47 ms to 190 ± 52 ms (P < .01) and from 98 ± 22 ms to 129 ± 24 ms (P < .01), whereas the A-H and H-V intervals were prolonged from 95 ± 39 ms to 108 ± 41 ms (P < .01) and from 54 ± 10 ms to 66 ± 23 ms (P < .01). A total of 89 (49%) patients had new-onset left bundle-branch block, and 33 (25%) required a pacemaker within the first 72 hours. The independent predictors for a pacemaker were baseline right bundle-branch block and prosthetic depth. Intracardiac intervals had no predictive value. In addition, 13 patients required a pacemaker after 72 hours. Conclusions: CoreValve prosthesis implantation has a high incidence of conduction disturbance, with left bundle-branch block being the most common. A total of 25% of patients required a permanent pacemaker. The need for a pacemaker was related to baseline right bundle-branch block and prosthetic depth (AU)

Atrioventricular Conduction Changes After CoreValve Transcatheter Aortic Valve Implantation.

INTRODUCTION AND OBJECTIVES: Conduction disturbances often occur after CoreValve transcatheter aortic valve implantation. The aim was to analyze which cardiac conduction changes occur in patients with aortic stenosis treated with this type of prosthesis. METHODS: A total of 181 patients with severe aortic stenosis treated with this prosthesis and studied by electrocardiography between April 2008 and December 2013 were selected. A subgroup of 137 (75.7%) consecutive patients was studied by intracardiac electrocardiogram before and after prosthesis implantation. The primary endpoint of the study was the need for a permanent pacemaker within 72 hours after prosthesis implantation. Numerous variables to predict this possibility were analyzed. RESULTS: Following implantation, PR and QRS intervals were increased from 173±47 ms to 190±52ms (P < .01) and from 98±22ms to 129±24 ms (P < .01), whereas the A-H and H-V intervals were prolonged from 95±39ms to 108±41ms (P < .01) and from 54±10ms to 66±23ms (P < .01). A total of 89 (49%) patients had new-onset left bundle-branch block, and 33 (25%) required a pacemaker within the first 72hours. The independent predictors for a pacemaker were baseline right bundle-branch block and prosthetic depth. Intracardiac intervals had no predictive value. In addition, 13 patients required a pacemaker after 72 hours. CONCLUSIONS: CoreValve prosthesis implantation has a high incidence of conduction disturbance, with left bundle-branch block being the most common. A total of 25% of patients required a permanent pacemaker. The need for a pacemaker was related to baseline right bundle-branch block and prosthetic depth.

Mitral regurgitation during transcatheter aortic valve implantation: the same complication with a different mechanism.

AIMS: Mitral regurgitation (MR) is a complication that may occur during transcatheter aortic valve implantation (TAVI) in a certain percentage of cases and may require different treatments depending on the mechanism. Our purpose was to describe the occurrence rate of this complication during TAVI with the CoreValve prosthesis, as well as to assess the usefulness of transesophageal echocardiogram (TEE) in the detection of the mechanism of MR. METHODS AND RESULTS: We analyzed a total of 129 cases of severe aortic stenosis treated with CoreValve prosthesis from June 2008 to October 2011. We defined a significant MR after TAVI as grade III MR or higher, considering either the new appearance of MR or the worsening of a preexisting MR, as assessed by both TEE and angiography. In our series, there was a total of 11 cases of significant MR after TAVI (8.5%). Angiography detected 100% of the MR cases, but was unable to determine the mechanism of MR in any case. TEE, on the other hand, determined 100% of the MR cases, and determined that 1 case was caused by mechanical asynchrony due to a new left bundle branch block, 3 cases were due to an aortic prosthesis impingement on the anterior mitral leaflet, 2 cases were due to the appearance of a systolic anterior movement of the anterior mitral leaflet with dynamic obstruction of the left ventricular outflow tract, 1 case was caused by a commissural tearing of the valve, and 4 cases were explained by a "functional" mechanism, probably due to transient damage of the subvalvular mitral apparatus by the delivery system. All cases had an MR grade II or less as evidenced by transthoracic echocardiography at discharge. Surgery was not required in any case. Knowledge of the mechanism of MR made it possible to provide the best treatment option in each case. CONCLUSION: There is a certain percentage of patients treated with CoreValve prosthesis who develop significant MR during the procedure. TEE, unlike angiography, can define the very diverse mechanisms of MR in 100% of cases, and elucidates the best approach to this complication. Surgery was not required in any case.

Monitoring complex secundum atrial septal defects percutaneous closure with real time three-dimensional echocardiography.

BACKGROUND: Atrial septal defect (ASD) is one of the most common congenital heart diseases. Nowadays, percutaneous closure is considered the treatment of choice in most of secundum ASDs. Assessment of the defect and procedure monitoring have been usually performed by angiographic balloon-sizing and/or two-dimensional (2D) transesophageal echocardiography. However, in complex ASDs these techniques might be inaccurate. METHODS: From January 2009 to January 2011 all adult patients with complex ASDs submitted for percutaneous closure were selected. Those defects, where shunts were present through a device previously implanted on the atrial septum or through multiperforated septums, were considered complex ASDs. Two-dimensional transesophageal echocardiography and real time three-dimensional (3D) echocardiography were performed simultaneously during the percutaneous closure procedure. Number of orifices, relationships between the defect, catheter, and device, as well as residual shunt were assessed. RESULTS: Seven patients were included. Five patients had a multiperforated septum and in two cases the defect in the septum was through a previously implanted device. In all cases, 3D echocardiography was superior to 2D echocardiography in relation to the assessment of the relationship between the defect and the catheter or the device. Mechanisms responsible for residual shunts through a device were also better assessed by 3D echocardiography. CONCLUSION: Three-dimensional echocardiography is a safe and useful technique when monitoring percutaneous closure of ASDs, showing relevant advantages over 2D echocardiography.