Subject(s)
Cardiac Catheterization , Coronary Artery Bypass , Coronary Artery Disease/surgery , Coronary Vessels/surgery , Fractional Flow Reserve, Myocardial , Belgium , Canada , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronary Vessels/physiopathology , Humans , Predictive Value of Tests , Time Factors , Treatment OutcomeABSTRACT
AIMS: Visual estimation is the most commonly used method to evaluate the degree of coronary artery stenosis prior to coronary artery bypass grafting. In interventional cardiology, the use of fractional flow reserve (FFR) to guide revascularization decisions has become routine. We investigated whether the preoperative FFR measurement of coronary lesions is associated with anastomosis function 6 months after surgical revascularization using a multiarterial grafting strategy. METHODS AND RESULTS: In this prospective double-blind study, 67 patients were enrolled from two institutions in Europe and Canada. From these patients, 199 coronary lesions were assessed visually and with FFR at the time of the preoperative angiogram. All patients received coronary revascularization using multiple arterial grafts. A post-operative 6-month angiogram was performed to assess anastomosis functionality using a described angiographic method. The primary outcome was the association between preoperative FFR values and anastomosis function 6 months after surgery. Preoperative FFR was significantly associated with 6-months anastomotic function for all conduits and for all targets (P < 0.001). An FFR value of ≤0.78 was associated with an anastomotic occlusion rate of 3%. CONCLUSION: We found a significant association between the preoperative FFR measurement of the target vessel and the anastomotic functionality at 6 months, with a cut-off of 0.78. Integration of FFR measurement into the preoperative diagnostic workup before multiarterial coronary surgical revascularization leads to improved anastomotic graft function. CLINICAL TRIALS. GOV IDENTIFIER: NCT02527044.
Subject(s)
Coronary Artery Bypass , Fractional Flow Reserve, Myocardial , Aged , Angiography , Coronary Angiography , Coronary Artery Bypass/methods , Coronary Circulation , Double-Blind Method , Humans , Preoperative Period , Prospective Studies , Treatment OutcomeABSTRACT
Direct transaortic implantation (TAo) has been described as a new alternative approach for transcatheter aortic valve implantation in patients with unsuitable transfemoral access. TAo is usually achieved through an upper ministernotomy or, more recently, through a right thoracotomy in the second intercostal space. We describe here our first experience with a fully thoracoscopic approach that allowed successful deployment of a 23-mm Edwards SAPIEN valve.
Subject(s)
Aortic Valve/surgery , Heart Valve Prosthesis Implantation/methods , Cardiac Catheterization , HumansSubject(s)
Coronary Artery Bypass/adverse effects , Gastroepiploic Artery/transplantation , Heart Ventricles , Hernia, Diaphragmatic/complications , Myocardial Infarction/surgery , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Diagnosis, Differential , Echocardiography , Female , Hernia, Diaphragmatic/diagnosis , Hernia, Diaphragmatic/surgery , Humans , Middle Aged , Plastic Surgery ProceduresABSTRACT
Techniques for transcatheter aortic valve implantation involve manipulation of the native aortic valve and the aortic arch. As a result, excellent technical outcomes of this technique remain counterbalanced by a level of neurologic complications that remain unacceptably high. We present here a report of a new potential combined approach to reduce periprocedural neurologic events. After a 6-cm J-shaped upper-mini-sternotomy, 26-mm Sapien valve (Edwards Lifesciences, Irvine, CA) was deployed through a transaortic approach. In addition, the Embol-X device (Edwards Lifescience) was directly inserted in the distal ascending aorta was deployed during all the procedure. Postoperative evolution was clinically uneventful. Postoperative magnetic resonance imaging revealed no new ischemic lesions in this first patient.
Subject(s)
Aortic Valve/surgery , Embolic Protection Devices , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Intracranial Embolism/prevention & control , Intracranial Thrombosis/prevention & control , Aged, 80 and over , Aorta, Thoracic , Catheterization , Equipment Design , Heart Valve Prosthesis Implantation/adverse effects , Humans , MaleABSTRACT
The randomized Partner study [1] has recently shown superiority of transfemoral transcatheter aortic valve implantation, in patients who are not candidates for surgical aortic valve replacement, when compared with conventional nonsurgical therapies. In patients who are not candidates for the transfemoral approach because of peripheral vascular disease or other contraindications, deployment of the SAPIEN valve (Edwards Lifesciences, Irvine, CA) in an antegrade fashion can be achieved through the apex of the left ventricle. However this valuable technique carries specific risks inherent to the access route. Transaortic implantation, through an upper ministernotomy, offers a new alternative that could avoid complications related to the transapical approach.
