The routine use of surgical exposure approach for trans-femoral implantation of the balloon expandable aortic prosthesis is associated to a low rate of vascular complications.

BACKGROUND: The most frequent complications of transfemoral aortic valve implantation are vascular (15-25%) and are related to an increase in mortality. We sought to assess the rate of vascular complications, its treatment and outcomes using a surgical approach for transfemoral implantation of Edwards-SAPIEN (Edwards Lifescience, Irvine, CA, USA) aortic valve. METHODS: We have conducted a multicenter registry including 4 hospitals using a systematic surgical exposure approach. Vascular complications have been collected following the definitions of the Valve Academic Research Consortium. RESULTS: From 2008 to 2013 a total of 312 consecutive patients have been included. Vascular complications were reported in 22 (7%), among those 6 (1.9%) were major whereas 16 (5.1%) were minor. Patients suffering vascular complications had significantly more previous history of peripheral vascular disease. All but one major complications occurred in women, aged 82-88 and with chronic renal failure. Hospital stay was longer in cases suffering complications (17.8±11 days vs. 9±7 days; P<0.0001). The 30 days mortality was 13.6% in patients with vascular complications, 33.3% in patients with major complications and 5.5% in patients with no complications (P=0.05). CONCLUSIONS: In this registry, the systematic use of a surgical exposure of the femoral artery for TAVR has been associated with a lower rate of vascular complications.

Postdilatation for treatment of perivalvular aortic regurgitation after transcatheter aortic valve implantation.

OBJECTIVES: The study is made to describe the efficacy and safety of balloon postdilatation (BPD) for the treatment of residual aortic regurgitation (RAoR) after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: A single-center observational study is made with 157 consecutive patients accepted to TAVI. The patients were divided into two groups (no BPD-period and BPD-period). Before BPD, RAoR ≥ 2 was seen in 25% of the patients in group 1 and in 29% of the patients in group 2 (P ≥ 0.593). BPD was carried out in 95% (n = 21) of the patients in group 2 with RAoR ≥ 2. Regurgitation improved one grade in 68% of the cases (n = 15), 2 grades in 14% (n = 3), and remained without change in 18% (n = 4). RAoR < 2 was achieved in 91% (n = 73) of the patients in group 2 versus 75% (n = 58) in group 1 (RR = 0.35, 95% CI 0.16-0.80, P = 0.013). We recorded no aortic ring ruptures, damage to the device or displacements. Slight central regurgitation not present before BPD was registered in one case. CONCLUSIONS: BPD offers a very good safety profile and reduces RAoR in a large percentage of cases. BPD should be considered for the treatment of moderate to severe RAoR following TAVI.

Vía transapical como alternativa para el cierre del leak paravalvular / Transapical technique as an alternative approach to paravalvular leak closure

No disponible

Coronary stent immobilization during angioplasty by transcoronary ventricular pacing via a guidewire.

INTRODUCTION AND OBJECTIVES: In some patients, cardiac contractions cause the coronary artery segment adjacent to a stent to move in such a way that accurate stent positioning is difficult. A number of techniques have been described for immobilizing the stent at the target site by inducing periods of either asystole or tachycardia. This study shows how pulsatile motion can be controlled by means of rapid ventricular pacing via an angioplasty guidewire. METHODS: The study involved 27 consecutive patients in whom excessive stent movement during angioplasty complicated accurate stent implantation. In these selected patients, myocardial tachycardia was induced by transcoronary ventricular pacing via an angioplasty guidewire with the aim of reducing the pulsatile motion of the stent. RESULTS: At baseline, the median displacement was 4.08 mm (interquartile range 2.75 mm). During pacing at 100 and 150 beats per minute, the median displacement was 1.39 mm and 0.54 mm, respectively (interquartile range 1.66 mm and 0.54 mm, respectively). Transcoronary myocardial pacing was effective in 96% of cases. No complications associated with pacing were reported. CONCLUSIONS: Transcoronary ventricular pacing via an angioplasty guidewire was an effective and safe method for achieving stent immobilization in cases where there was excessive pulsatile motion.

Inmovilización del stent coronario durante la angioplastiamediante estimulación ventricular transcoronaria con guíaterapéutica / Coronary Stent Immobilization During Angioplasty by Transcoronary Ventricular Pacing Via a Guidewire

Introducción y objetivos. La contracción cardiacagenera en ocasiones un desplazamiento de la arteriacoronaria sobre el stent que puede dificultar su precisaimplantación. Se han descrito varias técnicas para inmovilizarel stent en la posición deseada mediante la inducciónde periodos tanto de asistolia como de taquicardia.Este estudio muestra cómo este fenómeno de vaivén escontrolable mediante la estimulación ventricular eléctricarápida a través de la guía terapéutica de angioplastia.Métodos. Se ha seleccionado de manera consecutivaa 27 pacientes en los que durante la angioplastia el excesivodesplazamiento del stent dificultaba su correcta implantación.En los casos seleccionados, se taquicardizael miocardio mediante estimulación eléctrica ventricularde forma transcoronaria a través de la guía terapéuticapara lograr una reducción del desplazamiento en vaivéndel stent.Resultados. El desplazamiento presenta una medianaen situación basal de 4,08 (intervalo intercuartílico, 2,75)mm. Durante la estimulación a 100 y 150 lat/min, el desplazamientopresenta una mediana de 1,39 y 0,54 (intervalosintercuartílicos, 1,66 y 0,54) mm, respectivamente.La estimulación miocárdica transcoronaria ha sido eficazen el 96% de los casos. No se han observado complicacionesen relación con la estimulación eléctrica.Conclusiones. La estimulación ventricular transcoronariaa través de la guía terapéutica es un método efectivoy seguro para inmovilizar el stent en caso de desplazamientode vaivén (AU)

Introduction and objectives. In some patients, cardiaccontractions cause the coronary artery segment adjacentto a stent to move in such a way that accurate stentpositioning is difficult. A number of techniques have beendescribed for immobilizing the stent at the target site byinducing periods of either asystole or tachycardia. Thisstudy shows how pulsatile motion can be controlledby means of rapid ventricular pacing via an angioplastyguidewire.Methods. The study involved 27 consecutive patientsin whom excessive stent movement during angioplastycomplicated accurate stent implantation. In theseselected patients, myocardial tachycardia was inducedby transcoronary ventricular pacing via an angioplastyguidewire with the aim of reducing the pulsatile motionof the stent.Results. At baseline, the median displacement was4.08 mm (interquartile range 2.75 mm). During pacing at100 and 150 beats per minute, the median displacementwas 1.39 mm and 0.54 mm, respectively (interquartilerange 1.66 mm and 0.54 mm, respectively). Transcoronarymyocardial pacing was effective in 96% of cases. Nocomplications associated with pacing were reported.Conclusions. Transcoronary ventricular pacing via anangioplasty guidewire was an effective and safe methodfor achieving stent immobilization in cases where therewas excessive pulsatile motion (AU)

Angioplastia retrógrada sobre obstrucción crónica / Retrograde angioplasty in chronic total occlusion

No disponible

No disponible