RESUMO
BACKGROUND: Vascular complications (VCs) still represent one of the principal concerns of trans-femoral trans-catheter aortic valve replacement (TF-TAVR). New-generation devices can minimize such complications but the arterial access management is left to the operator's choice. This study aims to describe the rate of VCs in a contemporary cohort of patients undergoing TAVR with new-generation devices and to determine whether an ultrasound-guided (USG) vs. a fluoroscopy-guided (FG) femoral access management has an impact on their prevention. METHODS: This is a prospective, observational, multicenter study. Consecutive patients undergoing TAVR with new-generation devices were analyzed from January 2022 to October 2022 in five tertiary care centers. Femoral accesses were managed according to the operator's preferences. All the patients underwent a pre-discharge peripheral ultrasound control. VCs and bleedings were the main endpoints of interest. RESULTS: A total of 458 consecutive patients were enrolled (274 in the USG group and 184 in the FG group). VCs occurred in 6.5 % of the patients (5.2 % minor and 1.3 % major). There was no difference between the USG and the FG groups in terms of any VCs (7.3 % vs. 5.4 %; p = 0.4), or any VARC-3 bleedings (6.9 % vs 6 %, p = 0.9). At logistic regression analysis, the two guidance strategies did not result as predictors of VCs (odds Ratio 0.8, 95 % Confidence Interval 0.46-1.4; P = 0.4). CONCLUSIONS: In a contemporary cohort of patients undergoing TAVR with new-generation devices, the occurrence of VCs is low and mostly represented by minor VCs. USG and FG modalities did not affect the rate of VCs.
Assuntos
Valva Aórtica , Cateterismo Periférico , Artéria Femoral , Punções , Radiografia Intervencionista , Sistema de Registros , Substituição da Valva Aórtica Transcateter , Ultrassonografia de Intervenção , Humanos , Artéria Femoral/diagnóstico por imagem , Masculino , Feminino , Estudos Prospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso de 80 Anos ou mais , Idoso , Fluoroscopia , Resultado do Tratamento , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Fatores de Risco , Radiografia Intervencionista/efeitos adversos , Próteses Valvulares Cardíacas , Fatores de Tempo , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Desenho de PróteseAssuntos
Aterosclerose , Reestenose Coronária , Humanos , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Reestenose Coronária/terapia , Stents , Ultrassonografia de Intervenção , Angiografia Coronária , Resultado do Tratamento , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgiaRESUMO
Undeployed stent loss is a rare but potentially serious complication of percutaneous coronary intervention. Its management is not assisted by well-defined guidelines, and it is made even more difficult when the dislodged stent is not protected by in situ guidewire. In this work, we present the case of a total stent loss with a crushed device protruding out of the left main. In this hopeless circumstance, an innovative ping-pong technique was used to contralaterally perform a successful stent retrieval.
Assuntos
Angioplastia Coronária com Balão , Intervenção Coronária Percutânea , Humanos , Resultado do Tratamento , Stents , Intervenção Coronária Percutânea/efeitos adversos , Remoção de Dispositivo/métodosAssuntos
Estenose da Valva Aórtica , Valvuloplastia com Balão , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Catéteres , Resultado do Tratamento , Desenho de Prótese , Valvuloplastia com Balão/efeitos adversosRESUMO
Current guidelines consider thrombosis as a potential (and reversible) cause of cardiorespiratory arrest (CA). However, cardiac thrombus formation (TF) is likely to be the consequence of the forward blood flow ceasing during cardiac standstill. We present the case of a young man who was hospitalized for infective endocarditis, complicated by multiorgan disease and sudden CA on the 5th day. Prompt cardiopulmonary resuscitation (CPR) warranted a return of spontaneous circulation in 16 min but, unexpectedly, a TF was recognized in the right atrium at echocardiography. The blood clot resolved with rapid administration of endovenous heparin and continued chest compressions. Even though cardiac ultrasound is not ready for a routine use during CPR, the present study confirms a key role in the management of CA patients.