Bruno Garcia

Coronariografía mediante tomografía computarizada de 16 detectores antes de la cirugía de recambio valvular

INTRODUCTION AND OBJECTIVES Multislice computed tomography is an excellent technique for the detection of significant coronary artery lesions. Our purpose was to assess whether computed tomography could replace routine invasive coronariography before valvular surgery. METHODS We studied 106 consecutive patients (mean age: 67 [10]): 76% aortic valvular disease (62% stenosis, 14% regurgitation), 20% mitral valvular disease (4% stenosis, 16% regurgitation), and 4% mitro-aortic disease. Non-invasive studies were performed by helical computed tomography. Eighty-four percent of patients were in sinus rhythm (40% using beta-blockers, 32% nitrates). Findings from both techniques were analyzed according to a predetermined segmented anatomical model of the coronary artery (a total of 1802 segments). RESULTS The incidence of coronary artery disease in these patients was 30%. Using computed tomography, 96.8% of segments could be evaluated and 3.2% could not. Calcium score ranged from 0 to 7572 (median: 182). In the per patient analysis, computed tomography showed a sensitivity of 95%, specificity 94%, positive predictive value 84%, and negative predictive value 98%. CONCLUSIONS Computed tomography is an excellent technique for ruling out coronary lesions prior to valvular surgery, making an invasive study unnecessary if the quality of the study is good and the result is negative.

Angiographic Quantification of Thrombus in ST-Elevation Acute Myocardial Infarction Presenting with an Occluded Infarct-Related Artery and Its Relationship with Results of Percutaneous Intervention

INTRODUCTION Routine thrombectomy has been advocated for ST-segment-elevation myocardial infarction (STEMI), but it is unknown how many patients present with a large thrombus. We aimed to quantify the intracoronary thrombus in STEMI and to correlate it with procedure results. METHODS In 98 patients with STEMI and TIMI flow grades 0-2 in the infarct-related artery, thrombus was qualified as small (ST) when its maximal dimension was <2 vessel diameters and large (LT) when >or=2. Main outcome measures were TIMI flow, myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment elevation resolution (STSER). RESULTS Only a third of the patients presented with an LT. Thrombus grade was independent of the initial vessel patency. Diabetes (OR 3.1, 95% CI 1.20-8.02, P = 0.027) and pretreatment with clopidogrel (OR 0.27, 95% CI 0.08-0.86, P = 0.034) were independent predictors of LT. LT was an independent predictor of unfavorable results: <3 TIMI flow (OR 2.87, 95% CI 1.04-8.00, P = 0.043), MBG 0-1 (OR 3.36, 95% CI 1.10-10.26, P = 0.033), cTFC > 21 (OR 2.86, 95% CI 1.09-7.49, P = 0.033) and <50% STSER (OR 3.19, 95% CI 1.06-9.63, P = 0.039). CONCLUSION Only a third of STEMI patients present with an LT, being diabetes and lack of clopidogrel pretreatment independent predictors. An LT is strongly associated with worse PCI results.

TCT-403 Bioresorbable Coronary Devices in Bifurcations: Immediate and 6-month Results of the REPARA Registry

TCT-403 Bioresorbable Coronary Devices in Bifurcations: Immediate and 6-month Results of the REPARA Registry Felipe Hernandez, Jose M. de la Torre Hernandez, Bruno Garcia, Jose Rumoroso, Ramiro Trillo, Armando Perez de Prado, eduardo molina, Raul Moreno, Jose Diaz, Ivan Gomez Blazquez, Hipolito Gutierrez, Pedro Canas da Silva, Vasco Gama Ribeiro Hospital 12 de Octubre, Madrid, Spain; Hospital Universitario Marques de Valdecilla, Santander, Spain; Hospital Universitari Vall D’Hebron, Barcelona, Spain; Hospital Galdakao-Usansolo, Galdakao, Spain; Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Fundación Investigación Sanitaria en León, Leon, Spain; Unknown, granada, Spain; University Hospital La Paz, Madrid, Spain; Unknown, huelva, Spain; Hospital Meixoeiro, Vigo, Spain; H Valladolid; Hospital Santa Maria, Lisboa, Portugal; Centro Hospitalar de Vila Nova de Gaia, Gaia, Portugal

The V-Wave Device for the Treatment of Heart Failure. Initial Experience in Europe.

Left heart failure is the final manifestation of various heart diseases involving left ventricular dysfunction, such as ischemic heart disease. Due to treatment advances, the prevalence of left heart failure is growing, but its natural course is associated with a continual decrease in quality of life, rehospitalizations, and early mortality. Previous studies have shown that tight control of left atrial pressure is associated with improved ventricular function and functional class, suggesting that this strategy could improve prognosis. The V-Wave device (V-Wave Ltd, Or Akiva, Israel) is based on this concept and on past experience of the creation of interatrial shunts to treat patients with congenital heart disease or ventricular assist devices. The V-Wave device, which permanently reduces left atrial pressure, is composed of an hourglass-shaped nitinol frame with a polytetrafluoroethylene polymer coating on its left side and a valve with 3 bovine pericardium leaflets on its right side to prevent paradoxical embolisms and early shunt closure (Figure). The first patient was described in Canada and the technology has recently been introduced in Europe, where the first 2 implants were successfully performed with the approval of the Agencia Española de Medicamentos y Productos Sanitarios (Spanish Agency for Medicines and Medical Devices). The selection criteria for this first-in-man study are summarized in the Table. Detailed clinical (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and functional (6-minute walk test) tests were performed, as well as measurement of the aminoterminal fraction of brain natriuretic peptide (NT-proBNP) and right heart catheterization. The first patient was a 73-year-old man with partially revascularized chronic ischemic heart disease and a cardiac resynchronization therapy device. He had severe left ventricular dysfunction (24%), moderate mitral regurgitation (II/IV), and acceptable right ventricular function (tricuspid annular plane systolic excursion [TAPSE] of 14 mm). His 6-minute walk test distance was 253 meters and his KCCQ score was 35.42, and the right heart catheter showed cardiac output of 3.5 L/min, Rev Esp Cardiol. 2015;68(9):808–819

Extended Szabo (Anchor-Wire) Technique Concept for Stent Implantation in Congenital Heart Lesions

We report the usefulness of the Szabo (anchor-wire) technique and two modifications of such based on the same concept for stent implantation in congenital heart lesions. The modifications of the original technique are related to the localization of the cell of the stent through which the anchor wire, which stops the stent advancement, is introduced: proximal in the original technique and central or distal in the reported modifications. These techniques were performed in six patients: in two to maintain permeability of the ductus arteriosus, in three to achieve a fenestration of the interatrial septum, and in one to implant a stent in a right ventricle–to–pulmonary artery conduit close to the bifurcation. We describe the technique as well as the most important difficulties and complications encountered. The Szabo or anchor-wire technique concept is a new tool for stent implantation that can provide more accurate stent positioning compared with conventional angiographically guided implantation in different congenital heart defects. As with any new tool, this technique demands a learning curve and knowledge of potential complications.