Eduardo Molina

The Ibero-American transcatheter aortic valve implantation registry with the CoreValve prosthesis. Early and long-term results

BACKGROUND Transcatheter aortic valve implantation (TAVI) is the recommended therapy for patients with severe aortic stenosis who are not suitable candidates for surgery. The aim of this study was to describe early experience and long-term follow-up with the CoreValve self-expanding aortic prosthesis at 42 Ibero-American hospitals. METHODS Multiple centre observational study including 1220 consecutive patients with symptomatic severe aortic stenosis who are not suitable candidates for surgery and underwent transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System between December 2007 and May 2012. RESULTS The registry included 1220 consecutive patients with a mean age of 80.8 ± 6.3 years and a mean logistic euroSCORE of 17.8% ± 13%. The procedural success rate was 96.1%. Hospital mortality was 7.3% and combined end-point was 21.3%. Aortic regurgitation after TAVI was present in 24.5% (Sellers grade ≥ 2). The estimated 1-year and 2-year survival rates were 82.1% and 73.4% respectively. The following issues were significant independent risk factors for hospital mortality: acute kidney failure (odds ratio 3.55); stroke (odds ratio 5.72); major bleeding (odds ratio 2.64) and euroSCORE (odds ratio 1.02). Long-term predictors of mortality were diabetes mellitus (hazard ratio 1.59, 95% confidence interval 1.09-2.31), severe chronic obstructive pulmonary disease (hazard ratio 1.85, 95% confidence interval 1.85-2.88), and functional classes NYHA III-IV (hazard ratio 1.31, 95% confidence interval 1.01-1.70). CONCLUSIONS Transcatheter aortic valve implantation constitutes a safe and viable therapeutic option for high operative risk patients with severe aortic stenosis. Long-term prognosis is conditioned by associate comorbidities.

El test de basculación en la evaluación del síncope de origen desconocido: ¿existen diferencias entre niños y adultos?

Introduccion y objetivos. Se sabe poco acerca de las diferencias entre ninos y adultos en lo que respecta a los resultados del test de basculacion. El objetivo de este estudio es investigar las posibles diferencias en cuanto a: a) el perfil clinico y las circunstancias del sincope espontaneo; b) el rendimiento global del test, y c) el tipo de respuesta positiva obtenida. Material y metodos. Hemos estudiado a 31 ninos y 123 adultos con sincope de origen desconocido. Cuando el test basal (basculacion a 70o durante 30 min) resulto negativo, se repitio bajo perfusion de isoprenalina a dosis bajas. Resultados. No se encontraron diferencias ni en el perfil clinico, excepto en lo que respecta a la ocurrencia de traumatismo severo mas comun en los adultos (el 25% frente al 3% en los ninos; p Conclusiones. En nuestra serie, y con el protocolo de mesa basculante empleado, los ninos, a diferencia de los adultos, raramente presentan un resultado positivo en la basculacion bajo infusion de isoprenalina, siendo su tasa de respuestas cardioinhibidoras, por otra parte, mucho mayor que la de los adultos.

Outcomes and predictors of success and complications for paravalvular leak closure: an analysis of the SpanisH real-wOrld paravalvular LEaks closure (HOLE) registry.

AIMS The aim of the study was to assess the safety and efficacy of percutaneous closure of paravalvular prosthetic leak (PVL) and to identify the predictors of procedural success and early complications. METHODS AND RESULTS A total of 514 first-attempt percutaneous PVL closure in 469 patients were included at 19 centres. Technical and procedural success was achieved in 86.6% and 73.2% of the patients, respectively. In multivariate analysis, the independent predictors for procedural success in mitral lesions were the type of device used (AMPLATZER AVP III vs. others, HR 2.68 [1.29-5.54], p=0.008) and the number of procedures performed at the centre (top quartile vs. others, HR 1.93 [1.051-3.53], p=0.03). For aortic leaks the only predictor of procedural success was the leak size (≥10 mm vs. <10 mm, HR 3.077 [1.13-8.33], p=0.027). The overall major adverse events rate (death or emergency surgery or stroke) at 30 days was 5.6%; the only predictor for combined adverse events was New York Heart Association functional Class IV (HR 4.2 [1.42-12.34], p=0.009). CONCLUSIONS Percutaneous closure of PVL can be performed with a reasonable rate of procedural success and a low rate of major complications. The type of device used, the accumulated experience and the leak size are predictors of procedural success.

Diagnóstico de miocardiopatía hipertrófica apical con ecocardiografía de contraste

Apical hypertrophic cardiomyopathy is a disease with clear electrocardiographic and echocardiographic characteristics. However, poor visualization of apical endocardial border is a limiting factor to diagnose apical hypertrophic cardiomyopathy by echocardiography. We present a case report of a patient with a characteristic electrocardiogram but poor apical endocardial border delineation. A contrast-enhanced echocardiography was performed to confirm the diagnosis of apical hypertrophic cardiomyopathy. We discuss the role of echocardiographic image enhancement with contrast to diagnose apical hypertrophic cardiomyopathy.

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

TCT-428 Bioresorbable Coronary Devices in Clinical Practice: 6-month Results of the Prospective REPARA Registry

Regular use of bioresorbable coronary devices in daily clinical practice is not fully established yet. Few data exist about clinical outcomes in specific lesions or clinical scenarios. REPARA is a multicentre, prospective registry, designed to evaluate the efficacy and safety of the bioresorbable