Quentin de Hemptinne

Initial clinical experience with the GORE(®) CARDIOFORM ASD occluder for transcatheter atrial septal defect closure.

To report the initial clinical experience with a novel atrial septal defect (ASD) closure device, the GORE® CARDIOFORM ASD Occluder (GCO).

Bioresorbable Vascular Scaffold During ST-Elevation Myocardial Infarction: A Systematic Review.

BACKGROUNDnThe bioresorbable vascular scaffold (BVS) represents a novel technology designed to overcome the long-term limitations of metallic coronary stent implantation in percutaneous coronary intervention. In this context, primary percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI) could be a preferred scenario for BVS implantation. Nevertheless, data on efficacy and safety are lacking in this specific subset of patients.nnnMETHODSnWe conducted a systematic review to examine the safety and efficacy of BVS use in STEMI patients. We searched PubMed, EMBASE, and the Cochrane Library through June 2016 for studies that included outcome data for BVS implantation in STEMI patients. Outcomes of interest included cardiac death, myocardial infarction, scaffold thrombosis, target lesion revascularization, restenosis, and composite end points.nnnRESULTSnWe identified 9 eligible articles, which included 1 randomized controlled trial and 8 cohort studies (5 controlled), for a total of 846 patients. These studies varied in size (11-290) and follow-up duration (1-24 months). The incidence of major cardiac events ranged from 1.1% to 13%, with no statistically significant difference between BVS and control groups in studies that included a comparison group. Although there was a trend toward an increase in scaffold thrombosis in the largest controlled registries, no statistically significant increase was found.nnnCONCLUSIONSnCurrent clinical data are scarce, but suggest that BVS might represent a reasonable alternative to drug-eluting stents in STEMI patients. The lack of large randomized controlled trials with extended follow-up periods and the scaffold thrombosis signal are limiting factors for widespread use before additional large-scale trials are available.

Right atrial mass in a patient with breast cancer: percutaneous transcatheter biopsy under intracardiac echocardiography guidance.

Precise diagnosis of intracardiac masses is fundamental to their treatment. However, the findings of non-invasive imaging techniques are frequently inconclusive. In this setting, percutaneous transcatheter biopsy might represent a valid alternative to surgical biopsy. Intracardiac echocardiography (ICE)-guided biopsy offers high-quality imaging, is a relatively quick and easy interventional procedure to perform and does not require patient intubation or the assistance of an echocardiographer. We describe the case of a 47-year-old woman undergoing chemotherapy for breast cancer, who presented with a right atrial mass. Non-invasive imaging was inconclusive. Since no changes in the aspect or size of the mass were noticed after 2-week treatment with heparin, ICE-guided biopsy was performed, which confirmed the thrombotic nature of the mass. The patient underwent surgical resection of the thrombus and curative treatment of her breast cancer was pursued.

Clinical outcomes of bioresorbable vascular scaffold to treat all-comer patients. Are patients with acute coronary syndrome better candidate for bioresorbable vascular scaffold?

BACKGROUNDnScaffold thromboses (ST) and adverse events and have been associated with bioresorbable vascular scaffolds (BVS) at long-term, but their mechanism remains unclear. We sought to evaluate patient and lesion characteristics associated with mid- to long-term outcomes in patients treated with BVS.nnnMETHODSnThis is an observational single-center, single-arm, retrospective study evaluating the performance of BVS in an all-comer population, including complex lesions (chronic total occlusions, long lesions), small vessels, and acute coronary syndromes (ACS).nnnRESULTSnFrom May 2013 to June 2015, we included 482 patients (580 lesions) that were treated with BVS implantation including 71.2% treated for ACS in the present analysis. Mean follow-up period was 816.2u202f±u202f242.6u202fdays. The primary endpoint was device oriented cardiac events (DOCE), defined as a composite of target-lesion revascularization (TLR), ST, target vessel myocardial infarction (TVMI) and cardiac death. Using Kaplan-Meier methods, the DOCE and ST rates at 36u202fmonths were 9.4% and 2.3%, respectively. No ST occurred between 2 and 3u202fyears and ST occurred after 3u202fyears, in one patient. Using multivariate analysis, ACS was the only significant predictor of lower rates of DOCE (pu202f=u202f0.04, HR: 0.47, 95% CI: 0.23-0.96).nnnCONCLUSIONSnIn this large all-comers real-world cohort, lesions treated with BVS had non-negligible rates of DOCE and ST, in line with previous published randomized trials. The occurrence of very late event was very low after 24u202fmonths. ACS patients had lower rates of DOCE.

Long-term outcomes of bioresorbable vascular scaffold in ST-elevation myocardial infarction

Abstract Background: Bioresorbable vascular scaffolds (BVS) implantation in selected patients with stable angina has been demonstrated feasible and safe. However, limited data are currently available on long-term outcomes after BVS implantation for ST-elevation myocardial infarction (STEMI). Therefore, we sought to assess the safety, efficacy and long-term results of BVS implantation in STEMI patients. Methods: Retrospective review of all STEMI patients treated with the Absorb® BVS (Abbott Vascular, Santa Clara, CA) or conventional drug eluting stent (DES) between 1 April 2013 and 30 March 2014. Primary outcomes were procedural success, device thrombosis and device-oriented composite endpoint (DOCE) including cardiac death, target vessel myocardial infarction and target lesion revascularization. The study included 54 BVS patients and 121 DES patients. Results: Patients were slightly younger in the BVS group (60 vs. 63 years old, pu2009=u2009.03). Other baseline characteristics were comparable between the two groups. Procedural success was achieved in all patients. Median follow-up was 901 days and 849 days for BVS and DES patients, respectively (pu2009=u2009.01). The cumulative incidence of DOCE was not significantly different between the BVS and DES groups (7.5% vs. 9.1%, hazard ratio [HR]: 0.74 [95% confidence interval (CI): 0.26–2.2], pu2009=u2009NS). Rate of probable/definite device thrombosis were not statistically different between both groups (3.7% vs. 3.3%, pu2009=u2009NS). Conclusions: The results of this single-centre retrospective study, one of the first assessing long-term safety and efficacy of BVS in STEMI, seems reassuring with similar long-term results as compared with patients treated with conventional DES.

Bioresorbable vascular scaffold to treat in‐stent restenosis: Single‐center experience

AIMSnThe management of patients with in-stent restenosis (ISR) is still a major clinical challenge even in the era of drug-eluting stents (DES). Recent studies have demonstrated acceptable clinical outcomes for the everolimus-eluting bioresorbable vascular scaffold (BVS) ABSORB™ in patients with stable coronary artery disease but data are scarce on its use in patients with ISR. We report the long-term results of our preliminary experience with this novel approach at our institution.nnnMETHODS AND RESULTSnWe investigated the safety and efficacy of BVS implantation to treat ISR. 34 consecutive patients (37 lesions) underwent PCI for ISR with BVS implantation between May 2013 and June 2015 at our institution and were included in the current analysis. Follow-up was available in 91.9% of the patients. Mean follow-up period was 801.9u2009±u2009179 days. One patient had definite scaffold thrombosis (ScT) 2 months after stent implantation which was treated with DES. Five patients (six lesions) experienced target lesion revascularization (TLR). The composite endpoint rate of TLR, ScT, myocardial infarction, and death occured in 6/37 lesions at follow-up (16.2%).nnnCONCLUSIONSnThese real-world data using BVS in patients with ISR demonstrates that ISR treatment with ABSORB™ BVS is feasible but could have slightly higher target lesion failure rates as compared to DES. This proof of concept could be hypothesis-generating for larger randomized controlled studies.

Everolimus-eluting bioresorbable vascular scaffold implantation to treat saphenous vein graft disease, single-center initial experience

AIMSnRecent studies have shown favorable outcomes with everolimus-eluting bioresorbable vascular scaffold (BVS) in patients with stable coronary artery disease. Data on the use of BVS in saphenous vein graft disease (SVG) is currently lacking.nnnMETHODS AND RESULTSnA total of 10 consecutive patients (13 lesions, including 6 in-stent restenosis) who underwent BVS for SVG disease between May 2013 and June 2015 at a tertiary care institution were included. Median follow-up period was 874 (720-926) days. One patient had scaffold thrombosis (ScT) 15 months after implantation, which was treated medically. Another patient had target lesion revascularization (TLR) in two different lesions, where BVS was used to treat in-stent restenosis. The composite endpoint of TLR, ScT, target vessel myocardial infarction, and cardiac death, was reached in two patients CONCLUSIONS: This first real-world data on the use of the ABSORB™ BVS in patients with SVG disease shows that its implantation is technically feasible. The observed rate of target lesion revascularization was similar to those observed with drug-eluting stents in similar settings. Larger studies are required to better define the optimal use of BVS to treat SVG disease.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy in a patient with a chronic total occlusion of the right coronary artery: “beware of collateral damage”

Alcohol septal ablation (ASA) is an effective semi-invasive alternative to surgical myectomy in selected patients for the management of severely symptomatic and drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). One contraindication of this procedure is the presence of collateral flow originating from the target septal perforator to a remote myocardial territory. In such circumstances, ethanol injection could cause remote non-target myocardial necrosis in the collateralized territory. Percutaneous revascularization of the collateralized vessel prior to ASA might cope with this contraindication by restoring normal antegrade flow in the occluded artery. We report a case that illustrates the feasibility and efficacy of such strategy.

Percutaneous Coronary Intervention in Nonagenarians: Prevalence, Indications, Vascular Approach and Mortality at 3 months

Background: Percutaneous coronary intervention (PCI) in nonagenarians has been shown to be feasible, with a high success rate. However, there is paucity of data regarding the prevalence, vascular access, procedural data and mortality after PCI in this population. nMethods: All patients aged 90 and older referred to our institution from 2004 to 2014 for coronary angiogram were included in our retrospective study. Clinical and procedural data including vascular access and 3-month mortality rates were obtained for all patients. nResults: A total of 26696 PCI were performed over the last 11 years, of which 177 PCI (0.66%) were realized in 167 nonagenarians. The prevalence of PCI in nonagenarians increased from 0.17% in 2004 to 1.22% in 2014. In this population, with an age of 92 ± 2 years and 51.4% of males, 76 (43%) PCI were performed in the setting of ST-elevation myocardial infarction, and 89 (50%) of the procedures were non-ST elevation myocardial infarction or unstable angina. Transradial approach (TRA) was used in 76 (43%) and transfemoral approach (TFA) in 101 (57%) procedures. Comparing TRA to TFA, the total fluoroscopic time and contrast volume was similar between the two groups. Overall complications, including cardiogenic shock, iatrogenic coronary dissection, perforation or no reflow phenomenon occurred in 22 of 177 procedures (12.4%). Overall survival rate was 92.8% at 3 months. nConclusion: The majority of the procedures was performed in acute coronary syndrome clinical setting. TRA and TFA were comparable in terms of fluoroscopic time and contrast volume. Overall procedural success rate was high and complication rates were low.

Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture

Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade.