Francisco Mazuelos Bellido
@uco.es
Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba
Universidad de Córdoba; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
Scopus Publications
Scopus Publications
Francisco Javier Toledano-Delgado, Isabel Jimenez-Alcantara, Jesus Cobo-Molinos, Francisco Carrasco-Avalos, Francisco Mazuelos, and Jose Angel Urbano-Moral
Ovid Technologies (Wolters Kluwer Health)
Mathieu Kerneis, Francesco Cosentino, Roberto Ferrari, Jean-Louis Georges, Elena Kosmachova, Cécile Laroche, Aldo P Maggioni, Harald Rittger, Philippe Gabriel Steg, Justyna Maczynska,et al.
Oxford University Press (OUP)
Abstract Aims In Europe, global data on guideline adherence, geographic variations, and determinants of clinical events in patients with chronic coronary syndrome (CCS) remain suboptimal. The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease Long-Term (CICD-LT) registry is a prospective European registry, and was designed to describe the profile, management, and outcomes of patients with CCS across the ESC countries. Methods and results We aimed to investigate clinical events at 1-year follow-up from the ESC EORP CICD-LT registry. One-year outcomes of 6655 patients from the 9174 recruited in this European registry were analysed. Overall, 168 patients (2.5%) died, mostly from cardiovascular (CV) causes (n = 97, 1.5%). Northern Europe had the lowest CV mortality rate, while southern Europe had the highest (0.5 vs. 2.0%, P = 0.04). Women had a higher rate of CV mortality compared with men (2.0 vs. 1.3%, P = 0.02). During follow-up, 1606 patients (27.1%) were hospitalized at least once, predominantly for CV indications (n = 1220, 20.6%). Among the population with measured low-density lipoprotein-cholesterol level at 1 year, 1434 patients (66.5%) were above the recommended target. Age, history of atrial fibrillation, previous stroke, liver disease, chronic obstructive pulmonary disease or asthma, increased serum creatinine, and impaired left ventricular function were associated with an increased risk of CV death or hospitalization. Conclusion In the CICD registry, the majority of patients with CCS have uncontrolled CV-risk factors. The 1-year mortality rate is low, but these patients are frequently hospitalized for CV causes. Early identification of comorbidities may represent an opportunity for enhanced care and better outcomes.
Francisco Hidalgo, Soledad Ojeda, Javier Suárez de Lezo, Miguel Romero, Adrián Lostalo, Rafael González, Cristina Pericet, Nick Paredes, Juan C. Elizalde, Aurora Luque,et al.
Publicidad Permanyer, SLU
Introduction and objectives: patients with long, sequential and diffuse coronary lesions who undergo a percutaneous coronary intervention remain at a high risk of suffering cardiovascular events despite the improved safety and efficacy of the new drug-eluting stents. The objective of this study was to analyze the utility of SyncVision/iFR-guided revascularization (SyncVision version 4.1.0.5, Philips Volcano, Belgium) in this type of lesions. Methods: Randomized, multicenter, controlled, and open-label trial designed to compare SyncVision/iFR-guided and angiography-guided revascularizations in patients with long, sequential or diffuse significant angiographic coronary stenosis (ClinicalTrials. gov identifier: NCT04283734). A total of 100 patients will be randomized (1:1, no stratification). The primary endpoint is the average length of the stent implanted. The secondary endpoint is a composite of cardiac death, myocardial infarction, definitive or probable stent thrombosis, new target lesion revascularization or new target lesion failure; and the presence of residual ischemia as seen on single-photon emission computed tomography at the 6-month follow-up. Patients will be followed for 12 months after the procedure. Results: The trial is currently in the recruitment phase, and it has already recruited the first 7 patients. We expect to complete the recruitment phase by February 2021 and the follow-up by February 2022. Conclusions: The iLARDI study is the first randomized trial to assess the potential utility of SyncVision-guided revascularization in long, sequential and diffuse coronary lesions.
Cristina Pericet-Rodríguez, Francisco José Hidalgo-Lesmes, Rafael González-Manzanares, Soledad Ojeda-Pineda, Aurora Luque-Moreno, Javier Suárez de Lezo, Miguel Ángel Romero-Moreno, Francisco Mazuelos-Bellido, José María Segura Saint-Gerons, Ana Fernández-Ruiz,et al.
Publicidad Permanyer, SLU
Introduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.
Michel Komajda, Francesco Cosentino, Roberto Ferrari, Cécile Laroche, Aldo Maggioni, Philippe Gabriel Steg, Luigi Tavazzi, Mathieu Kerneis, Marco Valgimigli, Chris P Gale,et al.
Oxford University Press (OUP)
Abstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry aims to study the clinical profile, treatment modalities, and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular (CV) risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid- and long-term outcomes and their determinants in this population. Methods and results Nine thousand one hundred and seventy-four patients over 18 years with documented CICD defined by a history acute coronary syndrome with/without ST elevation, previous coronary revascularization, or stable coronary artery disease were enrolled between 1 May 2015 and 31 July 2018. Individual patient data on clinical profile, biology, and treatment modalities were collected across 154 centres from 20 ESC countries. Two years of follow-up is scheduled in order to determine the following clinical outcomes: all-cause and CV death, all-cause and CV hospitalizations, changes in medications, and quality of life using the EuroQol5D-5L score. Conclusion The CICD LT is an international registry of care and outcomes of patients hospitalized with CICD which will provide insights into the contemporary profile and management of patients with this common disease.
Manuel Pan, Soledad Ojeda, Francisco Hidalgo, Javier Suárez de Lezo, Adrián Lostalo, Francisco Mazuelos, Jose Segura, Cristina Pericet, Aurora Luque, Rafael González,et al.
Europa Digital & Publishing
AIMS
To assess the efficacy and safety of percutaneous reintervention in patients who underwent aortic coarctation stenting at an early age.
METHODS AND RESULTS
From 1993 to 2018, 177 patients with aortic coarctation were treated at our centre with stent implantation; 33 of them were treated at younger than 12 years of age and required reintervention because of their rate of growth. The average age of the patients at the first and second procedure was 6±3 years and 19±7 years, respectively. At the reintervention procedure, 15 (45%) patients were treated with balloon re-expansion, and 18 (55%) were treated with re-stenting. Success was obtained in 30 patients (91%). The gradient across the coarctation changed from 22±10 mmHg to 6±6 mmHg, while the minimal lumen diameter increased from 9±6 mm to 15±3 mm. There were 8 occlusions of the femoral artery (after the first procedure), and two covered stents were needed because of femoral bleeding. The mean follow-up time after the second procedure was 5±4 years. A third procedure was required only in 3 patients (9%).
CONCLUSIONS
Patients with aortic coarctation treated with stent placement at an early age can be successfully re-treated after the completion of their somatic growth.
Soledad Ojeda, Francisco Hidalgo, Miguel Romero, Francisco Mazuelos, Javier Suárez de Lezo, Ernesto Martín, Adrián Lostalo, Aurora Luque, Rafael González, Ana Fernández,et al.
Wiley
To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI.
Óscar Cano, Alejandro Bellver, Adolfo Fontenla, Roger Villuendas, Pablo Peñafiel, Jaume Francisco-Pascual, José Luis Ibáñez, Vicente Bertomeu-González, Lorena García-Riesco, Javier García-Seara,et al.
Elsevier BV
Resumen Introduccion y objetivos Se describen los resultados en Espana de la segunda encuesta de la Sociedad Europea de Cardiologia sobre terapia de resincronizacion cardiaca (CRT-Survey II) y se comparan con los de los demas paises participantes. Metodos Pacientes a los que se implanto un dispositivo de terapia de resincronizacion cardiaca entre octubre de 2015 y diciembre de 2016 en 36 centros participantes. Se recogieron datos sobre las caracteristicas basales de los pacientes y del implante, y un seguimiento a corto plazo hasta el alta hospitalaria. Resultados La tasa de exito del implante fue del 95,9%. La mediana [intervalo intercuartilico] de implantes anuales/centro en Espana fue significativamente menor que en los demas paises participantes: 30 [21-50] frente a 55 [33-100] implantes/ano (p = 0,00003). En los centros espanoles hubo una menor proporcion de pacientes de edad ≥ 75 anos (el 27,9 frente al 32,4%; p = 0,0071), una mayor proporcion de pacientes en clase funcional II de la New York Heart Association (el 46,9 frente al 36,9%; p Conclusiones La encuesta CRT-Survey II muestra que en Espana hay una menor proporcion de pacientes de 75 o mas anos que reciben un dispositivo de terapia de resincronizacion cardiaca, una mayor proporcion de pacientes en clase funcional II de la New York Heart Association, con bloqueo completo de la rama izquierda del haz de His y con seguimiento a distancia, con estancias hospitalarias significativamente menores.
Francisco Hidalgo, Manuel Pan, Soledad Ojeda, Javier Suárez de Lezo, Adrián Lostalo, Aurora Luque, Ernesto Martín, José Segura, Francisco Mazuelos, and Miguel Romero
Elsevier BV
During provisional stenting (PS) of a bifurcation lesion (BL), evaluation of the side branch (SB) result can be challenging [(1)][1]. To our knowledge, no studies have evaluated the feasibility of using a pressure wire (PW) as a jailed wire for the evaluation of SB results during PS. Thus, we
F. Javier García-Fernández, José Luis Ibáñez Criado, Aurelio Quesada Dorador, Miguel Álvarez-López, Jesús Almendral, Concepción Alonso, Pau Alonso-Fernández, Nelson Alvaralenga, Luis Álvarez-Acosta, Ignasi Anguera,et al.
Elsevier BV
Resumen Introduccion y objetivos Se describen los resultados del Registro Espanol de Ablacion con Cateter correspondientes al ano 2017. Metodos La recogida de datos se llevo a cabo de forma retrospectiva con la cumplimentacion de un formulario de recogida de datos de cada uno de los centros participantes. Resultados El numero total de procedimientos de ablacion fue de 15.284 realizados en 98 centros (mayor numero de centros y de procedimientos de ablacion comunicados historicamente en este registro) con una media de 156 ± 126 y una mediana de 136 procedimientos. El sustrato abordado con mas frecuencia ha sido por primera vez en el registro la fibrilacion auricular (n = 3.457; 22,6%), seguida del istmo cavotricuspideo (n = 3.449; 22,5%) y la taquicardia intranodular (n = 3.429; 22,4%). La tasa total de exito fue del 87%; la de complicaciones mayores, del 2,6% y la mortalidad, del 0,09%. Se ha producido un aumento de los procedimientos realizados sin apoyo de fluoroscopia hasta suponer un 6% del total de las ablaciones. Un 2,3% de las ablaciones se realizo en pacientes pediatricos. Conclusiones El Registro Espanol de Ablacion con Cateter recoge sistematica e ininterrumpidamente los procedimientos de ablacion realizados en Espana, y esto nos ha permitido observar un aumento progresivo del numero de ablaciones y de centros que las realizan manteniendo una tasa de exito elevada y unos porcentajes de complicaciones bajos.
Jesus Mates, Irene Mademont-Soler, Bernat del Olmo, Carles Ferrer-Costa, Monica Coll, Alexandra Pérez-Serra, Ferran Picó, Catarina Allegue, Anna Fernandez-Falgueras, Patricia Álvarez,et al.
Springer Science and Business Media LLC
Several studies have identified copy number variants (CNVs) as responsible for cardiac diseases associated with sudden cardiac death (SCD), but very few exhaustive analyses in large cohorts of patients have been performed, and they have been generally focused on a specific SCD-related disease. The aim of the present study was to screen for CNVs the most prevalent genes associated with SCD in a large cohort of patients who suffered sudden unexplained death or had an inherited cardiac disease (cardiomyopathy or channelopathy). A total of 1765 European patients were analyzed with a homemade algorithm for the assessment of CNVs using high-throughput sequencing data. Thirty-six CNVs were identified (2%), and most of them appeared to have a pathogenic role. The frequency of CNVs among cases of sudden unexplained death, patients with a cardiomyopathy or a channelopathy was 1.4% (8/587), 2.3% (20/874), and 2.6% (8/304), respectively. Detection rates were particularly high for arrhythmogenic cardiomyopathy (5.1%), long QT syndrome (4.7%), and dilated cardiomyopathy (4.4%). As such large genomic rearrangements underlie a non-neglectable portion of cases, we consider that their analysis should be performed as part of the routine genetic testing of sudden unexpected death cases and patients with SCD-related diseases.
J López-Aguilera, J M Segura Saint-Gerons, J Sánchez Fernández, F Mazuelos Bellido, M Pan Álvarez-Ossorio, J Suárez de Lezo, M Romero Moreno, S Ojeda Pineda, D Pavlovic, D Mesa Rubio,et al.
Oxford University Press (OUP)
Aims
To determine the impact of permanent cardiac pacing after transcatheter aortic valve implantation (TAVI) with the CoreValveTM prosthesis in terms of all-cause mortality and morbidity [rehospitalizations for heart failure (HF) or stroke] at the long-term follow-up.
Methods and results
The prospective analysis comprised 259 patients (138 women, 53.3%, age 78 ± 6 years) treated by a CoreValveTM prosthesis from April 2008 to December 2015. Forty-two patients were excluded for analysis: 9 with pre-existing permanent pacemaker (PPM) implantation, 19 who required a PPM during the follow-up and 14 patients because of hospital mortality during or after the CoreValveTM prosthesis implantation procedure. The remaining 217 patients were divided in two groups: Group-1 included those patients who required a PPM immediately after TAVI, and Group-2 included those patients who did not require permanent cardiac pacing at the long-term follow-up. Patients received follow-up at 1-month, 6-months, 12-months, and yearly thereafter. A total of 39 patients required a PPM immediately after TAVI (15.0%), but 178 patients (68.7%) did not. The mean follow-up was 37 ± 27 months (range 3-99 months) in both groups. There was no difference between the two groups in terms of all-cause mortality (52.6% vs. 56.8%, P = 0.125; HR 1.22 [0.87-1.77, 95% CI]), or stroke (13.3% vs. 15.1% P = 0.842; HR 1.12 [0.37-3.32, 95% CI]). However, patients who underwent PPM implantation developed an increase in readmissions for HF (21.1% vs. 31.9%, P = 0.015; HR 1.82 [1.23-3.92, 95% CI]).
Conclusion
Patients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up.
Soledad Ojeda, Lorenzo Azzalini, Jorge Chavarría, Antonio Serra, Francisco Hidalgo, Susanna Benincasa, Livia L. Gheorghe, Roberto Diletti, Miguel Romero, Barbara Bellini,et al.
Elsevier BV
Resumen Introduccion y objetivos Hay escasa evidencia sobre el tratamiento de lesiones en bifurcacion en relacion con una oclusion coronaria cronica total (OCT). Este estudio analiza los resultados inmediatos y a medio plazo de pacientes con lesiones en bifurcacion en OCT tratados con 1 stent provisional frente a 2 stents en un registro multicentrico. Metodos Entre enero de 2012 y junio de 2016, se recanalizaron 922 OCT en los 4 centros participantes. De ellas, 238 (25,8%) con lesion en bifurcacion se trataron mediante estrategia simple (n = 201) o compleja (n = 37). Se calculo la puntuacion de propension emparejada para detectar sesgos entre ambos grupos. Los eventos adversos cardiovasculares mayores (MACE) se definieron como muerte cardiaca, infarto y revascularizacion de la lesion diana. Resultados Los exitos angiografico y del procedimiento fueron similares con la tecnica simple (el 94,5 frente al 97,3%; p = 0,48) y con la compleja (el 85,6 frente al 81,1%; p = 0,49), aunque la cantidad de contraste, la dosis de radiacion y el tiempo de fluoroscopia fueron menores con la tecnica simple. Al seguimiento (25 meses), la tasa de MACE fue del 8% de los pacientes con la tecnica simple y el 10,8% de los tratados con 2 stents (p = 0,58). En este grupo hubo tendencia a una menor supervivencia libre de MACE (el 80,1 frente al 69,8%; p = 0,08). Despues del analisis de propension, no se observaron diferencias entre los grupos en los resultados inmediatos ni al seguimiento. Conclusiones Las LB en OCT pueden tratarse de modo similar que las demas bifurcaciones, para las que el stent provisional es la tecnica de eleccion. Despues de la puntuacion de propension emparejada, no hubo diferencias en los resultados inmediatos y a medio plazo entre ambos grupos.
Jorge Chavarría, Javier Suárez de Lezo, Soledad Ojeda, Manuel Pan, José Segura, Francisco Mazuelos, Simona Espejo, José López, Miguel Romero, and José Suárez de Lezo
Elsevier BV
Resumen Introduccion y objetivos La reestenosis coronaria tras implantar un armazon vascular bioabsorbible (AVB) es infrecuente. Hay poca informacion disponible sobre las principales caracteristicas de este tipo de lesiones. El objetivo de este estudio es caracterizar las reestenosis del AVB mediante tomografia de coherencia optica (OCT). Metodos Se estudio a 330 pacientes que recibieron 398 AVB para tratar 380 lesiones. Se evaluo a estos pacientes clinica y angiograficamente y, tras detectarse la reestenosis, mediante OCT. Resultados Tras un seguimiento de 19 ± 10 meses, se detectaron 18 casos de reestenosis en 17 pacientes (5,4%). La mayoria eran tardias o muy tardias (9 ± 4 meses). El patron angiografico mas frecuente fue la reestenosis focal en 12 (67%) y principalmente localizada en el borde proximal en 9 (75%), afectando o no la plataforma. El patron predominantemente homogeneo fue infrecuente en 3 (25%) y solo se visualizo en 3 de las 6 reestenosis situadas en el margen. La reestenosis focal localizada dentro del armazon presento en la OCT un patron heterogeneo o en capas. Finalmente se observo reestenosis difusa en 6 casos (33%), en los que se identifico un patron rico en lipidos o un patron en capas. Ademas, se identificaron microvasos y microcalcificaciones en algunos de ellos, lo que sugiere un proceso de neoateroesclerosis. Conclusiones La tasa de reestenosis tras una media de seguimiento de 19 meses fue del 5,4%. La presentacion angiografica mas frecuente fue focal, situada en el borde proximal. La reestenosis difusa ocurrio tardia o muy tardiamente y la mayoria de estos pacientes presentaban signos de neoateroesclerosis.
Soledad Ojeda, Manuel Pan, Alejandro Gutiérrez, Miguel Romero, Jorge Chavarría, Javier Suárez de Lezo, Francisco Mazuelos, Laura Pardo, Francisco Hidalgo, Francisco Carrasco,et al.
Elsevier BV
BACKGROUND
The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact.
METHODS AND RESULTS
BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.
José López-Aguilera, José M. Segura Saint-Gerons, Francisco Mazuelos Bellido, Javier Suárez de Lezo Herreros de Tejada, Soledad O. Pineda, Manuel Pan Álvarez-Ossorio, Miguel Ángel Romero Moreno, Djordje Pavlovic, and José Suárez de Lezo Cruz Conde
Elsevier BV
New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n = 80), those with persistent new-onset LBBB, and group 2 (n = 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32 ± 22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p = 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p = 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p = 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.
Manuel Pan, Soledad Ojeda, Elena Villanueva, Jorge Chavarria, Miguel Romero, Javier Suarez de Lezo, Francisco Mazuelos, Jose Segura, Francisco Carrasco, Francisco Hidalgo,et al.
Elsevier BV
OBJECTIVES
The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions.
BACKGROUND
The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal.
METHODS
We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non-polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe.
RESULTS
The clinical characteristics were similar between patients treated with polymer-coated or non-polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non-polymer-coated wires. However, 63 (55%) of the non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05).
CONCLUSIONS
Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non-polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891).
Jose María Segura Saint-Gerons, Francisco Mazuelos Bellido, and Jose Suárez de Lezo Cruzconde
Elsevier BV
Javier Suárez de Lezo, Pedro Martín, Manuel Pan, Soledad Ojeda, José Nóvoa, José Segura, Francisco Mazuelos, Miguel Romero, Alfonso Medina, and José Suárez de Lezo
Elsevier BV
Resumen Introduccion y objetivos El tratamiento de lesiones coronarias con armazon vascular bioabsorbible ha demostrado ser eficaz. Hay poca informacion sobre su uso en bifurcaciones. El objetivo de este estudio es analizar la seguridad y la eficacia de esta plataforma en el tratamiento de bifurcaciones coronarias. Metodos Desde enero de 2012 hasta enero de 2015, se trato con plataforma bioabsorbible a 194 pacientes con 230 lesiones en bifurcaciones coronarias. Se analizo con tecnicas de imagen intracoronaria la geometria de 145 bifurcaciones (63%). El 78% de las lesiones se revaluaron angiograficamente (por tomografia computarizada, 138; por coronariografia, 41). Resultados La presentacion clinica mas habitual fue un sindrome coronario agudo (81%). El tipo de bifurcacion mas frecuente (34%) fue la 1,1,1. La estrategia simple fue de eleccion en 221 lesiones (96%). En 90 lesiones se posdilato la rama lateral a traves de las celdillas, y por tomografia de coherencia optica se observo fractura del dispositivo en 3 casos. Se obtuvo exito del procedimiento en todos los pacientes. En el primer mes se documento 1 trombosis subaguda y 1 muerte subita. El tiempo de seguimiento angiografico fue de 7,3 ± 1,6 meses y el del seguimiento clinico, 14 ± 6 meses. Se observaron 12 restenosis (5%). Durante el seguimiento, 2 pacientes (1%) tuvieron un infarto en otro territorio y otros 2 fallecieron (1%); los demas quedaron libres de sintomas. La tasa de trombosis fue del 1,3%. Conclusiones El tratamiento de lesiones en bifurcaciones coronarias con armazon vascular bioabsorbible provisional es seguro y eficaz. Al seguimiento, habia una tasa de eventos adversos baja.
Javier Suárez de Lezo, Pedro Martín, Francisco Mazuelos, José Nóvoa, Soledad Ojeda, Manuel Pan, José Segura, Enrique Hernández, Miguel Romero, Francisco Melián,et al.
Wiley
To analyze the feasibility and safety of direct bioresorbable vascular scaffold (BVS) implantation without previous balloon dilation.
Soledad Ojeda, Manuel Pan, Javier Suárez de Lezo, Pedro Martín, Francisco Mazuelos, Miguel Romero, José Novoa, Simona Espejo, José Segura, Carmen Morenate,et al.
Europa Digital & Publishing
AIMS
The behaviour of side branches (SBs) covered by a bioresorbable vascular scaffold (BVS) is not well known. This study analysed the rate of side branch occlusion (SBO) immediately after BVS implantation, its clinical impact, predictors of SBO and the fate of such SBs at follow-up.
METHODS AND RESULTS
We assessed 140 patients with 346 jeopardised SBs divided into three groups: small (<1 mm, n=181), intermediate (1-2 mm, n=102) and large (>2 mm, n=63). SBO was defined as a TIMI flow 0 or 1. Computed tomography was scheduled at six months for patients with jailed SBs >1 mm. Immediate occlusion occurred in 31 (9%) SBs: 22 (12%) small, 8 (8%) intermediate and one (1.6%) large, while post-procedural SBO was 5.5%. In-hospital events included one thrombosis (0.7%) and eight non-Q-wave myocardial infarctions (6%). After 17±3 months, one patient died (0.7%) and six patients needed repeat revascularisation (4%). Re-evaluation showed no late SBO at 7±3 months. Predictors of SBO were: small SBs (OR 2.06, 95% CI: 1.08-4.63; p<0.05) and stenosis >50% at the origin (OR 17.22, 95% CI: 7.79-38.10; p<0.01).
CONCLUSIONS
The incidence of SBO and its clinical impact were low when SBs >1 mm were covered. These favourable results were maintained at midterm.
Juan Jiménez-Jáimez, Inmaculada de la Torre, Rafael Peinado Peinado, Esther Zorio Grima, Federico Segura, Pablo Moriña, Juan José Sánchez Muñoz, Francisco Mazuelos, Rocío Cózar, Juan Ramón Gimeno,et al.
Elsevier BV
Resumen Introduccion y objetivos La heredabilidad y la penetrancia familiar de los trastornos causantes de la parada cardiaca en ausencia de cardiopatia aparente es desconocida. Nuestro objetivo es describir los hallazgos clinicos y los medios para alcanzar el diagnostico en una muestra de familiares de probandos con parada cardiaca en ausencia de cardiopatia aparente. Material y metodos Estudiamos a familiares de primer a tercer grado de pacientes afectados por parada cardiaca de origen incierto. En todos se realizo electrocardiograma y ecocardiograma transtoracico. En los casos con diagnostico cierto en el probando, se realizo ademas estudio dirigido en funcion del mismo para desenmascarar la enfermedad. Resultados Se incluyo a 88 sujetos pertenecientes a 35 familias (media de 2,5 familiares por caso indice, con una edad media de 38,4 anos y 52,8% varones). El 55,6% fueron familiares de primer grado y el resto de segundo y tercer grado. En 18 de los 35 casos indice se alcanzo un diagnostico final. Se obtuvo un diagnostico positivo en 19 familiares (21,5%) consistentes en sindrome de Brugada (10 casos), sindrome de QT largo (3 casos), taquicardia ventricular catecolaminergica polimorfica (5 casos) y un caso de posible Sindrome de QT corto. En 4 familias, el diagnostico del probando se alcanzo exclusivamente mediante el estudio familiar. Conclusiones La prevalencia de canalopatias cardiacas entre los familiares de probandos con parada cardiaca de origen incierto fue alta, con frecuente necesidad de test de desenmascaramiento y genetico para logar un diagnostico cierto.
José López-Aguilera, José María Segura Saint-Gerons, Francisco Mazuelos Bellido, Javier Suárez de Lezo, Soledad Ojeda Pineda, Manuel Pan Álvarez-Ossorio, Miguel Ángel Romero Moreno, Djordje Pavlovic, Simona Espejo Pérez, and José Suárez de Lezo
Elsevier BV
ResumenIntroduccion y objetivos
Con frecuencia se producen alteraciones en la conduccion tras el implante de una protesis CoreValve. Se pretende analizar que cambios se producen en la conduccion cardiaca de pacientes con estenosis aortica tratados con este tipo de protesis.
Metodos
Desde abril de 2008 hasta diciembre de 2013, se selecciono a 181 pacientes con estenosis aortica grave tratados con esta protesis y estudiados mediante electrocardiograma. Se estudio a un subgrupo de 137 pacientes consecutivos (75,7%) mediante electrocardiogramas intracavitarios antes y tras implante protesico. El objetivo principal del estudio es la necesidad de marcapasos definitivo en las primeras 72 h tras el implante protesico. Se analizaron numerosas variables para predecir esta eventualidad.
Resultados
Tras el implante, los intervalos PR y QRS se incrementaron de 173 ± 47 a 190 ± 52 ms (p < 0,01) y de 98 ± 22 a 129 ± 24 ms (p < 0,01), mientras que los intervalos AH y HV se alargaron de 95 ± 39 a 108 ± 41 ms (p < 0,01) y de 54 ± 10 a 66 ± 23 ms (p < 0,01). En total, 89 pacientes (49%) presentaron bloqueo de rama izquierda de novo y 33 (25%) precisaron marcapasos en las primeras 72 h. Los predictores independientes de marcapasos fueron el bloqueo de rama derecha basal y la profundidad protesica. Los intervalos intracavitarios carecieron de valor predictivo. Ademas, 13 pacientes requirieron marcapasos despues de las 72 h.
Conclusiones
El implante de protesis CoreValve produce alta incidencia de alteraciones de la conduccion; la mas frecuente es el bloqueo de rama izquierda; el 25% de los pacientes precisaron marcapasos definitivo. La necesidad de marcapasos se relaciono con el bloqueo de rama derecha basal y la profundidad protesica.
Elena Villanueva, Manuel Pan, Soledad Ojeda, Javier Suárez de Lezo, Miguel Romero, Pedro Martín, Francisco Mazuelos, José Segura, Alfonso Medina, and José Suárez de Lezo
Elsevier BV
Resumen Introduccion y objetivos La tecnica de la guia encarcelada resulta de gran utilidad en el tratamiento de lesiones bifurcadas mediante la tecnica de stent condicional. Sin embargo, esta guia puede sufrir dano e incluso fracturarse en el momento de la retirada. El objetivo de este estudio es evaluar la aparicion de dano estructural en las guias encarceladas, tanto polimericas como no polimericas. Metodos Entre enero de 2011 y diciembre de 2012 se realizo un estudio observacional en el que se evaluaron mediante microscopia estereoscopica 135 guias (45 no polimericas y 90 polimericas) utilizadas previamente en el tratamiento percutaneo de bifurcaciones y que resultaron encarceladas. El dano tras la extraccion se valoro como leve, moderado o grave. Resultados Las distribuciones de edad y sexo fueron similares en los dos grupos de pacientes tratados con guias polimericas y no polimericas. Sin embargo, los operadores seleccionaron las guias polimericas con mas frecuencia en bifurcaciones mas complejas y en pacientes diabeticos. Se observo algun tipo de dano microscopico en 25 de las guias analizadas (18%). Paradojicamente, estas alteraciones fueron mas frecuentes en el grupo de guias no polimericas (el 53,0 frente al 1,1%; p Conclusiones Las guias coronarias que se encarcelan durante el tratamiento de las bifurcaciones con stent condicional presentan a menudo dano microscopico no grave. Aunque las guias polimericas se utilizaron en bifurcaciones mas complejas, paradojicamente se danaron con menos frecuencia.
Ignacio Gil-Ortega, Alonso Pedrote-Martínez, and Adolfo Fontenla-Cerezuela
Elsevier BV
Resumen Introduccion y objetivos Se detallan los resultados del Registro Espanol de Ablacion con Cateter ano 2014. Metodos La recogida de datos se llevo a cabo mediante dos sistemas: retrospectivo, mediante cumplimentacion de un formulario, y prospectivo, a traves de una base de datos comun. La eleccion de uno u otro fue voluntaria de cada uno de los centros. Resultados Se recogieron datos de 85 centros. El numero total de procedimientos de ablacion fue 12.871, con una media de 149,5 ± 103 procedimientos. Los tres sustratos abordados con mas frecuencia fueron la taquicardia intranodular (n = 3.026; 23,5%), la ablacion del istmo cavotricuspideo (n = 2.833; 22,0%) y la fibrilacion auricular (n = 2.498; 19,4%). La ablacion de arritmias ventriculares ha permanecido estable, con un ligero incremento de todos los sustratos ventriculares, en especial las taquicardias ventriculares idiopaticas y las asociadas a cicatriz tras infarto. La tasa total de exito fue del 95%; la de complicaciones mayores, del 1,3% y la de mortalidad, del 0,02%. Conclusiones En el registro del ano 2014 se mantiene una linea de continuidad ascendente en el numero de ablaciones realizadas y muestra, en lineas generales, una elevada tasa de exito y bajo numero de complicaciones. Continua el aumento del abordaje de sustratos mas complejos.