Vascular access approach for structural heart procedures

Vascular access is an essential part of all interventional procedures whether coronary or structural. Over the last 15 to 20 years, in coronary interventions, traditional femoral access has been mostly replaced by the radial approach. Nonetheless, the femoral approach through both artery and vein is still the main approach for structural heart procedures. Over the last few years, femoral access has evolved from a puncture guided by anatomical references to more accurate ultrasound-guided approaches. The relatively recent introduction of interventions such as transcatheter aortic valve replacement has conditioned the use of large introducers and ultimately the need for specific hemostatic systems, above all, percutaneous closure devices. This manuscript reviews different anatomical concepts, puncture techniques, diagnostic assessments, and closure strategies of the main arterial and venous approaches for the diagnosis and treatment of different structural heart procedures

Robotics and augmented reality for elderly assistance

This article presents a tele-assistance system based on augmented reality for elderly people that is integrated in a mobile platform. We propose the use of augmented reality for simplifying interaction with its users. The first prototype has been designed to help in medication control for ederly people. In this paper, both hardware and software architectures are described.The robotic platform is a slightly modified version of the Turtlebot platform. The software is based on ROS for the platform control, and in ArUco for the augmented reality interface. It also integrates other related systems in teleassistance such as VoIP, friendly user interface, etc

784-3 Prognostic Significance of Intimal Thickening Detected by Intracoronary Ultrasound in Heart Transplant Recipients

Intracoronary ultrasound (ICUS) is a sensitive tool for the detection of intimal thickening in coronary arteries of heart transplants recipients. However, the prognostic significance of this intimal thickening has not been proven.During a one year period, 90 transplant recipients had ICUS examination at the time of their annual angiogram. For each ICUS study an intimal index (II), defined as the ratio of the plaque area to the area within the media, was measured for the most diseased segment imaged. The angiogram at the time of ICUS was reviewed for the presence of visually apparent coronary artery disease (V-CADI· Those patients (n=19) with V-CAD present at the time of ICUS were excluded from the study. The time since transplantation for the 71 pts without V-CAD ranged from 1 to 15 yrs, with a mean of 4.2 yrs and median of 3.9 yrs. The subsequent annual follow-up angiograms of the 71 patients without V-CAD at the time of ICUS were reviewed for the development of V-CAD. Mean duration of angiographic follow-up was 2.0 yrs (range 1–3 yrs).V-CAD developed on follow-up angiograms in 13 of the 71 pts. Mean time to development of V-CAD was 1.5 yrs. Forty-six patients had II<0.3, 4 (9%) of whom subsequently developed V-CAD. Twenty-five patients had II ≥0.3, 9 (36%) of whom developed V-CAD. Odds ratio for future V-CAD between pts with II<0.3 and II 2: 0.3 was 5.9 (95% CI 1.8 to 19.0, difference significant at p<0.01 by Fisher's Exact test).In a subgroup of 22 patients more than 5 years post transplantation at the time of ICUS, 12 had II<0.3 and 10 had II 2≥0.3. In this subgroup none of the 12 pts with II<0.3 developed V-CAD and only 1 of the 10 with II >0.3 developed V-CAD (difference not significant).Conclusion — Among patients more than 1 year and less than 5 years post-transplantation without visually apparent angiographic coronary artery disease, the presence of moderate to severe intimal thickening by ICUS is predictive of the future development of angiographically apparent CAD. Intimal thickening as detected by ICUS is of prognostic significance in patients with angiographically silent transplant coronary artery disease

Realidad aumentada para la teleasistencia en ancianos

[ES] En las últimas décadas las mejoras en campos como la alimentación o la medicina ha permitido mejorar el día a día de los mayores y alargar su esperanza de vida lo que ha significado un aumento de la población mayor. Ahora bien, ante estas nuevas circunstancias debemos abordar las necesidades específicas sobre este grupo de población. Creemos que, aprovechando las ventajas que las nuevas tecnologías pueden ofrecernos, podemos desarrollar nuevos sistemas tecnológicos adaptados a los ancianos que les permitirán aprovechar las nueva etapas que tienen ante ellos

Incidence and prognosis of late readmission after percutaneous coronary intervention

Background: Early readmission (< 30 days) after percutaneous coronary intervention (PCI) is associated with a worse prognosis, but little is known regarding the causes and consequences of late readmission. The aim of the present study was to determine the incidence, causes, and prognosis of patients readmitted > 1 < 12-months after PCI (late readmission). Methods: Single-center retrospective cohort study of 743 consecutive post-PCI patients. Patient characteristics and follow-up data were collected by reviewing their electronic medical records and from standardized telephone interviews performed at 1 year and at the end of follow-up. Results: Of the 743 patients, 224 (30.14%) were readmitted 1–12 months after PCI, 109 due to chest pain (48.66%), and 115 for other reasons (51.34%). Hospital readmission was associated with lower survival rates of 77.6% vs. 98.3% at 24 months and 73.5% vs. 97.6% at 36 months (p < 0.001). Univariate predictors for late readmission were hypertension, older age, chronic kidney disease, lower left ventricular ejection fraction, and lower baseline hemoglobin concentration. Only baseline hemoglobin concentration was an independent predictor of late readmission (odds ratio: 0.867, 95% confidence interval: 0.778–0.966, p = 0.01). Readmission for chest pain portrayed a lower mortality rate compared to other causes, with survival rates of 90.2% vs. 50% at 36 months (p < 0.001). Conclusions: Late hospital readmission after PCI is associated with a worse prognosis and is related to patient comorbidities. Readmission for chest pain is common and portrayed a more favorable prognosis, similar to patients not readmitted. A readily available parameter, baseline anemia, was the main predictor of late readmission

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival.

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain, the European Union–European Regional Development Fund (EC07/90772 and PI19/00649), and the Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).S

Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry

Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. Methods: Prospective, multicenter, 'real-world' registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. Results: 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted

Evaluación y guía terapéutica de las lesiones coronarias intermedias en el laboratorio de hemodinámica

La evaluación de la severidad de las lesiones coronarias se realiza, desde hace 5 décadas, mediante angiografía de contraste. Sin embargo, esta técnica es muy limitada para detectar las lesiones intermedias capaces de inducir isquemia. Un elevado número de pacientes se somete a cateterismo cardíaco sin una evaluación precisa, no invasiva, de la perfusión coronaria mediante pruebas de detección de isquemia. Cabe esperar que, en los próximos años, esta tendencia se acentúe, a tenor de las actuales recomendaciones de las guías de tratamiento de los síndromes coronarios agudos, que favorecen un tratamiento invasivo precoz. Todo ello ha despertado el interés por disponer de nuevas técnicas capaces de evaluar la significación fisiológica de las lesiones intermedias en el laboratorio de hemodinámica. Esta puesta al día pretende repasar las alternativas de las que se dispone en la actualidad en el laboratorio para tratar de evaluar de una manera científica la significación fisiológica de las lesiones intermedias, así como sus ventajas y limitaciones

Editorial: Lesiones en bifurcaci\uf3n: la \ufaltima gran frontera del intervencionismo coronario

La aterosclerosis es una enfermedad sist\ue9mica que afecta de forma difusa, aunque no uniforme, al territorio arterial. Las bifurcaciones arteriales, debido a las turbulencias del flujo sangu\uedneo que all\ued se originan, son sitios de alto estr\ue9s endotelial, que caracter\uedsticamente enferman de aterosclerosis. Aunque existen m\ufaltiples definiciones sobre lo que constituye una lesi\uf3n bifurcada, desde el punto de vista del intervencionismo coronario se acepta que es la lesi\uf3n que ocurre adyacente al origen de una rama secundaria o lo involucra y es de calibre y desarrollo significativos. Alrededor de un 10-15% de las lesiones que se abordan mediante angioplastia afectan a una bifurcaci\uf3n (datos del Hospital de Alcorc\uf3n no publicados). Desde el punto de vista del cardi\uf3logo intervencionista, estas lesiones han constituido una dificultad especial, con peores resultados inmediatos y a medio plazo. A pesar de que acabamos de cumplir tres d\ue9cadas del comienzo del intervencionismo coronario, el abordaje \uf3ptimo de las lesiones en bifurcaci\uf3n sigue siendo objeto de debate e investigaci\uf3n..

Historia natural de la endocarditis infecciosa en pacientes heroinomanos

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai