Protocolo de sedo-analgesia para prevención del espasmo radial en hemodinámica cardíaca

Introducción y objetivo: El espasmo es la complicación más habitual en los cateterismos por arteria radial. Su frecuencia oscila entre el 10-30% y puede ser un factor limitante que impida la realización del cateterismo por esa vía. El objetivo de este estudio es evaluar con un nuevo protocolo de sedo-analgesia la reducción de la frecuencia del espasmo radial y la disminución de la ansiedad del paciente. Material y método: Estudio aleatorizado y prospectivo de 300 pacientes sometidos a cateterismo radial. Se randomizaron dos grupos, el Grupo I (n=150) con la pauta de sedación habitual (10mg diazepam sl) y el Grupo II (n=150) con una pauta de sedación con 2 mg de Midazolam + 0,035 mg/kg de Cloruro Mórfico y en caso de procedimientos de más de 45 minutos se añadía Fentanilo a 1 mcgr/kg. Resultados y conclusión: No se observaron diferencias significativas entre los dos grupos estudiados en cuanto a las características basales. La edad media de la población fue de 65 ± 11 años; 223 pacientes (74%) fueron hombres y el índice de masa corporal (IMC) medio 27,7 ± 3,8. Los pacientes del Grupo II presentaron reducción significativa del espasmo respecto a los del Grupo I (9,3% frente a 22,6%; p=0,002). También se objetivó una reducción significativa del dolor (2,05 frente a 2,77; p=0,007). La pauta sedo-analgésica propuesta demostró ser eficaz en la reducción del espasmo radial y del dolor durante el cateterismo

Cierre percutáneo de la orejuela izquierda: eficacia, seguridad y nuevas perspectivas

[spa] Esta tesis, presentada como compendio de publicaciones, estudia diversos aspectos relacionados con el cierre percutáneo de orejuela izquierda. Está técnica, de reciente introducción, permite mantener la protección frente a eventos cardioembólicos en pacientes con fibrilación auricular no valvular que no pueden tomar anticoagulación por algún motivo. La tesis doctoral analiza tanto aspectos más generales como la eficacia y seguridad de la técnica, como aspectos más técnicos relacionados con el análisis de las medidas de la orejuela, la selección del dispositivo de cierre y las futuras perspectivas con los dispositivos de segunda generación.[eng] Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) in patients with atrial fibrillation and a relative/absolute contraindication to OAC. The present research explores some clinical, procedural and technical aspect of this novel interventional technique. The most important conclusions that can be extracted from our study and publications are the following: 1- ­‐ LAAO with the Amplatzer Cardiac Plug (ACP) system is a feasible and safe procedure with a low percentage of thrombo-­‐embolic events at follow-­‐up. After comparing the observed and estimated events according to the CHADS2 and CHA2DS2VASc scores for stroke and HASBLED for bleeding, LAAO seem to be associated with an important reduction of the thromboembolic and bleeding risk. 2- ­‐ There is an important variability in the angiographic and echocardiographic measurements of the LAA. Device oversizing does not seem to be associated with its compression once implanted. Device oversizing is however associated with a significant reduction of peri-­‐device leaks during echocardiopgraphic follow-­‐up. 3- ­‐ LAAO occlusion using the Amulet system seems to be feasible and safe in most of LAAs. Despite the absence of differences in procedural success and complications compared to ACP, the Amulet system is associated with a significant reduction of peri-­‐device leaks at follow-­‐up. The novel design features of Amulet seem to ease the procedure in complex anatomies

Cierre percutáneo de la orejuela izquierda: eficacia, seguridad y nuevas perspectivas

Esta tesis, presentada como compendio de publicaciones, estudia diversos aspectos relacionados con el cierre percutáneo de orejuela izquierda. Está técnica, de reciente introducción, permite mantener la protección frente a eventos cardioembólicos en pacientes con fibrilación auricular no valvular que no pueden tomar anticoagulación por algún motivo. La tesis doctoral analiza tanto aspectos más generales como la eficacia y seguridad de la técnica, como aspectos más técnicos relacionados con el análisis de las medidas de la orejuela, la selección del dispositivo de cierre y las futuras perspectivas con los dispositivos de segunda generación.Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) in patients with atrial fibrillation and a relative/absolute contraindication to OAC. The present research explores some clinical, procedural and technical aspect of this novel interventional technique. The most important conclusions that can be extracted from our study and publications are the following: 1- ­‐ LAAO with the Amplatzer Cardiac Plug (ACP) system is a feasible and safe procedure with a low percentage of thrombo-­‐embolic events at follow-­‐up. After comparing the observed and estimated events according to the CHADS2 and CHA2DS2VASc scores for stroke and HASBLED for bleeding, LAAO seem to be associated with an important reduction of the thromboembolic and bleeding risk. 2- ­‐ There is an important variability in the angiographic and echocardiographic measurements of the LAA. Device oversizing does not seem to be associated with its compression once implanted. Device oversizing is however associated with a significant reduction of peri-­‐device leaks during echocardiopgraphic follow-­‐up. 3- ­‐ LAAO occlusion using the Amulet system seems to be feasible and safe in most of LAAs. Despite the absence of differences in procedural success and complications compared to ACP, the Amulet system is associated with a significant reduction of peri-­‐device leaks at follow-­‐up. The novel design features of Amulet seem to ease the procedure in complex anatomies

Cierre percutáneo de la orejuela izquierda: eficacia, seguridad y nuevas perspectivas

Esta tesis, presentada como compendio de publicaciones, estudia diversos aspectos relacionados con el cierre percutáneo de orejuela izquierda. Está técnica, de reciente introducción, permite mantener la protección frente a eventos cardioembólicos en pacientes con fibrilación auricular no valvular que no pueden tomar anticoagulación por algún motivo. La tesis doctoral analiza tanto aspectos más generales como la eficacia y seguridad de la técnica, como aspectos más técnicos relacionados con el análisis de las medidas de la orejuela, la selección del dispositivo de cierre y las futuras perspectivas con los dispositivos de segunda generación.Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) in patients with atrial fibrillation and a relative/absolute contraindication to OAC. The present research explores some clinical, procedural and technical aspect of this novel interventional technique. The most important conclusions that can be extracted from our study and publications are the following: 1- ­‐ LAAO with the Amplatzer Cardiac Plug (ACP) system is a feasible and safe procedure with a low percentage of thrombo-­‐embolic events at follow-­‐up. After comparing the observed and estimated events according to the CHADS2 and CHA2DS2VASc scores for stroke and HASBLED for bleeding, LAAO seem to be associated with an important reduction of the thromboembolic and bleeding risk. 2- ­‐ There is an important variability in the angiographic and echocardiographic measurements of the LAA. Device oversizing does not seem to be associated with its compression once implanted. Device oversizing is however associated with a significant reduction of peri-­‐device leaks during echocardiopgraphic follow-­‐up. 3- ­‐ LAAO occlusion using the Amulet system seems to be feasible and safe in most of LAAs. Despite the absence of differences in procedural success and complications compared to ACP, the Amulet system is associated with a significant reduction of peri-­‐device leaks at follow-­‐up. The novel design features of Amulet seem to ease the procedure in complex anatomies

Procedural Tools and Technics for Transcatheter Paravalvular Leak Closure: Lessons from a Decade of Experience.

Prosthetic paravalvular leaks (PVLs) are associated with congestive heart failure and hemolysis. Surgical PVL closure carries high risks. Transcatheter implantation of occluding devices in PVL is a lower risk but challenging procedure. Of the available devices, only two have been specifically approved in Europe for transcatheter PVL closure (tPVLc): the Occlutech® Paravalvular Leak Device (PLD) and Amplatzer™ ParaValvular Plug 3 (AVP 3). Here, we review the various tools and devices used for tPVLc, based on three observational registries including 748 tPVLc procedures performed in 2005-2021 at 33 centres in 11 countries. In this case, 12 registry investigators with over 20 tPVLc procedures each described their practical tips and tricks regarding imaging, approaches, delivery systems, and devices. They considered three-dimensional echocardiography to be the cornerstone of PVL assessment and procedure guidance. Anterograde trans-septal mitral valve and retrograde aortic approaches were used in most centres, although some investigators preferred the transapical approach. Hydrophilic-coated low-profile sheaths were used most often for device deployment. The AVP 3 and PLD devices were chosen for 89.0% of procedures. Further advances in design and materials are awaited. These complex procedures require considerable expertise, and experience accumulated over a decade has no doubt contributed to improve practices

Linking in vitro models of endothelial dysfunction with cell senescence

Endothelial cell dysfunction is the principal cause of several cardiovascular diseases that are increasing in prevalence, healthcare costs, and mortality. Developing a standardized, representative in vitro model of endothelial cell dysfunction is fundamental to a greater understanding of the pathophysiology, and to aiding the development of novel pharmacological therapies. We subjected human umbilical vein endothelial cells (HUVECs) to different periods of nutrient deprivation or increasing doses of H2O2 to represent starvation or elevated oxidative stress, respectively, to investigate changes in cellular function. Both in vitro cellular models of endothelial cell dysfunction‐associated senescence developed in this study, starvation and oxidative stress, were validated by markers of cellular senescence (increase in β‐galactosidase activity, and changes in senescence gene markers SIRT1 and P21) and endothelial dysfunction as denoted by reductions in angiogenic and migratory capabilities. HUVECs showed a significant H2O2 concentration-dependent reduction in cell viability (p<0.0001), and a significant increase in oxidative stress (p<0.0001). Furthermore, HUVECs subjected to 96h of starvation, or exposed to concentrations of H2O2 of 400 to 1000μM resulted in impaired angiogenic and migratory potentials. These models will enable improved physiological studies of endothelial cell dysfunction, and the rapid testing of cellular efficacy and toxicity of future novel therapeutic compounds