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142 Transcatheter valve-in-valve implantation for failed balloon expandable transcatheter aortic valves
S113
Abstracts
Table 1: Summary of admission and discharge variables for CKD and non-CKD groups. Outcome Measure
Resting Heart Rate (bpm) Resting Blood Pressure
CKD
Significance (p)
Admission Discharge Admission Discharge
Admission Discharge Change Values Values
72±13 SBP (mmHg) 120±17 DBP(mmHg) 68±10
Anthropometric Weight (kg) Measurements
Non-CKD
71±13
77±14
75±13
0.003
0.005
0.600
114±14
119±18
114±12
0.507
0.843
0.484
64±7
73±10
72.4±13.5
71.2±12.5 88.2±16.4
67±7
<0.001
<0.001
0.082
85.5±15.2
<0.001
<0.001
<0.001
WC (cm)
93.7±12.9
92.8±11.7 104.8±12.9 102.41±11.9 <0.001
<0.001
0.002
Choltotal (mmol/L)
3.70±1.02
3.48±0.83 3.67±1.04
3.49±0.87
0.838
0.923
0.876
HDL (mmol/L)
1.25±0.34
1.30±0.38 1.41±0.32
1.20±0.32
0.005
0.008
0.835
LDL (mmol/L)
1.84±0.86
1.66±0.64 1.87±0.84
1.76±0.69
0.768
0.205
0.499
Triglycerides 1.34±0.76 (mmol/L)
1.17±0.58 1.41±0.84
1.16±0.68
0.550
0.433
0.219
Inflammatory Marker
hs-CRP (mg/L)
4.1±8.6
3.4±10.3
3.4±7.1
2.6±7.7
0.035
0.001
0.962
Glucose Metabolism
HbA1c (%)
6.2±0.9
6.2±0.8
6.1±1.0
6.0±0.8
0.452
0.015
0.042
FBG (mmol/L)
5.9±1.5
5.8±1.2
6.0±1.6
5.8±1.2
0.527
0.843
0.576
peakMETs
6.4±2.1
7.8±2.0
8.09±2.2
9.5±2.42
<0.001
<0.001
0.572
Lipid Profile
Functional Exercise Capacity
Canadian Cardiovascular Society (CCS) CCS106 Oral CORONARY INTERVENTIONAL POTPOURRI Sunday, October 23, 2011
141 EFFECTIVENESS OF MODERN TECHNIQUES AND THE TRANSRADIAL APPROACH FOR THE RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS; EARLY CANADIAN EXPERIENCE S Rinfret, D Joyal, S Mansour, C Nguyen, R Leung, W Hui, MP Love Québec, Québec BACKGROUND: Chronic total occlusions (CTO) remain difficult le-
sions to treat with percutaneous coronary intervention (PCI). New devices and techniques are now available to improve recanalization success rates. Whether such techniques can be performed from a transradial approach was unknown. METHODS: This series is from a single high-volume operator (SR) who performed a total of 108 CTO PCI from January 2010 to April 2011, including 20 cases performed in other Canadian institutions while teaching new techniques to experienced transradial operators, including re-entry techniques and the retrograde approach. RESULTS: Most frequent indications for recanalization were CCS 3-4 angina (46%) and CCS 1-2 (24%). 79 patients (75%) were referred from other general or interventional cardiologists, and 38 (36%) patients underwent one or several previous failed attempts. CTO was in the right coronary in 54%,the left anterior descending in 23%, the left circumflex system in 15%, in diagonal branches in 6%, and the left main in 2%. Most lesions (74%) were ⱖ20 mm long, and 45% were calcified. Dual access was performed in 75% of patients. 56 patients (52%) had a retrograde component to the procedure; of these patients, a retrograde guidewire was successfully placed to the distal end of the occlusion in 82%.
Radial access was used in 94%, and was bilateral in 62%. 6 Fr guides were used in 95% for the contralateral side, 82% for the antegrade side. Otherwise, 7 Fr guides were used. The Corsair catheter was utilized in 79% of the retrograde procedures, most through 6 Fr. The FineCross microcatheter was used at the proximal cap in 60%. The Tornus catheter was used in 33% of cases, and 3 were performed using the BridgePoint CTO re-entry system, through 6 Fr catheters. Procedural success was achieved in 97 (90%), and no in-hospital major cardiac events occurred. CONCLUSION: Transradial CTO recanalization is feasible, teachable, safe, and associated with high success rates despite the use of smaller guide catheters. 142 TRANSCATHETER VALVE-IN-VALVE IMPLANTATION FOR FAILED BALLOON EXPANDABLE TRANSCATHETER AORTIC VALVES DA Wood, S Toggweiler, J Ye, A Cheung, J Leipsic, R Gurvitch, A Willson, R Binder, J Rodés-Cabau, S Kapadia, L Svensson, JG Webb Vancouver, British Columbia BACKGROUND: Device malposition after transcatheter aortic valve replacement can cause significant clinical and hemodynamic instability. Aortic regurgitation following transcatheter heart valve (THV) implantation may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing. When regurgitation is severe implantation of a second valve (THV-in-THV) may be effective by restoring normal leaflet function or extending the annular seal. METHODS AND RESULTS: 19 patients (age 80 ⫾ 8 years, 53% male)underwent aortic balloon-expandable THV-in-THV implantation at 3 centres (St. Paul’s Hospital, Vancouver, the Québec Heart and Lung Institute, Québec, and the Cleveland Clinic Foundation, Cleveland). Aortic regurgitation after the first implanted valve was paravalvular in 14 patients (implant too high in 2 patients, too low in 10 patients, and angiographically correct positioning in 2 patients) and transvalvular in 5 patients (4 Edwards SAPIEN valves, 1 Cribier Edwards valve). THV-in-THV implantation was successful in 17/19 (89%), while 2 patients (11%) required conversion to open heart surgery. None of the patients had transvalvular aortic regurgitation after the second procedure. Paravalvular aortic regurgitation was none in 4, mild in 11 and moderate to severe in 2 patients. Mean aortic valve gradient fell from 36 ⫾ 11 mmHg to 13 ⫾ 5 mmHg (P ⬍ 0.001) after implantation of the second valve. Mortality at 30 days and 1 year was 11.8% and 22.7%, respectively. At one year follow-up, all but one patient was NYHA class 1 or 2 and the mean gradient across the aortic valve remained stable (14 ⫾ 5 mmHg). CONCLUSIONS: This multicenter study shows that THV-inTHV implantation is feasible and results in satisfactory short and long term outcomes.
Abstracts
Table 1: Summary of admission and discharge variables for CKD and non-CKD groups. Outcome Measure
Resting Heart Rate (bpm) Resting Blood Pressure
CKD
Significance (p)
Admission Discharge Admission Discharge
Admission Discharge Change Values Values
72±13 SBP (mmHg) 120±17 DBP(mmHg) 68±10
Anthropometric Weight (kg) Measurements
Non-CKD
71±13
77±14
75±13
0.003
0.005
0.600
114±14
119±18
114±12
0.507
0.843
0.484
64±7
73±10
72.4±13.5
71.2±12.5 88.2±16.4
67±7
<0.001
<0.001
0.082
85.5±15.2
<0.001
<0.001
<0.001
WC (cm)
93.7±12.9
92.8±11.7 104.8±12.9 102.41±11.9 <0.001
<0.001
0.002
Choltotal (mmol/L)
3.70±1.02
3.48±0.83 3.67±1.04
3.49±0.87
0.838
0.923
0.876
HDL (mmol/L)
1.25±0.34
1.30±0.38 1.41±0.32
1.20±0.32
0.005
0.008
0.835
LDL (mmol/L)
1.84±0.86
1.66±0.64 1.87±0.84
1.76±0.69
0.768
0.205
0.499
Triglycerides 1.34±0.76 (mmol/L)
1.17±0.58 1.41±0.84
1.16±0.68
0.550
0.433
0.219
Inflammatory Marker
hs-CRP (mg/L)
4.1±8.6
3.4±10.3
3.4±7.1
2.6±7.7
0.035
0.001
0.962
Glucose Metabolism
HbA1c (%)
6.2±0.9
6.2±0.8
6.1±1.0
6.0±0.8
0.452
0.015
0.042
FBG (mmol/L)
5.9±1.5
5.8±1.2
6.0±1.6
5.8±1.2
0.527
0.843
0.576
peakMETs
6.4±2.1
7.8±2.0
8.09±2.2
9.5±2.42
<0.001
<0.001
0.572
Lipid Profile
Functional Exercise Capacity
Canadian Cardiovascular Society (CCS) CCS106 Oral CORONARY INTERVENTIONAL POTPOURRI Sunday, October 23, 2011
141 EFFECTIVENESS OF MODERN TECHNIQUES AND THE TRANSRADIAL APPROACH FOR THE RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS; EARLY CANADIAN EXPERIENCE S Rinfret, D Joyal, S Mansour, C Nguyen, R Leung, W Hui, MP Love Québec, Québec BACKGROUND: Chronic total occlusions (CTO) remain difficult le-
sions to treat with percutaneous coronary intervention (PCI). New devices and techniques are now available to improve recanalization success rates. Whether such techniques can be performed from a transradial approach was unknown. METHODS: This series is from a single high-volume operator (SR) who performed a total of 108 CTO PCI from January 2010 to April 2011, including 20 cases performed in other Canadian institutions while teaching new techniques to experienced transradial operators, including re-entry techniques and the retrograde approach. RESULTS: Most frequent indications for recanalization were CCS 3-4 angina (46%) and CCS 1-2 (24%). 79 patients (75%) were referred from other general or interventional cardiologists, and 38 (36%) patients underwent one or several previous failed attempts. CTO was in the right coronary in 54%,the left anterior descending in 23%, the left circumflex system in 15%, in diagonal branches in 6%, and the left main in 2%. Most lesions (74%) were ⱖ20 mm long, and 45% were calcified. Dual access was performed in 75% of patients. 56 patients (52%) had a retrograde component to the procedure; of these patients, a retrograde guidewire was successfully placed to the distal end of the occlusion in 82%.
Radial access was used in 94%, and was bilateral in 62%. 6 Fr guides were used in 95% for the contralateral side, 82% for the antegrade side. Otherwise, 7 Fr guides were used. The Corsair catheter was utilized in 79% of the retrograde procedures, most through 6 Fr. The FineCross microcatheter was used at the proximal cap in 60%. The Tornus catheter was used in 33% of cases, and 3 were performed using the BridgePoint CTO re-entry system, through 6 Fr catheters. Procedural success was achieved in 97 (90%), and no in-hospital major cardiac events occurred. CONCLUSION: Transradial CTO recanalization is feasible, teachable, safe, and associated with high success rates despite the use of smaller guide catheters. 142 TRANSCATHETER VALVE-IN-VALVE IMPLANTATION FOR FAILED BALLOON EXPANDABLE TRANSCATHETER AORTIC VALVES DA Wood, S Toggweiler, J Ye, A Cheung, J Leipsic, R Gurvitch, A Willson, R Binder, J Rodés-Cabau, S Kapadia, L Svensson, JG Webb Vancouver, British Columbia BACKGROUND: Device malposition after transcatheter aortic valve replacement can cause significant clinical and hemodynamic instability. Aortic regurgitation following transcatheter heart valve (THV) implantation may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing. When regurgitation is severe implantation of a second valve (THV-in-THV) may be effective by restoring normal leaflet function or extending the annular seal. METHODS AND RESULTS: 19 patients (age 80 ⫾ 8 years, 53% male)underwent aortic balloon-expandable THV-in-THV implantation at 3 centres (St. Paul’s Hospital, Vancouver, the Québec Heart and Lung Institute, Québec, and the Cleveland Clinic Foundation, Cleveland). Aortic regurgitation after the first implanted valve was paravalvular in 14 patients (implant too high in 2 patients, too low in 10 patients, and angiographically correct positioning in 2 patients) and transvalvular in 5 patients (4 Edwards SAPIEN valves, 1 Cribier Edwards valve). THV-in-THV implantation was successful in 17/19 (89%), while 2 patients (11%) required conversion to open heart surgery. None of the patients had transvalvular aortic regurgitation after the second procedure. Paravalvular aortic regurgitation was none in 4, mild in 11 and moderate to severe in 2 patients. Mean aortic valve gradient fell from 36 ⫾ 11 mmHg to 13 ⫾ 5 mmHg (P ⬍ 0.001) after implantation of the second valve. Mortality at 30 days and 1 year was 11.8% and 22.7%, respectively. At one year follow-up, all but one patient was NYHA class 1 or 2 and the mean gradient across the aortic valve remained stable (14 ⫾ 5 mmHg). CONCLUSIONS: This multicenter study shows that THV-inTHV implantation is feasible and results in satisfactory short and long term outcomes.