EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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For appropriately selected patients with severe mitral regurgitation, percutaneous mitral valve repair with the MitraClip® system is a promising alternative to open chest surgery. The procedure requires transoesophageal echocardiographic guidance and is performed under general anaesthesia. However, many patients undergoing percutaneous repair are at high risk for complications related to anaesthesia. We report our initial experience in the use of the MitraClip® system under deep sedation and local anaesthesia in five consecutive cases. ⋯ The implantation of a MitraClip® is feasible under local anaesthesia and sedation. In patients at high risk for complications related to general anaesthesia, percutaneous mitral valve repair under local anaesthesia may be a viable alternative.
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The aim of this study was to identify the incidence and risk factors for acute kidney injury (AKI) after TAVI, a potentially serious complication of transcatheter aortic valve implantation (TAVI) that has been redefined by the Valve Academic Research Consortium (VARC). ⋯ More than one third of patients sustain AKI after TAVI using the Edwards bioprosthesis, as defined by the VARC-modified RIFLE score. AKI increased the mortality at both 30 days and at one year. A history of diabetes mellitus, peripheral vascular disease and higher chronic kidney disease stage had the strongest independent associations with post-TAVI AKI.
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The Stent for Life Initiative was founded in September 2008 as a coalition of the European Society of Cardiology, European Association for Percutaneous Cardiovascular Interventions and Eucomed. The aim is to promote the life-saving indications for percutaneous coronary interventions--especially in all forms of acute myocardial infarction. This article describes how this initiative began.
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Review Meta Analysis Comparative Study
The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis.
There is an increasing amount of data suggesting that transradial approach is associated with lower incidence of complications in vascular access site and improved clinical outcomes compared with transfemoral approach in the setting of ST-segment elevation myocardial infarction (STEMI). The objective of this study was to assess the safety and efficacy of radial versus femoral percutaneous coronary intervention (PCI) for patients with STEMI. ⋯ This updated meta-analysis demonstrates that transradial PCI reduces the risk of significant periprocedural bleeding and improve clinical outcomes in patients with STEMI.
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In remote, sparsely populated areas with long transfer distances to percutaneous coronary intervention (PCI) centres it is impossible to deliver PCI within the recommended time limits, and fibrinolysis should be the treatment of choice in patients with ST-elevation myocardial infarction (STEMI). Fibrinolysis should preferably be administered in the pre-hospital setting. Patients with contraindications to fibrinolysis, late presenters and patients with cardiogenic shock should be transferred for primary PCI, even when the transfer delays are substantial. ⋯ The optimal timing of routine angiography following fibrinolysis is not settled, but recent trials suggest a time window of two to 12 hours. A well-organised system of care with clear treatment protocols and coordinated transfer systems is necessary for identifying treatment-eligible patients for on-site fibrinolysis or transfer for primary PCI, and for ensuring that therapies are available in a timely manner 24 hours a day, seven days a week. A well-organised STEMI network is also necessary for early transfer of lytic treated patients for rescue PCI or routine angiography.