COMUNICAZIONI - Giornale Italiano di Cardiologia

G Ital Cardiol Vol 8 Suppl 2-5 2007
Results. Successful deployment of the stent grafts in the intended position was
achieved in 44 patients (98%). Twenty-two patients received a single stent graft,
16 patients had 2 and one patient received 4 stents. There was one hospital
death.
A single primary dislocation required surgical transposition of the aortic arch
branches and the positioning of a second stent. Four surgical procedures have
been performed to facilitate the endovascular approach: three transpositions of
the aortic arch branches, and one carotid-subclavian shunt.
Complications included permanent paraplegia in 2 patients and transitory
paraplegia requiring spinal fluid drainage in one patient. Type I endoleaks were
reported in 4 patients and were successfully repaired by using endovascular
techniques.
No peripheral embolization or distal migration of the stents were observed. No
surgical conversion of the procedure was needed at the time of stent graft
placement and at follow up. There were 5 late deaths (two procedure-related).
Conclusions. In our experience endovascular stent-graft repair of different types
of descending thoracic aortic diseases is a less invasive procedure alternative to
surgical repair with acceptable morbidity and mortality rate. A team approach
between interventional radiologists and surgeons and careful follow-up of the
patient is mandatory to manage complications and to optimize the treatment of
complex lesions involving the thoracic aorta.
C66
SAFETY AND EFFICACY OF PROTECTED CAROTID ARTERY STENTING IN
ELDERLY PATIENTS - A SINGLE CENTER EXPERIENCE
A. Rizza, C. Palmieri, G. Trianni, L. Sulcaj, A. Al-Jabri, M. Ravani, M. Vaghetti,
S. Berti
Institute of Clinical Physiology-CNR, “G. Pasquinucci” Hospital, Massa, Italy
Background. Stroke is the second cause of death in elderly patients and 30-60%
of strokes in this age group are due to carotid stenosis. Carotid angioplasty with
stenting (CAS) is an alternative to endarterectomy for treatment of carotid
stenosis. Little is known about the results of CAS in elderly patients.
Objective. To assess the early- and long-term results of protected CAS in elderly
patients.
Methods. Included in this study were 70 patients aged >75 years with carotid
stenosis who underwent CAS with embolic protection devices in our hospital. Of
the whole population 53 patients had a history of coronary artery disease and 37
of them had undergone revascularization procedures; 18 patients suffered
peripheral artery disease; and 1 patient had renal artery stenosis. Mean age of
patients included in the study was 79±4 years; 24 patients were women. The
following risk factors: diabetes mellitus type II, arterial hypertension, and
hypercholesterolemia, were present in 27%, 90%, and 84% of the patients,
respectively. Of the total study population, 30 patients had bilateral carotid-artery
disease and 12 patients had suffered prior ischemic events. The following types
of carotid stents were implanted: Acculink (66 patients), Precise (3 patients) and
Wallstent (1 patients). The following types of embolic protection devices were
used: Accunet (54 patients), Percusurge (5 patients), Mo.Ma (8 patients) and
PAES (3 patients). Postprocedural antiplatelet therapy consisted of aspirin and a
thienopyridine agent during the first month and beyond it, all patients received
aspirin indefinitely. Clinical follow-up after hospital discharge was performed by
visits at the outpatient clinic after 25±13 months following the index procedure.
Results. In the early periprocedural period only 1 study patient suffered stroke;
no other adverse events occurred during this period of time. Mean hospitalization
time was 3±1 days, except for the single patient who developed stroke. At a mean
follow-up period of 25 months, 1 patient had a transient ischemic attack while 3
patients developed restenosis. No patients died or suffered a myocardial
infarction during the follow-up period.
Conclusions. The results of this study demonstrate that CAS with embolic
protection device can be safely and effectively performed in elderly patients with
significant carotid artery disease.
C67
TRATTAMENTO DELLE STENOSI CAROTIDEE CON IMPIANTO DI STENT:
FOLLOW-UP CLINICO-STRUMENTALE A 1, 2 e 3 ANNI
S. Galli, P. Montorsi, S. Ghulam-Ali, P. Ravagnani, F. Fabbiocchi, A. Lualdi,
D. Trabattoni, S. De Martini, G. Calligaris, G. Teruzzi, L. Grancini, A.L. Bartorelli
Centro Cardiologico Monzino, IRCCS, Università di Milano, Italia
Introduzione e scopo. Il trattamento delle stenosi carotidee con impianto di stent
(CAS) risulta ormai un’alternativa alla tradizionale endoarterectomia (TEA).
Tuttavia se i risultati a breve termine risultano sovrapponibili, poco è noto in
merito a quelli relativi all’outcome dei pz. trattati con CAS. Scopo dello studio è
valutare i risultati a medio e a lungo termine di CAS.
Metodi. Dal 2003 278 pz. consecutivi (età media 71.3±7.5 aa) sono stati
sottoposti a CAS, tutti con condotte con protezione cerebrale, prevalentemente
con filtri (Filtri 95%; Sistemi Occlusivi 5%). Gli stent utilizzati con design dedicato
erano: Wallstent 35%; Précise 25%; Protegé 20%; X-ACT 17% ed altri 3%. I pz.,
se sintomatici con stenosi ≥50% e asintomatici ≥75%), venivano sottoposti a
valutazione clinico-neurologica e strumentale con TC encefalo basale ed ECOdoppler
basale, a 3-6 mesi, a 12 mesi e quindi a cadenza annuale.
Risultati. Sesso maschile 65%; diabete mellito 21% e ad elevato rischio
chirurgico nel 22% dei casi. Sintomatici erano il 35% con stenosi ECOdoppler
basale = 85±7%. La morfologia della stenosi era: soft/ulcerata 28%; fibrosa 40%;
calcifica 25% e ristenosi post-TEA 7%. Nel 68% dei casi è stato eseguito impianto
diretto con post-dilatazione nel 99% dei casi. Il filtro presentava debris nel 60%
dei casi. Il tempo procedurale è risultato pari a 18±7 min. Il successo procedurale
è stato raggiunto nel 98% mentre quello angiografico nel 99% dei casi. Le
complicanze minori sono state: TIA 17 (6.1%; 11 risolti in sala angiografica e 6 in
reparto); ipotensione ortostatica >24 ore 11 (4%) e 6 (2.1%) le complicanze
vascolari maggiori in sede di accesso femorale. Gli eventi avversi maggiori sono
rappresentati in tabella:
FU a 30 gg A 1 anno A 2 anni A 3 anni Totale
N=278(%) N=208(%) N=137(%) N=75(%) N=278(%)
Morte Totale 0 (0) 4 (1.9) 0 (0) 0 (0) 0 (0)
Morte cerebro-cardiovascolare 0 (0) 1 (0.5) 0 (0) 0 (0) 0 (0)
Morte non-cardiaca 0 (0) 3 (1.4) 0 (0) 0 (0) 0 (0)
Stroke Maggiore Ipsilaterale 2 (0.7) 0 (0) 0 (0) 0 (0) 2 (0.7)
Stroke Minore Ipsilaterale 2 (0.7) 2 (0.9) 0 (0) 0 (0) 4 (1.4)
IMA Q/non-Q 0 (0) 5 (2.4) 3 (4.5) 2 (2.6) 10 (3.6)
Stroke Maggiore Controlaterale 0 (0) 0 (0) 0 (0) 1 (1.3) 1 (0.3)
Stroke Minore Controlaterale 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
MACCE Composito 4 (1.4) 11 (5.3) 7 (5.1) 7 (9.3) 24 (8.6)
Sopravv. libera da eventi 274 (98.6) 197 (94.7) 130 (94.9) 68 (90.6) 254 (91.3)
Ristenosi all’ECO ≥50% 0 (0) 2# (0.9) 0 (0) 0 (0) 2 (0.7)
MACCE: eventi avversi maggiori cerebro-cardiovascolari (Morte, Stroke Maggiore e Minore e IMA
Q/nonQ). #2 pz. con PSV= 150 cm/sec, stenosi derivata >50%, asintomatici, non trattate.
Conclusioni. I risultati, di questo studio monocentrico e prospettico, confermano
che il trattamento delle stenosi carotidee con CAS risulta altamente efficace e
sicuro. Anche i risultati clinico-strumentali a medio-lungo termine confermano che
tale efficacia e sicurezza si mantengono nel tempo.
Cardiochirurgia
C68
IS THERE STILL A ROLE OF PNEUMATIC ASSIST DEVICES FOR
MECHANICAL CIRCULATORY SUPPORT IN THE CURRENT ERA? THE
UDINE EXPERIENCE
G. Guzzi, V. Tursi, E. Spagna, L.P. Badano, D. Pavoni, E. Auci, A. Morelli, U. Livi
Department of Cardiopulmonary Sciences, S. Maria della Misericordia
University-General Hospital, Udine
Objectives. In recent years, new types of mechanical assist devices are
available, so the use of pneumatic ventricular assist devices (p-VAD) is
decreasing in favour of smaller pumps, considered to be more handy and less
invasive. Aim of the study is to evaluate our experience in using p-VAD, mainly as
bridge-to-transplant (BTT) and bridge-to-recovery (BTR).
Methods. Between 1994 and 2006, 22 pts were assisted with a p-VAD (Berlin
Heart Excor ® ) as BTT (18 pts, group A), BTR (3 pts, group B) or as postcardiotomy
assistance (1 pt).
All pts were male, mean age 49±14 years (range 14-67 years); indications for
assistance were ischemic or dilated cardiomyopathy in most of cases bridged to
HTx, acute myocarditis in recovered pts. In all but three patients assistance was
biventricular (BVAD), the remaining being left ventricular (LVAD).
Anticoagulation protocol consisted of a combination of acetylsalicylic acid and
warfarin (or acenocumarole) according to INR (target range 3.0-3.5); no i.v.
heparin needed.
Results. Overall mean (median) time of assistance (TA) was 31(22)±34 days
(range 1-146 years).
In group A, 13 pts were transplanted after a mean (median) TA of 32(26)±17 days
(range 6-68 days) and 10 of them are long-term survivors; in group B, weaning
from assistance occurred after 14(15)±2 days (range 12-16 days). The only pt
assisted after surgical closure of a wide ventricular septal defect post-AMI died
after one day.
Assistance succeeded in improving hemodynamics and organ functions, above
all hepatic and renal; in BTR cases, cardiac function was fully recovered.
No neurologic events occurred, being bleeding the most frequent complication
(overall 36%).
Overall early patient survival was 60%; in group A, early survival of transplanted
pts was 77%, in group B 100%.
Conclusions. Mechanical circulatory support with p-VADs, both in case of BTT
and BTR, demonstrates to be reliable and safe in our experience; clinical results
are satisfactory and similar to those of most recent pumps, still supporting their
use in such cases.
C69
DISFUNZIONE DIASTOLICA NEI PAZIENTI CON POSTUMI DI INTERVENTO
DI RIVASCOLARIZZAZIONE MIOCARDICA: IMPLICAZIONI PROGNOSTICHE
A. Lerro, F. Petteruti, A. Luciano, G. De Luca, G. Coronella, A. Contaldo,
P. Oliviero, P. Pepino
Dipartimento di Chirurgia Cardiotoracica Clinica Pineta Grande, Castel Volturno
(CE)
Premessa. Le modifiche delle proprietà diastoliche del ventricolo sinistro (VS)
possono essere studiate attraverso le registrazioni doppler del flusso mitralico e
le misurazioni delle velocità di flusso e degli intervalli di tempo. Le loro variazioni
si verificano in relazione alle anologhe variazioni delle pressioni atriali e
ventricolari e sono globalmente definite come disfunzione diastolica (DD).
Scopo. Valutare le alterazioni della funzione diastolica nei pazienti sottoposti ad
intervento cardiochirurgico di rivascolarizzazione miocardica (BPCA) e
l’eventuale correlazione tra le modifiche dei parametri ecocardiografici rilevati e
la ripresa della malattia coronarica, osservata attraverso il follow-up clinico, studio
radionuclidico ed esame coronografico.
Metodi. 135 pazienti, ricoverati da Gennaio a Dicembre 2006, 97 maschi e 38
femmine, età media 66 anni ± 9,4, sono stati sottoposti ad esami ecocardiografici
seriati e sono stati misurati i parametri non invasivi di funzione diastolica del VS:
velocità dell’ onda E (E) e dell’onda A (A), rapporto E/A, tempo di decelerazione
30S