Reuse of catheters for percutaneous transluminal coronary angioplasty: effects on procedure time and clinical outcomes

Mycobacterium abscessus: causing fatal endocarditis after cardiac catheterization

Mycobacterium abscessus is an unusual cause of infection in immunocompetent patients. The intrinsic and acquired resistance of this organism to multiple antibiotics is a major issue in planning treatment regimens. We report a case of M. abscessus endocarditis of the native aortic valve in an immunocompetent patient following coronary angiography with a fatal outcome. The case highlights an unfortunate intervention – related nosocomial infection and the difficulties in chemotherapeutic options for this organism, particularly in the presence of renal failure.

[Cost-effectiveness analysis on the reutilization of coronary artery catheters in a public hospital in Rio de Janeiro, Brazil]

The aim of this study was to compare the cost-effectiveness ratio of new versus reprocessed coronary artery catheters in a Federal public hospital. This was an analytical decision-making model prepared to estimate the cost-effectiveness ratio between two strategies in the use of materials in coronary artery catheterization, with pyrogenic reaction as the clinical outcome. Costs were estimated using direct data collection in the respective catheterization services and expressed in Brazilian Reais (R$), with 2012 as the reference year. The decision-making tree was constructed with the probabilities of pyrogenic reaction as described in a clinical trial. The cost per catheter for reuse was R$ 109.84, as compared to R$ 283.43 for a new catheter. The reutilization strategy proved to be cost cost-effective, and the incremental cost-effectiveness ratio indicated that R$ 13,561.75 would be spent to avoid one case of pyrogenic reaction. The study identified reuse of coronary artery catheters as a lower cost strategy compared to the exclusive use of new catheters, thus potentially assisting decision-making by health administrators.

Functional properties and performance of new and reprocessed coronary angioplasty balloon catheters

The need of health costs control has prompted the reuse of devices originally manufactured for single use only. To assess reprocessing feasibility of disposable medical devices, hygienic, technical, and functional aspects must be taken into account in addition to economical, ethical, and legal implications. This study aims to characterize coronary angioplasty catheters and to evaluate performance changes induced by reprocessing. Multiple analysis including crossing profile, slipperiness, compliance, mechanical, and burst pressure tests were performed at different steps of the protocol on 25 catheters reprocessed up to two times. The results highlighted that both use and reprocessing can affect the features of angioplasty catheters. Mechanical stress caused by clinical inflation and thermal-chemical stress undergone by polymers during cleaning and sterilization procedures caused partial modifications of material properties, inducing an overall shrinking effect on balloons. Compliance tests reported a maximum variation of 6.2% from nominal values, showing the conformity of reprocessed devices with manufacturers' original specifications (+/-10%). The burst pressure of reprocessed devices was 80% higher than the rated burst pressure certified by manufacturers, thus reducing concerns of breakage during reuse. A strict dependence on device model in the behavior of catheters was found, especially for balloons crossing profile and slipperiness. Main changes occurred after the first reprocessing cycle, while a second cleaning and sterilization did not introduce further significant alterations. On the whole, the magnitude of modifications introduced up to two reprocessing cycles did not compromise catheters performance.

Catheter interventions for congenital heart disease in third world countries

The term "Third World" loosely encompasses a group of middle- and low-income countries. Considerable differences exist in health care delivery and health indices among these countries. The vast majority of children in the Third World do not have health insurance for congential heart disease (CHD). Catheter interventions for CHD are expensive because of installation costs of expensive biplane equipment, the requirement of dedicated personnel, and the need to stock a large inventory of expensive hardware. As a result, many catheter intervention procedures are beyond the reach of the average patient in the developing world. The following cost-effective strategies have evolved in selected institutions that have attempted to perform catheter interventions for CHD at an affordable cost: sharing of space, equipment, and support personnel with a busy adult cardiology program; use of single plane equipment; the development of sedation protocols to reduce the need for anesthesiologists; strategies to reduce procedure time; reuse of hardware through ethylene oxide sterilization; improvisations to use adult hardware items for CHD interventions; judicious case selection; and improvised alternatives to occlusive devices. These strategies may help reduce costs and allow a larger proportion of patients in developing countries with CHD to undergo interventions. However, the safety of these strategies and the cost savings need to be carefully evaluated prospectively.

Reference levels in PTCA as a function of procedure complexity

The multicentre assessment of a procedure complexity index (CI) for the introduction of reference levels (RLs) in percutaneous transluminal coronary angioplasties (PTCA) is presented here. PTCAs were investigated based on methodology proposed by Bernardi et al. Multiple linear stepwise regression analysis, including clinical, anatomical and technical factors, was performed to obtain fluoroscopy time predictors. Based on these regression coefficients, a scoring system was defined and CI obtained. CI was used to classify dose values into three groups: low, medium and high complexity procedures, since there was good correlation (r = 0.41; P < 0.001) between dose-area product (DAP) and CI. CI groups were determined by an ANOVA test, and the resulting DAP and fluoroscopy time third quartiles suggested as preliminary RLs in PTCA, as a function of procedure complexity. PTCA preliminary RLs for DAP are 54, 76 and 127 Gy cm2, and 12, 20 and 27 min for fluoroscopy time, for the three CI groups.

Change of the mechanical properties of two different balloon catheters with increasing numbers of cycles of resterilization

An increasing number of centers are reusing PTCA catheters even though manufacturers warrant single use only. This prospective bench laboratory trial addresses the quality of PTCA balloon catheters after up to three resterilization cycles in order to determine whether a larger trial is warranted to discern whether catheters should be reused. Forty PTCA catheters from two different manufacturers (nominal diameters 1.5 and 3.0 mm) were taken from the shelf. An independent institute tested mechanical properties such as burst pressure, nominal diameter, crossing profile, and balloon surface. The crossing profile increased by 22.5%-39.2% with no additional deterioration after repeated sterilizations. The nominal diameter either increased or decreased by a maximum of 47%. In all 1.5 mm balloons, the burst pressure remained above the manufacturers' values, whereas in the 3.0 mm balloons, the value dropped below the rated burst pressure in 40%-50% of the trials. In conclusion, in both catheter types analyzed, reuse was associated with a considerably worse quality, which puts in question their routine clinical use.