Latest developments in chronic total occlusion percutaneous coronary intervention

Is it the Time to Move Towards Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve Guided Percutaneous Coronary Intervention? The Pros and Cons

Coronary artery disease is the leading cause of mortality worldwide. Diagnosis is conventionally performed by direct visualization of the arteries by invasive coronary angiography (ICA), which has inherent limitations and risks. Measurement of fractional flow reserve (FFR) has been suggested for a more accurate assessment of ischemia in the coronary artery with high accuracy for determining the severity and decision on the necessity of intervention. Nevertheless, invasive coronary angiography-derived fractional flow reserve (ICA-FFR) is currently used in less than one-third of clinical practices because of the invasive nature of ICA and the need for additional equipment and experience, as well as the cost and extra time needed for the procedure. Recent technical advances have moved towards non-invasive high-quality imaging modalities, such as magnetic resonance, single-photon emission computed tomography, and coronary computed tomography (CT) scan; however, none had a definitive modality to confirm hemodynamically significant coronary artery stenosis. Coronary computed tomography angiography (CCTA) can provide accurate anatomic and hemodynamic data about the coronary lesion, especially calculating fractional flow reserve derived from CCTA (CCTA-FFR). Although growing evidence has been published regarding CCTA-FFR results being comparable to ICA-FFR, CCTA-FFR has not yet replaced the invasive conventional angiography, pending additional studies to validate the advantages and disadvantages of each diagnostic method. Furthermore, it has to be identified whether revascularization of a stenotic lesion is plausible based on CCTA-FFR and if the therapeutic plan can be determined safely and accurately without confirmation from invasive methods. Therefore, in the present review, we will outline the pros and cons of using CCTA-FFR vs. ICA-FFR regarding diagnostic accuracy and treatment decision-making.

Study on the Mechanism of Cardiac Intensive Care after Thoracoscopic Surgery

Objective

To explore the mechanism of intensive care of the heart after thoracoscopic surgery.

Methods

104 patients with severe cardiac disease were selected after thoracoscopic surgery in our hospital, received nursing care after surgery, and divided into control group (n = 53) and research group (n = 51) according to different nursing methods. Before nursing, the research group carried out targeted nursing and prevention of postoperative complications. The quality of life, complications, anxiety, depression and satisfaction scores, 6-minute walking distance, self-care ability scores, and cardiac function were compared between the two groups.

Results

Patients' quality of life scores improved significantly in both groups after treatment, but the increase was greater in the study group than in the control group (P < 0.05); the incidence of complications was 18.9% and 5.9% in the study and control groups, respectively, and the incidence of complications was lower in the study group than in the control group (P < 0.05); and the incidence of complications was lower in the study group than in the control group (P < 0.05). After care, patients' anxiety and depression scores were significantly lower, and satisfaction scores were significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, patients' 6-minute walking distance was significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, LVEF indicators were significantly higher, and LVESD and LVED indicators were significantly higher, with a greater change in the study group than in the control group. After care, LVEF indexes increased significantly in both groups, while LVESD and LVED indexes decreased significantly in the study group, with a greater change than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a greater increase in the study group than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a more significant increase.

Conclusion

Targeted nursing for patients with severe cardiac disease after thoracoscopic surgery has a significant effect, which can improve patients' anxiety and depression, significantly improve patients' self-care ability and quality of life, and at the same time improve patients' cardiac function, heart rate, and blood pressure, with high patient satisfaction.

Anesthetic Considerations for Percutaneous Coronary Intervention for Chronic Total Occlusions-A Narrative Review

Advancing stent technology has enabled interventional cardiologists to perform percutaneous coronary intervention (PCI) to open chronic total occlusions (CTOs). Because PCI for CTOs improve patient anginal symptoms and quality of life, these procedures have been increasing over the past decade. Compared to standard PCI, these procedures are technically more difficult, with prolonged procedure time and increased risk of complications. Accordingly, anesthesiologists are increasingly being asked to provide sedation for these patients in the cardiac catheterization suite. In CTO PCI, anesthesiologists are more likely to encounter complications such as coronary artery perforation, malignant arrhythmias, non-target vessel ischemia, bleeding and shock. Additionally, CTO PCI may be supported by mechanical circulatory support devices. Understanding the procedural techniques of these complex PCI procedures is important to enable optimal anesthetic care in these patients. This narrative review discusses the pathophysiology, risks, benefits, procedural steps, and main anesthetic considerations for patients undergoing CTO PCI. Despite a growing body of literature, future research is still required to elucidate optimal anesthetic and mechanical support strategies in patients undergoing CTO PCI.