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Rodriguez JF, Pachón-Londoño MJ, Areiza LA, Rodriguez WG. Zero-contrast left atrial appendage closure, a feasible alternative for patients with a high risk of contrast-induced nephropathy: Systematic literature review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)02558-X. [PMID: 38750910 DOI: 10.1016/j.hrthm.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) is an alternative to reduce thrombotic risk in patients with nonvalvular atrial fibrillation. This procedure conventionally requires the use of a contrast agent. A significant proportion of patients who undergo this procedure have chronic kidney disease, with a high risk of contrast-induced nephropathy. OBJECTIVE We aimed to systematically review existing literature regarding the feasibility and safety of a zero-contrast LAAC technique. METHODS We searched the MEDLINE/PubMed, Embase, and Cochrane Central Register of Controlled Trials databases for studies comparing a zero-contrast LAAC technique with conventional LAAC up to April 2024. From each study, we extracted baseline characteristics, feasibility, and safety outcomes. A random model meta-analysis was used to compare outcomes between groups. RESULTS Five studies reporting data from 367 patients were included. A 100% successful implantation rate was reported in all the zero-contrast groups. The mean number of recaptures reached no significant difference between the groups (mean difference, -0.15; CI, -0.67 to 0.37; I2 = 0%; P = .58). The zero-contrast group had a significantly shorter fluoroscopy time (mean difference, -4.03; CI, -7.72 to -0.34; I2 = 67%; P = .03). Complications related to the procedure, peridevice leak, and device-associated thrombus rates were not significantly different between the groups. CONCLUSION Zero-contrast LAAC is a feasible alternative. The success and complication rates are consistent with those of conventional LAAC. Aside from the inherent benefit of zero-contrast exposure, this technique allows a reduction in fluoroscopy time.
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Affiliation(s)
| | | | - Luis A Areiza
- Hospital Universitario Mayor, Mederi, Bogotá, Colombia
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2
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Burysz M, Batko J, Malec-Litwinowicz MH, Kowalewski M, Litwinowicz RA, Burysz A, Graczykowski Ł, Olejek W. Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion - single center experience from Poland. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2024; 21:30-34. [PMID: 38693977 PMCID: PMC11059017 DOI: 10.5114/kitp.2024.138575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/30/2023] [Indexed: 05/03/2024]
Abstract
Introduction Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game-changer in transcatheter interventions. Aim This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions. Material and methods We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months. Results A cohort of 83 patients (mean age: 72.1 ±8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 ±34.3 min, contrast medium usage averaged 33.7 ±22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 ±3.4 days. Adverse effects were rare, including minimal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates. Conclusions This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures.
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Affiliation(s)
- Marian Burysz
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
| | - Jakub Batko
- CAROL – Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mariusz Kowalewski
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | | | - Aleksandra Burysz
- Department of Thoracic Surgery and Tumors, Oncology Centre, Prof. Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | | | - Wojciech Olejek
- CAROL – Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Zhang X, Gosnell J, Nainamalai V, Page S, Huang S, Haw M, Peng B, Vettukattil J, Jiang J. Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease. Diagnostics (Basel) 2023; 13:2981. [PMID: 37761348 PMCID: PMC10530233 DOI: 10.3390/diagnostics13182981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the last decade, three-dimensional (3D) transesophageal echocardiography (TEE) has become one of the most accessed imaging methods for structural interventions. Although 3D-TEE can assess cardiac structures and functions in real-time, its limitations (e.g., limited field of view, image quality at a large depth, etc.) must be addressed for its universal adaptation, as well as to improve the quality of its imaging and interventions. This review aims to present the role of TEE in the intraprocedural guidance of percutaneous structural interventions. We also focus on the current and future developments required in a multimodal image integration process when using TEE to enhance the management of congenital and SHD treatments.
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Affiliation(s)
- Xinyue Zhang
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, China; (X.Z.); (B.P.)
| | - Jordan Gosnell
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Varatharajan Nainamalai
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
| | - Savannah Page
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
| | - Sihong Huang
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Marcus Haw
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Bo Peng
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, China; (X.Z.); (B.P.)
| | - Joseph Vettukattil
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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Guarracini F, Bonvicini E, Preda A, Martin M, Muraglia S, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Bonmassari R, Marini M, Mazzone P. Appropriate Use Criteria of Left Atrial Appendage Closure Devices: Latest Evidences. Expert Rev Med Devices 2023; 20:493-503. [PMID: 37128658 DOI: 10.1080/17434440.2023.2208748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Atrial fibrillation is the most common arrythmia and it is linked to an increased risk of stroke. Even if anticoagulation therapy reduces the rate of stroke the benefits of this therapy have to been balanced with the increased risk of hemorrhagic event. Left atrial appendage closure is a valid alternative to long term anticoagulation in patients with atrial fibrillation and high hemorrhagic risk. Actually new devices with different features have been tested and introduced progressively in the clinical practice. Improvements preprocedural imaging evaluation and the learning curve of the operators led to percutaneous left atrial appendage closure a safe and effective procedure. A good knowledge of different devices and the technique of implant is necessary for optimization percutaneous left atrial appendage closure and the reduction of complications during the acute phase and follow up.
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Affiliation(s)
| | | | - Alberto Preda
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | | | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
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6
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Al-Sharydah AM, BinShaiq FK, Aloraifi RI, Almefleh AA, Alessa SA, Alobud AS, AlSharidah AM, Bin Dahmash A, Al-Aftan MS, Al-Dhaferi BF. Procedural Software Toolkit in the Armamentarium of Interventional Therapies: A Review of Additive Usefulness and Current Evidence. Diagnostics (Basel) 2023; 13:diagnostics13040765. [PMID: 36832254 PMCID: PMC9955934 DOI: 10.3390/diagnostics13040765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Interventional radiology is a fast-paced specialty that uses many advanced and emerging technological solutions. Several procedural hardware and software products are available commercially. Image-guided procedural software helps save time and effort in interventionist practice and adds precision to the intraoperative decisions made by the end user. Interventional radiologists, including interventional oncologists, have access to a wide range of commercially available procedural software that can be integrated into their workflow. However, the resources and real-world evidence related to such software are limited. Thus, we performed a detailed review of the current resources available, such as software-related publications, vendors' multimedia materials (e.g., user guides), and each software's functions and features, to compile a resource for interventional therapies. We also reviewed previous studies that have verified the use of such software in angiographic suites. Procedural software products will continue to increase in number and usage; these will likely be advanced further with deep learning, artificial intelligence, and new add-ins. Therefore, classifying procedural product software can improve our understanding of these entities. This review significantly contributes to the existing literature because it highlights the lack of studies on procedural product software.
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Affiliation(s)
- Abdulaziz M. Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
- Correspondence:
| | - Faisal Khalid BinShaiq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Rayan Ibrahim Aloraifi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Abdulrahman Abdulaziz Almefleh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Saud Abdulaziz Alessa
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Adi Saud Alobud
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Abdulmonem Mohammed AlSharidah
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
| | | | - Mohammad S. Al-Aftan
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
| | - Bander Fuhaid Al-Dhaferi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
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7
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Afzal S, Zeus T, Hofsähs T, Kuballa M, Veulemans V, Piayda K, Heidari H, Polzin A, Horn P, Westenfeld R, Kelm M, Hellhammer K. Safety of transoesophageal echocardiography during structural heart disease interventions under procedural sedation: a single-centre study. Eur Heart J Cardiovasc Imaging 2022; 24:68-77. [PMID: 34977935 DOI: 10.1093/ehjci/jeab280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this study was to determine the incidence of transoesophageal echocardiography (TOE)-related adverse events (AEs) during structural heart disease (SHD) interventions and to identify potential risk factors. METHODS AND RESULTS We retrospectively analysed 898 consecutive patients undergoing TOE-guided SHD interventions under procedural sedation. TOE-related AEs were classified as bleeding complications, mechanical lesions, conversion to general anaesthesia with intubation, and the occurrence of pneumonia. A follow-up was conducted up to 3 months after the intervention. TOE-related AEs were observed in 5.3% of the patients (n = 48). The highest rate of AEs was observed in the percutaneous mitral valve repair (PMVR) group with 8.2% (n = 32), whereas 4.8% (n = 11) of the patients in the left atrial appendage group and 1.8% (n = 5) in the patent foramen ovale/atrial septal defect group developed a TOE-related AE (P = 0.001). The most frequent AE was pneumonia with an incidence of 2.6% (n = 26) in the total cohort. Bleeding events occurred in 1.8% (n = 16) of the patients, mostly in the PMVR group with 2.1% (n = 8). In the multivariate regression analysis, we found a lower haemoglobin {odds ratio (OR) [95% confidence interval (CI)]: 8.82 (0.68-0.98) P = 0.025} and an obstructive sleep apnoea syndrome (OSAS) [OR (95% CI): 2.51 (1.08-5.84) P = 0.033] to be associated with AE. Furthermore, AEs were related to procedural time [OR (95% CI): 1.01 (1.0-1.01) P = 0.056] and oral anticoagulation [OR (95% CI): 1.97 (0.9-4.3) P = 0.076] with borderline significance in the multivariate regression analysis. No persistent damages were observed. CONCLUSION TOE-related AEs during SHD interventions are clinically relevant. It was highest in patients undergoing PMVR. A lower baseline haemoglobin level and an OSAS were found to be associated with the occurrence of a TOE-related AE.
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Affiliation(s)
- Shazia Afzal
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Timo Hofsähs
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Matti Kuballa
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Kerstin Piayda
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Houtan Heidari
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Katharina Hellhammer
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
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Drosos I, De Rosa R, Cremer S, Seppelt PC, Hemmann K, Oppermann J, Blessing R, Mas-Peiro S, Vasa-Nicotera M, Zeiher AM, Dimitriadis Z. Percutaneous left atrial appendage occlusion in a frail, high-risk, octogenarian patient population, after having undergone transcatheter aortic valve implantation. BMC Cardiovasc Disord 2022; 22:349. [PMID: 35918658 PMCID: PMC9344699 DOI: 10.1186/s12872-022-02786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI). METHODS Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study. RESULTS Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect. CONCLUSIONS Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation.
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Affiliation(s)
- Ioannis Drosos
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Roberta De Rosa
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Cremer
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Philipp C Seppelt
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Katrin Hemmann
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jana Oppermann
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Recha Blessing
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Silvia Mas-Peiro
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Cardiopulmonary Institute (CPI), Frankfurt, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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9
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Agricola E, Meucci F, Ancona F, Pardo Sanz A, Zamorano JL. Echocardiographic guidance in transcatheter structural cardiac interventions. EUROINTERVENTION 2022; 17:1205-1226. [PMID: 35177379 PMCID: PMC9724953 DOI: 10.4244/eij-d-21-00582] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Catheter-based treatment of structural heart diseases (SHD) has seen tremendous advances in the past decades, thanks to the development of new devices and advances in imaging techniques. Today, we have an extensive armamentarium of imaging tools for preprocedural planning, intraprocedural guidance and follow-up of SHD. Intraprocedural guidance is based mainly on transoesophageal echocardiography; however, other imaging modalities are used as complementary or alternative techniques, each of them with its strengths and weaknesses. Thus, a multimodality imaging approach provides added values in this setting. As the field of imaging parallels the continuous technical improvements, this review will describe the state of the art imaging techniques, focusing on echocardiography during procedural guidance of the most common catheter-based interventions, providing tips and tricks for interventional cardiologists: in particular, how to guide transseptal crossing; left atrial appendage closure; transcatheter mitral or tricuspid valve repair or replacement; percutaneous closure of patent foramen ovale and atrial defects; and percutaneous closure of paravalvular leaks. Open challenges for the near future are the need for physicians with specific technical skills and competencies in SHD imaging, more attention to high levels of radiation exposure, and optimisation of intraprocedural and post-procedural evaluation.
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Affiliation(s)
- Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ana Pardo Sanz
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), University Hospital Ramón y Cajal, Madrid, Spain
| | - José Luis Zamorano
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), University Hospital Ramón y Cajal, Madrid, Spain
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Afzal S, Piayda K, Hellhammer K, Veulemans V, Wolff G, Heidari H, Stüwe D, Kanschik D, Polzin A, Kelm M, Zeus T. Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging? Acta Cardiol 2021; 76:1004-1012. [PMID: 33435834 DOI: 10.1080/00015385.2020.1870193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time echocardiography-fluoroscopy fusion imaging (FI) merges real-time echocardiographic imaging with fluoroscopic images allowing intuitive anatomical spatial orientation during structural heart disease interventions. We aimed to assess the safety and efficacy of FI during percutaneous left atrial appendage closure (LAAC). METHODS 34 consecutive patients before (-FI) and 121 patients after (+FI) the introduction of FI for LAAC were included in a single-centre study. In-hospital safety parameters were analysed according to adverse event (AE) definition of the Munich consensus document and procedure-related parameters were assessed for efficacy. An ANCOVA was performed to investigate the influence of a learning curve. RESULTS Time until successful transseptal puncture was significantly reduced as well as total procedure time and the amount of contrast agent used (+FI/-FI:17 ± 6.35 min vs. 22 ± 8.33 min, p = 0.001; +FI/-FI: 50 min IQR 43 min - 60 min vs. 57 min IQR 45 min -70 min; p = 0.013; +FI/-FI: 70 mL, IQR 55 ml-90 mL vs. 152 mL, IQR 107 mL - 205 mL; p < 0.001). However, fluoroscopy time and dose-area product did not differ between both groups. There was no significant difference in the occurrence of in-hospital adverse events (+FI/-FI: 2.5% vs. 0%; p = 0.596). The ANCOVA revealed that the learning curve does not affect procedural efficacy parameters such as procedure time, time to transseptal puncture, amount of contrast agent and dose-area product. CONCLUSIONS FI for LAAC reduces the total procedure time, the time to successful transseptal puncture and periprocedural amount of contrast agent.
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Affiliation(s)
- Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominique Stüwe
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
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11
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Ciatti F, Stolcova M, Di Mario C, Meucci F. Fully contrast-less EchoNavigator-guided left atrial appendage occlusion in a patient with severe chronic kidney disease. Eur Heart J Case Rep 2021; 5:ytab436. [PMID: 34917879 PMCID: PMC8669545 DOI: 10.1093/ehjcr/ytab436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/22/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Francesca Ciatti
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
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12
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Mo BF, Wan Y, Alimu A, Sun J, Zhang PP, Yu Y, Chen M, Li W, Wang ZQ, Wang QS, Li YG. Image fusion of integrating fluoroscopy into 3D computed tomography in guidance of left atrial appendage closure. Eur Heart J Cardiovasc Imaging 2021; 22:92-101. [PMID: 31764982 DOI: 10.1093/ehjci/jez286] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS We evaluated the feasibility of left atrial appendage (LAA) closure guided by the image fusion of integrating fluoroscopy into 3D computed tomography (CT). METHODS AND RESULTS A total of 117 consecutive patients who underwent LAA closure with or without the image fusion were matched (1:2). Each LAA closure step of the Image fusion group was guided by the preprocedure CT and image fusion, especially in the plan of LAA measurement and transseptal puncture. All patients were successfully implanted with a WATCHMAN closure device. Comparing the two groups, the mean number of recapture times and the number of devices per patient of the Image fusion group were significantly lower (0.4 ± 0.5 vs. 0.7 ± 0.8, P = 0.031 and 1.0 ± 0.2 vs. 1.1 ± 0.3, P = 0.027, respectively). The one-time successful deployment rate by the support of the image fusion was higher than in the control group (66.7% vs. 44.9%, P = 0.026). Each case of the Image fusion group was completely occluded with one transseptal puncture, while five of the Non-image fusion group required redo transseptal punctures. During the 45-day follow-up, both group cases presented occlusion efficiency and no major adverse cardiac events were observed. CONCLUSION Image fusion technique integrating fluoroscopy into the 3D CT is safe and feasible which can be easily incorporated into the procedural work-flow of percutaneous LAA closure. The fusion image can play an important alternative role in the plan of LAA measurement and transseptal puncture site for improving the LAA closure procedure.
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Affiliation(s)
- Bin-Feng Mo
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Yi Wan
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Abudushalamu Alimu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Ying Yu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Zhi-Quan Wang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, #1665 Kong Jiang Road, Shanghai 200092, China
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13
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Maresch AC, Chacon MM, Markin NW. Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography-Fluoroscopy Fusion Imaging. J Cardiothorac Vasc Anesth 2021; 36:8-11. [PMID: 34376345 DOI: 10.1053/j.jvca.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew C Maresch
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - M Megan Chacon
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
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14
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Bruckheimer E, Goreczny S. Advanced imaging techniques to assist transcatheter congenital heart defects therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Intracardiac Echocardiography: "The ICEing on the Cake" for a Novel LAA Occlusion Approach? JACC Clin Electrophysiol 2021; 6:1643-1646. [PMID: 33334442 DOI: 10.1016/j.jacep.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 11/23/2022]
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16
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Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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17
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Ribeiro JM, Astudillo P, de Backer O, Budde R, Nuis RJ, Goudzwaard J, Van Mieghem NM, Lumens J, Mortier P, Mattace-Raso F, Boersma E, Cummins P, Bruining N, de Jaegere PP. Artificial Intelligence and Transcatheter Interventions for Structural Heart Disease: A glance at the (near) future. Trends Cardiovasc Med 2021; 32:153-159. [PMID: 33581255 DOI: 10.1016/j.tcm.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/16/2023]
Abstract
With innovations in therapeutic technologies and changes in population demographics, transcatheter interventions for structural heart disease have become the preferred treatment and will keep growing. Yet, a thorough clinical selection and efficient pathway from diagnosis to treatment and follow-up are mandatory. In this review we reflect on how artificial intelligence may help to improve patient selection, pre-procedural planning, procedure execution and follow-up so to establish efficient and high quality health care in an increasing number of patients.
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Affiliation(s)
- Joana Maria Ribeiro
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Ole de Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ricardo Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rutger Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeanette Goudzwaard
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Cummins
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nico Bruining
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Pt de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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18
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Melillo F, Fisicaro A, Stella S, Ancona F, Capogrosso C, Ingallina G, Maccagni D, Romano V, Ruggeri S, Godino C, Latib A, Montorfano M, Colombo A, Agricola E. Systematic Fluoroscopic-Echocardiographic Fusion Imaging Protocol for Transcatheter Edge-to-Edge Mitral Valve Repair Intraprocedural Monitoring. J Am Soc Echocardiogr 2021; 34:604-613. [PMID: 33453367 DOI: 10.1016/j.echo.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. METHODS The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI-). RESULTS The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI- groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P = .46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P = .003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P = .23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P = .086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = -10.4 min; 95% CI, -18.03 to -2.82; P = .007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P = .049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P = .039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P = .40). CONCLUSIONS The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
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Affiliation(s)
- Francesco Melillo
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Fisicaro
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Capogrosso
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ruggeri
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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19
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Ebelt H, Domagala T, Offhaus A, Wiora M, Schwenzky A, Hoyme M, Anacker J, Röhl P. Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure. Cardiovasc Drugs Ther 2020; 34:781-787. [PMID: 32761486 PMCID: PMC7674364 DOI: 10.1007/s10557-020-07048-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) is an alternative treatment strategy for patients with atrial fibrillation who are at risk for thromboembolic events and considered not suitable for oral anticoagulation (OAC). LAAC is mainly performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. The study presented here should analyze whether fusion imaging (FI) of transesophageal echocardiography and X-ray performed during LAAC is feasible and can improve the results of the procedure. METHODS The data presented here are from a retrospective single center study. Sample size was defined as 50 patients in which LAAC was performed without fusion imaging (control group) and 25 patients were the LAAC procedure was guided by fusion imaging (treatment group). Inclusion criteria were defined as age > 18 years and completion of an LAAC procedure defined as deployment of a WATCHMAN 2.5 LAA occluder. Study endpoints were procedure time, amount of used contrast medium, radiation dose, final position of the WATCHMAN in TEE (deviation from ideal positioning), and clinical endpoints, respectively. RESULTS LAA closure was successfully performed in all patients. No case of device embolism was occurring, and none of the patients experienced a periprocedural stroke/TIA nor a systemic embolism, respectively. Mean procedure time was 15 min shorter in the group of patients where fusion imaging was applied (p < 0.001). Additionally, the use of fusion imaging was associated with a significant reduction of contrast medium (20.6 ml less than in control; p < 0.045). Regarding the final position of the WATCHMAN, no relevant differences were found between the groups. The use of fusion imaging significantly reduced procedure time and the amount of contrast medium in patients undergoing LAAC.
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
| | - Thomas Domagala
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Alexandra Offhaus
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Jelena Anacker
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
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20
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Nobre C, Oliveira-Santos M, Paiva L, Costa M, Gonçalves L. Fusion imaging in interventional cardiology. Rev Port Cardiol 2020; 39:463-473. [PMID: 32736908 DOI: 10.1016/j.repc.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/26/2020] [Accepted: 03/23/2020] [Indexed: 01/27/2023] Open
Abstract
The number and complexity of percutaneous interventions for the treatment of structural heart disease has increased in clinical practice in parallel with the development of new imaging technologies, in order to render these interventions safer and more accurate. Complementary imaging modalities are commonly used, but they require additional mental reconstruction and effort by the interventional team. The concept of fusion imaging, where two different modalities are fused in real time and on a single monitor, aims to solve these limitations. This is an important tool to guide percutaneous interventions, enabling a good visualization of catheters, guidewires and devices employed, with enhanced spatial resolution and anatomical definition. It also allows the marking of anatomical reference points of interest for the procedure. Some studies show decreased procedural time and total radiation dose with fusion imaging; however, there is a need to obtain data with more robust scientific methodology to assess the impact of this technology in clinical practice. The aim of this review is to describe the concept and basic principles of fusion imaging, its main clinical applications and some considerations about the promising future of this imaging technology.
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Affiliation(s)
- Carolina Nobre
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Manuel Oliveira-Santos
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Luís Paiva
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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21
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Fusion imaging in interventional cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Jone PN. Applications of three-dimensional transesophageal echocardiography in congenital heart disease. Echocardiography 2020; 37:1665-1672. [PMID: 32594626 DOI: 10.1111/echo.14780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional echocardiography allows for presurgical planning for congenital heart disease, reduces radiation using fusion imaging in catheter interventions, and provides guidance during catheter interventions and lead placements or extractions. The purpose of this review is to detail applications of three-dimensional transesophageal echocardiography in presurgical planning of congenital heart disease, guidance of catheter interventions such as fusion imaging, and guidance in electrophysiology lead extractions or placements.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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23
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Saad Shaukat MH, Patel H, Alimohammad R, DeLago A. Transesophageal Echocardiography-Guided WATCHMAN Implantation Without Contrast Use: A Three-Year, Single-Center Experience. Cureus 2020; 12:e8375. [PMID: 32626619 PMCID: PMC7328691 DOI: 10.7759/cureus.8375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background It is unclear if the WATCHMAN device (Boston Scientific, St. Paul, Minnesota) can be implanted without contrast to prevent complications in patients with advanced chronic kidney disease (CKD) or contrast allergy. Objective The efficiency and safety of WATCHMAN implantation under transesophageal echocardiography (TEE)-guidance and fluoroscopy without contrast use. Methods This was a retrospective single-center study at Albany Medical Center between June 2016 and June 2019. Consecutive procedure notes for all WATCHMAN devices implanted between June 2016 and June 2019 were screened to identify patients who did not receive contrast. Patients with incomplete information on the calculation of the 'Congestive heart failure, Hypertension, Age [>75 years], Stroke, Diabetes mellitus, Vascular disease, Age [65 to 74 years], Sex category' (CHA2DS2VASc)/'Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile international normalized ratio, Elderly, Drugs/alcohol' (HAS-BLED) score and reason(s) precluding safe contrast use were excluded. Efficiency was measured as i) accuracy of device size estimation based on TEE-measured left atrial appendage (LAA) dimensions were determined by the need to change the size of the device initially selected, ii) number of implantation attempts, irrespective of change in device size, iii) whether more than one device was used secondary to inaccurate initial size estimation or other procedural complexities, and iv) successful LAA seal on TEE immediately and 45-days post-implantation (peri-device leak of < 5 mm by color Doppler). Procedure-related complications, immediate and delayed (0-45 days), were recorded. Results Twelve patients received WATCHMAN without contrast. The mean age was 79.2 years, with male predominance (n=8). The mean CHA2DS2VASc and HAS-BLED scores were 5.50 (+/-1.24) and 4.08 (+/-1.08), respectively. Contrast was avoided because of a history of CKD stage IV (n=5), rapidly progressive CKD stage III (n=1), and contrast allergy (n=6). In 11 out of 12 patients, initial TEE-based device size estimation was accurate with successful implantation at the first attempt. One patient required a change in initial device size and, therefore, required a second attempt for successful implantation. There was no peri-device leak immediately post-implantation in any patient; only one patient had a significant device leak on day 45 TEE requiring continuation of anticoagulation for four months until a successful device seal. There were no immediate or late complications up to 45-days post-implantation. Conclusion Our experience shows no significant compromise in the efficiency and safety of the WATCHMAN implantation without contrast in patients with advanced CKD or a contrast allergy.
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Affiliation(s)
| | - Hiren Patel
- Cardiology, Albany Medical College, Albany, USA
| | - Rizwan Alimohammad
- Cardiology, Capital Cardiology Associates, Albany Medical Center, Albany, USA
| | - Augustin DeLago
- Cardiology, Capital Cardiology Associates, Albany Medical Center, Albany, USA
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Zucca S, Solla I, Boi A, Loi S, Rossi A, Sanna F, Loi B. The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures. Phys Med 2020; 74:11-18. [PMID: 32388465 DOI: 10.1016/j.ejmp.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization. METHODS From September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures. RESULTS A total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied. CONCLUSIONS RDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.
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Affiliation(s)
- Sergio Zucca
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy.
| | - Ignazio Solla
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Stefano Loi
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
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Osman M, Busu T, Osman K, Khan SU, Daniels M, Holmes DR, Alkhouli M. Short-Term Antiplatelet Versus Anticoagulant Therapy After Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2020; 6:494-506. [PMID: 32439033 PMCID: PMC7988890 DOI: 10.1016/j.jacep.2019.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to compare bleeding, thromboembolic, device-related thrombus (DRT), and all-cause mortality events between patients treated with short-term oral anticoagulation (OAC) and those treated with short-term antiplatelet therapy (APT) following left atrial appendage occlusion (LAAO). BACKGROUND Short-term OAC is recommended for patients following LAAO. However, in practice many patients receive APT rather than OAC because of excessive bleeding risk. However, the safety and efficacy of APT compared with OAC have been debated. METHODS A search was conducted of databases for studies comparing OAC with APT following LAAO. The outcomes of interest were all-cause stroke, major bleeding, DRT, and all-cause mortality. Noncomparative studies were pooled into a single study to generate comparisons of the studies' outcomes. Effects measure were pooled using the random-effect model. RESULTS A total of 83 studies with 12,326 patients (APT, n = 7,900; OAC, n = 4,151) were included. Mean CHA2DS2-VASc and HAS-BLED scores were 4.1 ± 1.6 and 3.0 ± 1.3, respectively. There were no significance differences between the APT and OAC groups with regard to stroke (risk ratio [RR]: 1.04; 95% confidence interval [CI]: 0.54 to 1.98; p = 0.91; I2 = 31%), major bleeding (RR: 1.12; 95% CI: 0.68 to 1.84; p = 0.65; I2 = 53%), DRT (RR: 1.33; 95% CI: 0.74 to 2.39; p = 0.33; I2 = 36%), and all-cause mortality (RR: 1.29; 95% CI: 0.40 to 4.09; p = 0.18; I2 = 36%). These findings persisted in multiple secondary analyses: 1) excluding studies that reported no events; 2) including comparative studies only; 3) excluding patients who were treated with single APT; and 4) removing one study at a time to assess the effect of each study on the overall effect size. There was also no difference in the studies' endpoints among patients who received different LAAO devices. CONCLUSIONS In a meta-analysis of observational data, there were no differences in the occurrence of stroke, major bleeding DRT, and all-cause mortality in patients treated with short-term OAC or APT following LAAO.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Tatiana Busu
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Khansa Osman
- Michigan Health Specialist, Michigan State University, Flint, Michigan, USA
| | - Safi U Khan
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Matthew Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
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Jone P, Sandoval JP, Haak A, Hammers J, Rodriguez‐Zanella H, Quaife RA, Salcedo EE, Carroll JD, Gill E. Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance. Echocardiography 2020; 37:769-780. [DOI: 10.1111/echo.14670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Pei‐Ni Jone
- Pediatric Cardiology Children’s Hospital Colorado University of Colorado School of Medicine Aurora Colorado
| | - Juan Pablo Sandoval
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | | | | | - Hugo Rodriguez‐Zanella
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | - Robert A. Quaife
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Ernesto E. Salcedo
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Edward Gill
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
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Potential Value of Fusion Imaging and Automated Three-Dimensional Heart Segmentation During Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2020; 33:516-517.e1. [DOI: 10.1016/j.echo.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/15/2019] [Indexed: 11/19/2022]
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Jone PN, Haak A, Ross M, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Congenital and Structural Heart Disease Interventions Using Echocardiography-Fluoroscopy Fusion Imaging. J Am Soc Echocardiogr 2019; 32:1495-1504. [DOI: 10.1016/j.echo.2019.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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Contrast-free, echocardiography-guided left atrial appendage occlusion (LAAo): a propensity-matched comparison with conventional LAAo using the AMPLATZER™ Amulet™ device. Clin Res Cardiol 2018; 108:333-340. [DOI: 10.1007/s00392-018-1401-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/30/2018] [Indexed: 10/27/2022]
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Hascoët S, Hadeed K, Karsenty C, Dulac Y, Heitz F, Combes N, Chausseray G, Alacoque X, Auriol F, Amedro P, Fraisse A, Acar P. Feasibility, Safety and Accuracy of Echocardiography-Fluoroscopy Imaging Fusion During Percutaneous Atrial Septal Defect Closure in Children. J Am Soc Echocardiogr 2018; 31:1229-1237. [DOI: 10.1016/j.echo.2018.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 10/28/2022]
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Afzal S, Veulemans V, Kleinebrecht L, Stuewe D, Balzer J, Polzin A, Nijhof N, Kelm M, Zeus T, Hellhammer K. Fusion Imaging During the Interventional Closure of Patent Foramen Ovale and Atrial Septal Defects. JACC Cardiovasc Imaging 2018; 11:1543-1545. [DOI: 10.1016/j.jcmg.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/16/2022]
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Barreiro-Perez M, Cruz-Gonzalez I, Moreno-Samos JC, Fuertes Barahona M, Sanchez PL. Cardiovascular Structural Interventions - Echo/Computed Tomography-Fluoroscopy Fusion Imaging Atlas. Circ J 2018; 82:2206-2207. [PMID: 29367476 DOI: 10.1253/circj.cj-17-1229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manuel Barreiro-Perez
- University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERCV
| | - Ignacio Cruz-Gonzalez
- University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERCV
| | | | - Monica Fuertes Barahona
- University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERCV
| | - Pedro L Sanchez
- University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERCV
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Hadeed K, Hascoët S, Karsenty C, Ratsimandresy M, Dulac Y, Chausseray G, Alacoque X, Fraisse A, Acar P. Usefulness of echocardiographic-fluoroscopic fusion imaging in children with congenital heart disease. Arch Cardiovasc Dis 2018; 111:399-410. [DOI: 10.1016/j.acvd.2018.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022]
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Ternacle J, Gallet R, Nguyen A, Deux JF, Fiore A, Teiger E, Dubois-Randé JL, Riant E, Lim P. Usefulness of echocardiographic-fluoroscopic fusion imaging in adult structural heart disease. Arch Cardiovasc Dis 2018. [DOI: 10.1016/j.acvd.2018.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to detail three-dimensional echocardiographic (3DE) innovations in pre-surgical planning of congenital heart disease, guidance of catheter interventions such as fusion imaging, and functional assessment of patients with congenital heart disease. RECENT FINDINGS Innovations in 3DE have helped us delineate the details of atrioventricular valve function and understand the mechanism of atrioventricular valve failure in patients with atrioventricular septal defect and single ventricle post repair. Advancement in holographic display of 3D datasets allows for better manipulation of 3D images in three dimensions and better understanding of anatomic relationships. 3DE with fusion imaging reduces radiation in catheter interventions and provides presentations of 3DE images in the similar fashion as the fluoroscopic images to improve communication between cardiologists. Lastly, 3DE allows for quantitative ventricular volumetric and functional assessment. Recent innovations in 3DE allow for pre-surgical planning for congenital heart disease, reduce radiation using fusion imaging in catheter interventions, and enable accurate assessment of ventricular volume and function without geometric assumptions.
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Carvajal-Rivera JJ, García Fernández MÁ, López-Quintero JC, Pérez-de Isla L, Restrepo Molina G. Fusión de ecocardiografía 2D/3D–fluoroscopia: nueva herramienta en el intervencionismo cardiaco. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Basman C, Parmar YJ, Kliger C, Jelnin V, Pasala TKR, Ruiz CE, Kronzon I. Fusion Imaging for Structural Heart Disease Interventions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9436-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lempereur M, Aminian A, Dulgheru R, De Potter T, Oury C, Lancellotti P. Role of Imaging in Left Atrial Appendage Occlusion. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2017. [DOI: 10.21859/ijcp-020203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Roy A, Horvilleur J, Cormier B, Cazalas M, Fernandez L, Patane M, Neylon A, Spaziano M, Sawaya F, Arai T, Bouvier E, Hovasse T, Lefèvre T, Chevalier B, Garot P. Novel integrated 3D multidetector computed tomography and fluoroscopy fusion for left atrial appendage occlusion procedures. Catheter Cardiovasc Interv 2017; 91:322-329. [DOI: 10.1002/ccd.26998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/20/2017] [Accepted: 02/04/2017] [Indexed: 11/05/2022]
Affiliation(s)
- A.K. Roy
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - J. Horvilleur
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - B. Cormier
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | | | - L. Fernandez
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - M. Patane
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - A. Neylon
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - M. Spaziano
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - F.J. Sawaya
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - T. Arai
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - E. Bouvier
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - T. Hovasse
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - T. Lefèvre
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - B. Chevalier
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
| | - P. Garot
- Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé; Paris France
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Li H, Qingyao, Bingshen, Shu M, Lizhong, Wang X, Song Z. Application of 3D printing technology to left atrial appendage occlusion. Int J Cardiol 2017; 231:258-263. [DOI: 10.1016/j.ijcard.2017.01.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T. Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy. Neth Heart J 2016; 25:131-136. [PMID: 27966185 PMCID: PMC5260626 DOI: 10.1007/s12471-016-0937-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aims Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure. Methods Forty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min). Results In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006). Conclusions Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.
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Affiliation(s)
- S Afzal
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - V Veulemans
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - J Balzer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - T Rassaf
- Department of Cardiology, University Hospital Essen, Westgerman Heart-and Vascular Centre, Essen, Germany
| | - K Hellhammer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Polzin
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Kelm
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - T Zeus
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
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Jone PN, Ross MM, Bracken JA, Mulvahill MJ, Di Maria MV, Fagan TE. Feasibility and Safety of Using a Fused Echocardiography/Fluoroscopy Imaging System in Patients with Congenital Heart Disease. J Am Soc Echocardiogr 2016; 29:513-21. [PMID: 27143284 DOI: 10.1016/j.echo.2016.03.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fused real-time three-dimensional transesophageal echocardiography and fluoroscopy has been used in adult patients during percutaneous mitral valve and aortic valve procedures. The use of fused echocardiographic/x-ray fluoroscopic imaging (FEX) in pediatric patients undergoing congenital heart disease catheterization has not been evaluated for feasibility and safety. The aims of this study were to assess the feasibility and safety of FEX for interventional guidance and to perform a comparison of atrial septal defect (ASD) device closure using this technology with traditional guidance methods. METHODS Prospective evaluation of FEX in congenital cardiac interventions was conducted. A subset of patients with ASD closures were compared with patients with historical ASD closures with and without FEX. The interventionalist and echocardiographer rated the anatomic quality of the fusion imaging as (1) excellent, (2) good, or (3) poor. In addition, the utility of FEX procedural guidance was graded as (1) superior, (2) no added benefit, or (3) inferior to that of standard guidance by fluoroscopy and transesophageal echocardiography. RESULTS FEX was successfully used in 26 procedures on 25 patients with congenital heart disease from January 2013 to February 2015. The median age was 9 years (range, 3-26 years), and the median weight was 29 kg (range, 16-77 kg). Twenty-six procedures were performed, including ASD closure, Fontan fenestration closure, and transcatheter valve placement in the tricuspid valve position. There was reduced fluoroscopy time and radiation dose in patients with ASDs who underwent imaging using this new technology (P < .001 and P < .03, respectively). There were no statistically significant differences in procedural times between the two groups. Anatomic definition was rated as excellent in 20 of 26 procedures, with the remaining six rated was good. Twenty-one of 26 procedures were graded as superior (81%), and five of 26 (19%) were graded as providing no added benefit. There were no complications in any of the procedures. CONCLUSIONS In this early experience, FEX is feasible and safe in patients undergoing congenital heart disease catheterization and provides useful guidance in the majority of interventional procedures. There were relative reductions in fluoroscopy time and radiation dose with the use of FEX for ASD closure.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | - Michael M Ross
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - John A Bracken
- Philips Research North America, Briarcliff Manor, New York
| | - Matthew J Mulvahill
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael V Di Maria
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas E Fagan
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Balzer J, Zeus T, Veulemans V, Kelm M. Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions. Interv Cardiol 2016; 11:59-64. [PMID: 29588708 DOI: 10.15420/icr.2016.11.1.59] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.
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Affiliation(s)
- Jan Balzer
- Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
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