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Claeys MJ, Aminian A, Bartunek J, Bennett J, Buysschaert I, Claeys M, De Bock D, Delodder L, Debonnaire P, Dewilde W, Ferdinande B, Geerinck S, Goetschalckx K, Lambrechts O, Lochy S, Paelinck BP, Rosseel L, Stroobants D, Vanderheyden M, Van der Heyden J, Verbrugghe P, Verheye S, Dubois C. Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge-to-edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all-comers national registry. Catheter Cardiovasc Interv 2024; 103:382-388. [PMID: 38078877 DOI: 10.1002/ccd.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Evidence-based recommendations for antithrombotic treatment in patients who have an indication for oral anticoagulation (OAC) after transcatheter edge-to-edge mitral valve repair (TEER) are lacking. AIMS To compare bleeding and thrombotic risk for different antithrombotic regimens post-TEER with MitraClip in an unselected population with the need for OACs. METHODS Bleeding and thrombotic complications (stroke and myocardial infarction) up to 3 months after TEER with mitraclip were evaluated in 322 consecutive pts with an indication for OACs. These endpoints were defined by the Mitral Valve Academic Research Consortium criteria and were compared between two antithrombotic regimens: single antithrombotic therapy with OAC (single ATT) and double/triple ATT with a combination of OAC and aspirin and/or clopidogrel (combined ATT). RESULTS Collectively, 108 (34%) patients received single ATT, 203 (63%) received double ATT and 11 (3%) received triple ATT. Bleeding events occurred in 67 patients (20.9%), with access site related events being the most frequent cause (37%). Bleeding complications were observed more frequently in the combined ATT group than in the single ATT group: 24% versus 14% [p = 0.03, adjusted RR: 0.55 (0.3-0.98)]. Within the combined group, the bleeding risk was 23% in the double ATT and 45% in the triple ATT group. Thrombotic complications occurred in only three patients (0.9%), and all belonged to the combined ATT group. CONCLUSIONS In patients with an indication for OACs, withholding of antiplatelet therapy post-TEER with Mitraclip was associated with a 45% reduction in bleeding and without a signal of increased thrombotic risk.
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Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier, Universitaire de Charleroi, Charleroi, Belgium
| | - Jozef Bartunek
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ian Buysschaert
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Mathias Claeys
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Dina De Bock
- Deptartment of Cardiovascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lies Delodder
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | | | - Kaatje Goetschalckx
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Stijn Lochy
- Department of Cardiology, Brussels University Hospital, Brussels, Belgium
| | | | | | | | | | | | - Peter Verbrugghe
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Verheye
- Department of Cardiology, ZAS Hospital, Antwerp, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Sorajja P, Gorgorishvili I, Burns M, Buysschaert I, Debonnaire P, Van der Heyden J, Hamid N. First-in-human description of a novel transcatheter tricuspid valve prosthesis to preserve the asymmetric shape of the right ventricle. EUROINTERVENTION 2023; 19:662-663. [PMID: 37483101 PMCID: PMC10587843 DOI: 10.4244/eij-d-23-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/18/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | - Marcus Burns
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | | | | | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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Bouisset F, Sia J, Mizukami T, Karjalainen PP, Tonino PAL, Pijls NHJ, Van der Heyden J, Romppanen H, Kervinen K, Airaksinen JKE, Lalmand J, Frambach P, Roza da Costa B, Collet C, De Bruyne B. Titanium-Nitride-Oxide-Coated vs Everolimus-Eluting Stents in Acute Coronary Syndrome: 5-Year Clinical Outcomes of the TIDES-ACS Randomized Clinical Trial. JAMA Cardiol 2023:2805071. [PMID: 37203243 DOI: 10.1001/jamacardio.2023.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Importance Titanium-nitride-oxide (TiNO)-coated stents show faster strut coverage compared with drug-eluting stents without excessive intimal-hyperplasia observed in bare metal stents. It is important to study long-term clinical outcomes after treatment of patients with an acute coronary syndrome (ACS) by TiNO-coated stents, which are neither drug-eluting stents nor bare metal stents. Objective To compare the rate of main composite outcome of cardiac death, myocardial infarction (MI), or ischemia-driven target lesion revascularization at 5 years in patients with ACS randomized to receive either a TiNO-coated stent or a third-generation everolimus-eluting stent (EES). Design, Setting, and Participants This multicenter, randomized, controlled, open-label trial was conducted in 12 clinical sites in 5 European countries and enrolled patients from January 2014 to August 2016. Patients presenting with ACS (ST-segment elevation MI, non-ST-segment elevation MI, and unstable angina) with at least 1 de novo lesion were randomized to receive either a TiNO-coated stent or an EES. The present report analyzes the long-term follow-up for the main composite outcome and its individual components. Analysis took place between November 2022 to March 2023. Main outcome The primary end point was a composite of cardiac death, MI, or target lesion revascularization at 12-month follow-up. Results A total of 1491 patients with ACS were randomly assigned to receive either TiNO-coated stents (989 [66.3%]) or EES (502 [33.7%]). The mean (SD) age was 62.7 (10.8) years, and 363 (24.3%) were female. At 5 years, the main composite outcome events occurred in 111 patients (11.2%) in the TiNO group vs 60 patients (12%) in the EES group (hazard ratio [HR], 0.94; 95% CI, 0.69-1.28; P = .69). The rate of cardiac death was 0.9% (9 of 989) vs 3.0% (15 of 502) (HR, 0.30; 95% CI, 0.13-0.69; P = .005), the rate of MI was 4.6% (45 of 989) vs 7.0% (35 of 502) (HR, 0.64; 95% CI, 0.41-0.99; P = .049), the rate of stent thrombosis was 1.2% (12 of 989) vs 2.8% (14 of 502) (HR, 0.43; 95% CI, 0.20-0.93; P = .034), and the rate of target lesion revascularization was 7.4% (73 of 989) vs 6.4% (32 of 502) (HR, 1.16; 95% CI, 0.77-1.76; P = .47) in the TiNO-coated stent arm and in the EES arm, respectively. Conclusion and relevance In this study, patients with ACS had a main composite outcome that was not different 5 years after TiNO-coated stent or EES. Trial Registration ClinicalTrials.gov Identifier: NCT02049229.
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Affiliation(s)
- Frederic Bouisset
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Departement of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Jussi Sia
- Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | - Pasi P Karjalainen
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | - Kari Kervinen
- Clinical Research Center, Oulu University Hospital, Oulu, Finland
| | | | | | | | - Bruno Roza da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Lausanne University Center Hospital, Lausanne, Switzerland
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4
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Debonnaire P, Coussement P, Van der Heyden J. Transcatheter tricuspid valve repair using MitraClip device for significant tricuspid regurgitation: novel treatment for a common problem. Acta Cardiol 2020; 75:793-794. [PMID: 31599698 DOI: 10.1080/00015385.2019.1675921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Debonnaire P, Heyning CMVD, Haddad ME, Coussement P, Paelinck B, de Ceuninck M, Timmermans F, De Bock D, Drieghe B, Dujardin K, Vandekerckhove Y, Kedhi E, Claeys M, Van der Heyden J. Left Ventricular End-Systolic Dimension and Outcome in Patients With Heart Failure Undergoing Percutaneous MitraClip Valve Repair for Secondary Mitral Regurgitation. Am J Cardiol 2020; 126:56-65. [PMID: 32340713 DOI: 10.1016/j.amjcard.2020.03.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/17/2023]
Abstract
Recent MitraClip heart failure (HF) trials suggest that baseline left ventricular (LV) remodeling may be critical for patient selection. We, therefore, investigated whether baseline LV remodeling affects safety, efficacy, and clinical outcomes in HF patients with symptomatic secondary mitral regurgitation (MR) undergoing percutaneous mitral valve repair using MitraClip. LV remodeling was assessed by LV end-systolic dimension index (LVESDi) on transthoracic baseline echocardiography. Early and late outcome was reported using Mitral Valve Academic Research Consortium-criteria. A total of 107 consecutive HF patients (73 ± 10 years, 70% male) who underwent MitraClip intervention for secondary MR were studied. The study population was stratified by median LVESDi between nonadvanced (<28 mm/m², n = 49) and advanced LV remodeling (≥28 mm/m², n = 58). Both groups had similar acute procedural success, in hospital bleeding and nonbleeding complications and significant improvement in MR severity and symptoms, sustained up to 36 months (all p >0.05). LVESDi, but not LV end-diastolic diameter index nor LV ejection fraction, independently related to HF hospitalization (hazard ratio 1.11, 95% confidence interval 1.05 to 1.16, p <0.001) and mortality (hazard ratio 1.11, 95% confidence interval 1.06 to 1.17, p <0.001). At 1 and 3 years, survival free of HF hospitalization was higher in patients without versus with advanced LV remodeling (89% vs 66% and 65% vs 37%, p = 0.002) and mortality was lower (9% vs 24% and 36% vs 47%, p = 0.074), respectively. Annual HF hospitalization rate only decreased in the nonadvanced LV remodeling group (-43%, p = 0.025). Advanced LV remodeling, assessed by LVESDi, in HF patients who underwent MitraClip therapy does not influence therapeutic safety nor efficacy, but implies increased HF hospitalization and mortality risk. This parameter may be valuable for MitraClip therapy patient selection.
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Abstract
Endovascular baroreflex amplification is an alternative treatment strategy for patients with resistant hypertension. In endovascular baroreflex, the carotid baroreflex is activated by a MobiusHD® device (MD) which has been implanted in the internal carotid artery. This review will discuss the MD technology and mechanism of action and promising results in the first-in-human prospective study involving the use of the MD in patients with resistant hypertension.
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Affiliation(s)
- Jonathan Halim
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
| | - Jan Van der Heyden
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
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Kortlandt F, Velu J, Schurer R, Van den Branden B, Bouma B, Kelder J, Eefting F, Swaans M, Rensing B, Baan J, Van der Heyden J. Impact of mitral valve treatment choice on mortality according to aetiology. EUROINTERVENTION 2019; 14:1733-1739. [DOI: 10.4244/eij-d-18-00874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Habib N, Mahmoodi BK, Suttorp MJ, Kelder JC, Tromp SC, Sonker U, Van der Heyden J. Long-term results of carotid stenting and risk factors in patients with severe carotid artery stenosis undergoing subsequent cardiac surgery. Catheter Cardiovasc Interv 2019; 93:E134-E139. [PMID: 30411845 DOI: 10.1002/ccd.27947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 09/06/2018] [Accepted: 10/08/2018] [Indexed: 11/12/2022]
Abstract
AIMS To identify risk factors for composite outcome of mortality, stroke or myocardial infarction in patients with severe carotid stenosis undergoing staged carotid artery stenting (CAS) with subsequent cardiac surgery. METHODS AND RESULTS In this prospective observational study, we enrolled 643 consecutive patients with both symptomatic (i.e., with history of stroke) and asymptomatic severe carotid artery disease, who required cardiac surgery. Generally, cardiac surgery was planned 30 days after the CAS procedure. The composite outcome consisted of death, stroke and myocardial infarction. The composite outcome rate was 26.3% at 5 years and 47% at 8 years after CAS. Age ≥ 80 years (hazard ratio [HR] = 1.89; 95%CI, 1.18-3.03; P = 0.008), history of stroke (HR = 1.66, 1.16-2.37; P = 0.006), chronic obstructive pulmonary disease (HR = 1.86; 1.07-3.24; P = 0.03) and kidney disease (HR = 1.83, 1.11-3.04; P = 0.02) were independent risk factors for the composite outcome during long-term follow-up. CONCLUSIONS In this study with staged CAS followed by cardiac surgery, we confirm previously reported event-free survival rates and identify several risk factors for the composite outcome. Future studies are needed to confirm the importance of the identified risk factors and to assess their predictive ability.
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Affiliation(s)
- Najibullah Habib
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Maarten J Suttorp
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Selma C Tromp
- Department of Clinical Neurophysiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic and Cardiovascular Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan Van der Heyden
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
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Gheorghe L, Swaans M, Denti P, Rensing B, Van der Heyden J. Transcatheter Tricuspid Valve Repair With a Novel Cinching System. JACC Cardiovasc Interv 2018; 11:e199-e201. [PMID: 30503598 DOI: 10.1016/j.jcin.2018.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Livia Gheorghe
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Martin Swaans
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Paolo Denti
- Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Bernard Rensing
- Interventional Cardiology Unit, St. Antonius Hospital, Nieuwegein, the Netherlands
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Kortlandt F, Velu J, Schurer R, Hendriks T, Van den Branden B, Bouma B, Feldman T, Kelder J, Bakker A, Post M, Van der Harst P, Eefting F, Swaans M, Rensing B, Baan J, Van der Heyden J. Survival After MitraClip Treatment Compared to Surgical and Conservative Treatment for High-Surgical-Risk Patients With Mitral Regurgitation. Circ Cardiovasc Interv 2018; 11:e005985. [DOI: 10.1161/circinterventions.117.005985] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Friso Kortlandt
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Juliette Velu
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Remco Schurer
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Tom Hendriks
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Ben Van den Branden
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands (B.V.d.B.)
| | - Berto Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Ted Feldman
- Department of Cardiology, Evanston Hospital, NorthShore University Health System, IL (T.F.)
| | - Johannes Kelder
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Annelies Bakker
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Marco Post
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Pim Van der Harst
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Frank Eefting
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Martin Swaans
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Benno Rensing
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Jan Baan
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Jan Van der Heyden
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
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Kooiman J, de Vries JPPM, Van der Heyden J, Sijpkens YWJ, van Dijkman PRM, Wever JJ, van Overhagen H, Vahl AC, Aarts N, Verberk-Jonkers IJAM, Brulez HFH, Hamming JF, van der Molen AJ, Cannegieter SC, Putter H, van den Hout WB, Kilicsoy I, Rabelink TJ, Huisman MV. Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures. PLoS One 2018; 13:e0189372. [PMID: 29420536 PMCID: PMC5805164 DOI: 10.1371/journal.pone.0189372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 11/22/2017] [Indexed: 02/08/2023] Open
Abstract
Background Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures. Methods We performed an open-label multicentre non-inferiority trial between 2011–2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4–12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48–96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up. Results Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001). Conclusion Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings. Trial registration Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699
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Affiliation(s)
- Judith Kooiman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | | | - Jan Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Yvo W. J. Sijpkens
- Department of Internal Medicine, Bronovo Hospital, The Hague, the Netherlands
| | | | - Jan J. Wever
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hans van Overhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Antonie C. Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Nico Aarts
- Department of Radiology, Bronovo Hospital, The Hague, the Netherlands
| | | | - Harald F. H. Brulez
- Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam, the Netherlands
| | - Jaap F. Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Inci Kilicsoy
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ton J. Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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12
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Spiering W, Williams B, Van der Heyden J, van Kleef M, Lo R, Versmissen J, Moelker A, Kroon A, Reuter H, Ansel G, Stone GW, Bates M. Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. Lancet 2017; 390:2655-2661. [PMID: 28870716 DOI: 10.1016/s0140-6736(17)32337-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Carotid baroreflex activation lowers blood pressure and might have potential application for the treatment of resistant hypertension. We did a proof-of-principle trial with a novel endovascular baroreceptor amplification device, MobiusHD (Vascular Dynamics, Mountain View, CA, USA), in patients with resistant hypertension. METHODS CALM-FIM_EUR was a prospective, first-in-human, open-label study done at six European centres. Eligible patients were adults with resistant hypertension (office systolic blood pressure ≥160 mm Hg despite taking at least three antihypertensive agents, including a diuretic). MobiusHD devices were implanted unilaterally in the internal carotid artery. The primary endpoint was the incidence of serious adverse events at 6 months. Secondary endpoints included changes in office and 24 h ambulatory blood pressure. This trial is registered with ClinicalTrials.gov, number NCT01911897. FINDINGS Between December, 2013, and February, 2016, 30 patients were enrolled and underwent successful implantation. Mean age was 52 years (SD 12), 15 patients (50%) were men, and mean antihypertensive use was 4·4 drugs (1·4). Mean office blood pressure was 184/109 mm Hg (18/14) at baseline and was reduced by 24/12 mm Hg (13-34/6-18) at 6 months (p=0·0003 for systolic and p=0·0001 diastolic blood pressure). Mean baseline 24 h ambulatory blood pressure was 166/100 mm Hg (17/14) at baseline and was reduced by 21/12 mm Hg (14-29/7-16) at 6 months (p<0·0001 for systolic and diastolic blood pressure). Five serious adverse events had occurred in four patients (13%) at 6 months: hypotension (n=2), worsening hypertension (n=1), intermittent claudication (n=1) and wound infection (n=1). INTERPRETATION In patients with resistant hypertension, endovascular baroreceptor amplification with the MobiusHD device substantially lowered blood pressure with an acceptable safety profile. Randomised, double-blind, sham-controlled trials are warranted to investigate the use of this treatment further. FUNDING Vascular Dynamics.
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Affiliation(s)
- Wilko Spiering
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.
| | - Bryan Williams
- University College London (UCL) Institute of Cardiovascular Science and National Institute for Health Research (NIHR) UCL Hospitals Biomedical Research Centre, London, UK
| | | | - Monique van Kleef
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rob Lo
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Abraham Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Hannes Reuter
- Department of Cardiology, Heart Centre of the University of Cologne, Cologne, Germany
| | - Gary Ansel
- OhioHealth Research Institute, Columbus, OH, USA
| | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Mark Bates
- CAMC Research Institute and West Virginia University, Charleston, WV, USA
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Naber CK, Pyxaras SA, Ince H, Frambach P, Colombo A, Butter C, Gatto F, Hink U, Nickenig G, Bruschi G, Brueren G, Tchétché D, Den Heijer P, Schillinger W, Scholtz S, Van der Heyden J, Lefèvre T, Gilard M, Kuck KH, Schofer J, Divchev D, Baumgartner H, Asch F, Wagner D, Latib A, De Marco F, Kische S. A multicentre European registry to evaluate the Direct Flow Medical transcatheter aortic valve system for the treatment of patients with severe aortic stenosis. EUROINTERVENTION 2016; 12:e1413-e1419. [PMID: 27934611 DOI: 10.4244/eij-d-15-00511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to assess the clinical outcomes of the Direct Flow Medical Transcatheter Aortic Valve System (DFM-TAVS), when used in routine clinical practice. METHODS AND RESULTS This is a prospective, open-label, multicentre, post-market registry of patients treated with DFM-TAVS according to approved commercial indications. Echocardiographic and angiographic data were evaluated by an independent core laboratory and adverse events were adjudicated and classified according to VARC-2 criteria by an independent clinical events committee. The primary endpoint was freedom from all-cause mortality at 30 days post procedure. Secondary endpoints included procedural, early safety and efficacy endpoints at 30 days. Two hundred and fifty patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with the DFM-TAVS were enrolled in 21 European centres. The primary endpoint, freedom from all-cause mortality at 30 days, was met in 98% (245/250) of patients. Device success was 83.8%. Moderate or severe aortic regurgitation was reported in 3% of patients, and none/trace regurgitation in 73% of patients. Post-procedural permanent pacemaker implantation was performed in 30 patients (12.0%). CONCLUSIONS The DFM-TAVS was associated with good short-term outcomes in this real-world registry. The low pacemaker and aortic regurgitation rates confirm the advantages of this next-generation transcatheter heart valve (THV).
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Affiliation(s)
- Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
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14
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Habib N, Mahmoodi BK, Bos WJW, Tromp SC, Suttorp MJ, Bates MC, Van der Heyden J. Initial experience with therapeutic geometric modification of the carotid bulb for true resistant hypertension. EUROINTERVENTION 2016; 11:117-20. [PMID: 25982654 DOI: 10.4244/eijv11i1a20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The contribution of carotid baroreceptor feedback in preventing or potentially contributing to the essential hypertensive cascade is poorly understood. It is clear the carotid sinus nerve action potentials are triggered by carotid bulb stretch rather than pressure and are only sustained during pulsatile increases in pressure. In addition, the carotid baroreceptor negative feedback is gradually extinguished in hypertension patients (a phenomenon known as "resetting"). We report a case of significant reduction in blood pressure in a patient with true resistant hypertension after change in the carotid bulb pulsatile strain patterns following the implant of an intravascular prosthesis.
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Affiliation(s)
- Najibullah Habib
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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15
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Hasenfuß G, Hayward C, Burkhoff D, Silvestry FE, McKenzie S, Gustafsson F, Malek F, Van der Heyden J, Lang I, Petrie MC, Cleland JGF, Leon M, Kaye DM. A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): a multicentre, open-label, single-arm, phase 1 trial. Lancet 2016; 387:1298-304. [PMID: 27025436 DOI: 10.1016/s0140-6736(16)00704-2] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFPEF) is a common, globally recognised, form of heart failure for which no treatment has yet been shown to improve symptoms or prognosis. The pathophysiology of HFPEF is complex but characterised by increased left atrial pressure, especially during exertion, which might be a key therapeutic target. The rationale for the present study was that a mechanical approach to reducing left atrial pressure might be effective in HFPEF. METHODS The REDUCe Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF) study was an open-label, single-arm, phase 1 study designed to assess the performance and safety of a transcatheter interatrial shunt device (IASD, Corvia Medical, Tewkesbury, MA, USA) in patients older than 40 years of age with symptoms of HFPEF despite pharmacological therapy, left ventricular ejection fraction higher than 40%, and a raised pulmonary capillary wedge pressure at rest (>15 mm Hg) or during exercise (>25 mm Hg). The study was done at 21 centres (all departments of cardiology in the UK, Netherlands, Belgium, France, Germany, Austria, Denmark, Australia, and New Zealand). The co-primary endpoints were the safety and performance of the IASD at 6 months, together with measures of clinical efficacy, including functional capacity and clinical status, analysed per protocol. This study is registered with ClinicalTrials.gov, number NCT01913613. FINDINGS Between Feb 8, 2014, and June 10, 2015, 68 eligible patients were entered into the study. IASD placement was successful in 64 patients and seemed to be safe and well tolerated; no patient had a peri-procedural or major adverse cardiac or cerebrovascular event or need for cardiac surgical intervention for device-related complications during 6 months of follow-up. At 6 months, 31 (52%) of 60 patients had a reduction in pulmonary capillary wedge pressure at rest, 34 (58%) of 59 had a lower pulmonary capillary wedge pressure during exertion, and 23 (39%) of 59 fulfilled both these criteria. Mean exercise pulmonary capillary wedge pressure was lower at 6 months than at baseline, both at 20 watts workload (mean 32 mm Hg [SD 8] at baseline vs 29 mm Hg [9] at 6 months, p=0·0124) and at peak exercise (34 mm Hg [8] vs 32 [8], p=0·0255), despite increased mean exercise duration (baseline vs 6 months: 7·3 min [SD 3·1] vs 8·2 min [3·4], p=0·03). Sustained device patency at 6 months was confirmed by left-to-right shunting (pulmonary/systemic flow ratio: 1·06 [SD 0·32] at baseline vs 1·27 [0·20] at 6 months, p=0·0004). INTERPRETATION Implantation of an interatrial shunt device is feasible, seems to be safe, reduces left atrial pressure during exercise, and could be a new strategy for the management of HFPEF. The effectiveness of IASD compared with existing treatment for patients with HFPEF requires validation in a randomised controlled trial. FUNDING Corvia Medical Inc.
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Affiliation(s)
- Gerd Hasenfuß
- Heart Centre, Georg-August Universität, Gottingen, Germany
| | | | - Dan Burkhoff
- Cardiology Department, Columbia University, New York, NY, USA
| | | | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Irene Lang
- Allgemeines Krankenhaus Universitätskliniken, Vienna, Austria
| | - Mark C Petrie
- Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - John G F Cleland
- National Heart & Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Martin Leon
- Columbia University Medical Center, New York, NY, USA
| | - David M Kaye
- Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Waltenberger J, Hoffmann S, Brachmann J, Van der Heyden J, Richardt G, Frobert O, Seige M, Pachinger O, Erglis A, Dewilde W. TCT-169 BIOFLOW-III an all comers registry with a Sirolimus Eluting Stent, Presentation of One Year Target Lesion Failure Data. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Van der Heyden J, Wolters FJ, Garin N, Blant SA, Inglin M, Bal ET, Suttorp JM. The role of embolic protection devices during carotid stenting prior to cardiac surgery in asymptomatic patients: empty filters? Catheter Cardiovasc Interv 2012; 80:112-9. [PMID: 21953787 DOI: 10.1002/ccd.23383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/03/2011] [Accepted: 09/09/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the debris captured in the distal protection filters used during carotid artery stenting (CAS). BACKGROUND CAS is an option available to high-risk patients requiring revascularization. Filters are suggested for optimal stroke prevention during CAS. METHODS From May 2005 to June 2007, filters from 59 asymptomatic patients who underwent CAS were collected and sent to a specialized laboratory for light-microscope and histological analysis. Peri- and postprocedural outcomes were assessed during 1-year follow-up. RESULTS On the basis of biomedical imaging of the filter debris, the captured material could not be identified as embolized particles from the carotid plaque. On histological analysis the debris consisted mainly of red blood cell aggregates and/ or platelets, occasionally accompanied by granulocytes. We found no consistent histological evidence of embolized particles originating from atherosclerotic plaques. Post-procedure, three neurological events were reported: two (3.4%) transient ischemic attacks (TIA) and one (1.7%) ipsilateral minor stroke. CONCLUSION The filters used during CAS in asymptomatic patients planned for cardiac surgery often remained empty. These findings may be explained by assuming that asymptomatic patients feature a different atherosclerotic plaque composition or stabilization through antiplatelet medication. Larger, randomized trials are clearly warranted, especially in the asymptomatic population.
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Affiliation(s)
- Jan Van der Heyden
- Department of Interventional Cardiology, St-Antonius Hospital, Nieuwegein, The Netherlands.
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18
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Van der Heyden J, Van Neerven D, Sonker U, Bal ET, Kelder JC, Plokker HW, Suttorp MJ. Carotid Artery Stenting and Cardiac Surgery in Symptomatic Patients. JACC Cardiovasc Interv 2011; 4:1190-6. [DOI: 10.1016/j.jcin.2011.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/29/2011] [Accepted: 07/07/2011] [Indexed: 11/27/2022]
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Van der Heyden J, Waaijer A, Van ES W, van Neerven D, Sonker U, Suttorp M, Bal E, Prokop M. CT measurement of changes in cerebral perfusion in patients with asymptomatic carotid artery stenosis undergoing carotid stenting prior to cardiac surgery: "proof of principle". EUROINTERVENTION 2011; 6:1091-7. [DOI: 10.4244/eijv6i9a190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Van der Heyden J, Suttorp MJ, Bal ET, Ernst JM, Ackerstaff RG, Schaap J, Kelder JC, Schepens M, Plokker HW. Staged Carotid Angioplasty and Stenting Followed by Cardiac Surgery in Patients With Severe Asymptomatic Carotid Artery Stenosis. Circulation 2007; 116:2036-42. [PMID: 17938290 DOI: 10.1161/circulationaha.106.658625] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The strategy for treating patients with severe asymptomatic carotid artery stenosis and cardiac disease remains unresolved. Staged or combined carotid endarterectomy in these patients offers the potential benefit of decreased neurological morbidity during and after cardiac surgery; however, in high-risk patients with severe coronary artery disease, chronic obstructive pulmonary disease, or renal impairment, the incidence of death and stroke is significantly higher.
Methods and Results—
We report the results of a prospective, single-center study designed to evaluate the feasibility and safety of carotid artery angioplasty and stenting (CAS) before cardiac surgery in neurologically asymptomatic patients. The periprocedural and long-term outcomes of 356 consecutive patients who underwent CAS before cardiac surgery were analyzed. The procedural success rate of CAS was 97.7%. The death and stroke rate from time of CAS to 30 days after cardiac surgery was 4.8% (n=17). The myocardial infarction rate from time of CAS to 30 days after cardiac surgery was 2.0% (n=7), and the combined death, stroke, and myocardial infarction rate was 6.7% (n=24). Distal embolic protection devices were used in 40% of the cases.
Conclusions—
This large cohort of asymptomatic patients who underwent staged CAS and cardiac surgery experienced a low periprocedural complication rate. The high rate of freedom from death and stroke during the 5 years of follow-up supports the long-term durability of this approach. Our findings suggest that this new strategy may become a valuable alternative in the treatment of patients with combined carotid and cardiac disease.
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Affiliation(s)
- Jan Van der Heyden
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Maarten J. Suttorp
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Egbert T. Bal
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jef M. Ernst
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Rob G. Ackerstaff
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jeroen Schaap
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Johannes C. Kelder
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Mark Schepens
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Herbert W. Plokker
- From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands
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Van der Heyden J, Van Langenhove G, Vermeersch P. Traumatic ostial stenosis of internal mammary coronary graft. ACTA ACUST UNITED AC 2004; 6:42-4. [PMID: 15204173 DOI: 10.1080/1462884031000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because of the extensive use of arterial conduits for coronary surgery there is a growing interest in percutaneous intervention in these conduits. This kind of intervention presents a challenge for the interventional cardiologist owing to the anatomic and functional characteristics of this graft. In most cases significant internal mammary artery disease occurs at the distal anastomosis. Ostial stenoses are rare and their pathology uncertain. The authors report a case of an ostial graft lesion, most probably caused by repetitive ostial engagement of the left internal mammary artery in combination with atherosclerosis in the subclavian artery affecting the internal mammary artery.
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Affiliation(s)
- Jan Van der Heyden
- Department of Interventional Cardiology, AZ Middelheim, Antwerp, Belgium.
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