prostheses and implants

ABCIC

Case Report

TAV-in-TAV for Acute Failure of a Transcatheter Aortic Valve in a High Surgical Risk Octogenarian Patient

Gustavo Carvalho et al. Maria Fernanda Miranda Carvalho Enio Eduardo Guérios Pedro Calegari … Cláudia Biondo Zanlorensi Fernando Silva Botelho Bruna O. Erbano Vinícius D. Vaz

Abstract

An 82-year-old patient with severe aortic valve stenosis and high risk for conventional surgery due to chronic renal dysfunction and restrictive lung disease underwent transfemoral transcatheter aortic valve implantation (TAVI) using a self-expanding Navitor^® prosthesis (Abbott). Immediately after implantation, valve dysfunction was observed, characterized by inversion of the right coronary leaflet, resulting in severe acute prosthetic regurgitation and hemodynamic instability. Therefore, a 21.5 mm balloon-expandable Myval^® prosthesis was also implanted (TAV-in-TAV). The critical condition was resolved with immediate hemodynamic recovery. This case demonstrates the efficacy and safety of TAV-in-TAV as a bailout intervention in acute prosthetic failure.

Read Full Article

ABC

Artigo Original

Left atrial appendage closure with the Amplatzer Cardiac Plug in patients with atrial fibrillation

Ênio Eduardo Guérios et al. Michael Schmid Steffen Gloekler Ahmed A. Khattab … Peter M. Wenaweser Stephan Windecker Bernhard Meier

BACKGROUND: Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OA) for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVE: To describe the immediate results and short- to medium-term clinical follow-up (FU) of patients that underwent LAAC with Amplatzer Cardiac Plug (ACP) implantation in a single reference center. METHODS: Eighty-six consecutive patients with NVAF, contraindication to OA, and CHADS2 score=2.6±1.2 underwent LAAC with ACP implantation. Clinical and echocardiographic FU was performed at least four months after the procedure. RESULTS: All implants were guided by angiography alone. Procedural success was 99% (one patient suffered a cardiac tamponade requiring pericardiocentesis, and the procedure was waived). There were four major complications (the already mentioned cardiac tamponade, two transient ischemic attacks and one device embolization with percutaneous retrieval) and two minor complications (one pericardial effusion without clinical significance and one non-significant ASD evidenced at FU). There was one in-hospital death after six days, unrelated to the procedure. All other patients were discharged without OA. After 25.9 patient-years of FU (69 patients), there were no strokes and no late device embolization. The LAA was completely closed in 97% of the cases. Six patients showed evidence of thrombus formation on the device, which resolved after three months of OA. CONCLUSION: LAAC is associated with high success, acceptable complication rates, and promising FU results, and may be considered a valuable alternative or complement to OA for stroke prevention in patients with NVAF.

Read Full Article

ABC

Artigo Original

Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

Márcio José Montenegro et al. Edgard Freitas Quintella Aníbal Damonte Hugo de Castro Sabino … Ricardo Zajdenverg Gustavo Pinaud Laufer Bernardo Amorim André Pereira Duque Estrada Cristian Paul Yugcha Armas Aline Sterque

Background: Atrial fibrillation is associated with embolic strokes that often result in death or disability. Effective in reducing these events, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. Objective: To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. Methods: We report our initial experience with Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos) in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. Results: In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Conclusion: Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

Read Full Article

TAV-in-TAV for Acute Failure of a Transcatheter Aortic Valve in a High Surgical Risk Octogenarian Patient

Abstract

Left atrial appendage closure with the Amplatzer Cardiac Plug in patients with atrial fibrillation

Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)