Massive Audio PAT50 User Manual download pdf (Page 45)

J KARDIOL 2008; 15 (5–6)(2) 187

ÖKG-Jahrestagung – Abstracts (Zur Publikation nachgereichte Abstracts)

Percutaneous Aortic Valve Replacement for Severe

Symptomatic Aortic Stenosis: an Emerging New

Treatment Option for High-Risk Patients 125

R. Maier, R. Hödl, G. Stoschitzky, N. Watzinger, A. Schmidt, J. Binder,

P. Oberwalder, H. Brussee, B. Pieske, O. Luha

Division of Cardiology, Department of Medicine, and Division of Cardiac Surgery,

Department of Surgery, Medical University Graz

Background Degenerative aortic stenosis (AS) is currently the

most frequent acquired heart valve disease in industrialised coun-

tries. In symptomatic patients with severe AS, operative aortic valve

replacement is the treatment of choice. However, not only sympto-

matic AS becomes more prevalent in elderly patients, but also

comorbidities that increase the risk for operative valve replacement.

Therefore, percutaneous aortic valve replacement (PAVR) might be

an alternative therapy for high-risk patients.

Patients and Methods In our institution, 20 patients (6 male,

14 female; mean age 80 ± 6 years) with symptomatic severe AS un-

derwent PAVR between May 2007 and February 2008. Aortic valve

area was 0.5 ± 0.1 cm², logistic EuroSCORE 28 ± 15 %. The proce-

dure was performed in the catheterization laboratory via a bifemoral

percutaneous approach under local anaesthesia and analgesic seda-

tion without surgical cut-down and hemodynamic support. After bal-

loon valvuloplasty the self-expanding CoreValve prosthesis (diam-

eter 26 mm, n = 15; 29 mm, n = 5) was implanted using the current

18 French delivery catheter system.

Results Acute procedural success rate was 100 %. Device implan-

tation resulted in a significant reduction of mean aortic trans-

valvular gradient (59 ± 16 mmHg vs 11 ± 3 mmHg, p < 0.0001) and

a marked decline of NT-proBNP 30 days after PAVR (5645 ±

6319 pg/ml vs 2610 ± 2753 pg/ml, p = 0.07). Postprocedural aortic

regurgitation was trivial or mild in 16 patients and moderate in four

patients. Permanent pacemaker implantation was necessary in two

patients due to complete atrioventricular block. There was no myo-

cardial infarction but one periprocedural stroke in a patient who

died from multiorgan failure two days later. Another patient died 27

days after PAVR due to pneumonia (overall 30-day mortality rate

10 %). The remaining 18 patients had an uneventful postprocedural

course with marked clinical improvement over a total of 72 patient-

months.

Conclusion PAVR with the self-expanding CoreValve biopros-

thesis is an emerging alternative treatment for high-risk patients

with symptomatic severe AS. Complication rate is acceptable, and

mortality rate is lower than predicted by risk calculation.

Mid-Term Results of the Freedom Solo

Stentless

Pericardial Aortic Valve Prosthesis 126

R. Hödl

, S. Dolezal², R. Maier

, B. Rigler², A. Yates²

Medical University Graz, Dept of Medicine, Div of Cardiology and Dept of Surgery,

Div of Cardiac Surgery²

Objective Implantation of stentless prosthesis in patients with se-

vere aortic valve disease provides several advantages in haemody-

namics, as low transvalvular gradient and a more physiological

blood flow, furthermore short cross-clamp time and no need for per-

manent anticoagulation. The Freedom Solo

pericardial aortic valve

prosthesis (Sorin Biomedica, Saluggia, Italy) is a new stentless

bioprosthesis for supra-annular insertion by running suture. This

study provides mid-term results of a patient series treated in our in-

stitution.

Methods This is a prospective single-center observational study

to investigate survival and haemodynamic parameters such as trans-

valvular aortic gradient in patients treated with the above mentioned

aortic valve prosthesis. Therefore patients underwent transthoracic

echocardiography before surgery, at time of discharge an after about

18 month. Transvalvular gradient was measured using continuous-

wave Doppler signal and aortic regurgitation was judged by colour

Doppler imaging.

Results Between October 2004 and February 2007, 50 patients

(25 male, mean age 77 ± 4 years) underwent first time aortic valve

replacement with the Freedom Solo valve due to severe aortic steno-

sis. Twenty of those (40 %) had to undergo simultaneous bypass

grafting. Ejection fraction was 62 ± 12 % before surgery. Mean

cross-clamp time was 66 ± 19 min. in the entire group and 54 ±

7 min. in the valve replacement only group.

At a mean follow-up period of 20 ± 9 months 42 patients (84 %)

were alive. Three patients (6 %) died in the very early period (one due

to low cardiac output, two patients due to bleeding of ruptured aorta),

five more patients (10 %) died in the remaining follow-up time. Re-

garding haemodynamic parameters, mean transvalvular gradient was

11 ± 5 mmHg and ejection fraction was 65 ± 7 % at 20 months.

Transvalvular regurgitation occurred in 20 patients (40 %). It was

trivial in 16 patients (32 %) and mild in the remaining four (8 %).

Conclusion Mid-term results of the Freedom Solo aortic valve

stentless prosthesis are encouraging. Transvalvular gradients are

low and survival is acceptable with respect to the age and risk of the

patient population. Larger studies and results of long-term follow-

up have to be expected.

High Rate of Esophageal Ulceration after Ablation of

Atrial Fibrillation in a Su/jointfilesconvert/272007/bgroup of Patientes with

General Anesthesia 127

M. Martinek, G. Bencsik, J. Aichinger, H.-J. Nesser, H. Pürerfellner

Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching

Hospital, Linz, Austria

Background Atrioesophageal fistula is an uncommon but often

lethal complication of atrial fibrillation (AF) ablation. The inci-

dence of asymptomatic esophageal ulceration (EU) detected by en-

doscopy is high (35.7–46 %) as recently reported. The purpose of

our study was to investigate if direct visualisation of the esophagus

and energy titration at the posterior atrial wall (PW) can prevent EU.

Methods 83 patients (52 paroxysmal, 31 persistent) were rando-

mized into three groups and underwent oesophagogastroscopy 24

hours after ablation:

Group 0: AF ablation without real-time esophageal visualization,

25W power limit at the PW (n = 47).

Group 1: Direct visualization of the esophagus using barium swal-

lows (gastric tube in patients in general anesthesia) and energy re-

duction to 15W at the PW (n = 12).

Group 2: Direct visualization of the esophagus and energy reduction

to 25W and a maximum of 10 seconds energy delivery at the PW

(“short burns”) (n = 19).

Ablation was performed with a 3.5 mm tip open irrigation catheter

with a target temperature of 43 °C. For navigation in the left atrium

(LA) we used a 3D mapping system with CT integration.

Conscious sedation with midazolam and propofol was used in 70

patients (84 %) and general anesthesia in 13 patients (16 %). In the

latter group we used a nasogastric tube for visualisation of the

esophagus in 6 patients.

Results In total we found 5 of 83 patients presenting EU on endos-

copy (6 %). 2 patients were from the paroxysmal, and 3 from the

persistent group. Out of five 3 patients belonged to the su/jointfilesconvert/272007/bgroup

with general anesthesia and esophagus visualization with a

nasogastric tube. 1 patient belonged to the group 0 without visuali-

sation and 4 patients to the group 2 with visualisation (p = 0.027).

Patients with general anesthesia and esophagus visualization with a

nasogastric tube developed EU in 50 % of cases (p = 0.013). We

found no significant difference between energies delivered on the

PW comparing groups with and without EU.

Conclusions Ablation guided by real-time visualisation of the

esophagus was not able to prevent EU, but with the power limitation to

25 W on the PW we found a much lower rate of EU than reported in

other series. With a power setting of 15W no EU was reported at all.

We identified a su/jointfilesconvert/272007/bgroup of patients with general anesthesia and

nasogastric tube as a high risk population for EU.

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