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Minimized use of contrast agent and fluoroscopic time by 3D echocardiography in transapical TAVI procedures

Masseli, F ; Bostani, T ; Endlich, M ; Gestrich, C ; Sterner, D ; Welz, A ; Mellert, F ; Schiller, W

The Thoracic and Cardiovascular Surgeon, 2013, Vol.61 (S 01) [Periódico revisado por pares]

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  • Título:
    Minimized use of contrast agent and fluoroscopic time by 3D echocardiography in transapical TAVI procedures
  • Autor: Masseli, F ; Bostani, T ; Endlich, M ; Gestrich, C ; Sterner, D ; Welz, A ; Mellert, F ; Schiller, W
  • É parte de: The Thoracic and Cardiovascular Surgeon, 2013, Vol.61 (S 01)
  • Descrição: Objective: Fluoroscopy is the standard positioning and guiding method in TAVI procedures. From June 2008 to April 2010 our regime consisted of using fluoroscopic angiography with contrast medium during initial outlining of the aortic root, balloon valvuloplasty, for positioning of the prosthesis, optionally also for repositioning and for final control after implantation (group CP). From June 2010 we introduced a new protocol with the aid of 3D echocardiography (TEE) to minimize use of contrast agent and fluoroscopic time (group EP). Method: 84 consecutive patients were included in the analysis (CP: n = 28, EP: n = 56). Age and logistic EUROSCORE did not significantly differ between CP and EP (means 77.8 ± 0.6 years, 22.9 ± 1.8%). TEE was performed using the Philips iE33 ultrasound system with a Philips X7 – 2 t TEE-probe. All patients received an Edwards-Sapien transcatheter heart valve (ES-THV) via transapical approach. The cumulative dose of contrast agent and fluoroscopic time was compared between both groups. Patients treated with the new protocol (EP) regularely received only one dose of contrast agent just before the deployment of the prosthesis. Valvuloplasty, crude positioning of the valve and final control after deployment were performed using TEE and fluoroscopy without contrast agent. Continuous variables were given as mean with standard error in case of Gaussian distribution and median with interquartile range (IR) if not parametric. Differences were tested for with student's t or Mann-Whitney -U test. Results: Procedural success could be achieved in 95.3% with one intraoperative death and two conversions to open surgery. After implementation of the new implantation protocol median use of contrast agent could be reduced by 77% (p < 0.0001, mean values given 130 ± 16 ml vs. 30 ± 2.7 ml respectively), mean fluoroscopic time could be reduced by 28% (10.19 ± 0.8 min vs. 7.34 ± 0.3 min, p = 0.0001). Postoperative increase in creatinine was significantly higher in the CP group compared to the EP group (0.25 mg/dl, IR 0.15 – 0.58 vs. 0.12 mg/dl IR 0.01 – 0.47, p = 0.03). Conclusion: Changing the transapical implantation strategy to a 3D-TEE supported approach was accompanied by a significant decrease of both fluoroscopic time and use of contrast agent. Furthermore the EP group experienced less increase in postoperative creatinine. We therefore consider our approach as successful measure to preserve kidney function and reduce X-ray exposure for patients and personnel.
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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