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Chronic total occlusions: early results of a newly established proctor-guided program
Session:
Posters 1 - Écran 05 - Intervenção Coronária
Speaker:
CELIA DOMINGUES
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Célia Domingues; Elisabete Jorge; José Rumoroso; Hugo Vinhas; João Brum Silveira; Manuel Oliveira Santos; Luís Candal Leite; João Marques; João Calisto; Vitor Azevedo Matos; Rui Baptista; Mariano Pêgo; Maria João Vidigal Ferreira
Abstract
<p><strong>Background:</strong> It is now well established that coronary total occlusion (CTO) revascularization should only be conducted as a part of a structured program with rigorous previous planning and regular proctoring. We aimed to analyze the safety and efficacy outcomes of the patients enrolled in our CTO recanalization program.</p> <p><strong>Methods:</strong> We conducted a retrospective study in our institution, enrolling all patients that were integrated in an organized CTO revascularization program from January, 2017 to December, 2017. All patients were treated under formal proctoring from national or international experts.</p> <p><strong>Results:</strong> We enrolled 26 patients, with a median age of 62 ± 10 years and a large male predominance (92%). Most patients were dyslipidemic (81%), hypertensive (69%) and had smoking habits in the present or the past (58%); 27% were diabetic and 85% had a prior history of coronary artery disease. Median LVEF was 45 ± 8%. The large majority (85%) had non-invasive evidence of ischemia/viability concerning the territory of CTO vessel. Globally, the 26 patients represented 30 CTOs (single vessel in 22 patients and 2 vessels in 4 patients). The most commonly treated artery was the right coronary (17), followed by the left anterior descending (7) and the circumflex (5) arteries. Bilateral injection was used in 18 CTOs (60%); in 24 CTOs (80%), the anterograde approach was used. The global success rate was 90% (27 out of 30); of these, 8 have failed a previous attempt; however, all were successfully treated on a second attempt. During the procedures no major complications were registered; 2 patients developed a femoral hematoma, with spontaneous resolution; 1 patient developed contrast nephropathy, with no need of renal replacement therapy and with complete recovery of renal function. One procedure was carried on electively with the support of a transient left ventricular assist device (Impella® CP)</p> <pre> <strong>Conclusions:</strong> The favorable early results of our CTO program, similar to the ones reported in the literature, encourage the establishment of structured programs of complex coronary intervention with active proctoring assistance. </pre>
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