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Portuguese single centre experience in percutaneous catheter-directed treatment for acute pulmonary embolism: is time for a lung fast-track system (“via verde pulmonar”)?
Session:
Sessão de Comunicações Orais - Cardiologia de Intervenção
Speaker:
Ana Rita Pereira
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita F. Pereira; Rita Calé; Filipa Ferreira; Maria José Loureiro; Débora Repolho; Tiago Judas; Melanie Ferreira; Ana Gomes; Filipe Gonzalez; Corinna Lohmann; Hugo Moreira; Cristina Dantas Martins; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Acute pulmonary embolism (PE) is the most common cause of cardiovascular death after myocardial infarction and stroke. Interest in its management and outcomes recently reemerged with the development of percutaneous catheter-directed treatments (CDTs).</p> <p><strong>Aims:</strong> To evaluate the efficacy and safety of CDTs for acute high- and intermediate-high-risk PE.</p> <p><strong>Methods:</strong> Retrospective multicentre study including consecutive pts undergoing CDTs for central location, acute PE from 2018 to 2019. Pts were eligible for CDTs if had intermediate-high-risk with at least one early sign of haemodynamic decompensation or high-risk with systemic thrombolysis contraindication or failure. Invasive measurement of pulmonary artery pressures was performed before and after procedure. Clinical, laboratorial and echocardiographic data at baseline, after procedure and 3-months follow-up were collected.</p> <p><strong>Results:</strong> 28 pts were included: mean age 66.7 ± 15.5 years, 58.8% female, 42.9% with high-risk PE, 64.3% in class IV or V of original PESI score, 17.9% with concomitant active cancer. Right ventricular (RV) dysfunction was present in 74.7% and aminergic support was needed in 50%. Median values of high-sensitivity cardiac troponin and NTproBNP were 70 (42.0-136.5) ng/L and 6965.5 (2926.0-12305.0) pg/mL, respectively. PE was bilateral in 96.4%. Concerning procedure, femoral venous access was used in all cases and bilateral intervention was performed in 47.1%. All pts underwent mechanical thrombectomy (Penumbra Indigo aspiration system CAT8® used in 93%). A bolus injection of alteplase was administered to 20.6%, median dose of 12.5 mg. Mean procedural duration was 111.1 ± 30.2 minutes, mean contrast volume 161.6 ± 44.2 mL and median effective radiation dose 767570.0 (600700.0-1442270.0) μGy. No device related-death or device-related injury were reported. After percutaneous treatment, there was a significant decreased in mean pulmonary arterial pressure (- 5.5 mmHg, p < 0.01), mean paO<sub>2</sub>/fiO<sub>2</sub> ratio (+ 76.8, p < 0.01), need for aminergic support at first 48 hours after procedure (- 50%, p=0.03) and RV dysfunction (TAPSE + 4.7 mm, p = 0.02; tricuspid S’ wave + 4.2 m/s, p= 0.03) - figure 1. In-hospital mortality rate was 17.9% (n=5; 3 pts died due to hospital-acquired infections, 1 patient after PE recurrence and 1 due to RV failure). 3-months follow-up were completed in 21 out of the 23 hospital-discharged pts with a survival rate of 90.5% (2 pts died from cancer).</p> <p><strong>Conclusions: </strong>This study confirms the efficacy of CDTs for acute high- and intermediate-high-risk PE, improving clinical and haemodynamic parameters, gas exchange and echocardiographic signs of RV overload. Nevertheless, all-cause mortality rate was elevated, probably related with baseline high risk features assessed by original PESI score as well as concomitant comorbidities of the study population.</p>
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