SPC365

Acute Pulmonary Embolism Catheter-Directed Therapy: a safety and feasibility analysis

Session: Comunicações Orais (Sessão 28) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 3 - Vários Tópicos
Speaker: André Grazina

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: André Grazina; Luís Almeida Morais; António Fiarresga; Ruben Ramos; Lídia de Sousa; João Reis; Ana Galrinho; Bárbara Teixeira; Isabel Cardoso; José Miguel Viegas; Helena Teles Antunes; Rita Barata Moura; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Introduction: </span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Pulmonary embolism (PE) is the third most common cause of cardiovascular death. It has a broad clinical spectrum of severity.<strong> </strong>Systemic fibrinolysis is associated with reduction of circulatory collapse, long-term pulmonary hypertension (PH) and death in intermediate-high- and high-risk PE patients, when compared to anticoagulation alone. Dedicated multidisciplinary Pulmonary Embolism Response Teams (PERT) were created to deliver better care for these patients, centered in innovative catheter directed therapies (CDT) with mechanical thrombolysis and local fibrinolysis with the potential to reduce the systemic hemorrhagic effects of fibrinolysis. </span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Objectives:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> This analysis focus on the safety and feasibility of our PERT early experience with CDT. </span></span></span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">During 2021</span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">, consecutive intermediate-high- and high-risk PE patients considered suitable for CDT from our PERT, were prospectively enrolled in a single tertiary center. CDT options included mechanical thrombolysis using the Penumbra aspiration system and local fibrinolysis (alteplase perfusion 1mg/h, for 12 hours) through a 5F Craig McNamara catheter in the pulmonary artery (PA). Baseline characteristics, procedure data, complications and outcomes were noted. </span></span></span></span></span></h1>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Results: </span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">14 patients (mean age 55.9&plusmn;19.3 years old, 36% male) were submitted to CDT for intermediate-high-risk PE (table 1). Mean admission lactate levels and PaO2/FiO2 ratio were 1.5&plusmn;0.7mmol/L and 267&plusmn;120, respectively. Mean peak hs-troponin I and NT-proBNP levels were 2043pg/ml and 7372pg/ml, respectively. CT-scan showed a central PE in 43% (n=6) and a mean RV/LV ratio of 1.3&plusmn;0.2. Pre-procedural Transthoracic echocardiogram revealed RV dilation in 100% (n=14) and RV dysfunction in 62% (n=8), with mean TAPSE of 15.7&plusmn;3.3mm and estimated PASP of 54.3&plusmn;16.3mmHg. Right heart catheterization showed mean right atrium (RA) pressure of 9.2&plusmn;3.3mmHg and PA systolic, diastolic and mean pressures of 54.1&plusmn;18.7mmHg, 21.4&plusmn;7.8mmHg and 34.1&plusmn;11.2mmHg, respectively. Cardiac Output and Cardiac Index were 5.9&plusmn;1.6L/min and 2.5&plusmn;0.8L/min/m<sup>2</sup>. Mean PA resistance was 3.6&plusmn;2.1 Wood units. Pulmonary Angiogram revealed a modified Miller Index of 9.7&plusmn;3.0. Regarding complications, no major or potentially fatal bleeding were noted. It was noted a PA dissection, treated conservatively and no PA perforations or moderate/severe pulmonary valve regurgitation. Two patients died (one in-hospital death due to oncologic disease progression and another of unknown cause after hospital discharge). No re-hospitalizations were noted during the follow-up period (average of 6.5 months).</span></span></span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> Intermediate-high risk patients constitute a particularly challenge group of PE patients. We believe that PERT improves care in this subset, when a strict by-protocol application of CDT is implemented. Our first experience data supports the safety and feasibility of our approach. </span></span></span></span></span></span></p>