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Coronary sinus reducer device for the treatment of refractory angina. A single centre experience
Session:
Sessão de Posters 01 - Intervenção não valvular
Speaker:
MIGUEL VAZ ALMEIDA SOBRAL DOMINGUES
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Sobral Domingues; Rita Carvalho; Joana Pereira; Sérgio Madeira; João Brito; Luís Raposo; Rui Teles; Manuel Almeida
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Introduction</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">The coronary sinus Reducer emerged as a complementary therapy in patients with angina refractory to optimal medical therapy and not amenable to revascularization.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Aim</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Methods and population</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Twenty-six patients with refractory angina, objective evidence of myocardial ischemia attributable to the left coronary artery and deemed unsuitable for revascularization were treated with Reducer at a single center between April 2018 and November 2022. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at 6-month, were a reduction in Canadian Cardiovascular Society angina (CCS) class and a reduction in pharmacological antianginal therapy.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Results</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Twenty-one (81%) had end-stage coronary artery disease without targets for further revascularization (13 had previous CABG </span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black"> PCI and 8 had only PCI) and 5 patients had microvascular disease without epicardial stenosis.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">All procedures were performed via right jugular vein. The mean procedure and fluoroscopy duration were 66</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">29 and 19</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">8 minutes. Procedural success was achieved in all patients, with no device related complications. There was one cardiac tamponade, promptly treated with pericardiocentesis. Regarding the efficacy endpoint, 21 patients (81%) had at least 1 reduction in CCS class, 13 patients (50%) had at least 2 class reductions, and 7 patients (28 %) became asymptomatic, with a mean reduction of CCS class of 1.4</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">0.9, from 2.6</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">0.5 to 1.2</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">0.9 (p=0.001) at 6-month follow-up. During this time frame, twelve patients (46%) withdrawn or reduced the dose of at least on anti-anginal drug, the mean reduction of anti-anginal drugs was 0.54 </span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">0.86, from 3.5</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">1.02 to 2.9</span></span></span><span style="font-size:11.0pt"><span style="color:black">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">1.07 (p=0.04). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">Conclusion</span></span></span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Gill Sans",sans-serif"><span style="color:black">In this real-world, single-center experience, implantation of Reducer was safe and associated with improvement of angina and reduction of anti-anginal drugs intake in patients with refractory angina unsuitable for revascularization.</span></span></span></span></span></p>
Slides
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