Transcatheter Aortic Valve Implantation: Two-Year Follow-up of the Initial Southern Brazilian Experience Background: Aortic stenosis is a prevalent disease with high morbidity and mortality, whose classical approach is surgical valve replacement. Elderly patients and those with other comorbidities present high surgical risk. Transcatheter aortic valve implantation is an effective alternative to standard surgery. The objective of this study is to report the 2-year follow-up of the first cases performed in Southern Brazil. Methods: Series of cases describing the technique, immediate and medium term results of the CoreValve TM (Medtronic Inc., Minneapolis, USA) device implantation, a porcine pericardial bioprosthesis mounted on a self expanding nitinol stent, delivered via transarterial access. Results: Four female patients, with ages ranging from 81 to 90 years and a logistic EuroSCORE ranging from 20% to 36% were successfully submitted to the implantation of this device. A significant reduction in the left ventricle-aortic gradient, and no major cardiovascular complications were observed, although 2 patients required the implantation of a permanent pacemaker due to complete atrioventricular block. Improvement of functional class and maintenance of gradients and aortic valve areas obtained at the end of the procedure, as well as a progressive decrease of left ventricular mass were observed in the 2 year follow-up. Conclusions: This early experience with the CoreValve TM transcatheter aortic valve implantation has proved to be safe and effective in the medium term outcome. Long-term follow-up studies are required to define the exact role and adequate indications for this new and promising technology.
background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates. Methods: Consecutive patients undergoing primary PCI were enrolled from December of 2009 to June of 2011. Clinical, laboratory, and angiographic data were prospectively collected and entered into a dedicated database. The decision to perform thrombus aspiration was left to the discretion of the surgeons. One hundred and twelve samples of thrombi were collected, stored in 10% formalin fixed paraffin, stained with hematoxylineosin, and analysed by light microscopy. Upon histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organised thrombi. results: Recent thrombi were identified in 68 patients (61%), and lysed/organised thrombi were found in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P = 0.03). There were no other statistically significant differences regarding clinical, angiographic, laboratory, or clinical outcomes between the two study groups. Conclusions: In patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates presented the histopathological features of recent thrombi. There were no significant associations among these characteristics and the clinical, laboratory, and angiographic data in this
The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no significant anesthetic complications during this procedure.
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