TCT-351 Coronary sinus reducer implantation for the treatment of chronic refractory angina: a single center experience

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Objectives: To evaluate the impact of coronary sinus (CS) Reducer implantation upon left ventricular (LV) function. Background: CS Reducer implantation is associated with symptomatic relief in patients with refractory angina. The effects of the device upon left ventricular function remains unknown. Methods: Prior to device implantation and at 4-months, resting ventricular volumes and function were measured using cardiac magnetic resonance (CMR). Stress CMR was performed to extract quantitative indices of myocardial perfusion (myocardial perfusion reserve index-MPRI). Results: Nineteen patients (18 males, 66.0 [IQR 56.0-77.0] years), underwent successful Reducer implantation. Sixteen (84%) patients improved by at least 1 CCS class. Four months after Reducer implantation, we noticed a significant improvement in LV ejection fraction (LVEF) (61 [IQR 47-71] to 66 [IQR 57-72] %; p = .009), a reduction in LV end-diastolic volume (LVEDV)/Body surface area (BSA) (65.7 [IQR 57.4-89.6] to 64.7 [IQR 53.7-74.1] mL/m 2 ; p = .036) and a reduction in LV end-systolic volume (LVESV)/ BSA (28.7 [IQR 18.6-38.8] to 20.0 [IQR 15.0-31.4] mL/m 2 ; p = .007). Patients with reduced EF (EF < 50%, n = 6) presented a greater increase of EF at follow up compared to patients with preserved EF (11.3 [IQR 6.5-54.5] vs. 3.8 [IQR 0.6-9.1] %; p = .029). The observed decrease in LVESV/BSA was greater in patients with reduced EF (23.6 [IQR 11.6-33.8] vs. 4.2 [IQR −2.0 to 8.4] mL/m 2 ; p = .005). A significant increase in transmural MPRI was observed 4 months after Reducer implantation (p < .011). Conclusions: CS Reducer improved angina symptoms and improved left ventricular function. The improvement was pronounced in the subgroup of patients with reduced ejection fraction. Myocardial perfusion improvement could represent the underlying mechanism for the observed benefits. K E Y W O R D S cardiac magnetic resonance, coronary sinus reducer, ischemic cardiomyopathy, refractory angina, remodeling

Section: Introductionsupporting

confidence: 80%

The impact of the coronary sinus reducer upon left ventricular function in patients with refractory angina pectoris

Tzanis

Palmisano

Gallone

et al. 2019

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“…Following the initial promising results, CS Reducer might represent a therapeutic option for refractory angina with a consequent increase of the implantation procedures. Knowing how to manage complications that may arise, can improve patients' outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Following the initial promising results, 5 The balloon catheter with the pre-mounted scaffold was advanced to reach the landing zone and the Reducer was deployed by inflating at 4 atm (A). Device dislodgement in the right atrium, following the retrieval of the balloon (B).…”

Section: Discussionmentioning

confidence: 99%

“…As consequence of the maneuver, a distal deformation ("partial Although, evidence on CS Reducer safety is limited to some observational studies [3][4][5][6] and to the COSIRA trial 2 , initial experience shows rare periprocedural or device-related complications. Since the first CS Reducer implantation on 2004, only a case of CS perforation has been reported so far.…”

Section: Case Reportmentioning

confidence: 99%

“…The consequent increase of CS and backward pressures of the coronary tree should promote a redistribution of the blood flow toward more ischemic myocardial territories, thus improving ischemia and symptoms. A single randomized, sham‐controlled trial and few observational studies have demonstrated its safety and efficacy. The initial promising results, with associated reduction of both angina symptoms and myocardial ischemia burden might lead to increased future Reducer implantations; therefore, experience on how to manage potential complications that might arise would be of clinical significance.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous management of periprocedural coronary sinus Reducer migration

Tzanis

Durante

Mitomo

et al. 2018

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Coronary sinus anatomical features: Description and procedural implications during coronary sinus Reducer implantation

Wilgenhof

Zivelonghi

Verheye

et al. 2020

Objectives We hypothesized that some coronary sinus (CS) anatomies allow a more straightforward CS Reducer (CSR) implantation. Background Recent decades have seen a rise in patients with chronic angina. When complete revascularization and maximal medical therapy fail to reduce symptoms, CSR has become a new therapeutic option. Methods We identified a classical C‐shape—a near horizontal course of the proximal portion of a circular CS—in a retrospective analysis of 47 CSR implantations and compared the procedural time, fluoroscopic time, contrast use, presence of valves or bifurcations and procedural complications with the non‐C‐shape CS anatomy. Results We found a significant difference in procedural (20.0 [19.0–24.7] min vs. 24.5 [20.7–51.0] min; p = .028 and fluoroscopic time (9.5 [7.5–14.5] min vs. 11.0 [7.9–30.0] min; p = .016). There was no significant difference in contrast use. The presence of bifurcations or valves along the CS course did not influence the procedural timings. Conclusion This study is the first systematic evaluation of CS anatomy and its procedural implications. We identified a favorable C‐shape anatomy which allows for a more straightforward implantation. Operators should be aware of the different implications of CS anatomy, their influence on guiding catheter stability and overall procedure complexity.