Hesselson Aaron B, Duggal Sandeep, Rukavina Michael, Gallagher Peter L, Tomassoni Gery F
Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA.
Pacing Clin Electrophysiol. 2018 Apr;41(4):383-388. doi: 10.1111/pace.13303. Epub 2018 Mar 25.
Barriers to successful left ventricular lead placement within the coronary venous anatomy may include focal stenoses, thromboses, phrenic nerve stimulation, vessel tortuosity, small vessel caliber, nonexcitable tissue, and valve presence. A large series describing the utilization of coronary venous angioplasty (CVAP) for relief of these issues is absent in the literature.
We report our experience on all patients treated with CVAP in a single-center 13-year experience.
Forty-seven patients with CVAP (64% male, mean age 67 ± 12 years) were treated by five different implanting physicians for approved cardiac resynchronization therapy indications. The reason for CVAP was categorized by obstacle (focal occlusion, valve presence, small caliber vessel) and location. The number, type, and size of balloon used, inflation characteristics, complications, and success of lead deployment crossing the point of intervention were all tabulated.
Seventy-seven percent of patients (36/47) had successful CVAP. The most common reason for intervention was a focal occlusion (24/47; 51%), followed by valve presence (13/47; 28%), and small vessel caliber (10/47; 21%). Focal occlusions were most successfully managed with CVAP (23/24; 96%), followed by small vessel caliber (7/10; 70%) and valve presence (6/13; 46%). The reason for failure was most commonly due to failure to relieve the obstruction (5/11; 45%), thrombosis (3/11; 27.3%), dissection (2/11; 18.2%), and inability to pass the balloon through the occlusion (1/11; 9.0%). There were no significant complications developed from CVAP utilization.
In a large analysis, CVAP can be safely and successfully performed in the majority of instances required.
在冠状静脉解剖结构中成功放置左心室导线的障碍可能包括局灶性狭窄、血栓形成、膈神经刺激、血管迂曲、血管口径小、无兴奋性组织以及瓣膜的存在。文献中缺乏描述利用冠状静脉血管成形术（CVAP）来缓解这些问题的大型系列研究。
我们报告在单中心13年经验中接受CVAP治疗的所有患者的情况。
47例接受CVAP治疗的患者（64%为男性，平均年龄67±12岁）由5位不同的植入医生进行治疗，以符合批准的心脏再同步治疗适应症。CVAP的原因按障碍类型（局灶性闭塞、瓣膜存在、血管口径小）和位置进行分类。使用的球囊数量、类型和尺寸、充盈特征、并发症以及导线穿过干预点的部署成功率均被列表记录。
77%的患者（36/47）CVAP治疗成功。最常见的干预原因是局灶性闭塞（24/47；51%），其次是瓣膜存在（13/47；28%）和血管口径小（10/47；21%）。CVAP对局灶性闭塞的处理最为成功（23/24；96%），其次是血管口径小（7/10；70%）和瓣膜存在（6/13；46%）。失败的最常见原因通常是未能解除梗阻（5/11；45%）、血栓形成（3/11；27.3%）、夹层（2/11；18.2%）以及无法使球囊穿过闭塞处（1/11；9.0%）。CVAP使用过程中未出现严重并发症。
在一项大型分析中，在大多数需要的情况下，CVAP可以安全、成功地进行。
