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Impact of right ventricular side branch occlusion during percutaneous coronary intervention of chronic total occlusions on right ventricular function

Session Poster session 4

Speaker Pepijn Adriaan Van Diemen

Event : ESC Congress 2017

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Coronary Intervention: Complications
  • Session type : Poster Session

Authors : P A Van Diemen (Amsterdam,NL), W J Stuijfzand (Amsterdam,NL), S Biesbroek (Amsterdam,NL), P G Raijmakers (Amsterdam,NL), R S Driessen (Amsterdam,NL), S P Schumacher (Amsterdam,NL), A Nap (Amsterdam,NL), A C Van Rossum (Amsterdam,NL), N Van Royen (Amsterdam,NL), R Nijveldt (Amsterdam,NL), P Knaapen (Amsterdam,NL)

P.A. Van Diemen1 , W.J. Stuijfzand1 , S. Biesbroek1 , P.G. Raijmakers2 , R.S. Driessen1 , S.P. Schumacher1 , A. Nap1 , A.C. Van Rossum1 , N. Van Royen1 , R. Nijveldt1 , P. Knaapen1 , 1VU University Medical Center, Cardiology - Amsterdam - Netherlands , 2VU University Medical Center, Radiology & Nuclear Medicine - Amsterdam - Netherlands ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 674

Background: Recent developments in percutaneous coronary intervention (PCI) techniques have expanded the feasibility of treatment of chronic coronary total occlusions (CTO). However, the utilization of dissection and reentry techniques and extensive stent implantation may increase the risk of associated iatrogenic injury to coronary side branches. The aim of the present study was to determine the incidence of right ventricular side branch (RVB) occlusion due to PCI CTO of the right coronary artery (RCA), and its impact on right ventricular (RV) function as assessed with cardiac magnetic resonance (CMR) in the current PCI CTO era.

Methods: Fifty-four consecutive patients (80% male, 63±10 years) with successful PCI CTO RCA evaluated with CMR prior and 3 months after revascularization (median: 99 days, IQR: 92–105 days) were included in the study. Standard CMR cine images were examined to quantify right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), and ejection fraction (RVEF). Procedural invasive coronary angiograms were assessed for the occurrence of RVB occlusion and/or RVB positive vessel remodeling (PVR).

Results: Periprocedural RVB occlusion was observed in 12 patients (22%), either due to a coronary artery dissection (58%) or stent implantation (42%). Positive vessel remodeling of a RVB occurred in seven patients (13%), and was exclusively observed after successful true-to-true-wiring. On average, RVEF was comparable between baseline and follow-up CMR (53.8±5.8 vs. 53.9±5.8%, p=0.95). In patients with procedural RVB occlusion there was no significant difference between baseline and follow up RVEDV or RVEF (156.9±36.3 vs. 162.1±35.5mL, p=0.30 and 54.2±3.9 vs. 52.7±4.4%, p=0.19, respectively), however a trend was observed for an increase in RVESV at follow-up (72.5±20.0 vs. 77.4±20.7mL, p=0.05, respectively). Positive vessel remodeling did not result in a significant improvement of RVEF (55.4±4.6 vs. 56.1±5.3%, p=0.75).

Conclusion: In the present consecutive PCI CTO cohort, periprocedural occlusion of a significant RVB was not associated with a significant decreased RVEF at three months follow-up, although the results suggested a limited increase of RVESV.

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