Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy
Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy
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DOI：
10.1007/s12471-016-0937-0
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发表时间：
2017-02-01
影响因子：
2
通讯作者：
Zeus, T.
中科院分区：
文献类型：
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作者：
Afzal, S.;Veulemans, V.;Zeus, T.
目的通过超声心动图和x线透视的视觉引导对于在卵窝预定区域成功进行经隔穿刺（TSP）至关重要。新型EchoNavigator系统Release II （echonavii, Philips Healthcare, Andover, Massachusetts， USA）能够实时融合透视和超声心动图图像。我们评估了这种新的成像方法在mitraclip植入和左心房附件关闭期间TSP的安全性和有效性。方法采用回顾性、单中心研究，选取44例（+EchoNav）实时融合术前和术后患者。主要终点是TSP引起的不良事件的发生。次要终点是在预定的区域和时间成功穿刺，直到TSP （min）。结果两组患者均在预定区域成功完成了TSP，在完成TSP过程中或由于TSP而发生的不良事件均未发生。与EchoNav组相比，+EchoNav组的TSP时间显著缩短（18.48 +/- 5.62 min vs. 23.20 +/- 9.61 min, p = 0.006）。结论超声心动图与透视的实时融合被证明是TSP的安全和成功的标准最佳做法。此外，通过显著缩短至TSP的时间，疗效得到改善。
Aims Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP duringMitraClip implantation and left atrial appendage closure.Methods Forty-four patients before (-EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min).Results In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 +/- 5.62 min vs. 23.20 +/- 9.61 min, p = 0.006).Conclusions Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.