in the Elderly Busan- KOREA, 08 DEC 2018
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1 COMPLEX PCI in the Elderly A/Prof Ho Thuong Dung, MD, PhD, FSCAI, FACC Vice-Director,Thong Nhat Hospital, Hochiminh city Vice-President, Vietnam Society of Cardiac Intervention Busan- KOREA, 08 DEC 2018
2 Potential conflicts of interest Speaker's name: Ho Thuong Dung I have the following potential conflicts of interest to report: Consultant, Institutional grant/research support: Abbott Medtronic Terumo Biotronik Roche AstraZenrca Sanofi Synthelabo Boehringer Ingelheim
3 A/Prof Ho Thuong Dung, HCM city, VN CASE N o 1 Medical History 76 years old, Male Cardiovascular risk factors: HTA, ex-smoker, Hyper-LDL-C Current admission: NSTEMI Laboratory findings: hs TnT 534 ng/dl, Creatinin: 150 µmol/l; e GFR: 28.12ml/min; Pro-BNP: 746,9 pg/ml ECG: sinus rhythms, Q wave at DIII, avf. Physical exam: Unremarkable Echocardiography: Normal LV size. LVEF 55%. Mild MR
4 A/Prof Ho Thuong Dung, HCM city, VN RCA- Coronary Angiogram
5 A/Prof Ho Thuong Dung, HCM city, VN LCA- Coronary Angiogram
6 Our real practice SYNTAX SCORE= 37 Some very difficult challenging cases were sent to cathlab with over-indication for PCI The patients had already refused/declined CABG WHAT CAN WE DO? 5/26/2018 Ho Thuong Dung-- Thong Nhat H.- HCMC- VN
7 Revascularization for CAD How to decide? 2018 PGS Hồ Thượng Dũng, TPHCM
8 A/Prof Ho Thuong Dung, HCM city, VN Coronary Anatomy 2018 ESC/EACTS Guidelines on myocardial revascularization Type of revascularization in patients with stable coronary artery disease with suitable coronary anatomy for both procedures and low predicted surgical mortality (2) Recommendations according to extent of CAD Left main CAD CABG PCI Class Leve l Class Leve l Left main disease with low SYNTAX score (0-22). I A I A Left main disease with intermediate SYNTAX score (23-32). I A IIa A Left main disease with high SYNTAX score ( 33). I A III B a a PCI should be considered, if the patient refuses CABG after adequate counselling by the Heart Team. Class III: Relative Contraindication!!! 8
9 A/Prof Ho Thuong Dung, HCM city, VN
10 PGS TS Hồ Thượng Dũng, TPHCM Local Expertise
11 Wiring, Predilatation and Preparing for Stenting RCA- PCI
12 RCA- PCI Stenting: 1 st Stenting: distal stenting (2.75x 40 mm) 2 nd proximal stenting (3.0x 40 mm)
13 LM/LCA- PCI Wiring, Predilatation and Preparing for 1 st stenting
14 LM/LCA- PCI Deploying at prox LAD 1 st Stent (3.0x 40 mm) Preparing for 2 nd stenting (2.75x 26 mm) at ostio-prox LCx
15 LM/LCA- PCI Rewiring, ReBalooning, and First Kissing Balloon of DK-Crush Technique Being ready for The Last Stent
16 LM/LCA- PCI Positioning for The Last Stent (3.5x 16 mm) At LM-ostio/prox LAD Deploying last stenting At LM-ostio/prox LAD The Last Stent DK-Crush Technique
17 Final Result, Post-PCI Coronary Angiogram PRE- PCI POST- PCI
18 Final Result, Post-PCI Coronary Angiogram PRE- PCI POST- PCI
19 Final Result, Post-PCI Coronary Angiogram PRE- PCI POST- PCI
20 Final Result, Post-PCI Coronary Angiogram PRE- PCI POST- PCI
21 CONCLUSIONS Aging process have accumulative effects on CV system, particularly on CAD. CAD in the Elderly often being very severe: type C, bifurcation, LM, TVD, CTO with calcified, diffuse, tortuous lesions Interventionist should choose the strategy of PCI on the individual basis: Coronary Anatomy; Patient Preference; Experience; Medical Co-morbidities Some complex cases with Over-Indication is still well done with complete revascularization DK-Crush seems to be a suitable 2-stent techniques for revascularization of very complicated LM in the Elderly 5/26/2018 Ho Thuong Dung-- Thong Nhat Hospital- HCMC- VN 21
22 HUE City Thank you for your attention! 5/26/ Ho Thuong Dung-- Thong Nhat Hospital- HCMC- VN Ho Thuong Dung-- Thong Nhat Hospital- HCMC- VN
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