Author + information
- Hugo Gutiérrez Leonard,
- Luis Enrique Berumen Domínguez,
- José Luis Ojeda Delgado,
- Rodolfo Barrios Nanni and
- Miguel Ramírez Aldaraca
Determine the therapeutic effect of splinting with stenting the LAD. Improve the NYHA functional class. Improve the ejection fraction.
A total of 48 patients between 62 and 74 years old, 31 men and 17 women, from October 2009 through February 2013. We established a randomized study, 2 groups each one with 24 patients. All patients suffered refractory heart failure with left fraction ejection less than 30% in class III and IV (NYHA classification). Transthoracic echocardiogram was performed at admission, 6 and 12 months, nuclear imagine was done the day after improving their medical conditions, all studies shows no viability in this territory and coronary angiography was done the next day. All patients suffered from LAD disease only, and the vessel was patent in every one. We deliver bare metal stents from distal to proximal, the stents used are from 2.5mm to 3.5mm in diameter and 28 to 36mm long. We performed coronary angiography and ventriculography by femoral access then in the most severe lesions we made angioplasty before delivering the stents as we mentioned. All stents were spliced together with 5 mm each from distal to proximal just to the main lesion. All patients are reassessed clinically each month and an echocardiography study was performed at 6 and 12 months.
The functional class improves in all the patients from the experimental group (24 patients), 21 patients pass to II functional class and only 3 patients stayed in III functional class, actually 2 patients died, the first one died at the next 8 months and the second one at the 18 months. From the control Group 6 patients died in the first year, in the next six months 3 more patients died and all 6 patients stayed in III and the rest in IV functional class. The left fraction ejection improve in a average 5%, but in all the patients the therapeutic medication were reduced. From the control group we found that 80% of the patients were hospitalized around 3 or 4 times per year and in the experimental group only 10%.
This technique is effective for treat patients with refractory heart failure, besides being easy to apply, during the procedure there were no deaths, and functional class improved significantly for patients in a period of 6 months until these period. The containment of the discinetique zone with a mechanical barrier effect, promoted the consequent increase in the contractility of the rest of the walls. This clinical trial is innovative for the treatment of refractory heart failure using a percutaneous technique.