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Leone PP, Oliva A, Regazzoli D, Gitto M, Novelli L, Cozzi O, Stefanini GG, Rossi ML, Sticchi A, Tartaglia F, Mangieri A, Reimers B, Colombo A. Immediate and follow-up outcomes of drug-coated balloon angioplasty in de novo long lesions on large coronary arteries. EUROINTERVENTION 2023; 19:e923-e925. [PMID: 37670668 PMCID: PMC10719739 DOI: 10.4244/eij-d-23-00502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
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Gitto M, Sticchi A, Chiarito M, Novelli L, Leone PP, Mincione G, Oliva A, Condello F, Rossi ML, Regazzoli D, Gasparini G, Cozzi O, Stefanini GG, Condorelli G, Reimers B, Mangieri A, Colombo A. Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery. Circ Cardiovasc Interv 2023; 16:e013232. [PMID: 37874646 DOI: 10.1161/circinterventions.123.013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited. METHODS Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction. RESULTS We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40-82] versus 56 [46-66] mm; P=0.002), while longer DESs were implanted (38 [24-62] versus 56 [46-66] mm; P<0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; P=0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20-1.27]; P=0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07-0.58]; P=0.003), mainly driven by less target lesion revascularization. CONCLUSIONS A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.
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Leone PP, Mangieri A, Regazzoli D, Laricchia A, Khokhar A, Rossi ML, Latib A, Reimers B, Colombo A. Drug-Coated Balloon Angioplasty Guided by Postpercutaneous Coronary Intervention Pressure Gradient: The REDUCE-STENT Retrospective Registry. JACC Cardiovasc Interv 2023; 16:363-365. [PMID: 36609047 DOI: 10.1016/j.jcin.2022.09.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
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Tebaldi M, Biscaglia S, Fineschi M, Musumeci G, Marchese A, Leone AM, Rossi ML, Stefanini G, Maione A, Menozzi A, Tarantino F, Lodolini V, Gallo F, Barbato E, Tarantini G, Campo G. Evolving Routine Standards in Invasive Hemodynamic Assessment of Coronary Stenosis. JACC Cardiovasc Interv 2018; 11:1482-1491. [DOI: 10.1016/j.jcin.2018.04.037] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/13/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
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Rosenfeld J, Rossi ML, Briggs M. Glioblastoma Multiforme of the Cerebellum in an Elderly Man. A Case Report. TUMORI JOURNAL 2018; 75:626-9. [PMID: 2559527 DOI: 10.1177/030089168907500623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glioblastoma multiforme of the cerebellum is rare and comprises a small fraction of all glioblastomas. Eighty-five cases have been reported in the literature to date. A 75 year old man is reported with a left cerebellar glioblastoma multiforme. The pathogenesis, course, treatment and prognosis are reviewed.
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Rossi ML, Jones NR, Karr GF, Esiri MM, Havas L, Coakham HB. HLA-Dr Expression by Tumor Cells Compared with Survival in High Grade Astrocytomas. TUMORI JOURNAL 2018; 77:122-5. [PMID: 1646510 DOI: 10.1177/030089169107700206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Frozen samples from 78 high grade astrocytomas were reacted with a monoclonal antibody directed against HLA-Dr invariant chain. Survival data was obtained for all 78 cases. HLA-Dr was expressed by a proportion of tumor cells in 65/78 (83 %). Comparison of the survival of positive and negative cases showed that the difference was not statistically significant (p = 0.4). The relevance of the finding is discussed in the context of the immunoreaction to brain tumors.
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Rossi ML, Buller JR, Heath SA, Carey MP, Carboni P, Koutsoubelis G, Coakham HB. The Monocyte/Macrophage Infiltrate in 35 Medulloblastomas: A Paraffin-Wax Study. TUMORI JOURNAL 2018; 77:36-40. [PMID: 2017797 DOI: 10.1177/030089169107700109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have studied formalin fixed, paraffin-wax embedded tissue from 35 medulloblastomas, collected over 23 years (27 non-desmoplastic and 8 desmoplastic) with KP1 and Mac387 two monoclonal anti-monocytes/macrophage (M/Ms) antibodies recommended for use on paraffin wax embedded tissue. In non-desmoplastic medulloblastomas, outside areas of necrosis, M/Ms were detected in 50% of cases with KP1 and 52% with Mac387. M/Ms were seen In 100% of desmoplastic medulloblastomas with both antibodies. Semiquantitative assessment revealed that, on average, desmoplastic tumors had at least three times as many Infiltrating M/Ms as non-desmoplastic tumors. There was no significant difference in the findings with the two antibodies or, between recently embedded and « older » tumors. The findings may be indicative of the presence of a host M/Ms immune response in medulloblastoma, which may be more accentuated in desmoplastic medulloblastomas. Furthermore, we conclude that these antibodies are quite suitable for the study of infiltrating M/Ms, thus lessening (but not obviating) the need for frozen tissue for immunohistological studies.
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Rossi ML, Jones NR, Esiri MM, Havas L, al Izzi M, Coakham HB. Mononuclear Cell Infiltrate and Hla-Dr Expression in 28 Pituitary Adenomas. TUMORI JOURNAL 2018; 76:543-7. [PMID: 2284689 DOI: 10.1177/030089169007600605] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Frozen sections from 28 pituitary adenomas were reacted with a panel of monoclonal antibodies to macrophages, lymphocytes and HLA-Dr invariant chain. A low number of macrophages were demonstrated in all tumors, mainly perivascular. CD8 and CD4 lymphocytes were detected in even smaller numbers in 80% and 14% of tumors respectively. B lymphocytes were present in only 1 case. An occasional NK cell was present in 1/13 cases studied. HLA-Dr antigen was expressed by macrophages in all cases and by tumor cells in 2 growth hormone-producing adenomas/19 adenomas. These findings may represent evidence for a low degree of cellular immune response to pituitary adenomas.
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Rossi ML, Bevan JS, Fleming KA, Cruz-Sanchez F. Pituitary Metastasis from Malignant Bronchial Carcinoid. TUMORI JOURNAL 2018; 74:101-5. [PMID: 2451332 DOI: 10.1177/030089168807400118] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Metastases from a carcinoid tumor to the pituitary gland have, to our knowledge, not been described. We present a 49-year-old woman diagnosed as having a primary carcinoid tumor arising in the submucosa of a large bronchus who 8 years later presented with multiple metastases including one to the pituitary gland, which was in partial failure of pituitary function. This case illustrates than when confronted with a pituitary tumor resembling an adenoma but negative for pituitary hormones, the possibility of a metastasis from a carcinoid tumor should be considered.
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Conrotto F, D’Ascenzo F, Stella P, Pavani M, Rossi ML, Brambilla N, Napodano M, Covolo E, Saia F, Tarantini G, Agostoni P, Marzocchi A, Presbitero P, Bedogni F, Salizzoni S, D’Amico M, Moretti C, Rinaldi M, Gaita F. Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients. J Cardiovasc Med (Hagerstown) 2017; 18:103-108. [DOI: 10.2459/jcm.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Iannaccone M, Piazza F, Boccuzzi G, D’Ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Frangieh A, Hildick-Smith D, Templin C, Colombo A, Sardella G. ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry. EUROINTERVENTION 2016; 12:1457-1464. [DOI: 10.4244/eij-d-15-00485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Iannaccone M, Barbero U, D'ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Colombo A, Sardella G, Boccuzzi GG. Rotational atherectomy in very long lesions: Results for the ROTATE registry. Catheter Cardiovasc Interv 2016; 88:E164-E172. [PMID: 27083771 DOI: 10.1002/ccd.26548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/28/2016] [Accepted: 03/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is relatively contraindicated in patients with lesions ≥25 mm of length. Aim of this study was to evaluate RA safety and efficacy in this subset of patients with new technology and devices. METHODS AND RESULTS From April 2002 to August 2013, the ROTATE registry included all consecutive patients undergoing RA in 8 centres. They were divided into shorter lesion group (SLG, lesions < 25 mm) and longer lesion group (LLG, lesions ≥ 25 mm). The angiographic success (AS) was the primary end point. Procedural complications (PC), a composite end point of procedural perforation, slow flow/no flow, and in-hospital major acute cardiovascular events (MACE), were secondary end points, along with death, nonfatal MI, target lesion revascularization, and MACE during follow-up. Sensitivity analysis was performed according to generation of DES. 1186 patients were included: 51.5% in SLG and 48.4% in LLG. Mean age was 70.4 ± 9.3 years, 64.5% were male. AS and PC did not differ between the two groups (93% vs 91%, p = 0.24 and 9.8 vs 9.4%, p = 0.84). During follow-up (27.6 ± 22.9 months), MACE did not differ between the two groups (28% vs 29.1%, p = 0.95). At multivariate analysis chronic kidney disease, male gender increased risk of MACE (HR 1.94, IQR 1.29-2.0, p = 0.01, HR 0.52, IQR 0.34-0.79, p = 0.01) while second-generation DES seemed protective (HR 0.53, IQR 0.31-0.88, p = 0.02). Data were confirmed at sensitivity analysis for second-generation DES (759 pts, 63.9%). No differences were found in this subpopulation between the two groups in term of AS, PC, and long-term MACE (93.6% vs 93.5%, p = 0.28, 11.9% vs 9.4%, p = 0.32 and 25.5% vs 23.9%, p = 0.72, respectively). CONCLUSIONS Treating coronary lesions ≥ 25 mm length with RA does not impact short- and long-term outcome, in particular, in patients with second-generation DES. © 2016 Wiley Periodicals, Inc.
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Kawamoto H, Latib A, Ruparelia N, Boccuzzi GG, Pennacchi M, Sardella G, Garbo R, Meliga E, D'Ascenzo F, Moretti C, Rossi ML, Presbitero P, Ielasi A, Magri C, Nakamura S, Colombo A. Planned versus provisional rotational atherectomy for severe calcified coronary lesions: Insights From the ROTATE multi-center registry. Catheter Cardiovasc Interv 2016; 88:881-889. [DOI: 10.1002/ccd.26411] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/26/2015] [Indexed: 11/09/2022]
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Panico C, Mennuni MG, Rossi ML, Zavalloni D, Gasparini GL, Soldi M, Stefanini GG, Condorelli G, Presbitero P, Pagnotta P. TCT-675 New-onset intraventricular conduction delays with the Edwards Sapien 3 transcatheter aortic valve. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Attizzani GF, Ohno Y, Latib A, Petronio AS, De Carlo M, Giannini C, Ettori F, Curello S, Fiorina C, Bedogni F, Testa L, Bruschi G, De Marco F, Presbitero P, Rossi ML, Boschetti C, Picarelli S, Poli A, Barbanti M, Martina P, Colombo A, Tamburino C. Transcatheter Aortic Valve Implantation Under Angiographic Guidance With and Without Adjunctive Transesophageal Echocardiography. Am J Cardiol 2015; 116:604-11. [PMID: 26081069 DOI: 10.1016/j.amjcard.2015.05.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
Although transcatheter aortic valve implantation (TAVI) is still currently guided by transesophageal echocardiography (TEE) in a considerable number of hospitals, exclusive angiographic (Angio) guidance seems a reasonable approach in this setting. To date, however, no studies have directly compared the outcomes of TAVI according to the imaging modality used for procedural guidance. We, therefore, used data from a large multicenter data repository to compare the outcomes of TAVI guided exclusively by Angio and ATEE. All consecutive patients with severe aortic stenosis who underwent TAVI with the CoreValve Revalving System (CRS) in 9 Italian centers from September 2007 to March 2014, dichotomized according to the imaging support used to guide the procedure (ATEE and Angio), were included. Thirty-day and 12-month clinical outcomes were evaluated. Propensity matching analysis was performed to adjust for baseline differences. A total of 625 patients were included (256 and 369 patients were included in the ATEE and Angio groups, respectively). Patients from the ATEE more frequently underwent TAVI under general anesthesia compared with Angio group (37.9% vs 22.8%, respectively, p <0.001). Importantly, ∼80% of the patients experienced mild or even less aortic regurgitation as assessed by angiography after the procedure, without between-group differences. Postdilation and valve-in-valve rates were equivalent (24.7% vs 25%, p = 0.934 and 5.5% vs 3.4%, respectively, p = 0.217). No differences were revealed in the rates of death, cardiovascular death, and stroke or transient ischemic attack at 12-month follow-up. These results were sustained after propensity matching analysis. In conclusion, as long as a comprehensive procedural planning is performed, TAVI with CRS may be performed exclusively under angiographic guidance without the need for associated TEE.
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Rossi ML, Belli G, Pagnotta P, Lucarelli C, Presbitero P. Paravalvular Leak Leading to Severe Aortic Valve Regurgitation after TAVI: Percutaneous Closure Strategy. Heart Lung Circ 2015; 24:936-9. [PMID: 26048318 DOI: 10.1016/j.hlc.2015.04.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/13/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022]
Abstract
Regurgitation due to a paravalvular leak (PVL) is a complication that may affect patients undergoing surgical mechanical or bioprosthetic heart valve replacement. PVL can also occur after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and is associated with significantly worse outcomes. We report a case in which different closure strategies and devices were attempted and required to percutaneously close a severe PVL after TAVI in a patient with prohibitive surgical risk.
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D'Ascenzo F, Conrotto F, Salizzoni S, Rossi ML, Nijhoff F, Gasparetto V, Barbanti M, Mennuni M, Omedè P, Grosso Marra W, Quadri G, Giordana F, Tamburino C, Tarantini G, Presbitero P, Napodanno M, Stella P, Biondi-Zoccai G, Agostoni P, D'Amico M, Moretti C, Rinaldi M, Marra S, Gaita F. Incidence, predictors, and impact on prognosis of systolic pulmonary artery pressure and its improvement after transcatheter aortic valve implantation: a multicenter registry. THE JOURNAL OF INVASIVE CARDIOLOGY 2015; 27:114-9. [PMID: 25661764 DOI: pmid/25661764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS Elevated values of systolic pulmonary artery pressure (sPAP) represent a common finding in patients with aortic stenosis and severe left ventricular hypertrophy. Prognostic impact of sPAP and its potential improvement after transcatheter aortic valve implantation (TAVI) remains to be determined. METHODS AND RESULTS This is a multicenter retrospective registry in five European institutions. All consecutive patients undergoing TAVI were enrolled, and divided into two groups according to sPAP evaluated with echocardiography: ≤40 mm Hg and >40 mm Hg. All-cause mortality at follow-up of at least 1 year was the primary endpoint, while 30-day mortality, periprocedural complications, myocardial infarction, stroke, and reintervention rates at follow-up were the secondary endpoints. Among 674 patients enrolled, a total of 319 (47%) had sPAP >40 mm Hg. This was associated with higher mortality at 30 days (4.5% vs 8.5%; P=.03) and at a median follow-up of 477 days (17% vs 26%; P=.03). Improvement of sPAP was reported in 113 patients (27%), occurring more frequently in absence of moderate or severe mitral regurgitation and of right ventricle dysfunction. With multivariate adjustment, reduced renal function, insulin-dependent diabetes mellitus, and sPAP >40 mm Hg were independent predictors of all-cause mortality, improvement in sPAP values was related to a better survival, while ejection fraction was not. CONCLUSION Elevated values of sPAP represent a common finding in patients undergoing TAVI. This parameter, along with its improvement, may be used to stratify risk and determine prognosis for patients undergoing TAVI.
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D'Ascenzo F, Capodanno D, Tarantini G, Nijhoff F, Ciuca C, Rossi ML, Brambilla N, Barbanti M, Napodano M, Stella P, Saia F, Ferrante G, Tamburino C, Gasparetto V, Agostoni P, Marzocchi A, Presbitero P, Bedogni F, Cerrato E, Omedè P, Conrotto F, Salizzoni S, Biondi Zoccai G, Marra S, Rinaldi M, Gaita F, D'Amico M, Moretti C. Usefulness and validation of the survival posT TAVI score for survival after transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol 2014; 114:1867-74. [PMID: 25438915 DOI: 10.1016/j.amjcard.2014.09.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 02/08/2023]
Abstract
Surgical risk scores fail to accurately predict mortality after transcatheter aortic valve implantation (TAVI). The aim of this study was to develop and validate a dedicated risk score for accurate estimation of mortality risk in these patients. All consecutive patients who underwent TAVI at 6 international institutions were enrolled. Predictors for 1-year all-cause mortality were identified by means of Cox multivariate analysis and incorporated in a prediction score. Accuracy of the score was derived and externally validated for 30-day and 1-year mortality. The net classification improvement compared with the Society of Thoracic Surgeons (STS) score was appraised. A total of 1,064 patients constituted the derivation cohort and 180 patients constituted the external validation cohort. A total of 165 patients (15%) died at 1-year follow-up. Previous stroke (odds ratio [OR] 1.80, 1.4 to 3), inverse of renal clearance (OR 8, 6 to 14), and systolic pulmonary arterial pressure ≥50 mm Hg (OR 2.10, 1.5 to 3) were independently related to 1-year mortality. Area under the curve (AUC) of the survival post TAVI (STT) for 1-year mortality was 0.68 (0.62 to 0.71). At 30 days, 65 patients (7%) had died and the AUC for the STT at this time point was 0.66 (0.64 to 0.75). In the external validation cohorts, the AUC of the STT were 0.66 (0.56 to 0.7) for 30-day and 0.67 (0.62 to 0.71) for 1-year mortality. Net reclassification improvement for STT compared with STS was 31% (p <0.001) for 30-day mortality and 14% (p <0.001) for 1-year mortality. In conclusion, the STT score represents an easy and accurate tool to assess the risk of short-term and mid-term mortality in patients undergoing TAVI.
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Conrotto F, D'Ascenzo F, Salizzoni S, Presbitero P, Agostoni P, Tamburino C, Tarantini G, Bedogni F, Nijhoff F, Gasparetto V, Napodano M, Ferrante G, Rossi ML, Stella P, Brambilla N, Barbanti M, Giordana F, Grasso C, Biondi Zoccai G, Moretti C, D'Amico M, Rinaldi M, Gaita F, Marra S. A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1269-74. [PMID: 25159239 DOI: 10.1016/j.amjcard.2014.07.053] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 02/05/2023]
Abstract
The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients.
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Testa L, Latib A, Rossi ML, De Marco F, De Carlo M, Fiorina C, Oreglia J, Petronio AS, Ettori F, De Servi S, Klugmann S, Ussia GP, Tamburino C, Panisi P, Brambilla N, Colombo A, Presbitero P, Bedogni F. CoreValve implantation for severe aortic regurgitation: a multicentre registry. EUROINTERVENTION 2014; 10:739-45. [DOI: 10.4244/eijv10i6a127] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mennuni MG, Pagnotta P, Zavalloni D, Rossi ML, Soldi M, Gasparini G, Ferrante G, Presbitero P. TCT-781 Impact of Smaller and Expandable Sheath During TAVR: Results From a Single-Center Registry. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rossi ML, Pagnotta P, Barbaro C, Soldi M, Presbitero P. TCT-766 The Annulus Dimension is Crucial to Achieved Good Results in Pure Severe Native Aortic Regurgitation Treated by Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Botelho RG, Rossi ML, Maranho LA, Olinda RA, Tornisielo VL. Evaluation of surface water quality using an ecotoxicological approach: a case study of the Piracicaba River (São Paulo, Brazil). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2013; 20:4382-4395. [PMID: 23512238 DOI: 10.1007/s11356-013-1613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/04/2013] [Indexed: 06/01/2023]
Abstract
A long-term study was conducted to evaluate Piracicaba River water (São Paulo state, Brazil) using different methodologies and organisms. During 1 year (February 2011 to January 2012), water samples were collected monthly at six different locations and exposed under laboratory conditions to the microcrustaceans Ceriodaphnia dubia and Ceriodaphnia silvestrii for 7 days and to the fish Danio rerio for 4 days to evaluate effects on reproduction and on gill morphology, respectively. Physical-chemical parameters of the water were also measured. Physical-chemical characteristics demonstrated decreasing water quality from upstream to downstream of the river. Effects on the reproduction of C. dubia and C. silvestrii were observed in 3 months (February and March 2011 and January 2012) and occurred in samples collected close to industrialized cities like Americana and Piracicaba. Evaluation of the gills showed normal function of the organ during all months, except in February, September, and October for some locations.
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Rossi ML, Bocchi R, Barbaro C, Pagnotta P, Mennuni M, Zavalloni D, Gasparini G, Presbitero P. Successful treatment by transcatheter aortic valve implantation of severe aortic regurgitation in a patient with ascending aorta prosthesis. Heart Lung Circ 2012; 22:383-5. [PMID: 23164807 DOI: 10.1016/j.hlc.2012.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022]
Abstract
Severe aortic regurgitation (AR), when intervention is required, is managed by surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) has shown non-inferiority to SAVR and superiority to medical management. TAVR could be a valid "off label" option to treat severe AR for patients unsuitable for SAVR due to their high surgical risk. Among aortic pathologies leading to severe AR, those involving the aortic root are considered as high risk procedures and thus prohibit TAVR. For these reasons TAVR is not an option for severe AR due to concomitant aortic root dilatation and degeneration. We report a successful case of TAVR for severe AR due to dilatation of degenerated tract of aortic root.
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Presbitero P, Lanzone AM, Albiero R, Lisignoli V, Zavalloni Parenti D, Gasparini GL, Lodigiani C, Barbaro C, Fappani A, Barberis G, Rossi ML, Pagnotta P. Anatomical patterns of patent foramen ovale (PFO): do they matter for percutaneous closure? Minerva Cardioangiol 2009; 57:275-284. [PMID: 19513008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study was to describe and classify the various anatomical pattern of patent foramen ovale (PFO) with transesophageal echocardiography (TEE) and to relate such classification to the selection of PFO closure devices. METHODS This study enrolled 216 PFO patients (118 females) mostly with previous cryptogenic stroke or transitory ischemic attack (TIA) who underwent percutaneous closure of PFO with deep sedation under TEE control. Anatomical patterns were classified as follows: simple: PFO characterised by central/superior eccentric shunt or with a valve mechanism (45%); reduse: widely redundant septum primum (22%); ASA: atrial septal aneurysm (11%); EASA: entire atrial septal aneurysm (1.4%); CRIB: cribriform septum primum (9%); tunnel: tunnel between septum primum and secundum >10 mm (11%). Degree of right-to-left shunt, either at basal condition or at Valsalva manoeuvre, was classified as: 1=mild (45%); 2=moderate (42%); 3=severe (13%). Additional right-atrium anatomical features are also described. RESULTS Procedure was successful in 100% of the cases. At follow-up recurrent TIA occurred in two patients. Residual shunts were present in 4.9% of the patients after Valsalva manoeuvre. Palpitations were reported in 4%. CONCLUSIONS Closing the PFO choosing the device following strict anatomical criteria based on TEE assessment allowed excellent immediate and late results minimizing residual shunts.
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