151
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Danese A, Stegagno C, Tomelleri G, Piccoli A, Turri G, Carletti M, Variola A, Anselmi M, Mazzucco S, Ferrara A, Bovi P, Micheletti N, Cappellari M, Monaco S, Vassanelli C, Ribichini F. Clinical outcomes of secondary prevention strategies for young patients with cryptogenic stroke and patent foramen ovale. Acta Cardiol 2017; 72:410-418. [PMID: 28705105 DOI: 10.1080/00015385.2017.1307668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background The aim of this study was to compare the immediate and long-term clinical outcomes of medical therapy and percutaneous patent foramen ovale (PFO) closure as secondary prevention strategies in patients younger than 55 years of age presenting with cryptogenic stroke and PFO. Methods Between January 2006 and April 2015, all patients with the diagnosis of cryptogenic stroke and PFO were analysed and prospectively followed. Stroke was confirmed in 159 out of 309 patients (51%). In the remaining cases, other neurological conditions were found and therefore excluded from further analysis. Patients received PFO closure or medical therapy on the basis of a pre-specified algorithm. Primary outcome was the assessment of recurrent ischaemic events at follow-up. Results Percutaneous PFO closure was performed in 77 patients (48%) and 82 (52%) were treated medically. Mean follow-up was 51.6 ± 34.8 months. Two ischaemic strokes occurred in the medical group only (2.4% vs 0%; P = 0.16) and no complications related to the invasive procedure were observed. Conclusions The diagnosis of stroke in patients with PFO could be confirmed in 50% of cases only, underlining the importance of a multidisciplinary evaluation of these patients. A very low ischaemic recurrence rate was observed in the medical therapy group, suggesting that a personalized treatment based on a prespecified diagnostic algorithm yields good clinical results irrespective of the treatment modality. Given the low number of recurrences, larger cohorts may be needed to prove significant differences.
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152
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Scarsini R, Pesarini G, Lunardi M, Zivelonghi C, Ferrero V, Rossi A, Piccoli A, Vassanelli C, Ribichini F. P1321Functional evaluation of coronary lesions in patients with severe aortic stenosis undergoing TAVI using a hybrid iFR-FFR approach. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1321] [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: 11/15/2022] Open
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153
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Pacchioni A, Ferro J, Mantovani R, Mugnolo A, Pesarini G, Marchese G, Benedetto D, Fede A, Turri R, Penzo C, Bellamoli M, Sacca S, Ribichini F, Reimers B. P4302Role of residual anticoagulation in determining radial artery occlusion after transradial catheterization: preliminary results from a multicenter registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4302] [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: 11/13/2022] Open
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154
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Scarsini R, Bellamoli M, Pesarini G, Milano E, Lunardi M, Vassanelli C, Ribichini F. P6079Urgent percutaneous intervention versus conservative management in patients presenting with post-operative myocardial ischemia after coronary artery bypass graft surgery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6079] [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: 11/14/2022] Open
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155
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Di Gioia G, Scarsini R, Strisciuglio T, De Biase C, Zivelonghi C, Franco D, De Bruyne B, Ribichini F, Barbato E. 2194Discordance between angiographic and physiologic evaluation of coronary artery lesions in patients with aortic valve stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2194] [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: 11/14/2022] Open
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156
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Scarsini R, Cuman M, Rossi A, Pesarini G, Piccoli A, Setti E, Milano E, Forni A, Vassanelli C, Ribichini F. 4994Hemodynamic predictors of mortality in patients undergoing heart transplantation and left ventricular assist device. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4994] [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: 11/14/2022] Open
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157
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D’Onofrio A, Salizzoni S, Filippini C, Agrifoglio M, Alfieri O, Chieffo A, Tarantini G, Gabbieri D, Savini C, Immè S, Ribichini F, Cugola D, Raviola E, Loi B, Pompei E, Cappai A, Cassese M, Luzi G, Aiello M, Santini F, Rinaldi M, Gerosa G. Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: results from the Italian Transcatheter Balloon-Expandable Registry (ITER)†. Eur J Cardiothorac Surg 2017; 52:874-880. [DOI: 10.1093/ejcts/ezx227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/29/2017] [Indexed: 12/13/2022] Open
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158
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Di Gioia G, Scarsini R, Strisciuglio T, De Biase C, Zivelonghi C, Franco D, De Bruyne B, Ribichini F, Barbato E. Correlation between Angiographic and Physiologic Evaluation of Coronary Artery Narrowings in Patients With Aortic Valve Stenosis. Am J Cardiol 2017; 120:106-110. [PMID: 28483203 DOI: 10.1016/j.amjcard.2017.03.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
We aimed to assess the correlation between angiographic and physiologic evaluation of coronary lesions in aortic stenosis (AS) patients presenting with intermediate coronary stenoses at the angiography. From 2002 to 2010, we included 163 patients from 2 centers with both AS and coronary artery disease (CAD), matched by age and gender with 163 contemporary patients with CAD alone. With both quantitative coronary angiography and fractional flow reserve (FFR), we assessed 259 coronary stenoses in the AS + CAD group, and 256 in the CAD alone group. A significant correlation was found between diameter stenosis (DS) and FFR in both groups, although this was significantly stronger in the AS + CAD than in the CAD alone group (R = -0.63 vs -0.44, p <0.01). Likewise, the correlation between minimum lumen diameter and FFR was stronger in the AS + CAD than in the CAD alone group (R = -0.54 vs -0.41, p = 0.05). Receiver operator characteristic curves analysis showed that DS was a better predictor of hemodynamically significant coronary stenoses (FFR ≤0.8) in the AS + CAD rather than in the CAD alone group (area under the curve = 0.83 vs 0.67, p <0.01). With 50% DS cut-off value, the sensitivity, specificity, and accuracy was 77%, 66%, and 70% in the AS + CAD group versus 59%, 63%, and 61% in the CAD alone group. In both groups, the diagnostic accuracy of DS in predicting FFR was higher in the right and circumflex coronary artery compared with the left anterior descending artery (LAD), although this was only statistically significant in the AS + CAD group (area under the curve 0.88 in the right and circumflex coronary artery vs 0.76 in LAD, p = 0.03). In conclusion, the correlation between the angiographic and hemodynamic significance of coronary stenoses is modest in AS patients. The assessment of CAD severity solely based on angiography poorly predicts the hemodynamic significance of the coronary stenosis especially when these are located in the LAD.
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159
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Testa L, De Carlo M, Petrolini A, Rapetto C, Varbella F, Cortese B, Gabrielli G, Geraci S, Loi B, Boccuzzi G, Tarantini G, Fischetti D, Calabria P, Tomai F, Ribichini F, Tamburino C, Indolfi C, Bartorelli A, Petronio AS, Bedogni F. One-year clinical results of the Italian diffuse/multivessel disease ABSORB prospective registry (IT-DISAPPEARS). EUROINTERVENTION 2017; 13:424-431. [DOI: 10.4244/eij-d-17-00246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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160
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Conrotto F, Salizzoni S, Andreis A, D'Ascenzo F, D'Onofrio A, Agrifoglio M, Chieffo A, Colombo A, Rapetto F, Santini F, Tarantini G, Gabbieri D, Savini C, Immè S, Ribichini F, Valsecchi O, Aiello M, Lixi G, Iadanza A, Pompei E, Stolcova M, Ornaghi D, Minati A, Cassese M, Martinelli GL, Sbarra P, Agostinelli A, Audo A, Pieroni A, Fiorilli R, Gerosa G, Rinaldi M, Gaita F. Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease. Am J Cardiol 2017; 119:1438-1442. [PMID: 28325569 DOI: 10.1016/j.amjcard.2017.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients who underwent surgical aortic valve replacement, whereas its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD who underwent TAVI. A total of 1,904 consecutive patients who underwent balloon-expandable TAVI in 33 centers between 2007 and 2012 were enrolled in the Italian Transcatheter Balloon-Expandable Valve Implantation Registry. Advanced CKD was defined according to the estimated glomerular filtration rate: 15 to 29 ml/min/1.73 m2 stage 4 (S4), <15 ml/min/1.73 m2 stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. The primary end point was all-cause mortality during follow-up. Secondary end points were major adverse cardiac events at 30 days and at follow-up, defined with Valve Academic Research Consortium 2 criteria. A total of 421 patients were staged S5 (n = 74) or S4 (n = 347). S5 patients were younger and had more frequently porcelain aorta and a lower incidence of previous stroke. Periprocedural and 30-day outcomes were similar in S5 and S4 patients. During 670 (±466) days of follow-up, S5 patients had higher mortality rates (69% vs 39%, p <0.01) and cardiac death (19% vs 9%, p = 0.02) compared with S4 patients. Male gender (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.2 to 2.2), left ventricular ejection fraction <30% (HR 2.3, 95% CI 1.3 to 4), atrial fibrillation (HR 1.4, 95% CI 1.0 to 1.9), and S5 CKD (HR 1.5, 95% CI 1.0 to 2.1) were independent predictors of death. In conclusion, TAVI in predialytic or dialytic patients (i.e., S5) is independently associated with poor outcomes with more than double risk of death compared with patients with S4 renal function. Conversely, in severe CKD (i.e., S4) a rigorous risk stratification is required to avoid the risk of futility risk.
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161
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Scarsini R, Pesarini G, Castriota F, Vassanelli C, Ribichini F. Significant Drop in Right Atrial Pressure Does Not Influence Fractional Flow Reserve Coronary Assessment. THE JOURNAL OF HEART VALVE DISEASE 2017; 26:361-364. [PMID: 29092125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The effect of a highly elevated level of right atrial filling pressure on fractional flow reserve (FFR) measurement remains unclear. Transcatheter tricuspid valve intervention, a recently introduced option for inoperable or high-risk patients, represents a unique model of in-vivo physiology to investigate the eventual influence of central venous pressure on coronary FFR measurements. The case is reported of a patient with a degenerated tricuspid surgical bioprosthesis who underwent transcatheter tricuspid valve-in-valve replacement and concomitant coronary functional assessment with FFR. In an experimental model, the significant fall in right atrial pressure did not influence FFR measurements in the presence of angiographically proven mild coronary artery disease.
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162
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Scarsini R, Lunardi M, Pesarini G, Castriota F, Feola M, Ferrero V, Faggian G, Vassanelli C, Ribichini F. Long-term follow-up after trans-catheter tricuspid valve-in-valve replacement with balloon–expandable aortic valves. Int J Cardiol 2017; 235:141-146. [DOI: 10.1016/j.ijcard.2017.02.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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163
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Pernigo M, Canneto B, Betta D, Molinari G, Ribichini F, Zannini G, Vassanelli C, Rossi A. Dyspnea following thoracostomy closure after right pneumonectomy: An uncommon echocardiographic diagnosis and therapeutic approach. Echocardiography 2017; 34:782-785. [PMID: 28295572 DOI: 10.1111/echo.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Dyspnea and hypoxemia are common postoperative problems after pneumonectomy. One of the rarer causes of respiratory distress after right pneumonectomy is the development of a significant right-to-left shunt across a patent foramen ovale (PFO), which can evolve at a variable interval of time after the operation. We report here our experience with a patient who underwent right pneumonectomy, followed by several complications, and who presented severe dyspnea 7 months later, after the closure of a right thoracostomy. This report outlines the management of this challenging clinical condition; transesophageal echocardiography (TOE) provided a clear diagnosis and guided an effective percutaneous treatment.
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164
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Cook C, Kikuta Y, Sharp A, Salinas P, Nakayama M, Wijntjens G, Sen S, da Cunha RP, Al-Lamee R, Nijjer S, Mizuno A, Mates M, Janssens L, Hellig F, Horie K, Davies J, Yamawaki M, Keeble T, Ribichini F, Indotfi C, Piek J, Di Mario C, Escaned J, Matsuo H, Davies J. INSTANTANEOUS WAVE-FREE RATIO SCOUT PULLBACK (IFR SCOUT) PRE-ANGIOPLASTY PREDICTS HEMODYNAMIC OUTCOME IN HUMANS WITH CORONARY ARTERY DISEASE: PRIMARY RESULTS OF INTERNATIONAL MULTICENTRE IFR GRADIENT REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34439-x] [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: 11/26/2022]
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165
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Bartunek J, Terzic A, Davison BA, Filippatos GS, Radovanovic S, Beleslin B, Merkely B, Musialek P, Wojakowski W, Andreka P, Horvath IG, Katz A, Dolatabadi D, El Nakadi B, Arandjelovic A, Edes I, Seferovic PM, Obradovic S, Vanderheyden M, Jagic N, Petrov I, Atar S, Halabi M, Gelev VL, Shochat MK, Kasprzak JD, Sanz-Ruiz R, Heyndrickx GR, Nyolczas N, Legrand V, Guédès A, Heyse A, Moccetti T, Fernandez-Aviles F, Jimenez-Quevedo P, Bayes-Genis A, Hernandez-Garcia JM, Ribichini F, Gruchala M, Waldman SA, Teerlink JR, Gersh BJ, Povsic TJ, Henry TD, Metra M, Hajjar RJ, Tendera M, Behfar A, Alexandre B, Seron A, Stough WG, Sherman W, Cotter G, Wijns W. Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial. Eur Heart J 2017; 38:648-660. [PMID: 28025189 PMCID: PMC5381596 DOI: 10.1093/eurheartj/ehw543] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/22/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. METHODS AND RESULTS This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein-Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann-Whitney estimator 0.54, 95% confidence interval [CI] 0.47-0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200-370 mL (60% of patients) (Mann-Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. CONCLUSION The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.
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166
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Colli A, Besola L, Salizzoni S, Gregori D, Tarantini G, Agrifoglio M, Chieffo A, Regesta T, Gabbieri D, Saia F, Tamburino C, Ribichini F, Valsecchi O, Loi B, Iadanza A, Stolcova M, Minati A, Martinelli G, Bedogni F, Petronio A, Dallago M, Cappai A, D'Onofrio A, Gerosa G, Rinaldi M. Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI? Int J Cardiol 2017; 233:52-60. [PMID: 28188002 DOI: 10.1016/j.ijcard.2017.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/01/2017] [Accepted: 02/01/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes. METHODS AND RESULTS We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p<0.001 for PVL≥moderate and OR 1.04, p=0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi>75ml/m2) showed better survival than those without dilatation (HR 8.63, p=0.001). CONCLUSIONS In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.
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167
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Zivelonghi C, Lunardi M, Pesarini G, Scarsini R, Piccoli A, Ferrero V, Gottin L, Milano A, Faggian G, Vassanelli C, Ribichini F. Coronary artery disease in patients undergoing transcatheter aortic valve implantation. A single centre registry on prevalence, management and immediate clinical impact. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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168
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Pesarini G, Scarsini R, Maggio S, Piccoli A, Benini A, Zivelonghi C, Vassanelli C, Ribichini F. TCT-384 Contrast-Induced Acute Kidney Injury and Persistent Renal Damage: Early Predictors after Coronary Angiography and Interventions. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.518] [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: 11/29/2022]
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169
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Pesarini G, Scarsini R, Zivelonghi C, Piccoli A, Gambaro A, Gottin L, Rossi A, Ferrero V, Vassanelli C, Ribichini F. Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004088. [DOI: 10.1161/circinterventions.116.004088] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023]
Abstract
Background—
Aortic valve stenosis may influence fractional flow reserve (FFR) of concomitant coronary artery disease by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. We sought to investigate whether FFR values might change after valve replacement.
Methods and Results—
The functional relevance of 133 coronary lesions was assessed by FFR in 54 patients with severe aortic valve stenosis before and after transcatheter aortic valve implantation (TAVI) during the same procedure. A linear mixed model was used to verify the interaction of TAVI effect with the FFR values. No significant overall change in FFR values was found before and after the aortic valve stenosis removal (0.89±0.10 versus 0.89±0.13;
P
=0.73). A different trend in FFR groups (positive if ≤0.8; negative if >0.8) was found after TAVI (
P
for interaction <0.001). Positive FFR values worsened after TAVI (0.71±0.11 versus 0.66±0.14). Conversely, negative FFR values improved after TAVI (0.92±0.06 versus 0.93±0.07). Similarly, FFR values in coronary arteries with lesions presenting percent diameter stenosis >50 worsened after TAVI (0.84±0.12 versus 0.82±0.16;
P
=0.02), whereas FFR values in arteries with mild lesions (percent diameter stenosis <50) tended toward improvement after TAVI (0.90±0.07 versus 0.91±0.09;
P
=0.69). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 8 of 133 (6%) lesions.
Conclusions—
Coronary hemodynamics are influenced by aortic valve stenosis removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cutoff of 0.8 in a small number of patients after valve replacement. Borderline coronary lesions might become functionally significant after valve replacement, although FFR-guided interventions were infrequent even in patients with angiographically significant lesions.
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170
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Scarsini R, Pesarini G, Zivelonghi C, Piccoli A, Gambaro A, Vassanelli C, Ribichini F. TCT-516 Instantaneous-wave Free Ratio and Fractional Flow Reserve Comparison in Patients with and Without Severe Aortic Valve Stenosis. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.653] [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: 10/20/2022]
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171
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Benfari G, Dandale R, Rossi A, Onorati F, Mugnai G, Ribichini F, Temporelli PL, Vassanelli C. Functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2016; 17:767-73. [DOI: 10.2459/jcm.0000000000000429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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172
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pacchioni A, Pesarini G, Penzo C, turri R, ferro J, fede A, Sacca S, Umemoto T, Bellamoli M, Pavei A, Mugnolo A, Dell'Avvocata F, Ribichini F, reimers B. TCT-365 Correlation between residual anticoagulation and radial artery occlusion after transradial catheterization: preliminary results from an Italian multicenter study. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.498] [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: 11/29/2022]
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173
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Lunardi M, Pesarini G, Zivelonghi C, Piccoli A, Geremia G, Ariotti S, Rossi A, Gambaro A, Gottin L, Faggian G, Vassanelli C, Ribichini F. Clinical outcomes of transcatheter aortic valve implantation: from learning curve to proficiency. Open Heart 2016; 3:e000420. [PMID: 27621826 PMCID: PMC5013502 DOI: 10.1136/openhrt-2016-000420] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 11/14/2022] Open
Abstract
Objective The use of transcatheter aortic valve implantation (TAVI) is growing rapidly in countries with a predominantly elderly population, posing a huge challenge to healthcare systems worldwide. The increment of human and economic resource consumption imposes a careful monitoring of clinical outcomes and cost-benefit balance, and this article is aimed at analysing clinical outcomes related to the TAVI learning curve. Methods Outcomes of 177 consecutive transfemoral TAVI procedures performed in 5 years by a single team were analysed by the Cumulative Sum of failures method (CUSUM) according to the clinical events comprised in the Valve Academic Research Consortium (VARC-2) safety end point and the VARC-2 definition of device success. Margins for events acceptance were extrapolated from landmark trials that tested both balloon or self-expandable percutaneous valves. Results 30-day and 1-year survival rates were 97.2% and 89.9%, respectively. Achievement of the primary end point (number of cases needed to provide the acceptable margin of the composite end point of any death, stroke, myocardial infarction, life-threatening bleeding, major vascular complications, stage 2–3 acute kidney injury and valve-related dysfunction requiring a repeat procedure) required the performance of 54 cases, while the learning curve to achieve ‘device success’ identified 32 cases to reach the expected proficiency. In this experience, the baseline clinical risk as assessed by the Society of Thoracic Surgeons (STS) score determined the long-term survival rather than the adverse events related to the learning curve. Conclusions A relatively large number of cases are required to achieve clinical outcomes comparable to those reported in high-volume centres and controlled trials. According to our national workload standards, this represents more than 2 years of continuous activity.
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Ribichini F. Rationale for the use of bioresorbable vascular scaffolds. Why bioresorbable technology is the future of endovascular therapeutics. Minerva Cardioangiol 2016; 64:399-403. [PMID: 27228487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Maggio S, Zanetti C, Pesarini G, Zivelonghi C, Piccoli A, Gambaro A, Scarsini R, Cuman M, Vassanelli C, Ribichini F. Immediate and long-term clinical performance of bioresorbable vascular scaffolds in a real world population. Minerva Cardioangiol 2016; 64:404-410. [PMID: 26963445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and efficacy of bioresorbable vascular scaffolds (BVS) in terms of acute success and long-term clinical events in a real world population according to the most updated technical recommendations. METHODS Perspective, single-center registry involving symptomatic patients treated with BVS from February 2013 to January 2016. Primary end-point was the occurrence of MACCEs at one year: death, target vessel related myocardial infarction, target vessel revascularization, stroke, major bleeding. Secondary endpoints were acute device and procedural clinical success, and occurrence of MACCEs at long-term follow-up. RESULTS In total, 112 patients were treated on 173 lesions. Average age was 55.53±12.4 years and acute coronary syndrome was the admission diagnosis for 79.5% patients. Nine patients presented cardiac allograft vasculopathy after cardiac transplantation. Multi-vessel disease was treated in 50% of cases. Predilatation and post-dilatation were performed respectively in 96% and 88.4% of lesions. Intravascular imaging was used in 41 patients (37%). Angiographic success rate and procedural success rate were 100% and 97.3% respectively. Clinical follow-up was completed in 100 patients with an average follow-up of 10.5±8.3 months. Including peri-procedural and in-hospital MACCEs, target vessel failure was noticed in 7% of patients in the first year of follow up and in 11% of patients at long-term follow-up. Two cases of target lesion revascularization occurred 25 and 26 months after the index procedure. No cases of definite stent thrombosis were reported. CONCLUSIONS Strict adherence to expert recommendation for BVS placement may minimize device related peri-procedural and mid-to-long term MACCEs in a real world population.
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