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Ancona MB, Gentile D, Ferri LA, Monaco F, Russo F, Bellini B, Vella C, Ghizzoni G, Zanda G, Agricola E, Truci G, Beretta L, Turi S, Landoni G, Montorfano M. [Management of patent foramen ovale in non-cardiac surgery]. G Ital Cardiol (Rome) 2024; 25:295-299. [PMID: 38639118 DOI: 10.1714/4252.42291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Patent foramen ovale (PFO) is a remnant of normal fetal anatomy which may persist into adulthood, mostly asymptomatic. In some adults, PFO may result in a potential for shunting venous thromboembolism to the arterial circulation; less frequently it can cause interatrial, right-to-left shunting of deoxygenated blood. The pathogenesis of several medical conditions is related to the presence of PFO. Some randomized clinical trials have shown evidence of benefit for device closure as compared with medical therapy in patients with cryptogenic stroke. The literature reported several cases of carbon dioxide embolism during general laparoscopic surgery and sometimes stroke after laparoscopic or neurosurgery but there are neither prospective studies addressing these issues, nor randomized clinical trials assessing the effectiveness of pharmacotherapy or interventional procedures at decreasing risk. The European position paper suggests routine monitoring in non-cardiac surgery of patients with a PFO and no actual indications for closure. This article aims to further stratify the risk of periprocedural stroke and paradoxical embolism in this category of patients.
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Affiliation(s)
- Marco B Ancona
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Domitilla Gentile
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Luca A Ferri
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Fabrizio Monaco
- Unità di Anestesia e Terapia Intensiva, IRCCS Ospedale San Raffaele, Milano
| | - Filippo Russo
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Barbara Bellini
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Ciro Vella
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Giulia Ghizzoni
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Greca Zanda
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Eustachio Agricola
- Unità di Imaging Cardiovascolare, IRCCS Ospedale San Raffaele, Milano - Università Vita-Salute San Raffaele, Milano
| | - Giulio Truci
- Dipartimento di Neurologia, IRCCS Ospedale San Raffaele, Milano
| | - Luigi Beretta
- Unità di Anestesia e Terapia Intensiva, IRCCS Ospedale San Raffaele, Milano - Università Vita-Salute San Raffaele, Milano
| | - Stefano Turi
- Unità di Anestesia e Terapia Intensiva, IRCCS Ospedale San Raffaele, Milano
| | - Giovanni Landoni
- Unità di Anestesia e Terapia Intensiva, IRCCS Ospedale San Raffaele, Milano - Università Vita-Salute San Raffaele, Milano
| | - Matteo Montorfano
- Unità di Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano - Università Vita-Salute San Raffaele, Milano
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Scarsini R, Gallinoro E, Ancona MB, Portolan L, Paolisso P, Springhetti P, Della Mora F, Mainardi A, Belmonte M, Moroni F, Ferri LA, Bellini B, Russo F, Vella C, Bertolone DT, Pesarini G, Benfari G, Vanderheyden M, Montorfano M, De Bruyne B, Barbato E, Ribichini F. Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EUROINTERVENTION 2024; 20:e289-e300. [PMID: 37982178 PMCID: PMC10905195 DOI: 10.4244/eij-d-23-00735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Microvascular resistance reserve (MRR) is a validated measure of coronary microvascular function independent of epicardial resistances. AIMS We sought to assess whether MRR is associated with adverse cardiac remodelling, a low-flow phenotype and extravalvular cardiac damage (EVCD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS Invasive thermodilution-based assessment of the coronary microvascular function of the left anterior descending artery was performed in a prospective, multicentre cohort of patients undergoing TAVI. Coronary microvascular dysfunction (CMD) was defined as the lowest MRR tertile of the study cohort. Haemodynamic measurements were performed at baseline and then repeated immediately after TAVI. EVCD and markers of a low-flow phenotype were assessed with echocardiography. RESULTS A total of 134 patients were included in this study. Patients with low MRR were more frequently females, had a lower estimated glomerular filtration rate and a higher rate of atrial fibrillation. MRR was significantly lower in patients with advanced EVCD (median 1.80 [1.26-3.30] vs 2.50 [1.87-3.41]; p=0.038) and in low-flow, low-gradient AS (LF LG-AS) (median 1.85 [1.20-3.04] vs 2.50 [1.87-3.40]; p=0.008). Overall, coronary microvascular function tended to improve after TAVI and, in particular, MRR increased significantly after TAVI in the subgroup with low MRR at baseline. However, MRR was significantly impaired in 38 (28.4%) patients immediately after TAVI. Advanced EVCD (adjusted odds ratio 3.08 [1.22-7.76]; p=0.017) and a low-flow phenotype (adjusted odds ratio 3.36 [1.08-10.47]; p=0.036) were significant predictors of CMD. CONCLUSIONS In this observational, hypothesis-generating study, CMD was associated with extravalvular cardiac damage and a low-flow phenotype in patients with severe AS undergoing TAVI.
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Affiliation(s)
- Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Portolan
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Della Mora
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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Vella C, Romano V, Di Maio S, Ancona MB, Castriota F, Vassileva A, Ferri L, Bellini B, Moroni F, Russo F, Ghizzoni G, Gentile D, Palmisano A, Agricola E, Esposito A, Chieffo A, Montorfano M. Valve-in-valve transcatheter aortic valve implantation: The issues behind crossing a bioprosthesis. Cardiovasc Revasc Med 2023:S1553-8389(23)00969-7. [PMID: 38160130 DOI: 10.1016/j.carrev.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) is rapidly arising as a safe and effective alternative to redo-surgery in the treatment of bioprostheses deterioration. While scientific community is currently focusing its attention on the most common limitations related to this procedure, such as the risk of coronary obstruction and patient-prosthesis mismatch, data regarding the first step of a ViV TAVI, the crossing of a degenerated bioprosthesis, are still lacking. The aim of this review is to analyze the available information about bioprosthesis crossing, to show the inherent challenges encountered by interventional cardiologists during valve crossing and to describe the current strategies to perform a correct crossing.
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Affiliation(s)
- Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Ghizzoni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domitilla Gentile
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
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Montorfano M, Leoni O, Andreassi A, Ludergnani M, Moroni F, Ancona MB, Landoni G, Ciceri F, Zangrillo A. Chronic anticoagulant treatment and risk of mortality in SARS-Cov2 patients: a large population-based study. Minerva Med 2023; 114:628-633. [PMID: 35191294 DOI: 10.23736/s0026-4806.22.07797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypercoagulability is often seen in COVID-19 patients and thromboembolic events appear frequent; antithrombotic treatment has been proposed therefore as part of standard treatment for COVID-19. Under these premises, prior-to-infection antithrombotic treatment may have a protective effect with respect to COVID-19 related thromboembolic events. Aim of the present work was to evaluate the impact of prior-to-infection anticoagulant or antiplatelet treatment on COVID-19 outcomes. METHODS Beneficiaries of the Regional Health Service of the Lombardy region of Italy aged ≥40 years with a COVID-19 diagnosis made between February 21st and July 18th, 2020 were included in the present study. The impact on COVID-19 mortality of pre-existing and chronic therapy with anticoagulant drugs (vitamin-K antagonist or new oral anticoagulants) was evaluated. Analyses were repeated with antiplatelets drugs. RESULTS Among 79,934 SARS-CoV-2 patients beneficiaries of the Regional Healthcare System of the Lombardy Region who received a diagnosis between February 21st and July 18th, 2020, chronic pre-existing anticoagulant assumption was present in 6.0% and antiplatelets in 12.7%. The overall unadjusted mortality rate was 20.6%, with male sex, age category and comorbidity burden being significantly associated to increased mortality risk. Anticoagulant chronic treatment was not associated with a reduction in mortality. Similar results were observed when repeating the analyses for pre-existing oral antiplatelet treatment. CONCLUSIONS In a large population-based study evaluating more than 79,000 COVID-19 patients, pre-existing antithrombotic therapy was not associated to a benefit in terms of mortality. Further studies are needed to evaluate the role of antithrombotic therapy as standard treatment among COVID-19 patients.
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Affiliation(s)
- Matteo Montorfano
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Olivia Leoni
- Welfare Directorate, Regione Lombardia, Milan, Italy
| | | | | | - Francesco Moroni
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Hematology and Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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5
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Ghizzoni G, Ancona MB, Romano V, Bellini B, Ferri L, Russo F, Vella C, Gentile D, Chionchio G, Macelletti V, Ancona F, Agricola E, Palmisano A, Esposito A, Montorfano M. Mind the "commissural drop" when crossing the aortic valve! Catheter Cardiovasc Interv 2023; 102:538-541. [PMID: 37464968 DOI: 10.1002/ccd.30763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/17/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Giulia Ghizzoni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domitilla Gentile
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Chionchio
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Macelletti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Department of Cardio-Thoracic-Vascular, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Department of Cardio-Thoracic-Vascular, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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6
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Ghizzoni G, Ancona MB, Gentile D, Bellini B, Ferri L, Russo F, Vella C, Montorfano M. How to deal with myocardial bridge and angina. J Cardiovasc Med (Hagerstown) 2023; 24:219-220. [PMID: 36724392 DOI: 10.2459/jcm.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Giulia Ghizzoni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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7
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Khan JM, Kamioka N, Lisko JC, Perdoncin E, Zhang C, Maini A, Chen M, Li Y, Ludwig S, Westermann D, Amat Santos IJ, Kalińczuk Ł, Sinning JM, Kawaguchi T, Fuku Y, Cheema AN, Félix-Oliveira A, Yamamoto M, Kagase A, Codner P, Valle RD, Iyer VS, Kim HS, Lin MS, Maini B, Rodriguez R, Montorfano M, Ancona MB, Tada N, Miyasaka M, Ahmad H, Ruggiero NJ, Torguson R, Ben-Dor I, Shults CC, Weissman G, Lederman RJ, Greenbaum AB, Babaliaros VC, Waksman R, Rogers T. Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model. JACC Cardiovasc Interv 2023; 16:415-425. [PMID: 36858660 PMCID: PMC9991077 DOI: 10.1016/j.jcin.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies. OBJECTIVES This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis. METHODS Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort. RESULTS Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right. CONCLUSIONS A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
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Affiliation(s)
- Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Aneel Maini
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mao Chen
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Yijian Li
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Cardiovascular Research Foundation, New York, New York, USA
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ignacio J Amat Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Asim N Cheema
- Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Afonso Félix-Oliveira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Institute of Pharmacology and Neurosciences, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Raquel Del Valle
- Interventional Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vijay S Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Brijeshwar Maini
- Department of Cardiology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Roberto Rodriguez
- Structural Heart Program, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Palmerini T, Saia F, Kim WK, Renker M, Iadanza A, Fineschi M, Bruno AG, Ghetti G, Vanhaverbeke M, Søndergaard L, De Backer O, Romagnoli E, Burzotta F, Trani C, Adrichem R, Van Mieghem NM, Nardi E, Chietera F, Orzalkiewicz M, Tomii D, Pilgrim T, Aranzulla TC, Musumeci G, Adam M, Meertens MM, Taglieri N, Marrozzini C, Alvarez Covarrubias HA, Joner M, Nardi G, Di Muro FM, Di Mario C, Loretz L, Toggweiler S, Gallitto E, Gargiulo M, Testa L, Bedogni F, Berti S, Ancona MB, Montorfano M, Leone A, Savini C, Pacini D, Gmeiner J, Braun D, Nerla R, Castriota F, De Carlo M, Petronio AS, Barbanti M, Costa G, Tamburino C, Leone PP, Reimers B, Stefanini G, Sudo M, Nickenig G, Piva T, Scotti A, Latib A, Vercellino M, Porto I, Codner P, Kornowski R, Bartorelli AL, Tarantini G, Fraccaro C, Abdel-Wahab M, Grube E, Galié N, Stone GW. Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry. JACC Cardiovasc Interv 2023; 16:396-411. [PMID: 36858659 DOI: 10.1016/j.jcin.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. OBJECTIVES This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. METHODS Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). RESULTS Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). CONCLUSIONS Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.
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Affiliation(s)
- Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy.
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | | | | | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Fineschi
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Maarten Vanhaverbeke
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Enrico Romagnoli
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Matti Adam
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Max M Meertens
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Hector Alfonso Alvarez Covarrubias
- German Heart Centre Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Institutio Mexicano de Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Lucca Loretz
- Cardiology, Heart Center Lucerne, Lucerne, Switzerland
| | | | - Enrico Gallitto
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Sergio Berti
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Leone
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Savini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonas Gmeiner
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Marco De Carlo
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | | | - Bernhard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Stefanini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Mitsumasa Sudo
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Tommaso Piva
- Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I - GM Lancisi, Torette, Italy
| | - Andrea Scotti
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Matteo Vercellino
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Eberhard Grube
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Nazzareno Galié
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hajjar LA, Ancona MB, Filho RK, Tresoldi M, Caldas JG, Monti G, Carnevale FC, De Cobelli F, Moreira de Assis A, Ciceri F, Landoni G, Dijkstra J, Moroni F, Abizaid AAC, Willemann Ungaretti F, Carvalho Carmona MJ, De Backer D, Pompilio CE, de Britto FS, Campos CM, Zangrillo A, Montorfano M. Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography. Front Med (Lausanne) 2023; 10:1050531. [PMID: 36873865 PMCID: PMC9978141 DOI: 10.3389/fmed.2023.1050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. Clinical trial registration ClinicalTrial.gov, identifier NCT04410549.
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Affiliation(s)
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Kalil Filho
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francesco De Cobelli
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria José Carvalho Carmona
- Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Eduardo Pompilio
- Department of Intensive Care, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio S de Britto
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Zangrillo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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10
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Ancona MB, Vella C, Beneduce A, Moroni F, Ancona F, Russo F, Ferri LA, Bellini B, Verzini A, Monaco F, Scandroglio AM, Castiglioni A, Montorfano M. Impella implantation as a rescue strategy in balloon aortic valvuloplasty complicated by acute aortic regurgitation. J Cardiovasc Med (Hagerstown) 2022; 23:e1-e2. [PMID: 34839322 DOI: 10.2459/jcm.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Fabrizio Monaco
- Cardio-Thoracic Intensive Care Unit, IRCCS San Raffaele Scientific Institute
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11
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Ancona MB, Montorfano M, Masiero G, Burzotta F, Briguori C, Pagnesi M, Pazzanese V, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Casu G, Garbo R, Preti G, Nicolini E, Sclafani R, Colonna G, Mojoli M, Siviglia M, Denurra C, Caprioglio F, Scandroglio AM, Tarantini G, Chieffo A. Device-related complications after Impella mechanical circulatory support implantation: an IMP-IT observational multicentre registry substudy. Eur Heart J Acute Cardiovasc Care 2021; 10:999-1006. [PMID: 34389852 DOI: 10.1093/ehjacc/zuab051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/05/2021] [Accepted: 06/23/2021] [Indexed: 12/31/2022]
Abstract
AIMS To report the incidence, the predictors and clinical impact of device-related complications (DRCs) in the IMP-IT (IMPella Mechanical Circulatory Support Device in Italy) registry. Impella is percutaneous left ventricular assist devices, which provides mechanical circulatory support both in cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The IMP-IT registry is a multicentre registry evaluating the trends in use and clinical outcomes of Impella in Italy. METHODS AND RESULTS A total of 406 patients have been included in this registry: 56.4% in the setting of CS, while 43.6% patients in the setting of HR-PCI. DRCs were defined as a composite endpoint of access-site bleeding, limb ischaemia, vascular complication requiring treatment, haemolysis, aortic injury, and left ventricular perforation. DRC incidence in the overall population was 25.6%, with significantly higher rate in the CS (37.1%) than in the HR-PCI (10.7%) group. The most frequent complication was haemolysis (11.8%), which occurred almost exclusively in CS population. Access-site bleeding was observed in 9.6% of the overall population, with no significant difference between the two groups. Limb ischaemia was observed in 8.3% of the overall population, with significantly higher rate in the CS group. CS and right ventricular dysfunction appear as the strongest independent predictors of DRC. One-year mortality in patients with DRC appears higher than in patients with no DRC. However, DRC was not confirmed as an independent predictor of 1-year mortality at multivariate analysis. CONCLUSION In the IMP-IT registry, the rate of DRC was 25.6%, with CS being the strongest independent predictor. DRC was not found as an independent predictor of 1-year mortality.
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Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2 - 35128, Padua, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli, 1 - 00168, Rome, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2 - 80121, Naples, Italy
| | - Matteo Pagnesi
- Department of Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Vittorio Pazzanese
- Department of Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli, 1 - 00168, Rome, Italy
| | - Tommaso Piva
- Interventional Cardiology Unit, Ospedali Riuniti di Ancona, via Conca 71, 60126 - Ancona, Ancona, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2 - 20097 - San Donato Milanese, Milan, Italy
| | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Luigi Sacco, via G.B.Grassi 74 - 20157, Milan, Italy
| | - Paolo Pagnotta
- Cardiovascular Department, Humanitas Research Hospital, Via Alessandro Manzoni, 56 - 20089, Rozzano (MI), Italy
| | - Gavino Casu
- Clinical cardiology and Interventional cardiology Unit, Azienda Ospedaliera Universitaria Sassari, Via E. De Nicola - 07100 - Sassari, Italy
| | - Roberto Garbo
- Interventional Cardiology Unit, Maria Pia Hospital, GVM Care & Research, Strada Comunale di Mongreno 180 - 10132 - Torino, Italy
| | - Gerlando Preti
- Interventional Cardiology Unit, Ospedale di Conegliano, Via Brigata Bisagno 6 - 31015, Conegliano, Italy
| | - Elisa Nicolini
- Interventional Cardiology Unit, Ospedali Riuniti di Ancona, via Conca 71, 60126 - Ancona, Ancona, Italy
| | - Rocco Sclafani
- Cardiology Unit, Azienda Ospedaliera Santa Maria della Misericordia, Piazzale Gambuli 8-9 Sant'Andrea delle Fratte - 06129 - Perugia, Italy
| | - Giuseppe Colonna
- Interventional Cardiology Unit, Vito Fazzi Hospital, P.za F. Muratore 1, 73100, Lecce, Italy
| | - Marco Mojoli
- Department of Cardiology, Azienda Ospedaliera Friuli Occidentale - Ospedale Santa Maria degli Angeli Via della Vecchia Ceramica 1, 33170, Pordenone, Italy
| | - Massimo Siviglia
- Cardiology Unit, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, via Melacrino - 89100 - Reggio Calabria, Italy
| | - Cristiana Denurra
- Clinical cardiology and Interventional cardiology Unit, Azienda Ospedaliera Universitaria Sassari, Via E. De Nicola - 07100 - Sassari, Italy
| | - Francesco Caprioglio
- Cardiology Unit, Ospedale San Bortolo, Viale Rodolfi 37 - 36100 - Vicenza, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2 - 35128, Padua, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
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Ancona MB, Visco E, Bellini B, Romano V, Vella C, Ferri L, Russo F, Beneduce A, Ancona F, Vignale D, Esposito A, Chieffo A, Agricola E, Montorfano M. Percutaneous exclusion of left ventricular pseudoaneurysm. J Cardiovasc Med (Hagerstown) 2021; 22:864-865. [PMID: 32858643 DOI: 10.2459/jcm.0000000000001102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Davide Vignale
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Ancona MB, Romano V, Buzzatti N, Esposito A, Montorfano M. Transcatheter Pulmonary Valve Replacement With 32-mm Balloon-Expandable Prosthesis: Another Strategy in Mildly Dilated RVOT. JACC Cardiovasc Interv 2021; 14:711-712. [PMID: 33736781 DOI: 10.1016/j.jcin.2021.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022]
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Ancona MB, Toscano E, Moroni F, Ferri LA, Russo F, Bellini B, Sorropago A, Mula C, Festorazzi C, Gamardella M, Vella C, Beneduce A, Romano V, Belluschi I, Buzzatti N, Agricola E, Montorfano M. Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival. Int J Cardiol Heart Vasc 2021; 34:100817. [PMID: 34169142 PMCID: PMC8207181 DOI: 10.1016/j.ijcha.2021.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. MATERIALS AND METHODS Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. RESULTS Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). CONCLUSIONS TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.
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Affiliation(s)
- Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evelina Toscano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A. Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Sorropago
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Caterina Mula
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Festorazzi
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Gamardella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Igor Belluschi
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ancona MB, Moroni F, Romano V, Agricola E, Esposito A, Ajello S, De Bonis M, Cappelletti AM, Zangrillo A, Scandroglio AM, Montorfano M. [Transcatheter aortic valve implantation for aortic regurgitation in patients with left ventricular assist device]. G Ital Cardiol (Rome) 2021; 22:39S-42S. [PMID: 33847322 DOI: 10.1714/3578.35633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic valve regurgitation is a not negligible complication of prolonged support with continuous-flow left ventricular assist device (LVAD) and is associated with recurrence of heart failure and reduced survival. Transcatheter aortic valve implantation has been described as a feasible option in this setting, usually with self-expanding prosthesis. Giving the absence of valvular calcification, a proper prosthesis oversizing should be guaranteed in order to achieve sufficient sealing and avoid prosthesis migration or paravalvular leak. Current self-expanding prosthesis may be too small to fit aortic annulus anatomies without calcification and with the need of significant oversize. We report the first case of 32 mm balloon expandable Myval prosthesis implantation in a patient with LVAD-related aortic regurgitation. Large balloon-expandable prosthesis can be considered when a significant oversize is needed.
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Affiliation(s)
- Marco B Ancona
- Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Francesco Moroni
- Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Vittorio Romano
- Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
| | - Eustachio Agricola
- Laboratorio di Ecocardiografia, IRCCS Ospedale San Raffaele, Milano - Università Vita-Salute San Raffaele, Milano
| | - Antonio Esposito
- Università Vita-Salute San Raffaele, Milano - U.O. Radiologia, IRCCS Ospedale San Raffaele, Milano
| | - Silvia Ajello
- Unità di Terapia Intensiva Cardiotoracica, IRCCS Ospedale San Raffaele, Milano
| | - Michele De Bonis
- Università Vita-Salute San Raffaele, Milano - U.O. Cardiochirurgia, IRCCS Ospedale San Raffaele, Milano
| | | | - Alberto Zangrillo
- Università Vita-Salute San Raffaele, Milano - Unità di Terapia Intensiva Cardiotoracica, IRCCS Ospedale San Raffaele, Milano
| | | | - Matteo Montorfano
- Emodinamica e Cardiologia Interventistica, IRCCS Ospedale San Raffaele, Milano
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Tarantini G, Masiero G, Burzotta F, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Mojoli M, Casu G, Giustino G, Lorenzoni G, Montorfano M, Ancona MB, Pappalardo F, Chieffo A. Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization. Catheter Cardiovasc Interv 2021; 98:E222-E234. [PMID: 33793051 PMCID: PMC8451815 DOI: 10.1002/ccd.29674] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
Objective To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella® pump) implantation pre‐percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high‐risk PCI populations. Background A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP‐IT Registry were included. Through propensity‐score weighting (PSW) analysis, 1‐year clinical outcomes were assessed separately in CS and HR‐PCI patients, stratified by timing of Impella support. Results Pre‐procedural insertion was associated with an improvement in 1‐year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p = .04 before PSW, p = .009 after PSW) and HR‐PCI (p < .01 both before and after PSW). Among patients undergoing HR‐PCI, early Impella support was also associated with a lower rate of the composite of mortality, re‐hospitalization for heart failure, and need for left‐ventricular assist device/heart transplantation at 1‐year (p = .04 before PSW, p = .01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in‐hospital life‐threatening and severe bleeding among patients with AMI‐CS receiving PCI (7 vs. 16%, p = .1) and HR‐PCI (1 vs. 9%, p = .02). Conclusions Our findings suggested a survival benefit and reduced rates of major bleeding when a pre‐PCI Impella implantation instead of during‐after procedure was used in the setting of HR‐PCI and AMI‐CS.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Francesco Burzotta
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittorio Pazzanese
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Carlo Briguori
- Division of cardiology, Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Carlo Trani
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Piva
- Division of cardiology, Interventional Cardiology Unit, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Maurizio Di Biasi
- Division of cardiology, Interventional Cardiology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Paolo Pagnotta
- Division of cardiology, Cardiovascular Department, Humanitas Research Hospital, Milan, Italy
| | - Marco Mojoli
- Division of cardiology, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Gavino Casu
- Interventional Cardiology Unit, Ospedale San Francesco, Nuoro, Italy
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Matteo Montorfano
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pappalardo
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Alaide Chieffo
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ancona MB, Ferri LA, Russo F, Bellini B, Montorfano M. Left Ventricular Outflow Tract Calcification Localization and Risk of Pacemaker Implantation After TAVR. JACC Cardiovasc Interv 2020; 13:2445-2446. [PMID: 33092716 DOI: 10.1016/j.jcin.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
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18
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Ancona MB, Moroni F, Pagnesi M, Del Sole P, Demir O, Khawaja S, Bellini B, Ferri L, Beneduce A, Visco E, Capogrosso C, Agricola E, Esposito A, Palmisano A, Chieffo A, Montorfano M. Impact of Left Ventricular Outflow Tract Calcification on Pacemaker Implantation After Transcatheter Aortic Valve Implantation With Second-Generation Devices. J Invasive Cardiol 2020; 32:180-185. [PMID: 32045345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the impact of left ventricular outflow tract calcification (LVOT-CA) localization and extension on permanent pacemaker implantation (PPI) rates after transcatheter aortic valve implantation (TAVI) with second-generation devices. METHODS This single-center retrospective study included all consecutive patients who underwent transfemoral TAVI with second-generation devices at San Raffaele Hospital in Milan, Italy from January 2014 to June 2017. The localization and extension of LVOT-CA were evaluated using computed tomography imaging; LVOT regions were categorized according to the overlying coronary cusps. RESULTS The study population consisted of 377 patients, of which LVOT-CA was present in 133 patients (35.3%). Patients with LVOT-CA had significantly a higher rate of post-TAVI PPI (32.0% vs 19.2% in patients with no LVOT-CA; P<.01). Multivariable analysis demonstrated LVOT-CA in the non-coronary cusp, as well as preprocedural right bundle-branch block, age, body mass index, and mechanically expanded prosthesis implantation, to be strong independent predictors of PPI. CONCLUSIONS LVOT-CA in the non-coronary cusp is a strong independent predictor of PPI after TAVI with second-generation devices. Further studies are needed to confirm these data in a larger, multicenter population.
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Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
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19
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Demir OM, Poletti E, Lombardo F, Laricchia A, Beneduce A, Maccagni D, Cappelletti A, Colombo A, Bellini B, Ancona MB, Carlino M, Chieffo A, Montorfano M, Azzalini L. Rotational atherectomy-based percutaneous coronary intervention and the risk of contrast-induced nephropathy. Minerva Cardioangiol 2020; 68:137-145. [PMID: 32100984 DOI: 10.23736/s0026-4725.20.05099-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rotational atherectomy (RA)-related complications (e.g., no-reflow and perforation) may be associated with increased risk of contrast-induced nephropathy (CIN), causing hypotension, acute heart failure, and periprocedural myocardial infarction. Our aim was to evaluate the incidence of CIN in patients undergoing RA-based vs. non-RA-based percutaneous coronary intervention (PCI). METHODS This single-center retrospective registry included all patients who underwent PCI between 2012 and 2016 for whom post-procedural creatinine was determined. Study endpoint was CIN, defined as an increase of serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 h post-PCI. Propensity score matching (PSM) was performed to account for selection bias between RA and non-RA patients. RESULTS Study population included 2580 patients: 70 (3%) had RA PCI and 2510 (97%) had non-RA PCI. Following PSM, there were 70 patients in RA and 280 patients in non-RA group with good overall adjustment between groups, although RA patients received larger contrast volume (263±126 vs. 224±118 mL, P=0.01) and showed higher Mehran risk score at baseline (11.1±6.6 vs. 8.9±4.8, P=0.01). The incidence of CIN was similar between RA and non-RA patients (15.7% vs. 13.2%, P=0.59). New need for dialysis was required in 0% vs. 0.7% patients, respectively (P=0.48). On multivariate analysis, RA PCI was not independently associated with development of CIN. CONCLUSIONS Despite being performed in patients with a higher burden of comorbidities and with larger volumes of contrast, RA PCI is not associated with higher risk of CIN, compared with PCI in non-RA patients.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lombardo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy -
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20
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Chieffo A, Ancona MB, Burzotta F, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Casu G, Giustino G, Montorfano M, Pappalardo F, Tarantini G. Observational multicentre registry of patients treated with IMPella mechanical circulatory support device in ITaly: the IMP-IT registry. EUROINTERVENTION 2020; 15:e1343-e1350. [PMID: 31422925 DOI: 10.4244/eij-d-19-00428] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate nationwide trends and clinical outcomes of the Impella device for cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). METHODS AND RESULTS The IMP-IT study was a multicentre observational national registry which enrolled all patients treated with Impella 2.5, Impella CP, Impella 5.0 and Impella RP, both for CS and HR-PCI indications, across 17 Italian centres from 2004 to June 2018. A total of 406 patients were included: 229 had CS (56.4%) and 177 underwent HR-PCI (43.6%). The use of Impella increased significantly during the study period (average annual percent change 39.8%, 95% confidence interval: 30.4 to 49.9; p<0.0001) for both indications. The Impella 2.5 was the most commonly used device (N=242; 59.6%). Rates of in-hospital and one-year all-cause death in patients with CS were 46.9% and 57.0%, respectively; 18.5% underwent left ventricular assist device implantation or heart transplant at one year. Rates of in-hospital and one-year all-cause death in patients who underwent HR-PCI were 5.7% and 15.6%, respectively. Rates of device-related complications were 37.1% and 10.7% in the setting of CS and HR-PCI, respectively. CONCLUSIONS Use of the Impella for CS and HR-PCI is increasing substantially in Italy, despite relatively high rates of device-related complications.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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21
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Ancona MB, Visco E, Khawaja S, Romano V, Moroni F, Ferri L, Bellini B, Beneduce A, Ancona F, Agricola E, Buzzatti N, Palmisano A, Esposito A, Montorfano M. Valve-in-Valve With Allegra Implantation in Failed Direct Flow Transcatheter Heart Valve. JACC Cardiovasc Interv 2020; 13:e19-e20. [DOI: 10.1016/j.jcin.2019.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
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Pazzanese V, Ancona MB, Bertoldi LF, Pagnesi M, Marini C, Gramegna M, Montorfano M, Chieffo A, Pappalardo F, Camici PG. P1712The Impella percutaneous mechanical circulatory support device in cardiogenic shock: a single-center, real-world, observational experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Impella () percutaneous mechanical circulatory support device is a catheter-based, impeller-driven, axial-flow pump. It reduces left ventricular (LV) stroke work and myocardial oxygen demand while increasing systemic and coronary perfusion in the setting of cardiogenic shock (CS).
Purpose
The aim of the study was to evaluate clinical characteristics and outcomes of patients with CS treated with Impella at our center.
Methods
Our single-center, real-world, observational registry included all consecutive patients with CS treated with Impella 2.5, CP, 5.0, or RP at our center from February 2013 to June 2018. Indication for Impella implantation was CS, defined as hypotension (systolic blood pressure <90 mmHg) despite adequate filling status with signs of hypoperfusion.
Results
A total of 130 patients were included in the registry, mean age was 61±12 years, and 79.2% were males. A history of prior MI, chronic heart failure, and chronic kidney disease was present in 28.9%, 26.1%, and 18.3%, respectively. The etiologies of CS were the following: fulminant myocarditis in 6.1% of the patients, acute coronary syndromes in 59.2%, peri-procedural CS during ventricular tachycardia ablation in 7.7% and acute heart failure in 27%. Out-of-hospital cardiac arrest was present in 30.4% of the patients; 60.2% were in INTERMACS I class at presentation. At admission, mean arterial pressure (MAP) was 65±18 mmHg, serum lactate was 6.7±5.5 mmol/L, mean left ventricular ejection fraction 21.4±11.7%, right ventricular dysfunction was indeed present in 48.6% of the patients. Inotropic drugs support was used in 66.4% of the patients. Impella 2.5, CP, and 5.0 were implanted in 76.1%, 15.4%, and 1.5% of the patients, respectively. Impella RP was also used in 11.5% of patients.The mean duration of support was 135±167 hours. Of note, extra-corporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) were implanted before Impella insertion in 42.8% and 46.7% of the patients, respectively. Escalation to ECMO, ventricular assist device, or heart transplantation was needed in 35.8% of the patients. During hospital stay, acute kidney injury occurred in 56.7% of the patients; need of renal replacement therapy (RRT) 31.7%; access site-related bleeding 14.3%; life-threatening bleeding 31.5%; acute limb ischemia 14.5%; hemolysis 33.3%. The rate of all-cause mortality at 30 day was 39.7%. Need of RRT was the only independent predictor of 30-day mortality (OR 6.56; CI 1.71–25.15; p=0.006).
Conclusion
Our single-center, real-world, observational experience reports acceptable clinical outcomes after Impella implantation in a particularly complex population of patients with CS (INTERMACS class I in 60.2% of patients, prior use of ECMO in 42.8% of patients). All-cause mortality at 30 days was 39.7%, and need of RRT was the only independent predictor for 30-day mortality.
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Affiliation(s)
- V Pazzanese
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - M B Ancona
- San Raffaele Scientific Institute, Interventional Cardiology Unit, Milan, Italy
| | - L F Bertoldi
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - M Pagnesi
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - C Marini
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - M Gramegna
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - M Montorfano
- San Raffaele Scientific Institute, Interventional Cardiology Unit, Milan, Italy
| | - A Chieffo
- San Raffaele Scientific Institute, Interventional Cardiology Unit, Milan, Italy
| | - F Pappalardo
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
| | - P G Camici
- San Raffaele Scientific Institute, Intensive Care Coronary Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy
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Ancona MB, Moroni F, Chieffo A, Spangaro A, Federico F, Ferri LA, Bellini B, Carlino M, Romano V, Palmisano A, Nicoletti V, Esposito A, Buzzatti N, Agricola E, Ancona F, Azzalini L, Montorfano M. Impact of Ascending Aorta Dilation on Mid-Term Outcome After Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2019; 31:278-281. [PMID: 31522139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Severe aortic stenosis (AS) is often associated with ascending aorta dilation (AAD). AAD is amenable to surgical correction combined with aortic valve replacement. Transcatheter aortic valve implantation (TAVI) might represent a valid therapeutic option in these patients when AAD correction Is not indicated. The aim of the present study is to evaluate the impact of concomitant AAD on early and mid-term outcomes after TAVI for symptomatic severe AS. METHODS This is a single-center observational study including patients undergoing transfemoral TAVI. All patients with previous surgery on the left ventricular outflow tract, aortic valve, or ascending aorta (except coronary artery bypass graft surgery) were excluded from the analysis. Patients undergoing TAVI for congenital aortic valve defects or subjects in whom a computed tomography (CT) scan was not available were excluded from the analysis. Ascending aortas were measured on CT scans using appropriate multiplanar reconstructions. Ascending aortas were qualified as dilated if the measurement was >40 mm. Study outcomes were death from any cause, significant paravalvular leaks (PVLs), and new permanent pacemaker (PPM) implant. RESULTS The final population consisted of 680 subjects, 61% females, mean age 82 ± 7 years. One hundred subjects (15%) had AAD. No differences in terms of significant PVL or PPM implantation were found between subjects with or without AAD (P>.99 and P=.13, respectively). At a median follow-up of 498 ± 216 days, no significant difference in terms of mortality was found between subjects with or without AAD (P=.78). CONCLUSIONS AAD does not appear to impact the mid-term outcomes in a cohort of subjects undergoing TAVI.
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Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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24
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Azzalini L, Poletti E, Demir OM, Ancona MB, Mangieri A, Giannini F, Carlino M, Chieffo A, Montorfano M, Colombo A, Latib A. Impact of Post-Percutaneous Coronary Intervention Fractional Flow Reserve Measurement on Procedural Management and Clinical Outcomes: The REPEAT-FFR Study. J Invasive Cardiol 2019; 31:229-234. [PMID: 31199348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We evaluated the impact of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) in a prospective study. METHODS This was a single-center, prospective registry of patients undergoing PCI following a baseline FFR ≤0.80. Patients were divided according to the post-PCI FFR value (<0.90 vs ≥0.90). The primary endpoint was the proportion of cases in which further action was undertaken in light of a post-PCI FFR value <0.90. RESULTS Of 65 PCIs, a total of 43 (66%) had a post-PCI FFR <0.90 and 22 (34%) had a post-PCI FFR ≥0.90. Baseline characteristics were similar between groups. Baseline FFR was similar between patients with post-PCI FFR <0.90 and ≥0.90 (0.72 ± 0.08 vs 0.69 ± 0.14; P=.40). Post-PCI FFR values were 0.82 ± 0.05 in post-PCI FFR <0.90 patients and 0.94 ± 0.02 in post-PCI FFR ≥0.90 patients (P<.001). The most common reason for a post-PCI <0.90 was residual small-vessel disease (42%). In 15 patients (35%) with a post-PCI FFR <0.90, an action was undertaken. An increase of 0.05 ± 0.07 in FFR value (P=.01) was noted after these maneuvers. However, a final FFR value ≥0.90 was achieved in only 3 patients (20%). The major adverse cardiac event (MACE) rate at 1-year follow-up was higher in patients with final FFR <0.90 (31.6% vs 9.1%; P=.047). CONCLUSIONS A suboptimal physiologic outcome is observed in two-thirds of patients undergoing PCI. Despite further interventions, a satisfactory outcome is achieved in only a minority of cases. A post-PCI suboptimal physiologic outcome appears to be associated with a higher incidence of MACE at follow-up.
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Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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25
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Azzalini L, Ancona MB, Bellini B, Chieffo A, Carlino M, Montorfano M. Intravascular Lithotripsy and Microaxial Percutaneous Left Ventricular Assist Device for Complex and High-Risk Percutaneous Coronary Intervention. Can J Cardiol 2019; 35:940.e5-940.e7. [DOI: 10.1016/j.cjca.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022] Open
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26
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Beneduce A, Ancona F, Ancona MB, Romano V, Stella S, Capogrosso C, Montorfano M, Agricola E. Multimodality Imaging for Transcatheter Paravalvular Leak Closure in Radiolucent Mitral Bioprosthesis. Circ Cardiovasc Imaging 2019; 12:e009285. [PMID: 31213087 DOI: 10.1161/circimaging.119.009285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alessandro Beneduce
- Interventional Cardiology Unit (A.B., M.B.A., V.R., M.M.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Echocardiography Laboratory (A.B., F.A., S.S., C.C., E.A.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Echocardiography Laboratory (A.B., F.A., S.S., C.C., E.A.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit (A.B., M.B.A., V.R., M.M.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit (A.B., M.B.A., V.R., M.M.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Echocardiography Laboratory (A.B., F.A., S.S., C.C., E.A.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Capogrosso
- Echocardiography Laboratory (A.B., F.A., S.S., C.C., E.A.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit (A.B., M.B.A., V.R., M.M.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Laboratory (A.B., F.A., S.S., C.C., E.A.) Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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Pagnesi M, Regazzoli D, Ancona MB, Mangieri A, Lanzillo G, Giannini F, Buzzatti N, Prendergast BD, Kodali S, Lansky AJ, Colombo A, Latib A. Cerebral Embolic Risk During Transcatheter Mitral Valve Interventions: An Unaddressed and Unmet Clinical Need? JACC Cardiovasc Interv 2019; 11:517-528. [PMID: 29566796 DOI: 10.1016/j.jcin.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/04/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
Abstract
As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.
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Affiliation(s)
- Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lanzillo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Alexandra J Lansky
- Division of Cardiovascular Medicine and Yale Cardiovascular Research Group, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, St Bartholomew's Hospital and William Harvey Research Institute and Queen Mary University of London, London, United Kingdom
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
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Demir OM, Mitomo S, Giannini F, Mangieri A, Ancona MB, Montorfano M, Latib A, Colombo A. Supra-Annular Transcatheter Aortic Valve Position May Correct Annular Under-Expansion Due to Valvular Asymmetry. Circ J 2019; 83:691. [PMID: 30175802 DOI: 10.1253/circj.cj-18-0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ozan Mehmet Demir
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Marco B Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Matteo Montorfano
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University
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Hachinohe D, Latib A, Laricchia A, Iannopollo G, Demir OM, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Azzalini L, Mitomo S, Chieffo A, Montorfano M, Carlino M, Colombo A. Long‐term follow‐up of covered stent implantation for various coronary artery diseases. Catheter Cardiovasc Interv 2019; 94:571-577. [DOI: 10.1002/ccd.28117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of Cardiology, Sapporo Heart CenterSapporo Cardio Vascular Clinic Sapporo Japan
| | - Azeem Latib
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of CardiologyMontefiore Medical Centre New York
| | | | | | - Ozan M. Demir
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of CardiologyHammersmith Hospital, Imperial College Hospital Healthcare NHS Trust London United Kingdom
| | - Marco B. Ancona
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Antonio Mangieri
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Damiano Regazzoli
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Francesco Giannini
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Lorenzo Azzalini
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Satoru Mitomo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
| | - Alaide Chieffo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Mauro Carlino
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Antonio Colombo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
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30
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Azzalini L, Ancona MB, Mitomo S, Carlino M, Colombo A. Self-apposing stent fracture in the context of myocardial bridging leading to in-stent chronic total occlusion: When the muscle trumps the metal. Cardiol J 2018; 25:144-145. [PMID: 29512100 DOI: 10.5603/cj.2018.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
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31
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Hachinohe D, Ancona MB, Colombo A, Latib A. Severe aortic regurgitation due to a Lunderquist Extra-Stiff Wire Guide during transcatheter aortic valve implantation. Cardiol J 2018; 25:642-643. [PMID: 30394515 DOI: 10.5603/cj.2018.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daisuke Hachinohe
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; EMO-GVM Centro Cuore Columbus, Via Michelangelo Buonarroti, 48, 20145 Milan, Italy; Sapporo Heart Center, Sapporo Cardio Vascular Clinic, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan.
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Demir OM, Iannopollo G, Mangieri A, Ancona MB, Regazzoli D, Mitomo S, Colombo A, Weisz G, Latib A. The Role of Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2018; 5:150. [PMID: 30406115 PMCID: PMC6205957 DOI: 10.3389/fcvm.2018.00150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/03/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve replacement is the therapy of choice for patients with severe aortic stenosis who have prohibitive or high surgical risk. However, the benefit of TAVR is attenuated by the occurrence of major disabling stroke which is associated with increased mortality and early-reduced quality of life. Despite advances in TAVR technology, stroke remains a serious complication that is associated with significant negative outcomes. The majority of these occur in the acute phase following TAVR where cerebral embolic events are frequent. Cerebral embolic protection devices (CEPD) have been developed to minimize the risk of peri-procedural ischemic stroke during TAVR. CEPD have the potential to reduce intraprocedural burden of new silent ischemic injury. In this review we outline the etiology and incidence of stroke in TAVR population, and systematically review current evidence for cerebral embolic protection devices.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gianmarco Iannopollo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Azeem Latib
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Hachinohe D, Latib A, Laricchia A, Demir OM, Agricola E, Romano V, Del Sole PA, Leone PP, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Mitomo S, Monaco F, Buzzatti N, Montorfano M, Colombo A. Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation. Catheter Cardiovasc Interv 2018; 93:522-529. [PMID: 30286515 DOI: 10.1002/ccd.27827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. BACKGROUND Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. METHODS At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. RESULTS Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. CONCLUSIONS The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Division of Cardiology, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Hospital Healthcare NHS Trust, London, United Kingdom
| | - Eustachio Agricola
- Non-invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pier Pasquale Leone
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Demir OM, Regazzoli D, Mangieri A, Ancona MB, Mitomo S, Weisz G, Colombo A, Latib A. Transcatheter Tricuspid Valve Replacement: Principles and Design. Front Cardiovasc Med 2018; 5:129. [PMID: 30283790 PMCID: PMC6156134 DOI: 10.3389/fcvm.2018.00129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Tricuspid regurgitation (TR) may affect as much as 65-85% of the population with the prevalence of moderate-to-severe TR in the United States reported at greater than 1.6 million. However, only 8,000 tricuspid valve operations are performed annually in the United States. As severe TR is associated with poor outcomes, there is an unmet clinical need for surgical or percutaneous transcatheter based treatment of TR. Over the last two decades there have been significant developments in percutaneous transcatheter based therapies for valvular disease. However, this progress has not been mirrored for the tricuspid valve until recently; we are now at a cross-roads of new transcatheter devices becoming available for treatment of TR. In this review, we discuss the principles of performing transcatheter tricuspid valve replacement, analyze the devices that can be utilized and outline the challenges related to this procedure.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Damiano Regazzoli
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Regazzoli D, Mangieri A, Demir O, Ancona MB, Lanzillo G, Giannini F, Leone PP, Colombo A, Latib A. The future of percutaneous tricuspid valve interventions. Minerva Cardioangiol 2018; 66:735-743. [PMID: 29963813 DOI: 10.23736/s0026-4725.18.04757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tricuspid valve regurgitation has a high prevalence and, when severe, is associated with poor outcomes. Nevertheless, surgical repair or replacement (isolated or as a part of a combined procedure) is rarely performed due to high surgical risk. Therefore, there is a significant unmet clinical need for percutaneous transcatheter-based treatments. Significant development in percutaneous therapies for both aortic and mitral valve disease has been accomplished over the last two decades, while transcatheter therapies for the tricuspid valve are still at an early stage. We are today at a cross-road of new transcatheter devices that are becoming available for the treatment of tricuspid regurgitation; the current review evaluates the challenges that current and future technologies have to face in order to become a safer, less invasive and equally effective alternative to surgery.
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Affiliation(s)
- Damiano Regazzoli
- Unit of Cardiovascular Interventions, Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Ozan Demir
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Marco B Ancona
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Lanzillo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Pier P Leone
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Ancona MB, Hachinohe D, Giannini F, Del Sole PA, Regazzoli D, Mangieri A, Romano V, Latib A, Ancona F, Monaco F, Castiglioni A, Esposito A, Montorfano M, Colombo A. Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:e29-e30. [PMID: 29471959 DOI: 10.1016/j.jcin.2017.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo A Del Sole
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Echocardiography Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Anesthesiology Unit; San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Esposito
- Radiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Mangieri A, Montorfano M, Stella S, Regazzoli D, Ancona MB, Jabbour RJ, Mitomo S, Seresini G, Monaco F, Lanzillo G, Pagnesi M, Colombo A, Latib A. Severe Mitral Stenosis and Persistent Left Appendage Thrombosis. JACC Cardiovasc Interv 2018; 11:e11-e13. [DOI: 10.1016/j.jcin.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
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Ancona MB, Giannini F, Mangieri A, Regazzoli D, Jabbour RJ, Tanaka A, Testa L, Romano V, Longoni M, Giglio M, Besana F, Cacucci M, Agricola E, Chieffo A, Alfieri O, Montorfano M, Colombo A, Latib A. Impact of Mitral Annular Calcium on Outcomes after Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:2233-2240. [PMID: 29106835 DOI: 10.1016/j.amjcard.2017.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/31/2022]
Abstract
A high prevalence of mitral annular calcium (MAC) is expected in patients undergoing transcatheter aortic valve implantation (TAVI); however, data regarding the prevalence of MAC and impact on risk of cardiovascular events are lacking. To determine the prevalence of MAC and its association with clinical outcomes in patients undergoing TAVI, we retrospectively analyzed 424 patients who underwent transfemoral TAVI from 2007 to 2015 and whose preoperative computed tomography images were available for assessment of MAC. Severe circumferential MAC (SC-MAC) was defined as calcification involving at least the whole posterior annulus alone or with the attachment of the anterior leaflet. Clinical outcomes were examined according to Valve Academic Research Consortium-2 criteria up to 2 years. SC-MAC was found in 17.7% of patients. Patients with SC-MAC were more likely to be female, with a higher prevalence of atrial fibrillation and peripheral artery disease. There were no differences between the groups regarding age, functional class, prevalence of diabetes, kidney disease, and operative risk. Female gender and peripheral artery disease were independent predictors of SC-MAC. SC-MAC did not appear to be associated with periprocedural and 30-day outcomes. At 2 years' follow-up, patients with SC-MAC had significantly higher cardiovascular and all-cause mortality rates. SC-MAC was an independent predictor of cardiovascular mortality during follow-up. In conclusion, SC-MAC is a frequent finding in the TAVI population and appears to be an independent predictor of cardiovascular mortality at 2 years' follow-up.
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Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Akihito Tanaka
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Cardiology Department, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Longoni
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Manuela Giglio
- Centre for Cardiovascular Prevention, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Besana
- Centre for Cardiovascular Prevention, San Raffaele Scientific Institute, Milan, Italy
| | | | - Eustachio Agricola
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiothoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
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Pappalardo F, Ancona MB, Giannini F, Regazzoli D, Mangieri A, Montorfano M, De Bonis M, Alfieri O, Zangrillo A, Scandroglio AM, Colombo A, Latib A. First in man prolonged pressure-controlled intermittent coronary sinus occlusion to treat refractory left ventricular dysfunction and ischemia with patent epicardial coronary arteries. Int J Cardiol 2017; 241:138-141. [DOI: 10.1016/j.ijcard.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
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Regazzoli D, Ancona MB, Mangieri A, Tanaka A, Romano V, Leone PP, Tresoldi M, Lanzillo G, Agricola E, Latib A, Colombo A, Montorfano M. Patent foramen ovale closure through inferior vena cava filter in a patient with deep venous thrombosis and recurrent ischemic events. J Cardiovasc Med (Hagerstown) 2017; 18:828-830. [PMID: 28368881 DOI: 10.2459/jcm.0000000000000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Damiano Regazzoli
- aInterventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department bDivision of Internal Medicine and Clinical Immunology cNoninvasive Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan dInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Latib A, Ancona MB, Agricola E, Giannini F, Mangieri A, Regazzoli D, Monaco F, Alfieri O, Hahn R, Colombo A. Percutaneous Bicuspidization of the Tricuspid Valve. JACC Cardiovasc Imaging 2017; 10:488-489. [DOI: 10.1016/j.jcmg.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
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Mangieri A, Jabbour RJ, Montalto C, Pagnesi M, Regazzoli D, Ancona MB, Giannini F, Tanaka A, Bertoldi L, Monaco F, Agricola E, Giglio M, Mattioli R, Ferri L, Montorfano M, Chieffo A, Alfieri O, Colombo A, Latib A. Single-Antiplatelet Therapy in Patients with Contraindication to Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 119:1088-1093. [PMID: 28237287 DOI: 10.1016/j.amjcard.2016.11.065] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis. A total of 439 patients were included in the final analysis; 108 patients were discharged on SAPT and 331 on DAPT. Reasons for discharge SAPT included high risk of bleeding (n = 33; 31%), postprocedural bleeding (n = 42; 39%), thrombocytopenia (n = 20; 18%), vascular complications (n = 13; 12%). The mean length of DAPT was 5.2 ± 2.7 months. Patients discharged in SAPT had a higher incidence of life-threatening bleeding during the index hospitalization. At follow-up, no differences were observed in the incidence of net adverse clinical event, all-cause or cardiovascular mortality, and cerebrovascular events. A similar rate of valve thrombosis was reported in both groups. In conclusion, prescribing only SAPT after TAVI in selected patients was not associated with an increased risk of events and may be an acceptable alternative to DAPT in elderly patients at high risk of bleeding.
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Del Furia F, Ancona MB, Giannini F, Jabbour RJ, Regazzoli D, Mangieri A, Latib A, Colombo A, Montorfano M. First-in-man Percutaneous LAA Closure With an Amplatzer Amulet and TriGuard Embolic Protection Device in a Patient With LAA Thrombus. J Invasive Cardiol 2017; 29:E51-E52. [PMID: 28368849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Percutaneous left atrial appendage (LAA) closure is currently utilized for the prophylaxis of thromboembolic cerebrovascular accidents in patients with non-valvular atrial fibrillation. The presence of LAA thrombus is usually considered a contraindication for the procedure, since there is a high risk of thrombus embolization. While reports in the literature have shown the feasibility of LAA closure in the presence of LAA thrombus with certain cerebral embolic protection devices, we present the first-in-man LAA closure of a patient with LAA thrombus using the TriGuard Embolic Protection Device.
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Affiliation(s)
- Francesca Del Furia
- Interventional Cardiology Unit, San Raffaele Scientific Institute, 60 Via Olgettina, 20132 Milan, Italy.
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Latib A, Mangieri A, Vicentini L, Ferri L, Montorfano M, Ismeno G, Regazzoli D, Ancona MB, Giglio M, Denti P, Colombo A, Agricola E. Percutaneous Tricuspid Valve Annuloplasty Under Conscious Sedation (With Only Fluoroscopic and Intracardiac Echocardiography Monitoring). JACC Cardiovasc Interv 2017; 10:620-621. [DOI: 10.1016/j.jcin.2016.12.283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
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Colombo A, Ancona MB, Chieffo A. The Unforgettable Cornerstone: Role of Ticlopidine in Developing Current Antithrombotic Treatment After Percutaneous Coronary Intervention. J Am Coll Cardiol 2017; 69:755-756. [PMID: 28183518 DOI: 10.1016/j.jacc.2016.09.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022]
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Giannini F, Latib A, Ancona MB, Costopoulos C, Ruparelia N, Menozzi A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Colombo A. A propensity score matched comparative study between paclitaxel-coated balloon and everolimus-eluting stents for the treatment of small coronary vessels. Catheter Cardiovasc Interv 2017; 90:380-386. [PMID: 28109036 DOI: 10.1002/ccd.26929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare the long-term clinical outcomes of paclitaxel drug-coated-balloons (DCB) and everolimus-eluting-stents (EES) following the treatment of de novo small vessel coronary artery disease. BACKGROUND It is currently unclear whether treatment of de novo small vessel coronary disease with DCB is comparable to second generation drug-eluting stents, which are the current standard of care. METHODS The present study enrolled 90 patients with small vessel coronary disease from the DCB treatment arm of the BELLO (Balloon Elution and Late Loss Optimization) trial and 2,000 patients treated with EES at the San Raffaele Scientific Institute. Propensity score matching was performed to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 181 patients: 90 patients with 94 lesions receiving DCB and 91 patients with 94 lesions receiving EES. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, recurrent non-fatal myocardial infarction, and target vessel revascularization. RESULTS After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. The cumulative MACE rate at 1-year was 12.2% with DCB and 15.4% with EES (P = 0.538). Patients in the DCB group had similar TLR rates as compared to EES over the same interval (4.4% vs. 5.6%; P = 0.720). There were no cases of definite or probable stent or vessel thrombosis. CONCLUSIONS The use of paclitaxel-DCB appears to be associated with similar clinical outcomes when compared to second-generation-EES in small coronary artery disease. The findings of this study should be confirmed with larger prospective randomized studies with longer follow-up. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Charis Costopoulos
- Department of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Neil Ruparelia
- Hammersmith Hospital, Imperial NHS Healthcare Trust, London, United Kingdom
| | - Alberto Menozzi
- Interventional Cardiology Unit, Cardiology Department, Ospedale di Parma, Parma, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
| | - Antonio Micari
- Interventional Cardiology Unit, Maria Eleonora Hospital, GVM Care and Research, Palermo, Italy
| | - Alberto Cremonesi
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | | | - Alfredo Marchese
- Interventional Cardiology Unit, Anthea Hospital, GVM Care and Research, Bari, Italy
| | - Maurizio Tespili
- Interventional Cardiology Unit, Ospedale Bolognini, Seriate, Bergamo, Italy
| | - Patrizia Presbitero
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Gregory A Sgueglia
- Interventional Cardiology Unit, Ospedale Santa Maria Goretti, Latina, Italy
| | | | - Corrado Tamburino
- Interventional Cardiology Unit, Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Pagnesi M, Baldetti L, Del Sole P, Mangieri A, Ancona MB, Regazzoli D, Buzzatti N, Giannini F, Colombo A, Latib A. Predilatation Prior to Transcatheter Aortic Valve Implantation: Is it Still a Prerequisite? Interv Cardiol 2017; 12:116-125. [PMID: 29588739 DOI: 10.15420/icr.2017:17:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Predilatation has been historically considered a mandatory step before transcatheter aortic valve implantation (TAVI) since it facilitates valve crossing and prosthesis delivery, ensures optimal valve expansion and improves hemodynamic stability during valve deployment. However, as a result of procedural evolution over time, direct TAVI (without pre-implantation balloon aortic valvuloplasty) has emerged as an interesting option to simplify the procedure and to avoid potential valvuloplasty-related complications. Several real-world retrospective studies and one small randomised study have shown that direct TAVI (with both self-expanding and balloon-expandable prostheses) is feasible, safe and associated with outcomes similar to standard TAVI with pre-implantation balloon aortic valvuloplasty. In the absence of high-quality, robust evidence, the current review aims to discuss the advantages and disadvantages of omitting predilatation prior to TAVI.
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Affiliation(s)
- Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Del Sole
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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48
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Latib A, Ancona MB, Ferri L, Montorfano M, Mangieri A, Regazzoli D, Giannini F, Monaco F, Giglio M, De Servi S, Alfieri O, Colombo A, Agricola E. Percutaneous Direct Annuloplasty With Cardioband to Treat Recurrent Mitral Regurgitation After MitraClip Implantation. JACC Cardiovasc Interv 2016; 9:e191-2. [DOI: 10.1016/j.jcin.2016.06.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/26/2022]
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Giannini F, Latib A, Jabbour RJ, Ruparelia N, Aurelio A, Ancona MB, Figini F, Mangieri A, Regazzoli D, Tanaka A, Montalto C, Azzalini L, Monaco F, Agricola E, Chieffo A, Montorfano M, Alfieri O, Colombo A. Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation. Int J Cardiol 2016; 221:892-7. [PMID: 27434367 DOI: 10.1016/j.ijcard.2016.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. OBJECTIVES To evaluate whether post-procedural glucose levels are associated with AKI after TAVI. METHODS AND RESULTS A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥150mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p<0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p<0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p<0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI. CONCLUSIONS Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
| | - Azeem Latib
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, UK
| | - Neil Ruparelia
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Andrea Aurelio
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Filippo Figini
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Akihito Tanaka
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | | | - Fabrizio Monaco
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | - Alaide Chieffo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Antonio Colombo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
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Pagnesi M, Jabbour RJ, Latib A, Kawamoto H, Tanaka A, Regazzoli D, Mangieri A, Montalto C, Ancona MB, Giannini F, Chieffo A, Montorfano M, Monaco F, Castiglioni A, Alfieri O, Colombo A. Usefulness of Predilation Before Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:107-12. [PMID: 27184169 DOI: 10.1016/j.amjcard.2016.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/24/2022]
Abstract
Balloon predilation is historically considered a requirement before performing transcatheter aortic valve implantation (TAVI). As the procedure has evolved, it has been questioned whether it is actually needed, but data are lacking on mid-term outcomes. The aim of this study was to evaluate the effect of balloon predilation before TAVI. A total of 517 patients who underwent transfemoral TAVI from November 2007 to October 2015 were analyzed. The devices implanted included the Medtronic CoreValve (n = 216), Medtronic Evolut R (n = 30), Edwards SAPIEN XT (n = 210), and Edwards SAPIEN 3 (n = 61). Patients were divided into 2 groups depending on whether pre-implantation balloon aortic valvuloplasty (pre-BAV) was performed (n = 326) or not (n = 191). Major adverse cardiac and cerebrovascular events (MACCE) were primarily evaluated. Propensity score matching was used to adjust for differences in baseline characteristics and potential confounders (n = 113 pairs). In the overall cohort, patients without pre-BAV had a significantly higher MACCE rate at 30 days, driven by a higher incidence of stroke (0.3% pre-BAV vs 3.7% no-pre-BAV, p <0.01). MACCE and mortality at 1 year were, however, similar in both groups. Independent predictors of MACCE at 1 year included serum creatinine, NYHA class 3 to 4, logistic European System for Cardiac Operative Risk Evaluation, and postdilation. Of note, the postdilation rate was higher in the no-pre-BAV group (21.5% pre-BAV vs 35.6% no-pre-BAV, p <0.001). After propensity score matching, there were no differences in MACCE between the 2 groups. In conclusion, this study showed that, in selected patients and with specific transcatheter valves, TAVI without pre-BAV appears to be associated with similar mid-term outcomes compared with TAVI with pre-BAV, but it may increase the need for postdilation.
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