1
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Meier D, Grant D, Frawley C, Akodad M, Landes U, Khokhar AA, Dudek D, George I, Rinaldi MJ, Kim WK, Yakubov SJ, Sorajja P, Tarantini G, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure. EUROINTERVENTION 2024; 20:e376-e388. [PMID: 38506739 PMCID: PMC10941669 DOI: 10.4244/eij-d-23-00783] [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: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI). AIMS We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3. METHODS Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV. Hydrodynamic testing was performed to assess THV function. Multimodality assessment was performed using photography, X-ray, microcomputed tomography (micro-CT), and high-speed videos. RESULTS The ACURATE in S3 combinations had favourable hydrodynamic performance compared to the S3 in S3 for all size combinations. In the 20 mm S3, redo-TAVI with the ACn2 had lower gradients compared to the S3 (mean gradient 16.3 mmHg for the ACn2 vs 24.7 mmHg for the 20 mm S3 in 20 mm S3). Pinwheeling was less marked for the ACURATE THVs than for the S3s. On micro-CT, the S3s used for redo-TAVI were underexpanded across all sizes. This was also observed for the ACURATE platform, but to a lesser extent. CONCLUSIONS Redo-TAVI with an ACn2/AC XL within an S3 has favourable hydrodynamic performance and less pinwheeling compared to an S3 in S3. This comes at the price of a taller neoskirt.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Klinik Heart Center, Bad Nauheim, Germany
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth Hospital, Columbus, OH, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Italy
- University of Padua Medical School, Padua, Italy
| | - David A Wood
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Boston Scientific Corporation, Marlborough, MA, USA
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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2
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Benenati S, Gallo F, Kim WK, Khokhar AA, Zeus T, Toggweiler S, Galea R, De Marco F, Mangieri A, Regazzoli D, Reimers B, Nombela-Franco L, Barbanti M, Regueiro A, Piva T, Rodes-Cabau J, Porto I, Colombo A, Giannini F, Sticchi A. Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff. J Cardiovasc Dev Dis 2024; 11:33. [PMID: 38276659 PMCID: PMC10816002 DOI: 10.3390/jcdd11010033] [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: 11/30/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. METHODS Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. RESULTS A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). CONCLUSIONS TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.
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Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell’Angelo, AULSS3 Serenissima, Mestre, 30174 Venezia, Italy
| | - Won-keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | - Arif A. Khokhar
- Cardiology Service, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, 40225 Duesseldorf, Germany
| | - Stefan Toggweiler
- Department of Cardiology, Cantonal Hospital Lucern, 6000 Luzern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | | | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luis Nombela-Franco
- Interventional Cardiology Unit, Hospital Àlvaro Cunqueiro, 36312 Vigo, Spain
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, 60126 Ancona, Italy;
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Italo Porto
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy
| | - Alessandro Sticchi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
- Dipartimento di Patologia Chirurgica, University of Pisa, Medica, Molecolare e dell’Area Critica, 56126 Pisa, Italy
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3
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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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4
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Sticchi A, Tatali C, Ferraro M, Khokhar AA, Scoccia A, Cereda A, Toselli M, Gallo F, Laricchia A, Mangieri A, Grigioni F, Ussia GP, Giannini F, Colombo A. Long Stent Implantation on the Left Anterior Descending Coronary Artery at a Follow-Up of More Than Five Years. J Clin Med 2023; 13:210. [PMID: 38202217 PMCID: PMC10779530 DOI: 10.3390/jcm13010210] [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: 10/13/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated. METHODS We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres. The main inclusion criteria were the implantation of stents longer than 30 mm on the LAD and a minimum follow-up (FU) of five years. The primary endpoint was mortality, and the secondary endpoints were any myocardial infarction (MI), target vessel and lesion revascularization (TVR and TLR, respectively), and stent thrombosis (ST) observed as definite, probable, or possible. RESULTS In this selected population with characteristics of complex PCI (99.1%), the long-term follow-up (mean 92.18 ± 35.5 months) estimates of all-cause death, cardiovascular death, and any myocardial infarction were 18.3%, 10.5%, and 9.3%, respectively. Both all-cause and cardiovascular deaths are significantly associated with three-vessel disease (HR 6.8; confidence of interval (CI) 95% 3.844-11.934; p < 0.001, and HR 4.7; CI 95% 2.265-9.835; p < 0.001, respectively). Target lesion (TLR) and target vessel revascularization (TVR) are associated with the presence of three-lesion disease on the LAD (HR 3.4; CI 95% 1.984-5.781; p < 0.001; HR 3.9 CI 95% 2.323-6.442; p < 0.001, respectively). Re-PCI for any cause occurred in 31.5% of patients and shows an increased risk for three-lesion stenting (HR 4.3; CI 95% 2.873-6.376; p < 0.001) and the treatment of bifurcation with two stents (HR 1.6; 95% CI 1.051-2.414; p = 0.028). Stent thrombosis rate at the 5-year FU was 4.4% (1.3% definite; 0.9% probable; 2.1% possible), including a 1.7% rate of very-late thrombosis. The stent length superior to 40 mm was not associated with poor outcomes (all-cause death p = 0.349; cardiovascular death p = 0.855; MI p = 0.691; re-PCI p = 0.234; TLR p = 0.805; TVR p = 0.087; ST p = 0.189). CONCLUSION At an FU of longer than five years, patients treated with stents longer than 30 mm in their LAD showed acceptable procedural results but poor outcomes.
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Affiliation(s)
- Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy;
- University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Concetta Tatali
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Massimo Ferraro
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; (M.F.); (A.C.)
| | - Arif A. Khokhar
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Alessandra Scoccia
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo Carlo, 20142 Milan, Italy
| | - Marco Toselli
- Department of Interventional Cardiology, GVM Care & Research Maria Cecilia Hospital, 48033 Cotignola, Italy; (M.T.); (F.G.)
| | - Francesco Gallo
- Cardiology Unit, Ospedale dell’Angelo, ULSS3 Serenissima, 30174 Mestre, Italy;
| | | | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Francesco Grigioni
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Gian Paolo Ussia
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Francesco Giannini
- Department of Interventional Cardiology, GVM Care & Research Maria Cecilia Hospital, 48033 Cotignola, Italy; (M.T.); (F.G.)
| | - Antonio Colombo
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; (M.F.); (A.C.)
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5
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Kim WK, Frawley C, Charitos EI, Khokhar AA. Coronary Reaccess After Modified Chimney Stenting in a Self-Expanding Transcatheter Valve-in-Valve. JACC Case Rep 2023; 28:102118. [PMID: 38204544 PMCID: PMC10774812 DOI: 10.1016/j.jaccas.2023.102118] [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: 08/13/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 01/12/2024]
Abstract
We demonstrate a modified technique of heterotopic chimney stenting for coronary obstruction during valve-in-valve transcatheter aortic valve replacement With successful end-on cannulation via the stent ostium. Our technique was reproducible on the bench with successful reaccess and without any interaction between the deployed coronary stent and the prosthetic leaflets.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany, and German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany
| | | | | | - Arif A. Khokhar
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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6
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Khokhar AA, Marrone A, Bermpeis K, Wyffels E, Tamargo M, Fernandez-Avilez F, Ruggiero R, Złahoda-Huzior A, Giannini F, Zelias A, Madder R, Dudek D, Beyar R. Latest Developments in Robotic Percutaneous Coronary Interventions. Interv Cardiol 2023; 18:e30. [PMID: 38213745 PMCID: PMC10782427 DOI: 10.15420/icr.2023.03] [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: 04/30/2023] [Accepted: 10/02/2023] [Indexed: 01/13/2024] Open
Abstract
Since the first robotic-assisted percutaneous coronary intervention procedure (R-PCI) was performed in 2004, there has been a steady evolution in robotic technology, combined with a growth in the number of robotic installations worldwide and operator experience. This review summarises the latest developments in R-PCI with a focus on developments in robotic technology, procedural complexity, tele-stenting and training methods, which have all contributed to the global expansion in R-PCI.
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Affiliation(s)
- Arif A Khokhar
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS TrustLondon, UK
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
| | - Andrea Marrone
- Cardiovascular Institute, Azienda Ospedaliero-Universataria di FerraraCona, Italy
| | - Konstantinos Bermpeis
- Department of Cardiology, AHEPA University General HospitalThessaloniki, Greece
- Cardiovascular Center Aalst, OLV-ClinicAalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-ClinicAalst, Belgium
| | - Maria Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio MaranonMadrid, Spain
| | | | | | - Adriana Złahoda-Huzior
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
- Department of Measurement and Electronics, AGH University of Science and TechnologyKrakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, IRCCS Galeazzi Sant’AmbrogioMilan, Italy
| | - Aleksander Zelias
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
- Center for Invasive Cardiology, Electrotherapy and AngiologyNowy Sacz, Poland
| | - Ryan Madder
- Frederik Meijer Heart and Vascular Institute, Spectrum HealthGrand Rapids, MI, US
| | - Dariusz Dudek
- Center of Digital Medicine and Robotics, Jagiellonian University Medical CollegeKrakow, Poland
- GVM Care & Research, Maria Cecilia HospitalCotignola, Italy
| | - Rafael Beyar
- Department of Cardiology, Rambam Health Care Campus and the TechnionHaifa, Israel
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7
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Curio J, Khokhar AA, Beneduce A, Mylotte D, Fezzi S, Kim WK, Zlahoda-Huzior A, Giannini F, Dudek D. Patient-specific commissural alignment for ACURATE neo2 implantation in degenerated surgical bioprostheses. Catheter Cardiovasc Interv 2023; 102:1401-1405. [PMID: 37694603 DOI: 10.1002/ccd.30828] [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: 04/05/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
Valve-in-valve TAVI to treat failing surgical aortic valves (SAVs) is increasingly performed, and commissural alignment is a key technical aspect in such procedures. Surgeons optimize valve alignment, accounting for potential coronary eccentricity and achieving a patient-specific optimized commissural orientation, representing the ideal target for TAVI alignment. Therefore, here we present a dedicated stepwise valve-in-valve implantation technique using the ACURATE neo2. In a specific SAV postoverlap view, isolating one surgical post to the right of the screen representing the target for alignment, rotational orientation of the TAVI commissures, matching the SAV orientation, is achieved and verified before implantation. This technique has been tested in a patient-specific three-dimensionally-printed aortic root anatomy, attached to a pulsatile flow simulator, allowing for native-like simulation of coronary cannulations under fluoroscopy, and enabling detailed assessment with fluoroscopic as well as direct videographic visualization. Furthermore, the technique is exemplified by providing an educational clinical case example.
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Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Arif A Khokhar
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
- Digital Innovations & Robotics Hub, Krakow, Poland
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Darren Mylotte
- Department of Cardiology, Saolta University Health Care Group, University Hospital Galway, Health Service Executive and University of Galway, Galway, Ireland
| | - Simone Fezzi
- Department of Cardiology, Saolta University Health Care Group, University Hospital Galway, Health Service Executive and University of Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Interventional Cardiology Unit GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
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8
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Tsai TY, Onuma Y, Złahoda-Huzior A, Kageyama S, Dudek D, Wang Q, Lim RP, Garg S, Poon EKW, Puskas J, Ramponi F, Jung C, Sharif F, Khokhar AA, Serruys PW. Merging virtual and physical experiences: extended realities in cardiovascular medicine. Eur Heart J 2023; 44:3311-3322. [PMID: 37350487 PMCID: PMC10499546 DOI: 10.1093/eurheartj/ehad352] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.
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Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Xitun District, Taichung 40705, Taiwan
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Adriana Złahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, al. A. Mickiewicza 30, 30-059 Kraków, Poland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
- Center of Digital Medicine and Robotics, Jagiellonian University Medical College, Świętej Anny 12, 31-008 Kraków, Poland
| | - Qingdi Wang
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Ruth P Lim
- Department of Radiology and Surgery (Austin), Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 161 Barry St, Carlton VIC 3010, Australia
- Department of Radiology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn BB1 2RB, UK
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Fabio Ramponi
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London W12 0HS, UK
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
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9
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Beneduce A, Khokhar AA, Curio J, Giannini F, Zlahoda-Huzior A, Grant D, Maisano F, de Backer O, Sathananthan J, Dudek D. Comparison of BASILICA and Balloon-Assisted BASILICA Coronary Protection for Redo-TAVR: Insights From Bench Testing. JACC Cardiovasc Interv 2023; 16:1431-1433. [PMID: 37316157 DOI: 10.1016/j.jcin.2023.04.031] [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: 04/07/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 06/16/2023]
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10
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Mangieri A, Nerla R, Castriota F, Reimers B, Regazzoli D, Leone PP, Gasparini GL, Khokhar AA, Laricchia A, Giannini F, Casale F, Bezzeccheri A, Briguori C, Colombo A. Cutting balloon to optimize predilation for stent implantation: The COPS randomized trial. Catheter Cardiovasc Interv 2023; 101:798-805. [PMID: 36841945 DOI: 10.1002/ccd.30603] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES The objective of this study is to investigate the use of cutting balloon (CB) inflated at high pressure compared with noncompliant balloon (NCB) for the treatment of calcified coronary lesions. BACKGROUND No data are available regarding the safety and efficacy of CB inflated at high pressure in coronary artery calcifications. METHODS Patients with calcified lesions (more than 100° of calcium demonstrated at baseline intravascular ultrasound) were randomized. Primary endpoint of the study was the final minimal stent area (MSA) and stent symmetry in the calcific segment. Secondary endpoints included rate of device failure and the 1-year rate of target lesion revascularization, target vessel revascularization, and major adverse cardiovascular events. RESULTS From September 2019 to June 2021, a total of 100 patients were included and randomized; 13 patients were excluded for major protocol deviations. Lesions were complex (type B2/C n = 61 [71.2%]) with a mean arch of calcium of 266 ± 84°, a calcium length of 12 ± 6.6 mm. CB was inflated at comparable atmospheres when compared with NCB (18.3 ± 5 vs. 19 ± 4.5, p = 0.46). In the per-protocol population, the final MSA at the level of the calcium site was significantly higher in the CB group (8.1 ± 2 vs. 7.3 ± 2.1, p = 0.035) with a higher eccentricity index achieved in the CB group (0.84 ± 0.07 vs. 0.8 ± 0.08, p = 0.013). Three device failure occurred in the CB group. One-year follow-up outcomes were comparable. CONCLUSIONS Treatment of calcified lesions with high-pressure CB has a good safety profile and is associated with a larger MSA and higher eccentricity of the stent at the level of the calcium site compared with NCB.
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Affiliation(s)
- Antonio Mangieri
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Roberto Nerla
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Fausto Castriota
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Bernhard Reimers
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Damiano Regazzoli
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Pier P Leone
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | | | - Arif A Khokhar
- Department of Cardio-Thoracic Cardiology Service, Imperial College Healthcare NHS Trust, London, UK
| | | | - Francesco Giannini
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Fulvio Casale
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | | | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Cardiology Cardio Center IRCCS, Humanitas Research Hospital, Rozzana, Italy
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11
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Zakrzewski P, Mikhail G, Dudek D, Giannini F. Coronary access techniques following ACURATE neo2 implantation in surgical bioprosthesis. EUROINTERVENTION 2022; 18:820-821. [PMID: 35708304 PMCID: PMC9725048 DOI: 10.4244/eij-d-22-00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Arif A Khokhar
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Digital Innovations & Robotics Hub, Krakow, Poland
| | | | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement & Electronics, AGH University of Science & Technology, Krakow, Poland
| | | | - Ghada Mikhail
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
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12
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Ruggiero R, Khokhar AA, Cocco M, Chandra K, Toselli M, Zlahoda-Huzior A, Zelias A, Giannini F, Dudek D. Robotic Control of a 0.035-Inch Guidewire: Initial Feasibility and First-in-Human Experience. Can J Cardiol 2022; 38:1773-1774. [PMID: 35933062 DOI: 10.1016/j.cjca.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/17/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research, Cotignola, Italy.
| | - Arif A Khokhar
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Marta Cocco
- Cardiovascular Institute, AziendaOspedaliero-Universitaria di Ferrara, Italy
| | - Kailash Chandra
- Interventional Cardiology Unit, GVM Care & Research, Cotignola, Italy
| | - Marco Toselli
- Interventional Cardiology Unit, GVM Care & Research, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- AGH, University of Science and Technology, Department of Measurement and Electronics, Krakow, Poland
| | - Aleksander Zelias
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & Research, Cotignola, Italy; Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sacz, Poland
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13
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Khokhar AA, Giannini F, Zlahoda‐Huzior A, Mikhail G, Dudek D. Coronary access after ACURATE neo2 implantation for valve-in-valve TAVR: Insights from ex vivo simulations. Catheter Cardiovasc Interv 2022; 100:662-666. [PMID: 36116020 PMCID: PMC9826017 DOI: 10.1002/ccd.30367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Arif A. Khokhar
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
- Digital Innovations & Robotics HubKrakowPoland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
| | - Adriana Zlahoda‐Huzior
- Digital Innovations & Robotics HubKrakowPoland
- Department of Measurement and ElectronicsAGH University of Science and TechnologyKrakowPoland
| | - Ghada Mikhail
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
- Institute of CardiologyJagiellonian University Medical CollegeKrakowPoland
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14
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Khokhar AA, Curio J, Beneduce A, Giannini F, Dudek D. Combining Imaging-Based With Simulation-Based Techniques to Evaluate Coronary Access. JACC Cardiovasc Interv 2022; 15:2109-2110. [DOI: 10.1016/j.jcin.2022.09.008] [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: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
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15
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Chandra K, Ruggiero R, Toselli M, Gallo F, Cereda A, Sticchi A, Laricchia A, Regazzoli D, Mangieri A, Reimers B, Biscaglia S, Tumscitz C, Campo G, Mikhail GW, Kim WK, Colombo A, Dudek D, Giannini F. Coronary access following ACURATE neo implantation for transcatheter aortic valve-in-valve implantation: Ex vivo analysis in patient-specific anatomies. Front Cardiovasc Med 2022; 9:902564. [PMID: 36187005 PMCID: PMC9515364 DOI: 10.3389/fcvm.2022.902564] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary access after transcatheter aortic valve implantation (TAVI) with supra-annular self-expandable valves may be challenging or un-feasible. There is little data concerning coronary access following transcatheter aortic valve-in-valve implantation (ViV-TAVI) for degenerated surgical bioprosthesis. Aims To evaluate the feasibility and challenge of coronary access after ViV-TAVI with the supra-annular self-expandable ACURATE neo valve. Materials and methods Sixteen patients underwent ViV-TAVI with the ACURATE neo valve. Post-procedural computed tomography (CT) was used to create 3D-printed life-sized patient-specific models for bench-testing of coronary cannulation. Primary endpoint was feasibility of diagnostic angiography and PCI. Secondary endpoints included incidence of challenging cannulation for both diagnostic catheters (DC) and guiding catheters (GC). The association between challenging cannulations with aortic and transcatheter/surgical valve geometry was evaluated using pre and post-procedural CT scans. Results Diagnostic angiography and PCI were feasible for 97 and 95% of models respectively. All non-feasible procedures occurred in ostia that underwent prophylactic “chimney” stenting. DC cannulation was challenging in 17% of models and was associated with a narrower SoV width (30 vs. 35 mm, p < 0.01), STJ width (28 vs. 32 mm, p < 0.05) and shorter STJ height (15 vs. 17 mm, p < 0.05). GC cannulation was challenging in 23% of models and was associated with narrower STJ width (28 vs. 32 mm, p < 0.05), smaller transcatheter-to-coronary distance (5 vs. 9.2 mm, p < 0.05) and a worse coronary-commissural overlap angle (14.3° vs. 25.6o, p < 0.01). Advanced techniques to achieve GC cannulation were required in 22/64 (34%) of cases. Conclusion In this exploratory bench analysis, diagnostic angiography and PCI was feasible in almost all cases following ViV-TAVI with the ACURATE neo valve. Prophylactic coronary stenting, higher implantation, narrower aortic sinus dimensions and commissural misalignment were associated with an increased challenge of coronary cannulation.
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Affiliation(s)
- Arif A. Khokhar
- Department of Cardiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
- Digital Innovations and Robotics Hub, Kraków, Poland
- *Correspondence: Arif A. Khokhar,
| | - Francesco Ponticelli
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, Akademia Gorniczo-Hutnicza (AGH) University of Science and Technology, Kraków, Poland
| | - Kailash Chandra
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Toselli
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell’Angelo, Venice, Italy
| | - Alberto Cereda
- Department of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandro Sticchi
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Carlo Tumscitz
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Ghada W. Mikhail
- Department of Cardiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Dariusz Dudek
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Francesco Giannini
- Gruppo Villa Maria (GVM) Care and Research, Maria Cecilia Hospital, Cotignola, Italy
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16
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Giannini F, Khokhar AA, Curio J, Zlahoda-Huzior A, Mikhail G, Dudek D. Coronary Access and PCI After Chimney-Stenting During Self-Expanding Transcatheter Aortic Valve Replacement in Surgical Bioprosthesis. JACC Cardiovasc Interv 2022; 15:1585-1589. [PMID: 35717397 DOI: 10.1016/j.jcin.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Cardiology Service, Imperial College Healthcare NHS Trust, London, United Kingdom; Digital Innovations and Robotics Hub, Krakow, Poland
| | - Jonathan Curio
- Department of Cardiology, Campus Benjamin Franklin, Charité University Medical Care, Berlin, Germany
| | - Adriana Zlahoda-Huzior
- Digital Innovations and Robotics Hub, Krakow, Poland; Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Ghada Mikhail
- Cardiology Service, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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17
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Laricchia A, Khokhar AA, Giannini F, Colomb A. PCI for Unprotected Left Main Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch15] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Khokhar AA, Giannini F, Colombo A. Peri‐procedural Complications of Transcatheter Aortic Valve Replacement (TAVR). Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch59] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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19
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Ruggiero R, Kim WK, Mangieri A, Colombo A, Dudek D, Giannini F. A novel three-dimensional imaging approach to evaluate coronary access before transcatheter aortic valve-in-valve implantation. EUROINTERVENTION 2022; 17:1238-1239. [PMID: 34338640 PMCID: PMC9725003 DOI: 10.4244/eij-d-21-00634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/23/2022]
Affiliation(s)
- Arif A. Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova 1, 48033 Cotignola RA, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- AGH University of Science and Technology, Department of AGH Department of Measurement & Electronics, Krakow, Poland
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Cardio Center, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Cardio Center, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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20
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Mangieri A, Khokhar AA, Petronio AS, Giannini C, Angelillis M, Fiorina C, Adamo M, Curello S, Tamburino C, Barbanti M, Bedogni F, Testa L, Iadanza A, Fineschi M, Bruschi G, Poli A, Montorfano M, Maffeo D, Colombo A. Valve-in-Valve Implantation of Medtronic CoreValve Prosthesis in Patients With Failing Bioprosthetic Aortic Valves: Mid-term Outcomes From the Italian CoreValve Clinical Service Project. J Invasive Cardiol 2022; 34:E73-E79. [PMID: 35100553] [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: 06/14/2023]
Abstract
OBJECTIVES We evaluated the acute and two-year safety and efficacy of using the Corevalve, Evolut R, and Evolut PRO valves for treating failed surgical bioprosthesis from the Italian CoreValve Clinical Service Project. BACKGROUND Valve-in-valve (ViV) TAVR is an emerging treatment option for failed surgical bioprosthesis. Choice of transcatheter valve is an important determinant of procedural and clinical outcomes, however, longer-term data are lacking. METHODS The Clinical Service Project is a national clinical data repository evaluating the use of implantable devices across Italy. The present multi-center analysis includes consecutive patients who underwent ViV-TAVR with the Medtronic CoreValve series between October 2008 to June 2019. Evaluated endpoints included rates of overall mortality, cardiovascular mortality, myocardial infarction, and cerebrovascular accidents at 2-year follow-up. Procedural success, complications, and echocardiographic outcomes were reported according to VARC-2 criteria. RESULTS A total of 139 patients (mean age, 80 ± 7 years; 47.5% male; mean STS score, 10.0 ± 9.7%) underwent ViV-TAVR with CoreValve (28.5%), Evolut R (68.6%), and Evolut Pro (2.9%) valves. Device success was achieved in 68% and acute coronary obstruction requiring PCI was observed in 4 patients (2.9%). Moderate PVL was observed in 3.7% and 2.8% of patients at 30-day and 2-year follow-up and moderate structural valve degeneration seen only 5 patients (3.6%). All-cause and cardiovascular mortality were 3.6% and 2.9% at 30 days, respectively, and 20.6% and 10.2% at 2-year follow-up. CONCLUSIONS This real-world nationwide analysis demonstrates the acute and longer-term safety and efficacy of using the self-expanding Medtronic THV for ViV-TAVR.
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Affiliation(s)
- Antonio Mangieri
- Maria Cecilia Hospital, Via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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21
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Khokhar AA, Zelias A, Zlahoda‐Huzior A, Dudek D. Complication during robotic‐PCI: Iatrogenic guiding catheter dissection. Catheter Cardiovasc Interv 2022; 99:1526-1528. [DOI: 10.1002/ccd.30107] [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] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Arif A. Khokhar
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
- Digital Innovations & Robotics Hub Krakow Poland
| | - Aleksander Zelias
- Center for Invasive Cardiology Electrotherapy, and Angiology in Nowy Sacz Poland
| | - Adriana Zlahoda‐Huzior
- Digital Innovations & Robotics Hub Krakow Poland
- Department of Measurement and Electronics AGH University of Science and Technology Krakow Poland
| | - Dariusz Dudek
- Institute of Cardiology Jagiellonian University Medical College Krakow Poland
- GVM Care & Research Maria Cecilia Hospital Cotignola Italy
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22
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Sticchi A, Gallo F, Benenati S, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 595 Impact of age on outcomes in a large multicentre low-to-intermediate risk TAVI population: in and out the age cut-off from ESC 2021 valvular heart disease guidelines. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.023] [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: 11/12/2022]
Abstract
Abstract
Aims
The ESC 2021 valvular heart disease [VHD] guidelines introduced an important and debated age cut-off (75 years) to lead the choice between surgical and transcatheter aortic valve implantation (TAVI) in non-high-risk patients. The aim of this study was to evaluate what impact an age cut-off has on clinical outcomes following TAVI in low-to-Intermediate Risk patients from a real word registry.
Methods
We performed the investigation in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients, comparing the rates of patient risk factors, procedural characteristics, complications, and outcomes in the populations with < or ≥ 75 years old.
Results
In our real-world cohort of 2977 patients with mean STS score of 3.6% (5.0–2.5), we found 301 (10.1%) patients with age <75 years and 2676 (89.9%) with ≥75 years. In the younger group compared with the older, we have a higher prevalence of male (44% vs. 35%, P=0.003), higher BMI (mean of 28.5 kg/m² vs. 26.7 kg/m², P = <0.001), diabetes (32% vs. 26%, P=0.027), insulin-dependent diabetes (12% vs. 7%, P=0.001), smoking (18% vs. 7%, P<0.001), COPD (26% vs. 16%, P<0.001). Moreover, younger patients presented less previous PM/ICD (6% vs. 11%, P=0.023), less atrial fibrillation (24% vs. 33%, P=0.033), less renal impairment (30% vs. 66%, P<0.001) and a lower mean STS score (2.6% vs. 3.7%, P<0.001). There was no difference in annular sizing, valvular and LVOT calcifications between the two groups. Older patients had a higher prevalence of porcelain aorta (2% for age<75 vs. 9%, P=0.001). Between the two groups no significant differences in procedural characteristics were observed, including rates of pre-dilatation (P=0.369), post-dilatation (P=0.159) and contrast volume (P=0.259). Procedural complications, in-hospital outcomes and 2-year Kaplan-Meier (KM) survival was equivalent between both groups (P=0.930). Finally, we assessed the best age cut-off related to 1-year mortality in our population, resulting in 86 years. Still, also in this scenario, the KM survival analysis did not show significant differences (P=0.120).
Conclusions
In our large real-world contemporary low-to-intermediate risk TAVI population, an age cut-off of 75 years was not associated with any difference in clinical outcomes and survival at 2-years follow-up. This data reinforces the concept that age alone is not a sufficient variable to be considered when choosing between TAVI or SAVR. The recent ESC 2021 VHD guidelines cut-off is justified only by the lack of evidence and valve durability strategy but not of a proper advantage age-related.
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Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foundation, Rome, Italy; Unicamillus, Saint Camillus International University Of Health Sicences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Stefano Benenati
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Tobias Zeus
- Division of Cardiology, Pulmonolgy and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS Genova
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital Irccs, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
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Sticchi A, Gallo F, Benenati S, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 597 Comparison between low versus intermediate-high risk patients in a contemporary real-world multicentre TAVI registry using self-expanding supra-annular valves: a propensity score matched analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.024] [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: 11/13/2022]
Abstract
Abstract
Aims
Recent ESC VHD guidelines from 2021 recommend TAVI for intermediate-risk and in certain cases low-risk populations. There is relatively little data regarding the impact of transcatheter heart valve design in these populations. The aim of this study was to investigate the clinical outcomes of low-risk versus intermediate-high risk patients following TAVI in a large real-world contemporary registry.
Methods
In a large TAVI registry using self-expanding supra-annular bioprosthesis, we performed a comparison between low vs. intermediate-high risk population. Primary outcome was 1-year mortality and secondary outcomes, defined according to Valve Academic Research Consortium 2 criteria, included major and minor vascular complications, annular rupture, myocardial infarction, cardiac tamponade, new permanent pacemaker, stroke, and major and minor bleeding. Finally, we assessed the same investigation applying a propensity score matched (PSM) analysis.
Results
In the unmatched comparison, the low-risk (LR) group included 1698 patients compared to the 1690 patients of the Intermediate-to-high risk group (IHR). The IHR population showed a mean age of 84 years old vs. 81 of the LR (P<0.001), a higher prevalence of male sex (41% vs. 30%, P<0.001) and increased prevalence of co-morbidities as evidenced by the higher mean STS score 5.80% vs. 2.63% (P<0.001). About the echocardiographic characteristics, the LR presented a higher mean gradient (45.9±15 mmHg vs. 43.7±16.8 mmHg, P<0.001) but similar area compared to the IHR group (0.7 [0.8–0.6] for LR and 0.7 (0.8–0.55) for IHR, P=0.096). In the first unmatched comparison, we found a higher rate of major vascular complications (5.4% vs. 7.3%, P=0.026), new permanent pacemaker (10.5% vs. 13.7%, P=0.006) and major bleeding (2.9% vs. 5.0%, P=0.002) for the IHR group. After the PSM, we obtained 1015 matched patients observing similar outcomes except for minor vascular complications (7.4% vs. 11%, P=0.014) for the IHR group. At a median follow-up of 368 days, the mortality rate was 12.2% (104/1559) vs. 6.8% (104/1520) for the un-matched populations (P<0.001), and 10.4% (98/940) vs. 7.9% (71/898) for the matched patients (P=0.100), respectively for the IHR and the LR group.
Conclusions
In this large, contemporary real-world registry of TAVI patients, there was no difference in mortality observed between LR and IHR populations at a 1-year follow-up. This data suggests that additional factors beyond surgical risk scores should be considered during heart team evaluation of patients with severe aortic stenosis towards a single-patient tailored approach.
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Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foudnation, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Stefano Benenati
- Cattedra Di Malattia Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institue, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Joseph Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattia Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova
| | - Antonio Colombo
- Department of Biomedical Sicences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital Irccs, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
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Sticchi A, Gallo F, Marzo VD, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, Marco FD, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 607 Comparison of incidence and predictors of new left bundle branch block and permanent pacemaker implantation in a large multicentre contemporary TAVI registry using the Evolut R/pro system vs. the accurate neo valve. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.044] [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: 11/14/2022]
Abstract
Abstract
Aims
Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves.
Methods and results
We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI.
Conclusions
In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.
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Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Vincenzo De Marzo
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Kim Won-keun
- Department of Cardiology Kerckoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center—IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi i Sunyer (Idibaps), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Insitute, Laval University, Quebec City, Quebec, Canada
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Cardio Center, Humanitas Research Hospital IRCCS, Humanitas University, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Khokhar AA, Zlahoda-Huzior A, Stanuch M, Ponticelli F, Ruggiero R, Chandra K, Kim WK, Giannini F, Dudek D. Advanced CT-based imaging techniques to evaluate coronary access following TAVI for degenerated surgical bioprosthesis. Can J Cardiol 2021; 38:392-394. [PMID: 34798083 DOI: 10.1016/j.cjca.2021.11.005] [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] [Received: 07/25/2021] [Revised: 10/15/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Coronary access following transcatheter aortic valve implantation (TAVI) can be challenging. We describe the use of CT-based advanced imaging techniques to evaluate, plan and simulate coronary access following TAVI for a degenerated surgical bioprosthesis. Post-procedural CT data was segmented to create a 3D digital model, which was visualised using mixed reality technology to enable operators to virtually plan a cannulation strategy. Bench-testing was then performed in a patient-specific 3D printed model to determine the optimal coronary cannulation technique. Our case demonstrates how CT-based advanced imaging techniques can be used to improve pre-procedural planning of structural heart interventions.
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Affiliation(s)
- Arif A Khokhar
- Imperial College Healthcare NHS Trust, London, UK; Digital Innovations & Robotics Hub, Krakow, Poland.
| | - Adriana Zlahoda-Huzior
- AGH University of Science and Technology, Department of Measurement and Electronics, Krakow, Poland
| | - Maciej Stanuch
- AGH University of Science and Technology, Department of Measurement and Electronics, Krakow, Poland
| | | | - Rossella Ruggiero
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Kailash Chandra
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Giannini
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Dariusz Dudek
- Imperial College Healthcare NHS Trust, London, UK; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Ponticelli F, Khokhar AA, Albani S, Tzanis G, Gallo F, Guarracini S, Banai S, Colombo A, Giannini F. Insights Into Coronary Sinus Reducer Non-Responders. J Invasive Cardiol 2021; 33:E884-E889. [PMID: 34544037] [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: 06/13/2023]
Abstract
Refractory angina affects an increasing proportion of the population with advanced coronary artery disease and microvascular dysfunction. Limited effective pharmacological and interventional therapies exist for this patient cohort. The coronary sinus (CS) reducer, recently recommended in the 2019 guidelines of the European Society of Cardiology for the management of chronic refractory angina, is a balloon-expandable, stainless-steel device designed for implantation in the CS. It acts by increasing CS pressure, thereby redistributing blood to ischemic myocardium, relieving symptoms, and improving quality of life. However, between 15%-30% of patients do not respond to this treatment. Six mechanisms appear to explain this poor response to CS reducer therapy: (1) inappropriate patient selection; (2) cardiac venous system heterogeneity; (3) CS size; (4) incomplete device endothelialization; (5) coronary artery disease phenotype and progression; and (6) limited myocardial ischemia at baseline. We hereby review these mechanisms in detail and highlight key areas that should be addressed in order to try and reduce the burden of non-responders following CS reducer implantation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033 Cotignola RA, Italy.
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Montalto C, Sticchi A, Crimi G, Laricchia A, Khokhar AA, Giannini F, Reimers B, Colombo A, Latib A, Waksman R, Mangieri A. Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Anatomy: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2021; 14:2144-2155. [PMID: 34620393 DOI: 10.1016/j.jcin.2021.07.052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare the feasibility, safety, and clinical outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis. BACKGROUND At present, limited observational data exist supporting TAVR in the context of bicuspid anatomy. METHODS Primary endpoints were 1-year survival and device success. Secondary endpoints included moderate to severe paravalvular leak (PVL) and a composite endpoint of periprocedural complications; incidence rates of individual procedural endpoints were also explored individually. RESULTS In the main analysis, 17 studies and 181,433 patients undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary analysis of 7,071 matched subjects with similar baseline characteristics was also performed. Device success and 1-year survival rates were similar between subjects with BAV and those with TAV (97% vs 94% [P = 0.55] and 91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a trend toward a higher risk for periprocedural complications was observed in our main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P = 0.07) but not in the matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24; P = 0.99). The risk for moderate to severe PVL was higher in subjects with BAV (RR: 1.42; 95% CI: 1.29-1.58; P < 0.0001) as well as the incidence of cerebral ischemic events (2.4% vs 1.6%; P = 0.015) and of annular rupture (0.3% vs 0.02%; P = 0.014) in matched subjects. CONCLUSIONS TAVR is a feasible option among selected patients with BAV anatomy, but the higher rates of moderate to severe PVL, annular rupture, and cerebral ischemic events observed in the BAV group warrant caution and further evidence.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Oxford Heart Center, Oxford University Hospital NHS Trust, Oxford, United Kingdom
| | - Alessandro Sticchi
- Centro per la Lotta Contro l'Infarto Foundation, Rome, Italy; Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Arif A Khokhar
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, New York, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
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Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F, Reimers B, Colombo A. Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. Curr Cardiol Rep 2021; 23:137. [PMID: 34410511 DOI: 10.1007/s11886-021-01569-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Annular-based strategies for treating tricuspid valve (TV) regurgitation do not always have satisfactory long-term outcomes. Management of failed TV annuloplasty can be challenging and requires a dedicated heart team approach. This review explores the treatment options available for failed TV annuloplasty. RECENT FINDINGS Recent developments and novel percutaneous treatment options have emerged as promising alternatives for patients with failed TV annuloplasty. Leaflet-based interventions, valve-in-valve procedures, transcatheter tricuspid valves and new-generation trans-caval valves are all feasible options, which can assure good results whilst minimizing risks for the patient. Failure of tricuspid annuloplasty is not uncommon amongst patients treated with either a tricuspid ring or suture-based device. The complex anatomy, physiology and clinical risk profile should be carefully evaluated on an individual patient-by-patient basis in order to select the most appropriate clinical and percutaneous treatment strategy. Different transcatheter tricuspid valve repair or replacement techniques may provide an attractive alternative treatment option for managing this challenging patient cohort.
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Affiliation(s)
- Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Arif A Khokhar
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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29
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Zelias A, Khokhar AA, Proniewska K, Zlahoda-Huzior A, Ruggiero R, Chandra K, Giannini F, Dudek D. Percutaneous coronary intervention of a tortuous and complex circumflex lesion using the robotic CorPath GRX system. Kardiol Pol 2021; 79:1044-1045. [PMID: 34231872 DOI: 10.33963/kp.a2021.0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Aleksander Zelias
- Center for Invasive Cardiology, Electrotherapy and Angiology in Nowy Sacz, Poland.
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy.,Jagiellonian University Medical College, Kraków, Poland
| | | | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, Poland and AGH University of Science and Technology, Kraków, Poland
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Kailash Chandra
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Sticchi A, Cereda A, Toselli M, Esposito A, Palmisano A, Vignale D, Nicoletti V, Leone R, Gnasso C, Monello A, Khokhar AA, Laricchia A, Biagi A, Turchio P, Petrini M, Gallone G, De Cobelli F, Ponticelli F, Casella G, Iannopollo G, Nannini T, Tacchetti C, Colombo A, Giannini F. Diabetes and mortality in patients with COVID-19: Are we missing the link? Anatol J Cardiol 2021; 25:376-379. [PMID: 34100723 PMCID: PMC8210942 DOI: 10.5152/anatoljcardiol.2021.29132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L'Infarto (CLI) Foundation; Rome-Italy
- Saint Camillus International University of Health Sciences; Rome-Italy
- GVM Care & Research Maria Cecilia Hospital; Cotignola-Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital; Cotignola-Italy
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital; Cotignola-Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | - Anna Palmisano
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | - Davide Vignale
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | - Valeria Nicoletti
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | - Riccardo Leone
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | - Chiara Gnasso
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | | | | | | | | | | | | | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza; Turin-Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
| | | | | | | | | | - Carlo Tacchetti
- School of Medicine, Vita-Salute San Raffaele University; Milan-Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute; Milan-Italy
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Ponticelli F, Khokhar AA, Leenders G, Konigstein M, Zivelonghi C, Agostoni P, van Kuijk JP, Ajmi I, Lindsay S, Bunc M, Tebaldi M, Cafaro A, Cheng K, Ielasi A, Patterson T, Wolter JS, Sgura F, De Marco F, Ioanes D, D'Amico G, Ciardetti M, Berti S, Guarracini S, Di Mauro M, Gallone G, Dekker M, Silvis MJM, Tarantini G, Redwood S, Colombo A, Liebetrau C, de Silva R, Rapezzi C, Ferrari R, Campo G, Schnupp S, Timmers L, Verheye S, Stella P, Banai S, Giannini F. Safety and efficacy of coronary sinus narrowing in chronic refractory angina: Insights from the RESOURCE study. Int J Cardiol 2021; 337:29-37. [PMID: 34029618 DOI: 10.1016/j.ijcard.2021.05.034] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Refractory angina (RA) is considered the end-stage of coronary artery disease, and often has no interventional treatment options. Coronary sinus Reducer (CSR) is a recent addition to the therapeutic arsenal, but its efficacy has only been evaluated on small populations. The RESOURCE registry provides further insights into this therapy. METHODS The RESOURCE is an observational, retrospective registry that includes 658 patients with RA from 20 centers in Europe, United Kingdom and Israel. Prespecified endpoints were the amelioration of anginal symptoms evaluated with the Canadian Cardiovascular Society (CCS) score, the rates of procedural success and complications, and MACEs as composite of all-cause mortality, acute coronary syndromes, and stroke. RESULTS At a median follow-up of 502 days (IQR 225-1091) after CSR implantation, 39.7% of patients improved by ≥2 CCS classes (primary endpoint), and 76% by ≥1 class. Procedural success was achieved in 96.7% of attempts, with 3% of procedures aborted mostly for unsuitable coronary sinus anatomy. Any complication occurred in 5.7% of procedures, but never required bailout surgery nor resulted in intra- or periprocedural death or myocardial infarction. One patient developed periprocedural stroke after inadvertent carotid artery puncture. At the last available follow-up, overall mortality and MACE were 10.4% and 14.6% respectively. At one, three and five years, mortality rate at Kaplan-Meier analysis was 4%, 13.7%, and 23.4% respectively. CONCLUSIONS CSR implantation is safe and reduces angina in patients with refractory angina.
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Affiliation(s)
- Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Geert Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maayan Konigstein
- Division of Cardiology, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Carlo Zivelonghi
- Antwerp Cardiovascular Center, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Pierfrancesco Agostoni
- Antwerp Cardiovascular Center, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Jan-Peter van Kuijk
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Issameddine Ajmi
- Department of Cardiology, Angiology and Pulmonology, Coburg Hospital, Coburg, Germany
| | - Steven Lindsay
- Department of Cardiology, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Matjaž Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - Alessandro Cafaro
- Department of Cardiology, General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Kevin Cheng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Tiffany Patterson
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhine-Main, Frankfurt am Main, Germany
| | - Fabio Sgura
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, Italy
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gianpiero D'Amico
- Department of Cardiology Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Marco Ciardetti
- Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Sergio Berti
- Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | | | - Michele Di Mauro
- Cardiovascular Department, Casa di cura Pierangeli, Pescara, Italy
| | | | - Mirthe Dekker
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max J M Silvis
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giuseppe Tarantini
- Department of Cardiology Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Simon Redwood
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Claudio Rapezzi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - Roberto Ferrari
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - Steffen Schnupp
- Department of Cardiology, Angiology and Pulmonology, Coburg Hospital, Coburg, Germany
| | - Leo Timmers
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Stefan Verheye
- Antwerp Cardiovascular Center, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Shmuel Banai
- Division of Cardiology, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
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Tzanis G, Khokhar AA, Ponticelli F, Gallone G, Palmisano A, Esposito A, Beneduce A, Guarracini S, Colombo A, Giannini F. Coronary sinus size and ischemia improvement after reducer implantation; “one size to fit them all?”. Catheter Cardiovasc Interv 2021; 98:E365-E369. [DOI: 10.1002/ccd.29699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/07/2020] [Revised: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Georgios Tzanis
- Unit of Cardiovascular Interventions IRCCS San Raffaele Scientific Institute Milan Italy
- Interventional Cardiology Department Henry Dunant Hospital Center Athens Greece
| | - Arif A Khokhar
- Interventional Cardiology Unit GVM Care & Research Maria Cecilia Hospital Cotignola Italy
| | - Francesco Ponticelli
- Unit of Cardiovascular Interventions IRCCS San Raffaele Scientific Institute Milan Italy
- Interventional Cardiology Unit GVM Care & Research Maria Cecilia Hospital Cotignola Italy
| | - Guglielmo Gallone
- Unit of Cardiovascular Interventions IRCCS San Raffaele Scientific Institute Milan Italy
| | - Anna Palmisano
- Department of Radiology and Experimental Imaging Centre IRCCS San Raffaele Scientific Institute Milan Italy
| | - Antonio Esposito
- Department of Radiology and Experimental Imaging Centre IRCCS San Raffaele Scientific Institute Milan Italy
| | - Alessandro Beneduce
- Unit of Cardiovascular Interventions IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Antonio Colombo
- Interventional Cardiology Unit GVM Care & Research Maria Cecilia Hospital Cotignola Italy
| | - Francesco Giannini
- Interventional Cardiology Unit GVM Care & Research Maria Cecilia Hospital Cotignola Italy
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Colombo A, Khokhar AA, Mangieri A. PCI Only for Left Main Ostial and Shaft Lesions?: Look at the Bifurcation and Beyond. JACC Cardiovasc Interv 2021; 13:2837-2839. [PMID: 33357521 DOI: 10.1016/j.jcin.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/04/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Antonio Colombo
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
| | - Arif A Khokhar
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Mangieri
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Montalto C, Sticchi A, Khokhar AA, Latib A, Mangieri A. Reply: Transcatheter Repair for Tricuspid Regurgitation: Ready or Not? JACC Cardiovasc Interv 2021; 14:585-586. [PMID: 33663790 DOI: 10.1016/j.jcin.2021.01.013] [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: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
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Proniewska K, Khokhar AA, Dudek D. Advanced imaging in interventional cardiology: mixed reality to optimize preprocedural planning and intraprocedural monitoring. Kardiol Pol 2021; 79:331-335. [PMID: 33599454 DOI: 10.33963/kp.15814] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Khokhar AA, Laricchia A, Ponticelli F, Kim WK, Gallo F, Regazzoli D, Toselli M, Sticchi A, Ruggiero R, Cereda A, Zlahoda-Huzior A, Fisicaro A, Gardi I, Mangieri A, Reimers B, Dudek D, Colombo A, Giannini F. Computed tomography analysis of coronary ostia location following valve-in-valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access. Catheter Cardiovasc Interv 2021; 98:595-604. [PMID: 33586278 DOI: 10.1002/ccd.29503] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an emerging alternative to re-do surgery. However, the challenge of coronary access (CA) following ViV-TAVR is a potential limitation as TAVR expands to younger lower-risk populations. OBJECTIVES Using post-implantation computed tomography (CT) scans to evaluate the geometrical relationship between coronary ostia and valve frame in patients undergoing ViV-TAVR with the ACURATE neo valve. METHODS Post-implant CT scans of 18 out of 20 consecutive patients treated with the ACURATE neo valve were analyzed. Coronary ostia location in relation to the highest plane (HP) (highest point of the ACURATE neo or surgical valve) was determined. Ostia located below the highest plan were further subclassified according to the gap available between the transcatheter heart valve frame and ostium (transcatheter-to-coronary [TTC] distance). The impact implantation depth has on these geometrical relationships was evaluated. RESULTS A total of 21 out of 36 coronary ostia (58%) were located below the level of the HP with the left coronary artery (36%) more likely to be affected than the right (22%). Further sub-classification of these ostia revealed a large (>6 mm), moderate (4-6 mm), and small (<4 mm) TTC distance in 57% (12/21), 38% (8/21), and in 6% (1/18) of cases, respectively. At an implantation depth <4 mm compared to >4 mm, all ostia were located below the HP with no difference in post-procedural mean gradients (14.5 mmHg ± 4.7 vs. 12.6 mmHg ± 5.8; p = .5, 95%CI 3.8-7.5). CONCLUSIONS CA following ACURATE neo implantation for ViV-TAVR could potentially be challenging in a significant proportion of patients and specific consideration should be given to the implantation depth.
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Affiliation(s)
- Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | - Marco Toselli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandro Sticchi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alberto Cereda
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, Poland and AGH University of Science and Technology, Krakow, Poland
| | - Andrea Fisicaro
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Ilja Gardi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Albani S, Giannini F, Mitomo S, Fabris E, Mangieri A, Ponticelli F, Khokhar AA, Toselli M, Latib A, Colombo A. Bioresorbable Vascular Scaffold With Optimized Implantation Technique: Long-Term Outcomes From a Single-Center Experience. J Invasive Cardiol 2021; 33:E115-E122. [PMID: 33443487] [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: 06/12/2023]
Abstract
BACKGROUND Previous randomized controlled trials demonstrated a higher rate of stent thrombosis with bioresorbable vascular scaffold (BVS) implantation as compared with second-generation drug-eluting stent in selected patients/lesions. However, long-term outcomes of BVS implantations that utilize an optimized technique (OIT) in unselected patients/lesions are lacking. The aim of this study was to assess the real-world, long-term clinical outcomes of BVS (Absorb; Abbott Vascular) with OIT. METHODS AND RESULTS In a cohort of 156 patients, a total of 347 BVS devices (435 lesions) were implanted, with intravascular ultrasound (IVUS) guidance utilized in 303 (87.3%) of the scaffolds. The primary efficacy endpoint was target-lesion revascularization (TLR) and the primary safety endpoint was scaffold thrombosis. Despite performing routine high-pressure postdilation, postintervention IVUS detected BVS underexpansion/malapposition in 53 scaffolds (28.7%), requiring further postdilation. At a median follow-up of 60 months (interquartile range, 45-73 months), TLR and scaffold thrombosis occurred in 16 patients (10.3%) and 1 patient (0.6%), respectively. At univariable analysis, IVUS-guided scaffold implantation was associated with lower TLR (odds ratio, 0.24; 95% confidence interval, 0.09-0.62; P<.01). CONCLUSION The use of first-generation BVS with OIT in real-world patients/lesions was associated with acceptable long-term outcomes.
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Affiliation(s)
| | - Francesco Giannini
- Interventional Cardiology Unit GVM Care and Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
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Laricchia A, Khokhar AA, Giannini F. New Percutaneous Options for Tricuspid Intervention: How to Identify the Good Clinical Candidate. Front Cardiovasc Med 2020; 7:583307. [PMID: 33409292 PMCID: PMC7779547 DOI: 10.3389/fcvm.2020.583307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
The tricuspid valve has been neglected for a long time and severe tricuspid regurgitation (TR) was largely undertreated in the past due to a high operative risk. In the last years we observed the development of different less invasive percutaneous options to treat TR. Currently, percutaneous treatments are reserved for high-risk patients presenting with advanced stage disease by which time they are likely to derive a partial benefit at best. There is a limited evidence base, including no randomized trials, to guide the management strategy for severe TR. In the interim we feel that choosing the best device for the most appropriate clinical candidate and with an adequate timing (most probably an “earlier” timing) will be the key combination to improve early and late outcomes of percutaneous treatments.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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Laricchia A, Mangieri A, Giannini F, Colombo A, Khokhar AA. A Claim for Consensus. JACC Cardiovasc Interv 2020; 13:1496-1497. [PMID: 32553341 DOI: 10.1016/j.jcin.2020.04.037] [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: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
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Colombo A, Khokhar AA, Laricchia A. Optimal Stenting Is the Gold Standard: We Have Plenty of Data and New Questions Arise. JACC Cardiovasc Interv 2020; 13:1414-1416. [PMID: 32473883 DOI: 10.1016/j.jcin.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/24/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Rafiq I, Khokhar AA, Alonso-Gonzalez R, Ghez O, Kempny A, Dimopoulos K. Severe Left Ventricular Outflow Tract Obstruction Immediately After Surgical Repair of Ebstein's Anomaly. JACC Case Rep 2020; 2:725-731. [PMID: 34317336 PMCID: PMC8302009 DOI: 10.1016/j.jaccas.2020.02.026] [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: 06/11/2019] [Revised: 11/13/2019] [Accepted: 02/13/2020] [Indexed: 11/07/2022]
Abstract
A 52-year-old man following surgery for Ebstein’s anomaly after repair developed acute hemodynamically significant left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve and severe mitral regurgitation. Fluid resuscitation and weaning of inotropes were unsuccessful. Left ventricular outflow tract obstruction and mitral regurgitation resolved by using esmolol. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Isma Rafiq
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Arif A Khokhar
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Olivier Ghez
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Aleksander Kempny
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Giannini F, Khokhar AA, Albani S. Percutaneous Intervention in Small-Vessel Coronary Disease: Time to Clear the Fog? JACC Cardiovasc Interv 2020; 13:805-807. [PMID: 32061603 DOI: 10.1016/j.jcin.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Stefano Albani
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
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Mangieri A, Bugani G, Giannini F, Laricchia A, Gallo F, Fisicaro A, Tripodi A, Khokhar AA, Squeri A, Colombo A. Percutaneous Treatment of a Four-Leaf Clover Valve Using the MitraClip Technology. Can J Cardiol 2019; 36:966.e7-966.e9. [PMID: 32407678 DOI: 10.1016/j.cjca.2019.12.006] [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] [Received: 11/21/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 11/16/2022] Open
Abstract
Percutaneous treatment of tricuspid valve regurgitation using MitraClip can be performed safely achieving improvement in reduction of regurgitation. Tricuspid valve shows different anatomic variations, in particular regarding the number of leaflets, which could represent a challenge for transcatheter valve intervention. We present a case of massive tricuspid regurgitation in a 4-leaf clover valve. We implanted a first MitraClip into the anteroseptal commissure and then a second one between the 2 posterior leaflets, with a successful reduction of residual regurgitation. In conclusion, this approach can be safely performed in a 4-leaflet right ventricular valve.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
| | - Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Angelo Squeri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Joshi PH, Khokhar AA, Massaro JM, Lirette ST, Griswold ME, Martin SS, Blaha MJ, Kulkarni KR, Correa A, D'Agostino RB, Jones SR, Toth PP. Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies. J Am Heart Assoc 2016; 5:JAHA.115.002765. [PMID: 27130348 PMCID: PMC4889167 DOI: 10.1161/jaha.115.002765] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [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] [Indexed: 12/22/2022]
Abstract
Background Remnant lipoproteins (RLPs), the triglyceride‐enriched precursors to low‐density lipoprotein, are an emerging risk factor for coronary heart disease (CHD). We sought to determine the association of RLP cholesterol (RLP‐C) levels with incident CHD in 2 diverse, prospective, longitudinal observational US cohorts. Methods and Results We analyzed cholesterol levels from serum lipoprotein samples separated via density gradient ultracentrifugation in 4114 US black participants (mean age 53.8 years, 64% women) from the Jackson Heart Study and a random sample of 818 predominantly white participants (mean age 57.3 years, 52% women) from the Framingham Offspring Cohort Study. Multivariable‐adjusted hazard ratios (HRs) for RLP‐C (the sum of very low‐density lipoprotein3 cholesterol and intermediate‐density lipoprotein cholesterol) were derived to estimate associations with incident CHD events consisting of myocardial infarction, CHD death, and revascularizations for each cohort separately and as a combined population. There were 146 CHD events in the combined population. After adjustments for age, sex, body mass index, smoking, blood pressure, diabetes, and lipid‐lowering therapy for the combined population, RLP‐C (HR 1.23 per 1‐SD increase, 95% CI 1.06–1.42, P<0.01) and intermediate‐density lipoprotein cholesterol (HR 1.26 per 1‐SD increase, 95% CI 1.08–1.47, P<0.01) predicted CHD during an 8‐year follow‐up. Associations were attenuated by high‐density lipoprotein cholesterol and ultimately lost significance with inclusion of real low‐density lipoprotein cholesterol, which excludes Lp(a) and IDL cholesterol fractions. Similar associations were seen in multivariable analyses within each cohort. Conclusion RLP‐C levels are predictive of incident CHD in this diverse group of primary prevention subjects. Interventions aimed at reducing RLP‐C to prevent CHD warrant further intensive investigation. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00415415.
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Affiliation(s)
- Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Seth T Lirette
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Griswold
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - Ralph B D'Agostino
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD CGH Medical Center, Sterling, IL University of Illinois School of Medicine, Peoria, IL
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Martin SS, Faridi KF, Joshi PH, Blaha MJ, Kulkarni KR, Khokhar AA, Maddox TM, Havranek EP, Toth PP, Tang F, Spertus JA, Jones SR. Remnant Lipoprotein Cholesterol and Mortality After Acute Myocardial Infarction: Further Evidence for a Hypercholesterolemia Paradox From the TRIUMPH Registry. Clin Cardiol 2015; 38:660-7. [PMID: 26459191 DOI: 10.1002/clc.22470] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Received: 07/10/2015] [Revised: 08/22/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Remnants are partially hydrolyzed, triglyceride-rich lipoproteins that, like other apolipoprotein B-containing lipoproteins, are atherogenic. Prior observational studies suggest paradoxically better outcomes in hypercholesterolemic patients who sustain an acute myocardial infarction (AMI), one of several known recurrent risk paradoxes. To date, the association of directly measured remnant lipoprotein cholesterol (RLP-C) with survival after an AMI has not been examined. HYPOTHESIS Higher RLP-C levels may be paradoxically associated with lower mortality. METHODS We examined 2465 AMI survivors in a prospective, 24-center US study of AMI outcomes. Lipoprotein cholesterol subfractions were directly measured by ultracentrifugation. RLP-C was defined as intermediate-density lipoprotein cholesterol (IDL-C) + very-low-density lipoprotein cholesterol subfraction 3 (VLDL3 -C). Given a linear relationship between RLP-C and mortality, we examined RLP-C by tertiles and continuously. Cox regression hazard ratios (HRs) were adjusted for the Global Registry of Acute Coronary Events (GRACE) score and 23 other covariates. RESULTS Participants were age 58 ± 12 years (mean ± SD), and 68% were men. After 2 years of follow-up, 226 (9%) participants died. The mortality proportion was 12.4% in the lowest tertile of RLP-C (0-15 mg/dL), 8.5% in the middle tertile (16-23 mg/dL), and 6.8% in the highest tertile (24-120 mg/dL; P < 0.001). A 1-SD increase in RLP-C (11 mg/dL) predicted a 24% lower adjusted risk of 2-year mortality (HR: 0.76, 95% confidence interval [CI]: 0.64-0.91). Similar results were found for a 1-SD increase in IDL-C (HR per 8 mg/dL: 0.80, 95% CI: 0.67-0.96), VLDL3 -C (HR per 4 mg/dL: 0.74, 95% CI: 0.61-0.89), and very-low-density lipoprotein cholesterol (VLDL-C; HR per 8 mg/dL: 0.69, 95% CI: 0.55-0.85). CONCLUSIONS Higher RLP-C levels were associated with lower mortality 2 years after AMI despite rigorous adjustment for known confounders. Unknown protective factors or a lead-time bias likely explains the paradox.
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Affiliation(s)
- Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Kamil F Faridi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | | | - Arif A Khokhar
- Northwest London Hospitals NHS Trust, London, United Kingdom
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, Denver, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | | | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.,Department of Preventive Cardiology, CGH Medical Center, Sterling, Illinois.,University of Illinois School of Medicine, Peoria, Illinois
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
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Joshi PH, Toth PP, Lirette ST, Griswold ME, Massaro JM, Martin SS, Blaha MJ, Kulkarni KR, Khokhar AA, Correa A, D'Agustino RB, Jones SR. Association of high-density lipoprotein subclasses and incident coronary heart disease: The Jackson Heart and Framingham Offspring Cohort Studies. Eur J Prev Cardiol 2014; 23:41-9. [PMID: 25062744 DOI: 10.1177/2047487314543890] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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: 04/25/2014] [Accepted: 06/27/2014] [Indexed: 11/17/2022]
Abstract
AIMS We aimed to clarify the associations of high-density lipoprotein cholesterol (HDL-C) subclasses with incident coronary heart disease (CHD) in two large primary prevention cohorts. METHODS We measured cholesterol at baseline from the two major HDL subfractions (larger, more buoyant HDL2 and smaller, denser HDL3) separated by density gradient ultracentrifugation in 4114 (mean age 53.8 years; 64% female) African American participants from the Jackson Heart Study and 818 (mean age 57.3 years, 52% female) predominantly Caucasian participants from the Framingham Offspring Cohort Study. Multivariable adjusted hazard ratios (HRs) for HDL-C and its subclasses were derived from Cox proportional hazards regression models to estimate associations with incident CHD events including myocardial infarction, CHD death, and revascularization. Analyses were performed for each cohort separately and as a combined population. RESULTS In models adjusted for cardiovascular risk factors for the combined population, HDL3-C (HR 0.76 per SD increase; 95% confidence interval (CI), 0.62-0.94; p = 0.01), rather than HDL2-C (HR 0.88 per SD; 95% CI, 0.72-1.09; p = 0.24) drove the inverse association of HDL-C (HR 0.79 per SD; 95% CI, 0.64-0.98; p = 0.03) with CHD. Similar associations were seen in multivariable analyses within each cohort including after adjusting for apolipoprotein A1 in the Jackson Heart Study. CONCLUSION Smaller, denser HDL3-C levels are primarily responsible for the inverse association between HDL-C and incident CHD in this diverse group of primary prevention subjects. These findings have important implications ranging from considerations of HDL biology to interpretations of clinical trials utilizing HDL-C therapeutics.
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Affiliation(s)
- Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA CGH Medical Center, Sterling, and the University of Illinois School of Medicine, Peoria, USA
| | - Seth T Lirette
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, USA Jackson Heart Study, University of Mississippi Medical Center, USA
| | - Michael E Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, USA Jackson Heart Study, University of Mississippi Medical Center, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | | | - Arif A Khokhar
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, USA
| | | | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
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Martin SS, Khokhar AA, May HT, Kulkarni KR, Blaha MJ, Joshi PH, Toth PP, Muhlestein JB, Anderson JL, Knight S, Li Y, Spertus JA, Jones SR. HDL cholesterol subclasses, myocardial infarction, and mortality in secondary prevention: the Lipoprotein Investigators Collaborative. Eur Heart J 2014; 36:22-30. [PMID: 24980493 DOI: 10.1093/eurheartj/ehu264] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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] [Indexed: 02/03/2023] Open
Abstract
AIMS High-density lipoprotein (HDL) is highly heterogeneous and the link of its subclasses to prognosis remains controversial. We aimed to rigorously examine the associations of HDL subclasses with prognosis in secondary prevention. METHODS AND RESULTS We collaboratively analysed data from two, complementary prospective cohorts: the TRIUMPH study of 2465 acute myocardial infarction patients, and the IHCS study of 2414 patients who underwent coronary angiography. All patients had baseline HDL subclassification by vertical-spin density gradient ultracentrifugation. Given non-linearity, we stratified by tertiles of HDL-C and its two major subclasses (HDL2-C, HDL3-C), then compared multivariable-adjusted hazard ratios for mortality and mortality/myocardial infarction. Patients were middle-aged to elderly (TRIUMPH: 58.2 ± 12.2 years; IHCS: 62.6 ± 12.6 years), and the majority were men (TRIUMPH: 68.0%; IHCS: 65.5%). IHCS had lower mean HDL-C levels (34.6 ± 10.1 mg/dL) compared with TRIUMPH (40 ± 10.6 mg/dL). HDL3-C accounted for >3/4 of HDL-C (mean HDL3-C/HDL-C 0.78 ± 0.05 in both cohorts). During 2 years of follow-up in TRIUMPH, 226 (9.2%) deaths occurred, while death/myocardial infarction occurred in 401 (16.6%) IHCS patients over 5 years. No independent associations with outcomes were observed for HDL-C or HDL2-C. In contrast, the lowest tertile of HDL3-C was independently associated with >50% higher risk in each cohort (TRIUMPH: with middle tertile as reference, fully adjusted HR for mortality of HDL3-C, 1.57; 95% CI, 1.13-2.18; IHCS: fully adjusted HR for mortality/myocardial infarction, 1.55; 95% CI, 1.20-2.00). CONCLUSION In secondary prevention, increased risk for long-term hard clinical events is associated with low HDL3-C, but not HDL2-C or HDL-C, highlighting the potential value of subclassifying HDL-C.
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Affiliation(s)
- Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA
| | - Arif A Khokhar
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heidi T May
- Cardiovascular Department, Intermountain Medical Center, Murray, UT, USA
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA
| | - Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA University of Illinois School of Medicine, Peoria, IL, USA
| | | | - Jeffrey L Anderson
- Cardiovascular Department, Intermountain Medical Center, Murray, UT, USA
| | - Stacey Knight
- Cardiovascular Department, Intermountain Medical Center, Murray, UT, USA
| | - Yan Li
- St Luke's Mid-America Heart Institute, University of Missouri - Kansas, Kansas City, MO, USA
| | - John A Spertus
- St Luke's Mid-America Heart Institute, University of Missouri - Kansas, Kansas City, MO, USA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA
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Affiliation(s)
- A Natarajan
- The Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK.
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