Giuseppe Tarantini

University-Hospital of Padova, Padua, Veneto, Italy

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Publications (180)743.99 Total impact

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    ABSTRACT: Aims: Tryton side branch (SB) reverse culotte stenting has been employed for the treatment of left main (LM) stem bifurcations in patients at high risk for bypass surgery. The aim of this study was to assess acute angiographic results and six-month clinical outcome after implantation of the Tryton stent in the LM. Methods and results: We studied 52 consecutive patients with LM disease treated in nine European centres. Angiographic and clinical data analysis was performed centrally. Fifty-one of 52 patients (age 68±11 yrs, 75% male, 42% unstable angina, SYNTAX score 20±8) were successfully treated with the Tryton stent. Medina class was 1,1,1 in 33 (63%), 1,0,1 in 7 (13%), 1,1,0 in 3 (6%), 0,1,1 in 8 (4%) and 0,0,1 in 1 (2%). The Tryton stent on a stepped balloon (diameter 3.5-2.5 mm) was used in 41/51 (80%) of cases. The mean main vessel stent diameter was 3.4±0.4 mm with an everolimus-eluting stent employed in 30/51 (59%) of cases. Final kissing balloon dilatation was performed in 48/51 (94%). Acute gain was 1.52±0.86 mm in the LM and 0.92±0.47 mm in the SB. The angiographic success rate was 100%; the procedural success rate reached 94%. Periprocedural MI occurred in three patients. At six-month follow-up, the TLR rate was 12%, MI 10% and cardiac death 2%. The hierarchical MACE rate at six months was 22%. No cases of definite stent thrombosis occurred. Conclusions: The use of the Tryton stent for treatment of LM bifurcation disease in combination with a conventional drug-eluting stent is feasible and achieves an optimal angiographic result. Safety of the procedure and six-month outcome are acceptable in this high-risk lesion PCI. Further safety and efficacy studies with long-term outcome assessment of this strategy are warranted.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 03/2013; 8(11):1259-69. · 3.17 Impact Factor
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    ABSTRACT: BACKGROUND: Aortic regurgitation (AR) is an important limitation of transcatheter aortic valve replacement (TAVR) with ill-defined predictors and unclear long term impact on outcomes. We sought to analyze currently published literature to establish the incidence, impact and predictors of post TAVR AR. METHODS AND RESULTS: Studies published between 2002 and 2012 with regards to TAVR were identified using an electronic search and reviewed using the random effects model of DerSimonian and Laird. From 3871 initial citations, 45 studies reporting on 12,926 patients (CoreValve 5,261 and Edward's valve 7,279) were included in the analysis of incidence and outcomes of post TAVR AR. The pooled estimate for moderate or severe AR post TAVR was 11.7% (95% CI 9.6% to 14.1%). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p =0.005). The presence of moderate or severe AR post TAVR increased mortality at 30 days (OR 2.95, 95% CI 1.73- 5.02) and at 1 year, (HR 2.27, 95% CI - 1.84-2.81). Mild AR was also associated with an increased hazard for mortality (HR 1.829, 95% CI 1.005-3.329) that was however overturned by sensitivity analysis. Twenty five studies reported on predictors of post TAVR AR. Implantation depth, valve under sizing and Agatston calcium score (r=0.47, p = 0.001) were identified as important predictors. CONCLUSION: Moderate or severe aortic regurgitation is common after TAVR and is an adverse prognostic indicator of short and long term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long term mortality. Every effort should therefore be made to minimize AR by a comprehensive pre procedural planning and meticulous procedural execution.
    Journal of the American College of Cardiology 03/2013; · 14.09 Impact Factor
  • Chiara Fraccaro, Massimo Napodano, Giuseppe Tarantini
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    ABSTRACT: The presence of periprocedural conduction disorders (CD) and the need for permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) are frequent findings in clinical practice. Notwithstanding, robust information on the prognostic and therapeutic implications of these complications are lacking. The newly occurrence of CD after TAVI seems related to the trauma of the conduction system during procedure. On the contrary, major predictors for PPM implantation after TAVI seems to be the use of CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) and the presence of CD before TAVI. An accurate pre-TAVI screening, careful valve implantation as well as post-TAVI monitoring must be pursued to prevent avoidable PPM implantation. The aim of this report is to analyze the available data on this field and to propose some practical clinical tips to prevent or to manage these complications. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 03/2013; · 2.51 Impact Factor
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    ABSTRACT: An 88-year-old man with severe aortic stenosis and normal left ventricular ejection fraction underwent transcatheter aortic valve implantation via a transapical approach, without periprocedural complications. Some 16 months later the patient was readmitted because of worsening dyspnea, when left ventricular dysfunction due to apical akinesia was identified. A gated, rest-only myocardial single-photon emission computed tomography (G-SPECT) demonstrated apical hypoperfusion that persisted after attenuation correction. Necrosis involved the apical and mid-inferior wall, the apical lateral wall, and the apical segment.
    The Journal of heart valve disease 03/2013; 22(2):259-60. · 1.07 Impact Factor
  • Giuseppe Tarantini, Filippo Cademartiri
    European heart journal cardiovascular Imaging. 02/2013;
  • Enrico Favaretto, Giuseppe Tarantini
    International journal of cardiology 02/2013; · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: -Endocardial voltage mapping (EVM) identifies low-voltage right ventricular (RV) areas, which may represent the electroanatomic scar substrate of life-threatening tachyarrhythmias. We prospectively assessed the prognostic value of EVM in a consecutive series of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). METHODS AND RESULTS: -We studied 69 consecutive ARVC/D patients [47 males; median age 35 years(28-45)] who underwent electrophysiological study and both bipolar and unipolar EVM. The extent of confluent bipolar (<1.5mV) and unipolar (<6.0mV) low-voltage electrograms was estimated using the CARTO-incorporated area calculation software. Fifty-three patients (77%) showed ≥1 RV electroanatomic scars with an estimated burden of bipolar vs unipolar low-voltage areas of 24.8% (7.2-31.5) and 64.8% (39.8-95.3), respectively (P=0.009). In the remaining patients with normal bipolar-EVM (n=16;23%), the use of unipolar EVM unmasked ≥1 region of low-voltage electrogram affecting 26.2% (11.6-38.2) of RV wall. During a median follow-up of 41 (28-56) months, 19(27.5%) patients experienced arrhythmic events, such as sudden death (n=1), appropriate ICD interventions (n=7), or sustained ventricular tachycardia (n=11). Univariate predictors of arrhythmic outcome included previous cardiac arrest or syncope (HR=3.4; 95%CI:1.4-8.8; P=0.03) and extent of bipolar low-voltage areas (HR=1.7 per 5%; 95%CI=1.5-2; P<0.001), while the only independent predictor was the bipolar low-voltage electrogram burden (HR=1.6 per 5%; 95% CI:1.2-1.9; P<0.001). Patients with normal bipolar-EVM had an uneventful clinical course. CONCLUSIONS: -The extent of bipolar RV endocardial low-voltage area was a powerful predictor of arrhythmic outcome in ARVC/D, independently of history and RV dilatation/dysfunction. A normal bipolar-EVM characterized a low-risk subgroup of ARVC/D patients.
    Circulation Arrhythmia and Electrophysiology 02/2013; · 5.95 Impact Factor
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    ABSTRACT: A 57-year-old man underwent myocardial revascularization for unstable angina. Cardiocirculatory arrest complicated the procedure and the patient was rapidly treated with advanced cardiac life support. After 26-min long resuscitation attempts, 5 DC-shock and cardioactive drug administration, an extracorporeal system was positioned and activated (extracorporeal membrane oxygenation, ECMO). After ECMO positioning, sinus rhythm was achieved after another DC-shock. Therapeutic hypothermia was started with a target temperature of 33°C. ECMO was removed after 12h, and therapeutic hypothermia was continued for 27h without any complications. The patient was discharged with good neurological outcome. This report shows the feasibility of treatment of a dramatic event such as refractory cardiac arrest, using modern and advanced techniques in the intensive cardiac care unit.
    Giornale italiano di cardiologia (2006) 02/2013; 14(2):145-8.
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    Dataset: JACC CI2012
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    ABSTRACT: OBJECTIVES: This study sought to evaluate the prevalence and potential role of myocardial bridging in the pathogenesis of apical ballooning syndrome (ABS). BACKGROUND: ABS is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event, but the pathogenesis remains still unclear. METHODS: Forty-two consecutive patients (40 female, mean age 66 ± 7 years) with ABS underwent echocardiography, cardiac magnetic resonance, coronary angiography (CA) with intravascular ultrasound, and computed tomography angiography (CTA). Myocardial bridging was diagnosed by CA when a dynamic compression phenomenon was observed in the coronary artery and by CTA when a segment of coronary artery was completely (full encasement) or incompletely (partial encasement) surrounded by the myocardium. The prevalence of myocardial bridging detected by CTA and CA in ABS patients was compared with 401 controls without ABS who underwent both CTA and CA. RESULTS: Myocardial bridging by CTA was observed in 32 ABS patients (76%): 23 with partial encasement and 9 with full encasement. All myocardial bridging was located in the mid segment of the left anterior descending coronary artery (LAD) with a mean length of 17 ± 9 mm. CA revealed myocardial bridging in 17 subjects (40%) (9 with partial encasement and 8 with full encasement by CTA). All subjects in which dynamic compression was observed by CA showed myocardial bridging by CTA, while none of the subjects with negative findings for myocardial bridging by CTA revealed dynamic compression by CA. Compared with controls, ABS patients showed a significant higher prevalence of myocardial bridging in the LAD either by CA (40% vs. 8%; p < 0.001) or by CTA (76% vs. 31%; p < 0.001). CONCLUSIONS: Our study showed that myocardial bridging of the LAD is a frequent finding in ABS patients as revealed both by CA and, mostly, by CTA, suggesting a role of myocardial bridging as potential substrate in the pathogenesis of ABS.
    JACC. Cardiovascular imaging 01/2013; 6(1):32-41. · 14.29 Impact Factor
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    ABSTRACT: Although transcatheter aortic valve implantation (TAVI) for severe aortic stenosis is becoming an established technique, the effect of gender-related differences is poorly described. We performed a gender-based comparison of high-risk patients undergoing TAVI with the self-expandable CoreValve Revalving System for severe aortic stenosis to evaluate early and mid-term clinical outcomes. From the Italian prospective CoreValve registry, 659 consecutive patients (55.8% women) who underwent TAVI were included in the present study. We analyzed the gender-based differences in terms of clinical, angiographic, and procedural features and the differences in the rate of early and mid-term major adverse cardiac and cerebrovascular events. The men were younger, presented more often with severe left ventricular dysfunction, and had a greater rate of previous myocardial infarction, coronary revascularization, peripheral artery disease, renal failure, and heart conduction disorders than the women. The logistic European System for Cardiac Operative Risk Evaluation score did not differ between the 2 groups. The overall unadjusted and adjusted analyses failed to show significant differences between genders in terms of major adverse cardiac and cerebrovascular events at a median follow-up of 13 months (range 8 to 18). At late follow-up (landmark analysis >12 months), a survival benefit was observed in women (hazard ratio 0.27, 95% confidence interval 0.09 to 0.84, p = 0.02). In conclusion, in this multicenter registry, the gender-based comparison of TAVI patients showed that men, despite the younger age, had more extensive atherosclerotic burden compared to women. Overall, the early and mid-term outcomes were similar between genders, although women might have a survival benefit with longer follow-up.
    The American journal of cardiology 01/2013; 111(1):88-93. · 3.58 Impact Factor
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    ABSTRACT: Coronary artery disease is the leading cause of death worldwide and it often clinically manifests as stable angina. The optimal diagnostic and therapeutic strategy of patients with stable angina may be controversial. Coronary revascularization with percutaneous coronary intervention (PCI) is associated with a reduction in cardiovascular events in patients with acute coronary syndrome, whereas recent trials have failed to demonstrate the superiority of myocardial revascularization over optimal medical therapy in stable angina. The treatment of a patient with stable angina is still challenging, as the definition of "stable" and "unstable" is not so clear. Moreover, the benefit of PCI in terms of quality of life is evident, and independent from its neutral effect on survival. To date, the best timing of coronary angiography and the role of further investigations on myocardial ischemia still need to be defined. On the other hand, in spite of the clear benefit on clinical outcome of an early invasive treatment of patients with acute coronary syndrome, elderly are often undertreated, whereas the overtreatment with PCI of stable patients undergoing non cardiac surgery might even increase ischemic events due to the premature discontinuation of the antiplatelet therapy, without reducing the perioperative risk.
    American journal of cardiovascular disease. 01/2013; 3(1):27-38.
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    ABSTRACT: Thrombus removal by manual thrombectomy improves coronary flow and myocardial perfusion after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI); growing interest is on mechanical devices for thrombectomy which may allow a larger thrombus removal as compared to manual devices. We aimed to perform the first direct and adjusted indirect meta-analysis of studies on manual and mechanical thrombectomy in PCI for STEMI. The literature was scanned for direct and indirect randomized comparisons between manual and/or mechanical thrombectomy and/or placebo by formal searches of electronic databases from November 1994 to June 2013. Clinical and procedural endpoints were selected. Three studies directly comparing (2 RCTs and 1 non-randomized; N = 513) and 21 RCTs (N = 4514) indirectly comparing the two strategies were included in the meta-analysis. The direct meta-analysis showed comparable rates of survival (p = 0.88), re-infarction (MI) (p = 0.84) and procedural outcomes between the two strategies; direct evidence was however limited in number of enrolled patients. The indirect meta-analysis showed a superior reduction in mortality with manual thrombectomy compared to mechanical thrombectomy in the overall analysis (p = 0.01); by excluding trials with low percentage of patients with intracoronary thrombus (< 50%) at baseline, the two strategies were comparable in survival, but mechanical thrombectomy was associated with a significant reduction in re-MI (p < 0.001) and stroke (p = 0.04). This meta-analysis lends support to mechanical thrombectomy in the population with high thrombus burden only where, compared to manual thrombectomy, it is likely to provide higher benefits.
    American journal of cardiovascular disease. 01/2013; 3(3):146-57.
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    ABSTRACT: Background Bivalirudin significantly reduces 30-day major and minor bleeding compared with unfractionated heparin (UFH), while resulting in similar or lower rates of ischemic events in both patients with stable and unstable coronary disease undergoing percutaneous coronary intervention (PCI). We performed a meta-analysis of randomized trials to evaluate the impact of bivalirudin compared with UFH, with or without glycoprotein IIb/IIIa receptor inhibitors (GPI), on the rates of mortality, myocardial infarction (MI) and major bleeding. Methods We searched electronic databases for randomized, controlled trials with > 100 patients comparing bivalirudin (+/− provisional GPI) to UFH with either routine or provisional GPI in patients undergoing PCI. The principal efficacy endpoints were mortality and MI within 30 day, while major bleeding was the principal safety endpoint. We assessed the benefit of bivalirudin for each efficacy endpoint relative to the baseline bleeding risk, using the control (UFH) major bleeding rate as proxy for that risk. Results A total of 12 randomized trials that enrolled 33,261 patients were included. Overall, there was no significant difference in mortality and MI between bivalirudin monotherapy and UFH (+/− GPI), whereas major bleeding was significantly lower with bivalirudin. Bivalirudin reduced major and minor bleeding across the entire bleeding risk spectrum. Conclusions Bivalirudin significantly reduces major and minor bleeding regardless of the estimated baseline hemorrhagic risk.
    American Heart Journal. 01/2013;
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    ABSTRACT: The primary goal in patients with ST-elevation myocardial infarction (STEMI) is the restoration of myocardial tissue-level perfusion. In a variable proportion of patients with STEMI, however, microcirculatory impairment may persist after epicardial coronary artery recanalization. This phenomenon is known as "myocardial no-reflow". Of note, no-reflow is associated with a worse prognosis both at short- and long-term follow-up. Depending on the population under study and the diagnostic technique used for its detection, the incidence of no-reflow ranges from 5 to 50%. No-reflow can be directly assessed in the cath-lab in several ways, including angiographic Thrombolysis in Myocardial Infarction (TIMI) flow grade assessment and more complex angiographic indexes, such as TIMI frame count, TIMI perfusion grade, myocardial blush grade, or by direct invasive assessment of coronary flow. After the cath-lab, both the evaluation of electrocardiographic ST-segment resolution and imaging techniques, as myocardial contrast echocardiography or cardiac magnetic resonance, are able to monitor no-reflow evolution, with imaging playing a crucial role in its quantification. In this article, we review indexes of no-reflow used both in the cath-lab and thereafter.
    Current pharmaceutical design 12/2012; · 4.41 Impact Factor
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    ABSTRACT: Peaked and tall T waves represent a hyperacute electrocardiogram (ECG) manifestation of coronary artery occlusion which usually evolves into ST-segment elevation. We sought to investigate using cardiac magnetic resonance (CMR) the myocardial tissue changes underlying an atypical ECG pattern of presentation of left anterior descending artery (LAD) occlusion consisting of persistent hyperacute T waves and mild ST-segment depression. This ECG pattern is often associated with the presence of collateral circulation, which may modulate myocyte action potential changes in response to ischemia and prevent the appearance of ST-segment elevation. However, CMR findings resembled those of typical anterior myocardial infarction with nearly transmural necrosis in the large myocardial area supplied by LAD. Accordingly, persistent hyperacute T waves should be regarded as an equivalent to ST-segment elevation and immediate reperfusion therapy should be considered.
    European heart journal. Acute cardiovascular care. 12/2012; 1(4):344-8.
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    ABSTRACT: The authors sought to investigate the impact of distal embolization (DE) on myocardial damage and microvascular reperfusion, according to time-to-treatment, using contrast-enhanced cardiac magnetic resonance (CE-CMR). DE, occurring during primary percutaneous coronary intervention (p-PCI), appears to increase myocardial necrosis and to worsen microvascular perfusion, as shown by surrogate markers. However, data regarding the behavior of DE on jeopardized myocardium, and in particular on necrosis extent and distribution, are still lacking. In 288 patients who underwent p-PCI within 6 h from symptom onset, the authors prospectively assessed the impact of DE on infarct size and microvascular damage, using CE-CMR. The impact of DE was assessed according to time-to-treatment: for group 1, <3 h; for group 2, ≥3 and ≤6 h. DE occurred in 41 (14.3%) patients. Baseline clinical characteristics were not different between the 2 groups. At CE-CMR, patients with DE showed larger infarct size (p = 0.038) and more often transmural necrosis compared with patients without DE (p = 0.008) when time-to-treatment was <3 h, but no impact was proven after this time (p = NS). Patients with DE showed more often microvascular obstruction, as evaluated at first-pass enhancement, than patients without DE (100% vs. 66.5%, p = 0.001) up to 6 h from symptom onset. These findings suggest that the detrimental impact of DE occurring during p-PCI on myocardial damage is largely influenced by ischemic time, increasing the extent of necrosis in patients presenting within the first hours after symptom onset, and having limited or no impact after this time window.
    JACC. Cardiovascular Interventions 11/2012; 5(11):1170-7. · 1.07 Impact Factor
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    Journal of the American College of Cardiology 10/2012; 60(18):1841-2. · 14.09 Impact Factor
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    ABSTRACT: BACKGROUND: Gender-based differences in diabetic patients are understudied in the field of percutaneous coronary intervention (PCI) with drug-eluting stents. METHODS: Data were obtained from a multicenter registry of 2420 consecutive patients with diabetes mellitus (DM) who underwent PCI with paclitaxel- or sirolimus-eluting stents between 2003 and 2009. Among them, 679 (28.1%) women were compared to 1741 (71.9%) men in terms of clinical aspects and major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR). Target vessel revascularization (TVR) and any revascularization were also reported. RESULTS: Women were less numerous, older, used more insulin and showed more tortuous coronary arteries, while men were more frequently smokers and received larger stents. At the median follow-up of 24.3months (interquartile range 12.3-39.7), MACE, TVR and any revascularization did not significantly differ between females and males (19.9% vs 18.7%, 12.2% vs 13.4%, 14.1% vs 15.1%, respectively). At multivariable analysis of the overall cohort, female gender was not a predictor of MACE (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.92-2.36, p=0.11), death (HR 1.04, 95% CI 0.84-1.24, p=0.86), MI (HR 1.48, 95% CI 0.92-2.36, p=0.11), and TLR (HR 1.14, 95% CI 0.85-1.52, p=0.38). CONCLUSION: In this registry of diabetic patients treated by drug-eluting stents, women were less represented, older and needed more insulin compared to men who, on the other hand, received larger stents. Gender-related outcomes were similar and female sex did not predict MACE.
    International journal of cardiology 10/2012; · 6.18 Impact Factor
  • International journal of cardiology 10/2012; · 6.18 Impact Factor

Publication Stats

1k Citations
743.99 Total Impact Points

Institutions

  • 2004–2014
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2000–2014
    • University of Padova
      • • Department of Cardiac, Thoracic and Vascular Sciences
      • • Department of Medicine DIMED
      Padua, Veneto, Italy
  • 2013
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2012
    • University of Catania
      Catania, Sicily, Italy
  • 2009–2010
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy