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Nuccia Morici,
Stefano Savonitto,
Ernesto Murena,
Roberto Antonicelli,
Giancarlo Piovaccari,
Daniele Tucci,
Corrado Tamburino,
Alessandro Fontanelli,
Leonardo Bolognese,
Mila Menozzi,
Claudio Cavallini, Anna Sonia Petronio,
Giuseppe Ambrosio,
Federico Piscione,
Giuseppe Steffenino,
Stefano De Servi
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ABSTRACT: The causes of death within 1 year of hospital admission in patients with non-ST-segment elevation acute coronary syndromes are ill defined, particularly in patients aged ≥75 years. From January 2008 through May 2010, we enrolled 645 patients aged ≥75 years with non-ST-segment elevation acute coronary syndromes: 313 in a randomized trial comparing an early aggressive versus an initially conservative approach, and 332, excluded from the trial for specific reasons, in a parallel registry. Each death occurring during 1 year of follow-up was adjudicated by an independent committee. The mean age was 82 years in both study cohorts, and 53% were men. By the end of the follow-up period (median 369 days, interquartile range 345 to 391), 120 patients (18.6%) had died. The mortality was significantly greater in the registry (23.8% vs 13.1%, p = 0.001). The deaths were classified as cardiac in 94% of the cases during the index admission and 68% of the cases during the follow-up period. Eighty-six percent of the cardiac deaths were of ischemic origin. In a multivariate logistic regression model that included the variables present on admission in the whole study population, the ejection fraction (hazard ratio 0.95, 95% confidence interval 0.94 to 0.97; p <0.001), hemoglobin level (hazard ratio 0.85, 95% confidence interval 0.76 to 0.94; p = 0.001), older age (hazard ratio 1.05, 95% confidence interval 1.01 to 1.10, p = 0.010), and creatinine clearance (hazard ratio 0.99, 95% confidence interval 0.97 to 0.99; p = 0.030) were the independent predictors of all-cause death at 1 year. In conclusion, within 1 year after admission for non-ST-segment elevation acute coronary syndromes, most deaths in patients aged ≥75 years have a cardiac origin, mostly owing to myocardial ischemia.
The American journal of cardiology 03/2013; · 3.58 Impact Factor
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Fleur Descoutures,
Dominique Himbert,
Francesco Maisano,
Filip Casselman,
Arend de Weger,
Oana Bodea,
Frank Van der Kley,
Antonio Colombo,
Cristina Giannini,
Kjell Arne Rein,
Bernard De Bruyne, Anna Sonia Petronio,
Gry Dahle,
Ottavio Alfieri,
Alec Vahanian
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ABSTRACT: OBJECTIVES: Redo surgery after failed mitral valve repair may be high risk, or contraindicated in patients with comorbidities. Because of this high risk, other interventional possibilities like transcatheter valve implantation might be of benefit. We report our experience with transcatheter mitral valve-in-ring implantation (TVIR) in high-risk patients after failure of surgical ring annuloplasty. METHODS: From January 2010 to February 2012, following a multidisciplinary discussion, 17 high-risk patients underwent TVIR using Edwards SAPIEN XT prostheses, via either a transvenous transseptal (n = 8), or a transapical approach (n = 9). RESULTS: Patients were aged 70 ± 16 years, in New York Association classes III/IV. Their mean logistic EuroSCORE was 36 ± 17% and mean Society of Thoracic Surgeons risk score 13 ± 9%. The mean time interval between surgery and repair failure was 7 ± 3 years. Annuloplasty rings were semi-rigid in 14 cases, flexible in 2, and rigid in 1. Manufacturers ring diameters were 26 mm in 4 patients, 27 mm in 1, 28 mm in 9, 30 mm, 31 mm and 34 mm in 1. The predominant failure mode was regurgitation in 12 cases and stenosis in 5. SAPIEN XT diameters were 26 mm in 15 patients, 23 mm and 29 mm in 1. Procedural success rate was 88% (15/17). Emergency surgery was needed in 1 patient due to acute dislodgement of the ring. The degree of mitral regurgitation was reduced to none or mild in all but 2 patients; final mean gradient was 7 ± 3 mmHg. Thirty-day survival was 82% (14/17 patients). At last follow-up (13 ± 5 months), survival rate was 71% (12/17). CONCLUSIONS: These preliminary results suggest that TVIR is feasible, with low operative risk, and may provide short-term clinical and haemodynamic improvement in selected high-risk patients with failure of mitral ring annuloplasty.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; · 2.40 Impact Factor
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Luca Testa,
Azeem Latib,
Federico De Marco,
Marco De Carlo,
Mauro Agnifili,
Roberto Adriano Latini, Anna Sonia Petronio,
Federica Ettori,
Arnaldo Poli,
Stefano De Servi,
Angelo Ramondo,
Massimo Napodano,
Silvio Klugmann,
Gian Paolo Ussia,
Corrado Tamburino,
Nedy Brambilla,
Antonio Colombo,
Francesco Bedogni
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ABSTRACT: BACKGROUND: Conduction disturbances are relatively common after Transcatheter Aortic Valve Implantation (TAVI). Previous data demonstrated an adverse impact of persistent left bundle branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new onset LBBB may also impact on prognosis of patients after TAVI. METHODS AND RESULTS: Among 1060 patients treated with the CoreValve Revalving System (CRS)-TAVI between October 2007 and April 2011 in high volume centers in Italy, we analyzed those without LBBB or pacemaker (PM) at admission (879 patients, 82.7%). Among them, 224 patients (Group A, 27.3%) developed a persistent LBBB and the remaining 594 patients (Group B, 72.7%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in Group A (15% vs. 9.8%, p=0.02). No patients were censored before one year, median follow-up period 438 days (Interquartile range, 174-798 days). Survival analyses and inherent log rank tests showed that LBBB was not associated with a higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days and at 1 year. At 30 days, but not at 1 year, Group A had a significantly higher rate of PM implantation. CONCLUSIONS: In this registry of high volume centers, persistent LBBB after CRS-TAVI showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of PM implantation.
Circulation 02/2013; · 14.74 Impact Factor
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Paolo Buja,
Massimo Napodano,
Corrado Tamburino, Anna Sonia Petronio,
Federica Ettori,
Gennaro Santoro,
Gian Paolo Ussia,
Silvio Klugmann,
Francesco Bedogni,
Angelo Ramondo,
Francesco Maisano,
Antonio Marzocchi,
Arnaldo Poli,
Valeria Gasparetto,
David Antoniucci,
Antonio Colombo,
Giuseppe Tarantini
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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: At present, transcatheter aortic valve implantation (TAVI) is a proven treatment option for patients with symptomatic degenerative aortic stenosis at high risk for conventional surgery. In countries where TAVI is currently performed, the number of procedures and centers involved has been continuously increasing. The present document from the Italian Society of Interventional Cardiology (SICI-GISE) aims to improve the available evidence and current consensus on this topic through the definition of training needs and knowledge base for both operators and centers.
Giornale italiano di cardiologia (2006) 11/2012; 13(11):772-6.
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Marco Barbanti,
Gian Paolo Ussia,
Azeem Latib,
Federico De Marco,
Claudia Fiorina,
Gennaro Santoro,
Francesco Bedogni,
Antonio Colombo,
Giuseppe Bruschi,
Federica Ettori,
Cecilia Agostini,
Nedy Brambilla, Anna Sonia Petronio,
Giuseppe Tarantini,
Massimo Napodano,
Marco De Carlo,
Pierpaolo Confessore,
Corrado Tamburino
Journal of the American College of Cardiology 10/2012; 60(18):1841-2. · 14.16 Impact Factor
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Luca Testa,
Nedy Brambilla,
Maria Luisa Laudisa,
Marco De Carlo,
Stefania Lanotte,
Roberto Adriano Latini,
Samuele Pizzocri,
Matteo Casavecchia,
Mauro Luca Agnifili,
Cristina Giannini,
Uberto Bortolotti, Anna Sonia Petronio,
Francesco Bedogni
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ABSTRACT: Aims: Arterial access selection is crucial during transcatheter aortic valve implantation. When traditional femoral access has been deemed unfeasible the left subclavian artery has been used successfully. In cases where even the latter was ineligible, we opted, despite the lack of any data, for the right subclavian approach. We hereby present the results of the first series available. Our aim was to evaluate the feasibility and performance of the CoreValve ReValving System (CRS) implantation via the right subclavian artery in patients with contraindication to femoral and left subclavian accesses. Methods and results: Among 300 patients who have undergone CRS implantation, 70 (23%) have been treated via the subclavian approach, 10 via the right subclavian artery and 60 via the left. Demographic features were quite similar except for the presence of significant left subclavian disease in all patients treated via the right subclavian artery. The success rate was 100% for both groups. At 30-day follow-up, there was no significant difference in terms of all-cause mortality and cardiac mortality between right vs. left subclavian approach (0% vs. 6.6% and 0% vs. 6.6%, respectively). Consistent results were observed at a mean follow-up of 12±7.9 months (all-cause mortality: 10% vs. 15%). Incidences of new AV block requiring PM implantation were also statistically equivalent. Conclusions: CRS implantation via the right subclavian artery was as feasible and safe as the left subclavian approach. It poses very particular technical issues but should be considered when more conventional approaches are inadequate in order to provide patients with a further chance to be treated effectively.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 10/2012; 8(6):685-90. · 3.29 Impact Factor
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ABSTRACT: We present the case of a 67 year-old patient that presented to our institution with acute and severe chest pain. Optical coherence tomography high-resolution images of the coronary lumen, allowed us to confirm diagnosis of spontaneous coronary artery dissection, guide treatment, and verify the results of our intervention.
Cardiovascular revascularization medicine: including molecular interventions 08/2012; 13(5):301-3.
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Enrico Vizzardi,
Antonio D'Aloia,
Claudia Fiorina,
Silvia Bugatti,
Giovanni Parrinello,
Marco De Carlo,
Cristina Giannini,
Vitantonio Di Bello, Anna Sonia Petronio,
Salvatore Curello,
Federica Ettori,
Livio Dei Cas
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ABSTRACT: The aim of this study was to investigate the effects of transcatheter aortic valve implantation (TAVI) on left ventricular (LV) hypertrophy and diastolic function in patients with severe aortic valve stenosis (AVS). There are few and conflicting data on LV mass remodeling and LV diastolic function after TAVI.
Echocardiography and clinical assessment were performed at baseline and at 6 months in high-risk patients affected by severe AVS who underwent TAVI.
One hundred thirty-five patients successfully underwent TAVI. Peak transvalvular aortic pressure gradient and mean transvalvular aortic pressure gradient were reduced from 87 ± 25 to 18 ± 7 mm Hg and from 54 ± 14 to 9 ± 4 mm Hg, respectively (P < .001), accompanied by significant clinical improvement. The mean LV ejection fraction improved from 50 ± 13% to 54 ± 11% during follow-up (P = .009). At 6-month follow-up, interventricular septal wall thickness regressed from 14 ± 2 to 12 ± 1 mm and posterior wall thickness from 13 ± 3 to 11 ± 2 mm (P < .001). LV mass and LV mass index decreased from 332 ± 106 to 228 ± 58 g (P < .001) and from 191 ± 58 to 132 ± 30 g/m(2) (P < .001), respectively. Ninety-seven patients (72%) showed improvements in LV diastolic filling pattern. The mean e' value increased from 4.1 ± 1.7 to 5.6 ± 2.2 cm/sec, and the mean E/e' ratio decreased from 24 ± 7 to 17 ± 6 (P < .001) after TAVI.
Significant LV mass reverse remodeling associated with improvement in LV systolic and diastolic function was found in patients with severe AVS 6 months after TAVI. These changes may have relevant clinical prognostic value.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 07/2012; 25(10):1091-8. · 2.98 Impact Factor
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Anna Sonia Petronio,
Marco De Carlo,
Francesco Bedogni,
Francesco Maisano,
Federica Ettori,
Silvio Klugmann,
Arnaldo Poli,
Antonio Marzocchi,
Gennaro Santoro,
Massimo Napodano,
Gian Paolo Ussia,
Cristina Giannini,
Nedy Brambilla,
Antonio Colombo
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ABSTRACT: The goal of this study was to assess the procedural and 2-year results of the subclavian approach for transcatheter aortic valve implantation (TAVI) compared with those of the femoral approach by using propensity-matched analysis.
The subclavian approach with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) represents an interesting opportunity when the femoral access is unfeasible.
All consecutive patients enrolled in the Italian CoreValve Registry who underwent TAVI with the subclavian approach were included. Propensity score analysis was used to identify a matching group of patients undergoing femoral TAVI.
Subclavian approach was used in 141 patients (61% men; median age 83 years; median logistic European System for Cardiac Operative Risk Evaluation score 23.7%). The femoral group of 141 patients was matched for baseline clinical characteristics, except for peripheral artery disease. The 2 groups showed similar procedural success (97.9% vs. 96.5%; p = 0.47), major vascular complications (5.0% vs. 7.8%; p = 0.33), life-threatening bleeding events (7.8% vs. 5.7%; p = 0.48), and combined safety endpoint (19.9% vs. 25.5%; p = 0.26). The subclavian group showed lower rates of acute kidney injury/stage 3 (4.3% vs. 9.9%; p = 0.02), of minor vascular complications at the 18-F sheath insertion site (2.1% vs. 11.3%; p = 0.003), and of all types of bleeding events related to vascular complications. Survival at 2 years was 74.0 ± 4.0% in the subclavian group compared with 73.7 ± 3.9% in the femoral group (p = 0.78). The 2-year freedom from cardiovascular death was 87.2 ± 3.1% versus 88.7 ± 2.8% in the subclavian versus femoral group, respectively (p = 0.84).
The subclavian approach for TAVI is safe and feasible, with procedural and medium-term results similar to the femoral approach. Subclavian access should be considered a valid option not only when the femoral approach is impossible but also when it is difficult, albeit feasible.
Journal of the American College of Cardiology 06/2012; 60(6):502-7. · 14.16 Impact Factor
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ABSTRACT: Ischemic heart disease shows gender differences, both in terms of clinical characteristics and pathophysiological mechanisms. It is still debated whether these characteristics influence the diagnostic and therapeutic approach and the outcomes in female patients treated with percutaneous coronary intervention. Percutaneous coronary intervention in women has been shown to be feasible, safe and effective as it is in men throughout the whole clinical spectrum of ischemic syndromes. There is a solid scientific evidence of a different diagnostic and therapeutic approach to women suffering from ischemic heart disease compared to men, with a tendency to undertreat female patients, despite the worst risk profile at presentation. Women, in fact, less frequently undergo coronary angiography and receive antiplatelet, antithrombotic or anti-ischemic drugs. They experience more bleedings than men after administration of glycoprotein IIb/IIIa inhibitors. Gender differences, therefore, affect more the clinical than the interventional approach. At least in part, this is due to the fact that current guidelines are based on a male model of diagnostics. It would be desirable to analyze cohorts of patients in whom the percentage of individuals of both sexes will be equally represented, or rather, exclusively female cohorts in order to formulate more targeted diagnostic and therapeutic indications.
Giornale italiano di cardiologia (2006) 06/2012; 13(6):414-8.
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Gian Paolo Ussia,
Marco Barbanti,
Antonio Colombo,
Giuseppe Tarantini, Anna Sonia Petronio,
Federica Ettori,
Angelo Ramondo,
Gennaro Santoro,
Silvio Klugmann,
Francesco Bedogni, [......],
Francesco Maisano,
Antonio Marzocchi,
Arnaldo Poli,
Marco De Carlo,
Claudia Fiorina,
Federico De Marco,
Massimo Napodano,
Roberto Violini,
Alessandro Santo Bortone,
Corrado Tamburino
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ABSTRACT: BACKGROUND: Coronary artery disease (CAD) commonly coexists with degenerative aortic stenosis. The impact of CAD in patients undergoing transcatheter aortic valve implantation (TAVI) raises concerns due to the lack of comprehensive and consistent data on this topic. We sought to evaluate the impact of CAD on clinical outcomes in patients undergoing TAVI. METHODS: Consecutive patients(N=663) who underwent TAVI with the 18-French CoreValve ReValving System (CRS) (Medtronic Inc, MN USA) from June 2007 through December 2009 at 14 institutions across Italy were included in this prospective web-based registry. Four patients were excluded from the analysis due to failure to successfully release the prosthesis inside the native aortic valve. Previous percutaneous or surgical myocardial revascularizations were used to identify the existence of concomitant CAD (N=251; 38%). The primary endpoint was the incidence of Major Adverse Cerebrovascular and Cardiac Events (MACCE) and all-cause death in CAD and no-CAD groups. RESULTS: Patients with CAD were no more likely to develop MACCE within 12-months of the procedure than those who did not (CAD group vs no-CAD group, 15.7% vs 18.3%; adjusted hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.42 to 1.36; p=0.353). The 12-month mortality was 14.5% and 15.9% in CAD group and no-CAD group, respectively (adjusted HR 0.74; 95% CI 0.40 to 1.36; p=0.331). CONCLUSIONS: Coexisting CAD does not impact procedural outcomes and mid-term incidence of MACCE and survival in elderly patients undergoing TAVI with CRS prosthesis.
International journal of cardiology 03/2012; · 7.08 Impact Factor
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ABSTRACT: A 73 year-old man, with known situs viscerum inversus, symptomatic for effort dyspnea, was admitted to our Department for inducible myocardial ischemia. Coronary angiography showed severe narrowings of the distal right coronary artery, treated by percutaneous coronary intervention and drug eluting stents implantation. Percutaneous coronary intervention was performed using standard diagnostic and guide catheters, requiring opposite manipulation and inverted angiographic projections.
Recenti progressi in medicina 03/2012; 103(3):100-2.
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ABSTRACT: Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors.
We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing.
Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM (P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB (P = .37).
A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.
American heart journal 03/2012; 163(3):492-9. · 4.65 Impact Factor
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Gian Paolo Ussia,
Marco Barbanti, Anna Sonia Petronio,
Giuseppe Tarantini,
Federica Ettori,
Antonio Colombo,
Roberto Violini,
Angelo Ramondo,
Gennaro Santoro,
Silvio Klugmann, [......],
Antonio Marzocchi,
Arnaldo Poli,
Marco De Carlo,
Massimo Napodano,
Claudia Fiorina,
Federico De Marco,
David Antoniucci,
Emanuela de Cillis,
Davide Capodanno,
Corrado Tamburino
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ABSTRACT: The paucity of evidences about the long-term durability of currently available transcatheter prostheses is one of the main issues of transcatheter aortic valve implantation (TAVI). We sought to assess 3-year clinical and echocardiographic outcomes of patients undergoing TAVI with the third generation CoreValve prosthesis (Medtronic Incorporation, MN, USA).
From the Italian CoreValve registry, 181 who underwent TAVI from June 2007 to August 2008 and eligible for 3-year follow-up were analysed. All outcomes were defined according to the Valve Academic Research Consortium. All-cause mortality at 1, 2, and 3 years was 23.6, 30.3, and 34.8%, respectively. Cardiovascular death at 1, 2, and 3 years was 11.2, 12.1, and 13.5%, respectively. The actuarial survival free from a composite of death, major stroke, myocardial infarction, and life-threatening bleeding was 69.6% at 1 year, 63.5% at 2 years, and 59.7% at 3 years. Patients with renal insufficiency had a higher mortality at 3-year follow-up (49.0 vs. 29.2%, P = 0.007); moreover, patients experiencing post-procedural major or life-threatening bleeding had a higher rate of mortality already seen at 30 days (21.6 vs. 2.8%; P < 0.001) and this result was sustained at 3-year follow-up (62.2 vs. 27.7%; P < 0.001). Mean pressure gradients decreased from 52.2 ± 18.1 mmHg (pre-TAVI) to 10.3 ± 3.1 mmHg (1-year post-TAVI) (P < 0.001); aortic valve area increased from 0.6 ± 0.2 cm(2) (pre-TAVI) to 1.8 ± 0.4 cm(2) (1-year post-TAVI); these results remained stable over the 3 years of follow-up. Paravalvular leak was observed in the majority of patients. There were no cases of progression to moderate or severe regurgitation. No cases of structural valve deterioration were observed.
This multicentre study demonstrates that TAVI with the 18-Fr CoreValve ReValving System is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic stenosis up to 3-year follow-up. Non-cardiac causes accounted for the majority of deaths at follow-up.
European Heart Journal 01/2012; 33(8):969-76. · 10.48 Impact Factor
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ABSTRACT: Valvuloarterial impedance (Z(va)) can estimate the global hemodynamic load on the left ventricle in patients with severe aortic stenosis better than the standard indexes, as shown in previous studies. In fact, Z(va) can estimate global left ventricular hemodynamic load as the sum of valvular and vascular loads. The aim of this study was to evaluate the acute improvement of left ventricular performance in patients with symptomatic aortic stenosis after transcatheter aortic valve implantation (TAVI) using Z(va).
One hundred two consecutive patients who underwent TAVI were submitted to transthoracic echocardiography immediately before and after aortic valve implantation, together with invasive hemodynamic measurements.
After TAVI, immediate reductions in the transaortic peak pressure gradient (P < .0001) and mean pressure gradient (P < .0001) and a concomitant increase in aortic valve area (P < .0001) were seen on echocardiography. Left ventricular ejection fraction significantly increased immediately after TAVI in all patients (from 48.9 ± 10.3% to 52.1 ± 11.1%, P < .0001). Regarding global left ventricular hemodynamic load, acute and significant reductions in end-systolic meridional wall stress (from 82.7 ± 42.6 to 57.8 ± 30.1 kdyne · cm(-2), P < .0001) and in Z(va) (from 6.81 ± 2.51 to 5.38 ± 2.13 mm Hg · mL(-1) · m(-2), P < .0001) were observed. Furthermore, patients who died at 6-month follow-up had higher baseline Z(va) values compared with those who were alive at 6-month follow-up (8.13 ± 3.08 vs 6.41 ± 2.12 mm Hg · mL(-1) · m(-2), P < .004).
TAVI is characterized by an immediate enhancement of global left ventricular hemodynamic performance, as demonstrated by an acute Z(va) improvement, even in patients with low baseline ejection fractions.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2012; 25(4):444-53. · 2.98 Impact Factor
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Francesco Bedogni,
Maria Luisa Laudisa,
Samuele Pizzocri,
Corrado Tamburino,
Gian Paolo Ussia, Anna Sonia Petronio,
Massimo Napodano,
Angelo Ramondo,
Patrizia Presbitero,
Federica Ettori,
Gennaro Santoro,
Silvio Klugman,
Federico De Marco,
Nedy Brambilla,
Luca Testa
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ABSTRACT: The purpose of this study was to evaluate the performance of CoreValve Revalving System (CRS) (Medtronic, Minneapolis, Minnesota) implantation in patients with failed aortic bioprostheses.
Transcatheter aortic valve implantation with the CRS is an effective option in high-risk patients with severe aortic stenosis. It may be an option for patients with a failed aortic bioprosthesis, especially when the risk of a surgical redo is deemed prohibitive.
CRS "valve-in-valve" implantation was performed in 25 high-risk patients with a failed bioprosthesis. Their mean age was 82.4 ± 3.2 years. New York Heart Association functional classes III and IV were present in 21 and 4 patients, respectively. The logistic EuroSCORE was 31.5 ± 14.8%, whereas the Society of Thoracic Surgeons score was 8.2 ± 4.2. Patients/prostheses were divided in type A (mainly stenotic, n = 9) and type B (mainly regurgitant, n = 16).
The implantation success rate was 100%. In group A, the peak aortic gradient significantly decreased from 77.6 ± 21.6 mm Hg to 34.6 ± 19.4 mm Hg (p = 0.001). In all but 2 patients in group B, no significant regurgitation was observed post-implantation. No patients died during the procedure. At 30 days, there were 3 deaths (12%), 2 myocardial infarctions (8%), and 3 atrioventricular blocks requiring pacemaker implantation (12%). At a mean follow-up of 6 months, there were another death (survival rate of 84%) and a pacemaker implantation (cumulative incidence of 16%). New York Heart Association functional class improved in all patients to I and II.
CRS implantation was feasible and effective regardless of the prevalent mode of failure. This finding may significantly affect the treatment of patients with a failed bioprosthesis deemed at a prohibitive risk for surgical redo.
11/2011; 4(11):1228-34. · 1.07 Impact Factor
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Circulation Journal 09/2011; 75(10):2324-5. · 3.77 Impact Factor
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ABSTRACT: Coronary artery anomalies (CAAs) represent one of the most confusing topic in cardiology and affect approximately 1% of the general population. Although some anomalies seem to be only anatomical curiosities, others may sometimes have fatal consequences. This review describes the anatomical characteristics of main CAAs and focuses on the pathophysiological mechanisms by which CAAs may cause a pathological state. The last section describes these therapeutical options of this congenital disorders.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 06/2011; 76(2):66-71.
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ABSTRACT: The editors have requested that the article be withdrawn because of concern that some of its contents appear quite similar to portions of another publication from the same group of investigators. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 05/2011; · 2.98 Impact Factor
