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Azzalini L, Poletti E, Demir OM, Ancona MB, Mangieri A, Giannini F, Carlino M, Chieffo A, Montorfano M, Colombo A, Latib A. Impact of Post-Percutaneous Coronary Intervention Fractional Flow Reserve Measurement on Procedural Management and Clinical Outcomes: The REPEAT-FFR Study. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:229-234. [PMID: 31199348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We evaluated the impact of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) in a prospective study. METHODS This was a single-center, prospective registry of patients undergoing PCI following a baseline FFR ≤0.80. Patients were divided according to the post-PCI FFR value (<0.90 vs ≥0.90). The primary endpoint was the proportion of cases in which further action was undertaken in light of a post-PCI FFR value <0.90. RESULTS Of 65 PCIs, a total of 43 (66%) had a post-PCI FFR <0.90 and 22 (34%) had a post-PCI FFR ≥0.90. Baseline characteristics were similar between groups. Baseline FFR was similar between patients with post-PCI FFR <0.90 and ≥0.90 (0.72 ± 0.08 vs 0.69 ± 0.14; P=.40). Post-PCI FFR values were 0.82 ± 0.05 in post-PCI FFR <0.90 patients and 0.94 ± 0.02 in post-PCI FFR ≥0.90 patients (P<.001). The most common reason for a post-PCI <0.90 was residual small-vessel disease (42%). In 15 patients (35%) with a post-PCI FFR <0.90, an action was undertaken. An increase of 0.05 ± 0.07 in FFR value (P=.01) was noted after these maneuvers. However, a final FFR value ≥0.90 was achieved in only 3 patients (20%). The major adverse cardiac event (MACE) rate at 1-year follow-up was higher in patients with final FFR <0.90 (31.6% vs 9.1%; P=.047). CONCLUSIONS A suboptimal physiologic outcome is observed in two-thirds of patients undergoing PCI. Despite further interventions, a satisfactory outcome is achieved in only a minority of cases. A post-PCI suboptimal physiologic outcome appears to be associated with a higher incidence of MACE at follow-up.
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Azzalini L, Ancona MB, Bellini B, Chieffo A, Carlino M, Montorfano M. Intravascular Lithotripsy and Microaxial Percutaneous Left Ventricular Assist Device for Complex and High-Risk Percutaneous Coronary Intervention. Can J Cardiol 2019; 35:940.e5-940.e7. [DOI: 10.1016/j.cjca.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022] Open
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Beneduce A, Ancona F, Ancona MB, Romano V, Stella S, Capogrosso C, Montorfano M, Agricola E. Multimodality Imaging for Transcatheter Paravalvular Leak Closure in Radiolucent Mitral Bioprosthesis. Circ Cardiovasc Imaging 2019; 12:e009285. [PMID: 31213087 DOI: 10.1161/circimaging.119.009285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pagnesi M, Regazzoli D, Ancona MB, Mangieri A, Lanzillo G, Giannini F, Buzzatti N, Prendergast BD, Kodali S, Lansky AJ, Colombo A, Latib A. Cerebral Embolic Risk During Transcatheter Mitral Valve Interventions: An Unaddressed and Unmet Clinical Need? JACC Cardiovasc Interv 2019; 11:517-528. [PMID: 29566796 DOI: 10.1016/j.jcin.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/04/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
Abstract
As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.
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Demir OM, Mitomo S, Giannini F, Mangieri A, Ancona MB, Montorfano M, Latib A, Colombo A. Supra-Annular Transcatheter Aortic Valve Position May Correct Annular Under-Expansion Due to Valvular Asymmetry. Circ J 2019; 83:691. [PMID: 30175802 DOI: 10.1253/circj.cj-18-0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hachinohe D, Latib A, Laricchia A, Iannopollo G, Demir OM, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Azzalini L, Mitomo S, Chieffo A, Montorfano M, Carlino M, Colombo A. Long‐term follow‐up of covered stent implantation for various coronary artery diseases. Catheter Cardiovasc Interv 2019; 94:571-577. [DOI: 10.1002/ccd.28117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
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Azzalini L, Ancona MB, Mitomo S, Carlino M, Colombo A. Self-apposing stent fracture in the context of myocardial bridging leading to in-stent chronic total occlusion: When the muscle trumps the metal. Cardiol J 2018; 25:144-145. [PMID: 29512100 DOI: 10.5603/cj.2018.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
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Hachinohe D, Ancona MB, Colombo A, Latib A. Severe aortic regurgitation due to a Lunderquist Extra-Stiff Wire Guide during transcatheter aortic valve implantation. Cardiol J 2018; 25:642-643. [PMID: 30394515 DOI: 10.5603/cj.2018.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
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Demir OM, Iannopollo G, Mangieri A, Ancona MB, Regazzoli D, Mitomo S, Colombo A, Weisz G, Latib A. The Role of Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2018; 5:150. [PMID: 30406115 PMCID: PMC6205957 DOI: 10.3389/fcvm.2018.00150] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/03/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve replacement is the therapy of choice for patients with severe aortic stenosis who have prohibitive or high surgical risk. However, the benefit of TAVR is attenuated by the occurrence of major disabling stroke which is associated with increased mortality and early-reduced quality of life. Despite advances in TAVR technology, stroke remains a serious complication that is associated with significant negative outcomes. The majority of these occur in the acute phase following TAVR where cerebral embolic events are frequent. Cerebral embolic protection devices (CEPD) have been developed to minimize the risk of peri-procedural ischemic stroke during TAVR. CEPD have the potential to reduce intraprocedural burden of new silent ischemic injury. In this review we outline the etiology and incidence of stroke in TAVR population, and systematically review current evidence for cerebral embolic protection devices.
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Hachinohe D, Latib A, Laricchia A, Demir OM, Agricola E, Romano V, Del Sole PA, Leone PP, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Mitomo S, Monaco F, Buzzatti N, Montorfano M, Colombo A. Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation. Catheter Cardiovasc Interv 2018; 93:522-529. [PMID: 30286515 DOI: 10.1002/ccd.27827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. BACKGROUND Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. METHODS At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. RESULTS Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. CONCLUSIONS The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.
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Demir OM, Regazzoli D, Mangieri A, Ancona MB, Mitomo S, Weisz G, Colombo A, Latib A. Transcatheter Tricuspid Valve Replacement: Principles and Design. Front Cardiovasc Med 2018; 5:129. [PMID: 30283790 PMCID: PMC6156134 DOI: 10.3389/fcvm.2018.00129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Tricuspid regurgitation (TR) may affect as much as 65-85% of the population with the prevalence of moderate-to-severe TR in the United States reported at greater than 1.6 million. However, only 8,000 tricuspid valve operations are performed annually in the United States. As severe TR is associated with poor outcomes, there is an unmet clinical need for surgical or percutaneous transcatheter based treatment of TR. Over the last two decades there have been significant developments in percutaneous transcatheter based therapies for valvular disease. However, this progress has not been mirrored for the tricuspid valve until recently; we are now at a cross-roads of new transcatheter devices becoming available for treatment of TR. In this review, we discuss the principles of performing transcatheter tricuspid valve replacement, analyze the devices that can be utilized and outline the challenges related to this procedure.
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Regazzoli D, Mangieri A, Demir O, Ancona MB, Lanzillo G, Giannini F, Leone PP, Colombo A, Latib A. The future of percutaneous tricuspid valve interventions. Minerva Cardioangiol 2018; 66:735-743. [PMID: 29963813 DOI: 10.23736/s0026-4725.18.04757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tricuspid valve regurgitation has a high prevalence and, when severe, is associated with poor outcomes. Nevertheless, surgical repair or replacement (isolated or as a part of a combined procedure) is rarely performed due to high surgical risk. Therefore, there is a significant unmet clinical need for percutaneous transcatheter-based treatments. Significant development in percutaneous therapies for both aortic and mitral valve disease has been accomplished over the last two decades, while transcatheter therapies for the tricuspid valve are still at an early stage. We are today at a cross-road of new transcatheter devices that are becoming available for the treatment of tricuspid regurgitation; the current review evaluates the challenges that current and future technologies have to face in order to become a safer, less invasive and equally effective alternative to surgery.
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Ancona MB, Hachinohe D, Giannini F, Del Sole PA, Regazzoli D, Mangieri A, Romano V, Latib A, Ancona F, Monaco F, Castiglioni A, Esposito A, Montorfano M, Colombo A. Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:e29-e30. [PMID: 29471959 DOI: 10.1016/j.jcin.2017.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
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Mangieri A, Montorfano M, Stella S, Regazzoli D, Ancona MB, Jabbour RJ, Mitomo S, Seresini G, Monaco F, Lanzillo G, Pagnesi M, Colombo A, Latib A. Severe Mitral Stenosis and Persistent Left Appendage Thrombosis. JACC Cardiovasc Interv 2018; 11:e11-e13. [DOI: 10.1016/j.jcin.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
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Ancona MB, Giannini F, Mangieri A, Regazzoli D, Jabbour RJ, Tanaka A, Testa L, Romano V, Longoni M, Giglio M, Besana F, Cacucci M, Agricola E, Chieffo A, Alfieri O, Montorfano M, Colombo A, Latib A. Impact of Mitral Annular Calcium on Outcomes after Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:2233-2240. [PMID: 29106835 DOI: 10.1016/j.amjcard.2017.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/31/2022]
Abstract
A high prevalence of mitral annular calcium (MAC) is expected in patients undergoing transcatheter aortic valve implantation (TAVI); however, data regarding the prevalence of MAC and impact on risk of cardiovascular events are lacking. To determine the prevalence of MAC and its association with clinical outcomes in patients undergoing TAVI, we retrospectively analyzed 424 patients who underwent transfemoral TAVI from 2007 to 2015 and whose preoperative computed tomography images were available for assessment of MAC. Severe circumferential MAC (SC-MAC) was defined as calcification involving at least the whole posterior annulus alone or with the attachment of the anterior leaflet. Clinical outcomes were examined according to Valve Academic Research Consortium-2 criteria up to 2 years. SC-MAC was found in 17.7% of patients. Patients with SC-MAC were more likely to be female, with a higher prevalence of atrial fibrillation and peripheral artery disease. There were no differences between the groups regarding age, functional class, prevalence of diabetes, kidney disease, and operative risk. Female gender and peripheral artery disease were independent predictors of SC-MAC. SC-MAC did not appear to be associated with periprocedural and 30-day outcomes. At 2 years' follow-up, patients with SC-MAC had significantly higher cardiovascular and all-cause mortality rates. SC-MAC was an independent predictor of cardiovascular mortality during follow-up. In conclusion, SC-MAC is a frequent finding in the TAVI population and appears to be an independent predictor of cardiovascular mortality at 2 years' follow-up.
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Pappalardo F, Ancona MB, Giannini F, Regazzoli D, Mangieri A, Montorfano M, De Bonis M, Alfieri O, Zangrillo A, Scandroglio AM, Colombo A, Latib A. First in man prolonged pressure-controlled intermittent coronary sinus occlusion to treat refractory left ventricular dysfunction and ischemia with patent epicardial coronary arteries. Int J Cardiol 2017; 241:138-141. [DOI: 10.1016/j.ijcard.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
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Regazzoli D, Ancona MB, Mangieri A, Tanaka A, Romano V, Leone PP, Tresoldi M, Lanzillo G, Agricola E, Latib A, Colombo A, Montorfano M. Patent foramen ovale closure through inferior vena cava filter in a patient with deep venous thrombosis and recurrent ischemic events. J Cardiovasc Med (Hagerstown) 2017; 18:828-830. [PMID: 28368881 DOI: 10.2459/jcm.0000000000000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Latib A, Ancona MB, Agricola E, Giannini F, Mangieri A, Regazzoli D, Monaco F, Alfieri O, Hahn R, Colombo A. Percutaneous Bicuspidization of the Tricuspid Valve. JACC Cardiovasc Imaging 2017; 10:488-489. [DOI: 10.1016/j.jcmg.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
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Mangieri A, Jabbour RJ, Montalto C, Pagnesi M, Regazzoli D, Ancona MB, Giannini F, Tanaka A, Bertoldi L, Monaco F, Agricola E, Giglio M, Mattioli R, Ferri L, Montorfano M, Chieffo A, Alfieri O, Colombo A, Latib A. Single-Antiplatelet Therapy in Patients with Contraindication to Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 119:1088-1093. [PMID: 28237287 DOI: 10.1016/j.amjcard.2016.11.065] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis. A total of 439 patients were included in the final analysis; 108 patients were discharged on SAPT and 331 on DAPT. Reasons for discharge SAPT included high risk of bleeding (n = 33; 31%), postprocedural bleeding (n = 42; 39%), thrombocytopenia (n = 20; 18%), vascular complications (n = 13; 12%). The mean length of DAPT was 5.2 ± 2.7 months. Patients discharged in SAPT had a higher incidence of life-threatening bleeding during the index hospitalization. At follow-up, no differences were observed in the incidence of net adverse clinical event, all-cause or cardiovascular mortality, and cerebrovascular events. A similar rate of valve thrombosis was reported in both groups. In conclusion, prescribing only SAPT after TAVI in selected patients was not associated with an increased risk of events and may be an acceptable alternative to DAPT in elderly patients at high risk of bleeding.
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Del Furia F, Ancona MB, Giannini F, Jabbour RJ, Regazzoli D, Mangieri A, Latib A, Colombo A, Montorfano M. First-in-man Percutaneous LAA Closure With an Amplatzer Amulet and TriGuard Embolic Protection Device in a Patient With LAA Thrombus. THE JOURNAL OF INVASIVE CARDIOLOGY 2017; 29:E51-E52. [PMID: 28368849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Percutaneous left atrial appendage (LAA) closure is currently utilized for the prophylaxis of thromboembolic cerebrovascular accidents in patients with non-valvular atrial fibrillation. The presence of LAA thrombus is usually considered a contraindication for the procedure, since there is a high risk of thrombus embolization. While reports in the literature have shown the feasibility of LAA closure in the presence of LAA thrombus with certain cerebral embolic protection devices, we present the first-in-man LAA closure of a patient with LAA thrombus using the TriGuard Embolic Protection Device.
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Latib A, Mangieri A, Vicentini L, Ferri L, Montorfano M, Ismeno G, Regazzoli D, Ancona MB, Giglio M, Denti P, Colombo A, Agricola E. Percutaneous Tricuspid Valve Annuloplasty Under Conscious Sedation (With Only Fluoroscopic and Intracardiac Echocardiography Monitoring). JACC Cardiovasc Interv 2017; 10:620-621. [DOI: 10.1016/j.jcin.2016.12.283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
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Colombo A, Ancona MB, Chieffo A. The Unforgettable Cornerstone: Role of Ticlopidine in Developing Current Antithrombotic Treatment After Percutaneous Coronary Intervention. J Am Coll Cardiol 2017; 69:755-756. [PMID: 28183518 DOI: 10.1016/j.jacc.2016.09.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022]
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Giannini F, Latib A, Ancona MB, Costopoulos C, Ruparelia N, Menozzi A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Colombo A. A propensity score matched comparative study between paclitaxel-coated balloon and everolimus-eluting stents for the treatment of small coronary vessels. Catheter Cardiovasc Interv 2017; 90:380-386. [PMID: 28109036 DOI: 10.1002/ccd.26929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare the long-term clinical outcomes of paclitaxel drug-coated-balloons (DCB) and everolimus-eluting-stents (EES) following the treatment of de novo small vessel coronary artery disease. BACKGROUND It is currently unclear whether treatment of de novo small vessel coronary disease with DCB is comparable to second generation drug-eluting stents, which are the current standard of care. METHODS The present study enrolled 90 patients with small vessel coronary disease from the DCB treatment arm of the BELLO (Balloon Elution and Late Loss Optimization) trial and 2,000 patients treated with EES at the San Raffaele Scientific Institute. Propensity score matching was performed to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 181 patients: 90 patients with 94 lesions receiving DCB and 91 patients with 94 lesions receiving EES. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, recurrent non-fatal myocardial infarction, and target vessel revascularization. RESULTS After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. The cumulative MACE rate at 1-year was 12.2% with DCB and 15.4% with EES (P = 0.538). Patients in the DCB group had similar TLR rates as compared to EES over the same interval (4.4% vs. 5.6%; P = 0.720). There were no cases of definite or probable stent or vessel thrombosis. CONCLUSIONS The use of paclitaxel-DCB appears to be associated with similar clinical outcomes when compared to second-generation-EES in small coronary artery disease. The findings of this study should be confirmed with larger prospective randomized studies with longer follow-up. © 2017 Wiley Periodicals, Inc.
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Pagnesi M, Baldetti L, Del Sole P, Mangieri A, Ancona MB, Regazzoli D, Buzzatti N, Giannini F, Colombo A, Latib A. Predilatation Prior to Transcatheter Aortic Valve Implantation: Is it Still a Prerequisite? Interv Cardiol 2017; 12:116-125. [PMID: 29588739 DOI: 10.15420/icr.2017:17:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Predilatation has been historically considered a mandatory step before transcatheter aortic valve implantation (TAVI) since it facilitates valve crossing and prosthesis delivery, ensures optimal valve expansion and improves hemodynamic stability during valve deployment. However, as a result of procedural evolution over time, direct TAVI (without pre-implantation balloon aortic valvuloplasty) has emerged as an interesting option to simplify the procedure and to avoid potential valvuloplasty-related complications. Several real-world retrospective studies and one small randomised study have shown that direct TAVI (with both self-expanding and balloon-expandable prostheses) is feasible, safe and associated with outcomes similar to standard TAVI with pre-implantation balloon aortic valvuloplasty. In the absence of high-quality, robust evidence, the current review aims to discuss the advantages and disadvantages of omitting predilatation prior to TAVI.
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Latib A, Ancona MB, Ferri L, Montorfano M, Mangieri A, Regazzoli D, Giannini F, Monaco F, Giglio M, De Servi S, Alfieri O, Colombo A, Agricola E. Percutaneous Direct Annuloplasty With Cardioband to Treat Recurrent Mitral Regurgitation After MitraClip Implantation. JACC Cardiovasc Interv 2016; 9:e191-2. [DOI: 10.1016/j.jcin.2016.06.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/26/2022]
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