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Zhi Y, Madanchi M, Cioffi GM, Brunner J, Stutz L, Gnan E, Gjergjizi V, Attinger-Toller A, Cuculi F, Bossard M. Initial experience with a novel stent-based mechanical thrombectomy device for management of acute myocardial infarction cases with large thrombus burden. Cardiovasc Interv Ther 2024:10.1007/s12928-024-00998-3. [PMID: 38642291 DOI: 10.1007/s12928-024-00998-3] [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: 09/18/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) and large thrombus burden (LTB) still represent a challenge. Afflicted patients have a high morbidity and mortality. Aspiration thrombectomy is often ineffective in those cases. Mechanical thrombectomy devices (MTDs), which are effective for management of ischemic strokes, were recently CE-approved for treatment of thrombotic coronary lesions. Real-world data about their performance in AMI cases with LTB are scarce. This study sought to summarize our early experience with a novel MTD device in this context. METHODS We analyzed consecutive patients from the prospective OPTIMISER registry (NCT04988672), who have been managed with the NeVa™ MTD (Vesalio, USA) for AMI with LTB at a tertiary cardiology facility. Outcomes of interest included, among others, periprocedural complications, target lesion failure (TLF), target lesion revascularization (TLR) and target vessel myocardial infarction (TV-MI). RESULTS Overall, 15 patients underwent thrombectomy with the NeVa™ device. Thrombectomy was successfully performed in 14 (93%) patients. Final TIMI 3 flow was achieved in 13 (87%) patients, while 2 (13%) patients had TIMI 2 flow. We encountered no relevant periprocedural complications, especially no stroke, stent thrombosis or vessel closure. After a mean follow-up time of 26 ± 2.9 months, 1 (7%) patient presented with TLR due to stent thrombosis (10 months after treatment with the MTD and stenting). CONCLUSIONS In AMI patients with LTB, the deployment of the novel NeVa™ MTD seems efficient and safe. Further randomized trials are warranted to assess whether the use of the NeVa™ device in cases with LTB improves procedural and clinical outcomes.
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Affiliation(s)
- Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo Maria Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Julian Brunner
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Leah Stutz
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Università Statale Di Milano, Milan, Italy
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
| | - Adrian Attinger-Toller
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Madanchi M, Bossard M, Majcen I, Cioffi GM, Ferraro F, Gnan E, Gjergjizi V, Zhi Y, Bade V, Wolfrum M, Moccetti F, Toggweiler S, Attinger-Toller A, Cuculi F. Outcomes following coronary chronic total occlusion revascularization with drug-coated balloons. J Invasive Cardiol 2024; 36. [PMID: 38441987 DOI: 10.25270/jic/22.00260] [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: 03/07/2024]
Abstract
OBJECTIVES Despite the introduction of improved drug eluting stents (DES), the rate of repeat revascularization procedures following percutaneous coronary interventions (PCI) in coronary chronic total occlusions (CTO) remains high. By leaving vessels uncaged and limiting length of stented segments, drug-coated balloons (DCB) represent an appealing alternative to DES for CTO-PCI. Since data supporting the use of DCBs in CTO-PCI is scarce, we compared the outcomes of patients undergoing CTO-PCI involving DCBs vs DES only. METHODS From 2 prospective registries, outcomes of patients undergoing CTO-PCI involving DCBs and those undergoing PCI with DES only were compared. Outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death). RESULTS Overall, 157 patients were studied; 112 (71%) underwent CTO-PCI involving DCBs and 45 (29%) were treated with DES only. Mean J-CTO score was 1.84 ± 0.7. Most CTO-lesions involved the right coronary artery, 88 (56%), and 26 (17%) cases were in-stent occlusions. In the DCB group, 46 (41%) lesions were treated with DCBs alone. Mean lengths of the stented segments in the DCB vs DES cohorts were 59 ± 28 mm vs 87 ± 37 mm (P less than .001), respectively. After 12 months, the MACCE rate was higher in the DES only vs DCB group (26% vs 11%, P=.03). Length of the stented segment was an independent predictor for MACCE (HR 1.15 [95% CI, 1.05-1.26] per 10-mm stent length). CONCLUSIONS Revascularization of CTO lesions involving DCBs appears safe and potentially lowers MACCE rates compared to treatment with DES alone. Importantly, using DCBs for CTO treatment may reduce total stent length, which determines PCI outcomes.
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Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Francesco Ferraro
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Vanessa Bade
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; 2Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Madanchi M, Bossard M, Majcen I, Cioffi GM, Ferraro F, Gnan E, Gjergjizi V, Zhi Y, Bade V, Wolfrum M, Moccetti F, Toggweiler S, Attinger-Toller A, Cuculi F. Outcomes following coronary chronic total occlusion revascularization with drug-coated balloons. J Invasive Cardiol 2024; 36. [PMID: 38441987 DOI: 10.25270/jic/23.00260] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Despite the introduction of improved drug eluting stents (DES), the rate of repeat revascularization procedures following percutaneous coronary interventions (PCI) in coronary chronic total occlusions (CTO) remains high. By leaving vessels uncaged and limiting length of stented segments, drug-coated balloons (DCB) represent an appealing alternative to DES for CTO-PCI. Since data supporting the use of DCBs in CTO-PCI is scarce, we compared the outcomes of patients undergoing CTO-PCI involving DCBs vs DES only. METHODS From 2 prospective registries, outcomes of patients undergoing CTO-PCI involving DCBs and those undergoing PCI with DES only were compared. Outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death). RESULTS Overall, 157 patients were studied; 112 (71%) underwent CTO-PCI involving DCBs and 45 (29%) were treated with DES only. Mean J-CTO score was 1.84 ± 0.7. Most CTO-lesions involved the right coronary artery, 88 (56%), and 26 (17%) cases were in-stent occlusions. In the DCB group, 46 (41%) lesions were treated with DCBs alone. Mean lengths of the stented segments in the DCB vs DES cohorts were 59 ± 28 mm vs 87 ± 37 mm (P less than .001), respectively. After 12 months, the MACCE rate was higher in the DES only vs DCB group (26% vs 11%, P=.03). Length of the stented segment was an independent predictor for MACCE (HR 1.15 [95% CI, 1.05-1.26] per 10-mm stent length). CONCLUSIONS Revascularization of CTO lesions involving DCBs appears safe and potentially lowers MACCE rates compared to treatment with DES alone. Importantly, using DCBs for CTO treatment may reduce total stent length, which determines PCI outcomes.
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Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Francesco Ferraro
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Vanessa Bade
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; 2Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Madanchi M, Attinger-Toller A, Gjergjizi V, Majcen I, Cioffi GM, Epper A, Gnan E, Koch T, Zhi Y, Cuculi F, Bossard M. Treatment of coronary lesions with a novel crystalline sirolimus-coated balloon. Front Cardiovasc Med 2024; 11:1316580. [PMID: 38414923 PMCID: PMC10896972 DOI: 10.3389/fcvm.2024.1316580] [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: 10/10/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
Background There is mounting data supporting the use of drug-coated balloons (DCB) not only for treatment of in-stent restenosis (ISR), but also in native coronary artery disease. So far, paclitaxel-coated balloons represented the mainstay DCBs. The SeQuent® crystalline sirolimus-coated balloon (SCB) (B.Braun Medical Inc, Germany) represents a novel DCB, which allows a sustained release of the limus-drug. We evaluated its performance in an all-comer cohort, including complex coronary lesions. Methods Consecutive patients treated with the SeQuent® SCB were analyzed from the prospective SIROOP registry (NCT04988685). We assessed clinical outcomes, including major adverse cardiovascular events (MACE), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiovascular death. Angiograms and outcomes were independently adjudicated. Results From March 2021 to March 2023, we enrolled 126 patients and lesions, of which 100 (79%) treated using a "DCB-only" strategy and 26 (21%) with a hybrid approach (DES + DCB). The mean age was 68 ± 10 years, 48 (38%) patients had an acute coronary syndrome. Regarding lesion characteristics, ISR was treated in 27 (21%), 11 (9%) underwent CTO-PCI and 59 (47%) of the vessels were moderate to severe calcified. Procedural success rate was 100%. At a median follow-up time of 12.7 (IQR 12; 14.2) months, MACE occurred in 5 patients (4.3%). No acute vessel closure was observed. Conclusions Our data indicates promising outcomes following treatment with this novel crystalline SCB in an all-comer cohort with complex coronary lesions. These results require further investigation with randomized trials.
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Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M. Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Angelika Epper
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Tanja Koch
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Toggweiler S, Loretz L, Wolfrum M, Buhmann R, Fornaro J, Bossard M, Attinger-Toller A, Cuculi F, Roos J, Leipsic JA, Moccetti F. Relevance of Motion Artifacts in Planning Computed Tomography on Outcomes After Transcatheter Aortic Valve Implantation. Struct Heart 2023; 7:100214. [PMID: 38046862 PMCID: PMC10692358 DOI: 10.1016/j.shj.2023.100214] [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] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Background Motion artifacts in planning computed tomography (CT) for transcatheter aortic valve implantation (TAVI) can potentially skew measurements required for procedural planning. Whether such artifacts may affect safety or efficacy has not been studied. Methods We conducted a retrospective analysis of 852 consecutive patients (mean age, 82 years; 47% women) undergoing TAVI-planning CT at a tertiary care center. Two independent observers divided CTs according to the presence of motion artifacts at the annulus level (Motion vs. Normal group). Endpoints included surrogate markers for inappropriate valve selection: annular rupture, valve embolization or misplacement, need for a new permanent pacemaker, paravalvular leak (PVL), postprocedural transvalvular gradient, all-cause death. Results Forty-six (5.4%) patients presented motion artifacts on TAVI-planning CT (Motion group). These patients had more preexisting heart failure, moderate-severe mitral regurgitation, and atrial fibrillation. Interobserver variability of annular measurement (Normal vs. Motion group) did not differ for mean annular diameter but was significantly different for perimeter and area. Presence of motion artifacts on planning CT did not affect the prevalence of PVL (≥moderate PVL 0% vs. 2.5% p = 0.5), mean transvalvular gradient (6±3 mmHg vs 7±5 mmHg, p = 0.1), or the need for additional valve implantation (0% vs. 2.8%, p = 0.6). One annular rupture occurred (Normal group). Pacemaker implantation, procedural duration, hospital stay, 30-day outcomes, and all-cause mortality did not differ between the groups. Conclusions Motion artifacts on planning CT were found in about 5% of patients. Measurements for valve selection were possible without the need for repeat CT, with mean diameter-derived annulus measurement being the most accurate. Motion artifacts were not associated with worse outcomes.
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Affiliation(s)
- Stefan Toggweiler
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justus Roos
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jonathon A. Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Federico Moccetti
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
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Cioffi GM, Zhi Y, Madanchi M, Seiler T, Stutz L, Gjergjizi V, Romero JP, Attinger-Toller A, Bossard M, Cuculi F. Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus burden: Insights from a prospective cohort study. BMC Cardiovasc Disord 2023; 23:506. [PMID: 37828421 PMCID: PMC10571234 DOI: 10.1186/s12872-023-03540-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. METHODS From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. RESULTS Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. CONCLUSIONS Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.
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Affiliation(s)
- Giacomo Maria Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, McMaster University, Ontario, Hamilton, Canada
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Leah Stutz
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jean-Paul Romero
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
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Grebmer C, Bossard M, Attinger-Toller A, Kobza R, Hilfiker G, Berte B, Cuculi F. Cardiac resynchronization therapy in patients with a coronary sinus reducer: a case series. Eur Heart J Case Rep 2023; 7:ytad455. [PMID: 37743902 PMCID: PMC10516338 DOI: 10.1093/ehjcr/ytad455] [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: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
Background Reducing venous drainage of the coronary sinus is a promising intervention for refractory angina. Coronary Sinus Reducer (CSR) System™ effectively treats patients with refractory angina, possibly by increasing coronary collateral circulation, and leads to an improvement in their symptoms and quality of life. In patients with impaired left ventricular function and electrocardiographic dyssynchrony, cardiac resynchronization therapy (CRT) is an established treatment. However, there is only one published case report of CRT in a patient implanted with a CSR system. We present the first case series of CRT in patients implanted with the CSR system. Case summary This case series describes three patients. The first case demonstrated that CRT is feasible in patients implanted with a CSR system. The second case is the first report of a left ventricular lead extraction after CSR, and the third case was complicated due to the patient's medical history; however, CSR system implantation was feasible without major complications. Discussion Our results suggest that CRT is feasible in patients implanted with a CSR system, and lead extraction after CSR system implantation is possible. However, lead extraction in cases of severe adhesions around the CSR system and the coronary sinus may be associated with a high risk of complications; alternative options should be discussed at an early stage.
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Affiliation(s)
- Christian Grebmer
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Adrian Attinger-Toller
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Richard Kobza
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Gabriela Hilfiker
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Benjamin Berte
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland
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Brunner S, Brinkert M, Moccetti F, Loretz L, Fornaro J, Stämpfli SF, Attinger-Toller A, Bossard M, Buhmann R, Cuculi F, Wolfrum M, Toggweiler S. Hypoattenuated Leaflet Thickening After Implantation of the ACURATE neo or the ACURATE neo2 Transcatheter Heart Valve. Am J Cardiol 2023; 200:146-152. [PMID: 37321028 DOI: 10.1016/j.amjcard.2023.05.038] [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: 01/16/2023] [Revised: 04/28/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
Subclinical leaflet thrombosis, identified as hypoattenuated leaflet thickening (HALT) on cardiac computed tomography scan, has been observed after transcatheter aortic valve replacement (TAVR). However, data on HALT after the implant of the supra-annular ACURATE neo/neo2 prosthesis are limited. This study aimed to determine the prevalence and risk factors for the development of HALT after TAVR with the ACURATE neo/neo2. A total of 50 patients who received the ACURATE neo/neo2 prosthesis were prospectively enrolled. Patients underwent a contrast-enhanced multidetector row cardiac computed tomography scan at before, after, and 6 months after TAVR. At the 6-month follow-up, HALT was detected in 16% (8 of 50 patients). These patients had a lower implant depth of the transcatheter heart valve (8 ± 2 mm vs 5 ± 2 mm, p = 0.001), less calcified native valve leaflets, a better expansion of the frame at the level of the left ventricular outflow tract, and were less often hypertensive. Thrombosis of the sinus of Valsalva occurred in 18% (9/50). There was no difference in the anticoagulation regimen between patients with and without thrombotic findings. In conclusion, HALT was present in 16% of patients at 6 months follow-up, patients presenting with HALT had a lower implant depth of the transcatheter heart valve, and HALT was detected in patients on oral anticoagulation therapy.
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Affiliation(s)
- Stephanie Brunner
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Simon F Stämpfli
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
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9
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Seiler T, Vasiliauskaite E, Grüter D, Young M, Attinger-Toller A, Madanchi M, Cioffi GM, Tersalvi G, Müller G, Stämpfli SF, de Boeck B, Suter Y, Nossen J, Toggweiler S, Wuillemin WA, Cuculi F, Kobza R, Bossard M. Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombi-Insights from a Swiss Multicenter Registry. Am J Cardiol 2023; 194:113-121. [PMID: 36849314 DOI: 10.1016/j.amjcard.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 02/27/2023]
Abstract
Current guidelines recommend vitamin K antagonists (VKAs) for the treatment of a left ventricular thrombus (LVT). However, direct oral anticoagulants (DOACs) show superior safety and efficacy compared with VKAs in most thromboembolic disorders. Nevertheless, DOACs remain poorly investigated for the treatment of LVT. To describe the thrombus resolution rate and clinical efficacy of DOACs versus VKAs in patients with LVT, we analyzed consecutive patients with confirmed LVT from a multicenter echocardiography database. Echocardiograms and clinical end points were evaluated independently. The thrombus resolution rate and clinical outcomes were compared according to the underlying anticoagulation regimen. In total, 101 patients were included (17.8% women, mean age 63.3 ± 13.2 years), 50.5% had recently experienced a myocardial infarction. The mean left ventricular ejection fraction was 36.6 ± 12.2%. DOACs versus VKAs were used in 48 and 53 patients, respectively. The median follow-up was 26.6 (interquartile range 11.8;41.2) months. Among patients receiving VKAs compared with DOACs, the thrombus resolved more rapidly within the first month in those taking VKAs (p = 0.049). No differences were seen between the 2 groups with respect to major bleedings, strokes, and other thromboembolic events. In each group, LVT recurred in 3 of the subjects (a total of 6) after discontinuation of anticoagulation. In conclusion, DOACs appear to be a safe and effective alternative to VKAs for the treatment of LVTs, but the rate of thrombus dissolution within 1 month after initiation of anticoagulation appears to be higher with VKAs. A sufficiently powered randomized trial is required to definitively define the role of DOACs in the treatment of LVT.
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Affiliation(s)
- Thomas Seiler
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Egle Vasiliauskaite
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Daniel Grüter
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland; Department of Internal Medicine, Luzerner Kantonsspital, Wolhusen, Switzerland
| | - Mabelle Young
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Mehdi Madanchi
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Gregorio Tersalvi
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Gina Müller
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Simon F Stämpfli
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Bart de Boeck
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Yves Suter
- Department of Internal Medicine, Luzerner Kantonsspital, Wolhusen, Switzerland
| | - Jörg Nossen
- Department of Internal Medicine, Luzerner Kantonsspital, Sursee, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Florim Cuculi
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center - Luzerner Kantonsspital, Luzern, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
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10
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Seiler T, Attinger-Toller A, Cioffi GM, Madanchi M, Teufer M, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Bossard M, Cuculi F. Treatment of In-Stent Restenosis Using a Dedicated Super High-Pressure Balloon. Cardiovasc Revasc Med 2023; 46:29-35. [PMID: 36085285 DOI: 10.1016/j.carrev.2022.08.018] [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: 04/11/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment of in-stent restenosis (ISR) is challenging and treatment failure rate remains high. Correction of stent under-expansion and neointimal compression using the twin-layer OPN™ highly non-compliant balloon (NCB) at high pressure (>30 atm) may lead to increased luminal gain and thus better clinical outcomes. We evaluated periprocedural safety and clinical long-term outcomes after ISR treatment using the OPN™ NCB in a real-world population. METHODS From an ongoing registry, consecutive ISR patients treated with the OPN™ NCB at a tertiary cardiology center in Switzerland were analyzed. We evaluated procedural efficacy, periprocedural complications, target lesion/vessel failure (TLF/TVF), and major adverse cardiovascular events (MACE). RESULTS Totally, 208 ISR lesions were treated in 188 patients (mean age 68 ± 13 years, 78 % males). Most lesions were moderately to heavily calcified (89 %), the majority (70.2 %) had complex lesion characteristics (AHA Type B2/C lesions) and 50.5 % were non-focal ISR lesions. After ISR treatment using high pressure pre- and post-dilatation (mean pressure 33 ± 6 atm) with the OPN™ NCB device, the rate of major complications was low (0.96 % coronary perforation, 4 % major dissections, 1.9 % no-reflow and 0.5 % acute vessel closure). At 1-year follow-up, MACE occurred in 19.7 %; 15.4 % patients had TVF; MI and stent thrombosis was found in 5.9 % and 2.1 % of all patients, respectively; and 5 patients died. CONCLUSIONS For ISR treatment, using the super non-compliant OPN™ balloon at very high pressures is safe. Moreover, its use might lead to a low rate of TLF/TVF during long-term follow-up, but this requires further evaluation in dedicated comparative trials.
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Affiliation(s)
- Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Mario Teufer
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland; Medical School, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland.
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11
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Madanchi M, Cioffi GM, Attinger-Toller A, Seiler T, Somm S, Koch T, Tersalvi G, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Levine MB, Garcia-Garcia HM, Bossard M, Cuculi F. Metal free percutaneous coronary interventions in all-comers: First experience with a novel sirolimus-coated balloon. Cardiol J 2022; 29:906-916. [PMID: 36385601 PMCID: PMC9788730 DOI: 10.5603/cj.a2022.0106] [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: 06/24/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limus-eluting stents have become the mainstay for percutaneous coronary intervention (PCI). However, even with the latest generation drug-eluting stent, in-stent restenosis and very late stent thrombosis remain a concern. The Selution SLR™ drug-coated balloon (DCB) is a novel sirolimus-coated balloon that provides a controlled release of the antiproliferative drug. Herein we evaluated its performance in a real-world patient cohort with complex coronary artery lesions. METHODS Patients undergoing PCI using the Selution SLR™ DCB were analyzed from the prospective SIROOP registry. We evaluated procedural success and clinical outcomes, including major adverse cardiovascular event (MACE), cardiac death, target vessel myocardial infarction and target lesion revascularization. RESULTS From September 2020 to April 2021, we enrolled 78 patients (87 lesions) treated using a "DCB only" strategy. The mean age was 66.7 ± 10.4 years and 28 (36%) presented with an acute coronary syndrome. Almost all lesions were type B2/C 86 (99%) and 49 (63%) had moderate to severe calcifications. Procedural success was 100%. After a median follow-up of 11.2 months (interquartile range: 10.0-12.6), MACE occurred in 5 (6.8%) patients. No acute vessel closure was observed. CONCLUSIONS In complex coronary lesions, a "DCB only" strategy using the Selution SLR™ DCB is not just safe and feasible, but also seems to be associated with a low rate of MACE at 1-year follow-up. Our promising results warrant further evaluation in a dedicated comparative trial.
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Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland,Departement of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M. Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Sophie Somm
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tanja Koch
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Molly B. Levine
- Division of Interventional Cardiology — MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Georgetown University, Washington, United States
| | - Hector M. Garcia-Garcia
- Division of Interventional Cardiology — MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Georgetown University, Washington, United States
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland,Departement of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland,Departement of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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12
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Toggweiler S, Brinkert M, Wolfrum M, Moccetti F, Stämpfli SF, De Boeck BWL, Magarzo G, Gassenmaier T, Attinger-Toller A, Bossard M, Fornaro J, Buhmann R, Cuculi F, Kobza R. Paravalvular Leak After Implantation of the ACURATE neo and the ACURATE neo2 Transcatheter Heart Valve. Cardiovasc Revasc Med 2022; 45:37-43. [PMID: 35902306 DOI: 10.1016/j.carrev.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Affiliation(s)
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Simon F Stämpfli
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bart W L De Boeck
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Getulio Magarzo
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | | | - Matthias Bossard
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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13
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Brunner S, Stämpfli SF, Paul M, De Boeck B, Wolfrum M, Moccetti F, Attinger-Toller A, Bossard M, Cuculi F, Matt P, Kobza R, Toggweiler S. Tricuspid Regurgitation and Right Ventricular Function in Patients Undergoing Percutaneous Treatment of Mitral Regurgitation. J Invasive Cardiol 2022; 34:E850-E857. [PMID: 36328515] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Patients with severe mitral regurgitation (MR) frequently present with concomitant right ventricular (RV) dysfunction and tricuspid regurgitation (TR). We aimed to investigate the prognostic relevance of RV function, RV dimension, and TR in patients undergoing percutaneous intervention for MR. METHODS Consecutive patients undergoing percutaneous mitral valve intervention were enrolled in the prospective MitraSwiss registry. Tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), right ventricular pulmonary arterial coupling (RVC, defined as TAPSE/ PASP ratio), indexed tricuspid annulus (TA) dimension, and TR severity grade were analyzed at baseline, post procedure, and at 6-month follow-up. The endpoints of all-cause mortality, hospitalization for heart failure, and the combined endpoint of the 2 were observed during long-term follow-up (up to 4 years). RESULTS We analyzed 218 patients (mean age, 76 ± 9 years; 36% female). Edge-to-edge mitral valve repair resulted in an increase in TAPSE and RVC ratio and a decrease in indexed TA and PASP, but concomitant TR did not change significantly. In multivariable analysis, RV dysfunction and moderate/severe TR were independently associated with increased all-cause mortality (hazard ratio, 1.61; 95% confidence interval, 1.05-2.46; P=.03 and hazard ratio, 2.10; 95% confidence interval, 1.34-3.29; P<.01, respectively) and moderate/severe TR was further an independent predictor for hospitalization for heart failure and for the combined endpoint. CONCLUSION Treatment of MR resulted in favorable changes of RV function and dimension but did not reduce TR in the majority of patients. TR at baseline remained the strongest predictor for outcomes, outperforming parameters of RV function and dimension.
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14
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Tersalvi G, Attinger-Toller A, Kalathil D, Winterton D, Cioffi GM, Madanchi M, Seiler T, Stadelmann M, Goffredo F, Fankhauser P, Moccetti F, Wolfrum M, Toggweiler S, Bloch A, Kobza R, Cuculi F, Bossard M. Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction. CJC Open 2022; 5:77-85. [PMID: 36700188 PMCID: PMC9869354 DOI: 10.1016/j.cjco.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Left ventricular (LV) unloading via the percutaneous micro-axial Impella pump is increasingly used in patients with anterior ST-segment elevation myocardial infarction (STEMI) and overt cardiogenic shock. In this context, the evolution of cardiac function and dimensions beyond hospital discharge remains uncertain. We aimed to characterize echocardiographic changes over time in patients with acute anterior STEMI treated with an Impella device. Methods From an ongoing prospective registry, consecutive patients with acute anterior STEMI managed with an Impella device were extracted. Transthoracic echocardiography was performed at index hospitalization and at first outpatient follow-up. Predictors of response, defined as a ≥ 10% absolute increase in left ventricular ejection fraction (LVEF) at follow-up, were sought. Results A total of 66 patients (89.4% male, aged 64.3 ± 11.6 years) with anterior STEMI were treated with an Impella device in the first 24 hours of hospitalization, from 2014 to 2022. In-hospital mortality was 24%. Major bleeding and vascular complications requiring surgery occurred in 24% and 11% of patients, respectively. At baseline, mean LVEF was 34% ±12%. At follow-up, survivors showed a significant increase in LVEF (P < 0.0001), whereas LV dimensions, diastolic parameters, and measures of right ventricular dimension and function remained stable. Overall, 28 patients had a ≥ 10% absolute increase in LVEF at follow-up. Baseline creatinine was the only significant predictor of response at univariate analysis. Conclusions Among patients with anterior STEMI requiring mechanical hemodynamic support with an Impella device, the majority of survivors showed a sustained increase in LV function, without evidence of adverse remodelling. This signal warrants further investigation in dedicated trials.
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Affiliation(s)
- Gregorio Tersalvi
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Dhanya Kalathil
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Dario Winterton
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mehdi Madanchi
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Thomas Seiler
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marc Stadelmann
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Francesca Goffredo
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Patrick Fankhauser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Kobza
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Centre, Luzerner Kantonsspital, Lucerne, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland,Corresponding author: Dr Matthias Bossard, Cardiology Division – Heart Centre Lucerne, Luzerner Kantonsspital, 6000 Luzern 16, Lucerne, Switzerland. Tel.: +41 41 205 14 77.
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15
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Seiler T, Attinger-Toller A, Cioffi GM, Madanchi M, Tersalvi G, Moccetti F, Toggweiler S, Kobza R, Bossard M, Cuculi F. TCT-142 Treatment of In-Stent Restenosis With the Use of a Dedicated Super High-Pressure Balloon. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.166] [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] [Indexed: 10/14/2022]
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16
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Attinger-Toller A, Kalathil D, Winterton D, Cioffi GM, Madanchi M, Seiler T, Goffredo F, Fankhauser P, Moccetti F, Toggweiler S, Kobza R, Cuculi F, Bossard M, Tersalvi G. TCT-48 Left Ventricular Recovery Among Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction Treated With Impella. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.726] [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] [Indexed: 11/28/2022]
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17
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Cioffi GM, Madanchi M, Attinger-Toller A, Bossard M, Cuculi F. Pushing the Boundaries: Drug-Coated Balloons to Treat a Calcified and Thrombotic Lesion in Acute Coronary Syndrome. Am J Case Rep 2022; 23:e936950. [PMID: 36196027 PMCID: PMC9552860 DOI: 10.12659/ajcr.936950] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patient: Male, 72-year-old
Final Diagnosis: NSTEMI
Symptoms: ACS • NSTEMI
Medication: —
Clinical Procedure: —
Specialty: Cardiology
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Affiliation(s)
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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18
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Bossard M, Madanchi M, Avdijaj D, Attinger-Toller A, Cioffi GM, Seiler T, Tersalvi G, Kobza R, Schüpfer G, Cuculi F. Long-Term Outcomes After Implantation of Magnesium-Based Bioresorbable Scaffolds—Insights From an All-Comer Registry. Front Cardiovasc Med 2022; 9:856930. [PMID: 35498044 PMCID: PMC9046914 DOI: 10.3389/fcvm.2022.856930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/08/2022] [Indexed: 12/18/2022] Open
Abstract
BackgroundThe magnesium-based sirolimus-eluting bioresorbable scaffold (Mg-BRS) Magmaris™ showed promising clinical outcomes, including low rates of both the target lesion failure (TLF) and scaffold thrombosis (ScT), in selected study patients. However, insights regarding long-term outcomes (>2 years) in all-comer populations remain scarce.MethodsWe analyzed data from a single-center registry, including patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), who had undergone percutaneous coronary intervention (PCI) using the Mg-BRS. The primary outcome comprised the device-oriented composite endpoint (DoCE) representing a hierarchical composite of cardiac death, ScT, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR) up to 5 years.ResultsIn total, 84 patients [mean age 62 ± 11 years and 63 (75%) men] were treated with the Mg-BRS devices between June 2016 and March 2017. Overall, 101 lesions had successfully been treated with the Mg-BRS devices using 1.2 ± 0.4 devices per lesion. Pre- and postdilatation using dedicated devices had been performed in 101 (100%) and 98 (97%) of all the cases, respectively. After a median follow-up time of 62 (61–64) months, 14 (18%) patients had experienced DoCEs, whereas ScT was encountered in 4 (4.9%) patients [early ScTs (<30 days) in three cases and two fatal cases]. In 4 (29%) of DoCE cases, optical coherence tomography confirmed the Mg-BRS collapse and uncontrolled dismantling.ConclusionIn contradiction to earlier studies, we encountered a relatively high rate of DoCEs in an all-comer cohort treated with the Mg-BRS. We even observed scaffold collapse and uncontrolled dismantling. This implicates that this metal-based BRS requires further investigation and may only be used in highly selected cases.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- *Correspondence: Matthias Bossard
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dardan Avdijaj
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- Faculty of Medicine, University of Zurich, Luzern, Switzerland
| | | | | | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Guido Schüpfer
- Department of Anaestesiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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Attinger-Toller A, Bossard M, Cioffi GM, Tersalvi G, Madanchi M, Bloch A, Kobza R, Cuculi F. Ventricular Unloading Using the Impella TM Device in Cardiogenic Shock. Front Cardiovasc Med 2022; 9:856870. [PMID: 35402561 PMCID: PMC8984099 DOI: 10.3389/fcvm.2022.856870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiogenic shock (CS) remains a leading cause of hospital death. However, the use of mechanical circulatory support has fundamentally changed CS management over the last decade and is rapidly increasing. In contrast to extracorporeal membrane oxygenation as well as counterpulsation with an intraaortic balloon pump, ventricular unloading by the Impella™ device actively reduces ventricular volume as well as pressure and augments systemic blood flow at the same time. By improving myocardial oxygen supply and enhancing systemic circulation, the Impella device potentially protects myocardium, facilitates ventricular recovery and may interrupt the shock spiral. So far, the evidence supporting the use of Impella™ in CS patients derives mostly from observational studies, and there is a need for adequate randomized trials. However, the Impella™ device appears a promising technology for management of CS patients. But a profound understanding of the device, its physiologic impact and clinical application are all important when evaluating CS patients for percutaneous circulatory support. This review provides a comprehensive overview of the percutaneous assist device Impella™. Moreover, it highlights in depth the rationale for ventricular unloading in CS and describes practical aspects to optimize care for patients requiring hemodynamic support.
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Affiliation(s)
- Adrian Attinger-Toller
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland,*Correspondence: Adrian Attinger-Toller
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
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Madanchi M, Cioffi GM, Attinger-Toller A, Kobza R, Bossard M, Cuculi F. Geographic miss leading to neoatherosclerosis and very late stent thrombosis. Cardiovasc Med 2022. [DOI: 10.4414/cvm.2022.02195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
| | | | | | - Richard Kobza
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne
| | - Matthias Bossard
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne
| | - Florim Cuculi
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne
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Brunner S, Wolfrum M, Moccetti F, Stämpfli SF, Attinger-Toller A, Bossard M, Matt P, Cuculi F, Kobza R, Toggweiler S. The relevance of tricuspid regurgitation in patients undergoing percutaneous treatment of mitral regurgitation. Catheter Cardiovasc Interv 2022; 99:1848-1856. [PMID: 35114065 DOI: 10.1002/ccd.30114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Investigate the impact of concomitant tricuspid regurgitation (TR) on clinical outcomes during long-term follow-up in patients undergoing percutaneous treatment of mitral regurgitation (MR) with the MitraClip system. BACKGROUND Patients undergoing mitral repair using the MitraClip frequently present with concomitant TR. It is uncertain how the presence of TR impacts the long-term outcomes of such patients. METHODS We analyzed consecutive patients with MitraClip implantation from the prospective MitraSwiss registry. Endpoints were all-cause mortality, hospitalization for heart failure, and the composite endpoint of the two. RESULTS We enrolled 177 patients (mean age 76 ± 9 years, 37% female). Acute procedural success was achieved in 149 (84%). Concomitant moderate or severe TR was present in 31% at baseline and 32% before discharge. After a median follow-up of 1103 days (IQR: 555-1766 days), 70 (40%) of patients had died, and 34 (19%) were hospitalized for heart failure. In multivariable analysis, TR at baseline was associated with an increase in all-cause mortality (HR: 2.34, 95% CI: 1.36-4.03, p < 0.01), hospitalization for heart failure (HR: 3.19, 95% CI: 1.37-7.41, p = 0.01), and the composite endpoint (HR: 2.00, 95% CI: 1.19-3.36, p = 0.01). CONCLUSION Despite treatment of MR, TR did not improve in most patients. The presence of relevant TR at baseline was associated with reduced survival and higher rates of hospitalization for heart failure. More research is needed to understand the causal role of TR in such patients and to investigate if simultaneous treatment of concomitant TR may improve prognosis in patients undergoing percutaneous treatment of MR.
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Affiliation(s)
- Stephanie Brunner
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Attinger-Toller
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Peter Matt
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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Madanchi M, Cioffi GM, Attinger-Toller A, Seiler T, Teufer M, Vercelli L, Moccetti F, Wolfrum M, Toggweiler S, Kobza R, Bossard M, Cuculi F. CRT-100.67 Treatment of Coronary Chronic Total Occlusions Using Drug-Coated Balloons – Perspectives From the SIROOP Registry. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.121] [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] [Indexed: 10/19/2022]
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23
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Cioffi GM, Madanchi M, Attinger-Toller A, Seiler T, Vercelli L, Teufer M, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Bossard M, Cuculi F. TCT-207 First Experience With the Novel Selution SLR Sirolimus-Eluting Balloon in All-Comer Patients Presenting With Acute and Chronic Coronary Artery Disease. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1060] [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] [Indexed: 11/15/2022]
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Burkart P, Bossard M, Moccetti F, Hess S, Jeyarasa M, Madanchi M, Cioffi G, Seiler T, Wolfrum M, Hakimi M, Seelos R, Toggweiler S, Attinger-Toller A, Kobza R, Cuculi F. Utility and safety of the MANTA device for access site closure after removal of the mechanical hemodynamic support device Impella on the intensive care unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The percutaneously implanted hemodynamic mechanical support devices Impella are commonly used in patients at risk for or with cardiogenic shock (CS). Impella removal after hemodynamic stabilization on the intensive care unit (ICU) remains a major challenge and is prone to high rates of bleeding and vascular complications.
Purpose
It is unknown if the use of the novel large-bore access closure device MANTA® is safe and facilitates access management compared to manual compression.
Methods
Between January 2017 and December 2020, 172 CS patients were treated with an Impella® device at our centre. Of those, in 89 patients the Impella® was removed on the ICU and access site management occurred with either MANTA® device or manual compression. The criteria for MANTA® 14 french device deployment included: (i) femoral artery Diameter >6mm and (ii) absence of significant peripheral arterial disease (PAD). Bleeding and vascular access site complications were assessed and adjudicated according to the Valve Academic Research Consortium-2 (VARC-2) criteria.
Results
Among the 89 included patients, Impella® removal was performed using the MANTA® device in 31 cases and manual compression in 58 cases. Mean age was 66±11 years, and 50 (56.2%) patients had a CS classified as Society for Cardiovascular Angiography and Interventions (SCAI) D or higher due to myocardial infarction. Median support time was 40 (IQR 24; 69) hours. Baseline characteristics are displayed in Table 1. Immediate haemostasis was more frequently achieved by MANTA® device compared to manual compression (p=0.034). Moreover, we observed significantly less overall (2 (6.5%) vs. 22 (37.9%), p=0.001) and minor bleedings (1 (3.2%) vs. 15 (25.9%), p=0.006) with the MANTA® device when compared to manual compression. Of note, there were no significant differences in vascular complications between the two groups (Table 2).
Conclusions
In patients requiring Impella® support and residing on ICU, the MANTA® device, compared to standard of care manual compression, seems to be a safe and effective option for access site management, especially with regards to the reduction of bleeding events. However, physicians should carefully assess the vascular anatomy and degree of calcification prior to deployment of the MANTA® device. Nevertheless, more prospective data is necessary for evaluating the optimal access closure among CS patients treated with a percutaneously implanted Impella® device.
Funding Acknowledgement
Type of funding sources: None. Table 1. Baseline demographicsTable 2. Outcomes
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Affiliation(s)
- P Burkart
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - M Bossard
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - F Moccetti
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - S Hess
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - M Jeyarasa
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - M Madanchi
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - G Cioffi
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - T Seiler
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - M Wolfrum
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - M Hakimi
- Luzerner Kantonsspital, Vascular surgery, Luzern, Switzerland
| | - R Seelos
- Luzerner Kantonsspital, Vascular surgery, Luzern, Switzerland
| | - S Toggweiler
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | | | - R Kobza
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
| | - F Cuculi
- Luzerner Kantonsspital, Cardiology, Luzern, Switzerland
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Madanchi M, Cioffi GM, Attinger-Toller A, Wolfrum M, Moccetti F, Seiler T, Vercelli L, Burkart P, Toggweiler S, Kobza R, Bossard M, Cuculi F. Long-term outcomes after treatment of in-stent restenosis using the Absorb everolimus-eluting bioresorbable scaffold. Open Heart 2021; 8:openhrt-2021-001776. [PMID: 34518287 PMCID: PMC8438862 DOI: 10.1136/openhrt-2021-001776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 01/28/2023] Open
Abstract
Background Early studies evaluating the performance of bioresorbable scaffold (BRS) Absorb in in-stent restenosis (ISR) lesions indicated promising short-term to mid-term outcomes. Aims To evaluate long-term outcomes (up to 5 years) of patients with ISR treated with the Absorb BRS. Methods We did an observational analysis of long-term outcomes of patients treated for ISR using the Absorb BRS (Abbott Vascular, Santa Clara, California, USA) between 2013 and 2016 at the Heart Centre Luzern. The main outcomes included a device-oriented composite endpoint (DOCE), defined as composite of cardiac death, target vessel (TV) myocardial infarction and TV revascularisation, target lesion revascularisation and scaffold thrombosis (ScT). Results Overall, 118 ISR lesions were treated using totally 131 BRS among 89 patients and 31 (35%) presented with an acute coronary syndrome. The median follow-up time was 66.3 (IQR 52.3–77) months. A DOCE had occurred in 17% at 1 year, 27% at 2 years and 40% at 5 years of all patients treated for ISR using Absorb. ScTs were observed in six (8.4%) of the cohort at 5 years. Conclusions Treatment of ISR using the everolimus-eluting BRS Absorb resulted in high rates of DOCE at 5 years. Interestingly, while event rates were low in the first year, there was a massive increase of DOCE between 1 and 5 years after scaffold implantation. With respect to its complexity, involving also a more unpredictable vascular healing process, current and future BRS should be used very restrictively for the treatment of ISR.
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Affiliation(s)
- Mehdi Madanchi
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Mathias Wolfrum
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Thomas Seiler
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Luca Vercelli
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Philipp Burkart
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
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Kofler T, Kurmann R, Lehnick D, Cioffi GM, Chandran S, Attinger-Toller A, Toggweiler S, Kobza R, Moccetti F, Cuculi F, Jolly SS, Bossard M. Colchicine in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Am Heart Assoc 2021; 10:e021198. [PMID: 34369166 PMCID: PMC8475038 DOI: 10.1161/jaha.121.021198] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inflammation plays a pivotal role in coronary artery disease (CAD). The anti‐inflammatory drug colchicine seems to reduce ischemic events in patients with CAD. So far there is equipoise about its safety and impact on mortality. Methods and Results To evaluate the utility of colchicine in patients with acute and chronic CAD, we performed a systematic review and meta‐analysis. MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from January 1975 to October 2020. Randomized trials assessing colchicine compared with placebo/standard therapy in patients with CAD were included. Data were combined using random‐effects models. The reliability of the available data was tested using trial sequential analyses . Of 3108 citations, 13 randomized trials (n=13 125) were included. Colchicine versus placebo/standard therapy in patients with CAD reduced risk of myocardial infarction (odds ratio [OR] 0.64; 95% CI, 0.46–0.90; P=0.01; I2 41%) and stroke/transient ischemic attack (OR 0.50; 95% CI, 0.31–0.81; P=0.005; I2 0%). But treatment with colchicine compared with placebo/standard therapy had no influence on all‐cause and cardiovascular mortality (OR 0.96; 95% CI, 0.65–1.41; P=0.83; I2 24%; and OR 0.82; 95% CI, 0.55–1.22; P=0.45; I2 0%, respectively). Colchicine increased the risk for gastrointestinal side effects (P<0.001). According to trial sequential analyses, there is only sufficient evidence for a myocardial infarction risk reduction with colchicine. Conclusions Among patients with CAD, colchicine reduces the risk of myocardial infarction and stroke, but has a higher rate of gastrointestinal upset with no influence on all‐cause mortality.
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Affiliation(s)
- Thomas Kofler
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Reto Kurmann
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Dirk Lehnick
- Department of Biostatistics and Methodology CTU-CS University of Lucerne Lucerne Switzerland
| | | | - Sujay Chandran
- Royal Sussex County Hospital Sussex Worthing United Kingdom
| | | | - Stefan Toggweiler
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Richard Kobza
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Federico Moccetti
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Florim Cuculi
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Sanjit S Jolly
- McMaster UniversityHamilton Health Sciences Hamilton Ontario Canada
| | - Matthias Bossard
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
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Schlotter F, Miura M, Kresoja KP, Alushi B, Alessandrini H, Attinger-Toller A, Besler C, Biasco L, Braun D, Brochet E, Connelly K, de Bruijn S, Denti P, Estévez-Loureiro R, Fam NP, Gavazzoni M, Himbert D, Ho E, Juliard JM, Kalbacher D, Kaple R, Kreidel F, Latib A, Lubos E, Ludwig S, Mehr M, Monivas V, Nazif T, Nickenig G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Rommel KP, Schäfer U, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, Vahanian A, von Bardeleben R, von Roeder M, Webb J, Weber M, Wild MG, Windecker S, Zuber M, Hausleiter J, Maisano F, Leon MB, Hahn RT, Lauten A, Taramasso M, Lurz P. Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis. EUROINTERVENTION 2021; 17:e343-e352. [PMID: 33956637 PMCID: PMC9724849 DOI: 10.4244/eij-d-21-00191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown. AIMS The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function. METHODS We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality. RESULTS TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57). CONCLUSIONS TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mizuki Miura
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Brunilda Alushi
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | | | | | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Neil P. Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | | | | | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Georg Nickenig
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Alberto Pozzoli
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Schäfer
- Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marcel Weber
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | - Mirjam G. Wild
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | | | - Martin B. Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Alexander Lauten
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maurizio Taramasso
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
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Grebmer C, Kobza R, Attinger-Toller A. Remote diagnosis of ischaemia driven ventricular fibrillation. Europace 2021; 24:180. [PMID: 34148092 DOI: 10.1093/europace/euab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
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Attinger-Toller A, Ferrari E, Tueller D, Templin C, Muller O, Nietlispach F, Toggweiler S, Noble S, Roffi M, Jeger R, Huber C, Carrel T, Pilgrim T, Wenaweser P, Togni M, Cook S, Heg D, Windecker S, Goy JJ, Stortecky S. Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry. JACC Cardiovasc Interv 2021; 14:952-960. [PMID: 33865734 DOI: 10.1016/j.jcin.2021.01.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/07/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study. BACKGROUND TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups. METHODS Data from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios. RESULTS Between February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [HRadj]: 1.45; 95% confidence interval [CI]: 1.18 to 1.77; 1-year HRadj: 1.12; 95% CI: 1.01 to 1.24), cerebrovascular accidents (30-day HRadj: 1.35; 95% CI: 1.09 to 1.66; 1-year HRadj: 1.21; 95% CI: 1.02 to 1.45), and pacemaker implantation (30-day HRadj: 1.23; 95% CI: 1.12 to 1.34; 1-year HRadj: 1.19; 95% CI: 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI: 9.06 to 17.58), 4.09 (95% CI: 3.56 to 4.74), 1.63 (95% CI: 1.50 to 1.78), and 0.93 (95% CI: 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ≥90 years of age, respectively. CONCLUSIONS Increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250).
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Affiliation(s)
| | - Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland; University Heart Center, Zurich, Switzerland
| | - David Tueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabian Nietlispach
- Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
| | | | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Raban Jeger
- Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Heart Clinic Hirslanden, Zurich, Switzerland
| | - Mario Togni
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland; Department of Cardiology, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland; Department of Cardiology, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland; Department of Cardiology, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Moccetti F, Wolfrum M, Bossard M, Attinger-Toller A, Berte B, Cuculi F, Kobza R, Toggweiler S. Reduction of MANTA-associated vascular complications after implementation of key insights on failure mechanisms. Catheter Cardiovasc Interv 2021; 98:E462-E465. [PMID: 33847463 DOI: 10.1002/ccd.29696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/02/2020] [Revised: 02/01/2021] [Accepted: 03/23/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Report MANTA-associated vascular complications after implementation of key insights on failure mechanisms. BACKGROUND The MANTA vascular closure device is utilized to close large-bore arterial access sites. We have previously identified and published the mechanisms and predictors of MANTA-associated vascular complications. We identified three distinct mechanisms leading to MANTA-associated vascular complications, predictors were a common femoral artery (CFA) diameter <6 mm and clinically established peripheral artery disease (PAD). METHODS We compared 100 consecutive patients of the initial cohort (first n = 100) with consecutive patients in which the key insights acquired in the initial cohort were implemented (second n = 100). RESULTS The initial cohort (n = 100 patients) had a MANTA-related vascular complication rate of 11% (7% major and 4% minor), and 14% MANTA-related bleeding complications. In a subsequent cohort of n = 100 patients, we applied the abovementioned findings: we did not use the MANTA device if the CFA was <6 mm and in patients with PAD. In addition, femoral puncture was ultrasound guided. This strategy led to a decline in MANTA-related vascular complication rates: 2% (1% major and 1% minor) p = .03, as well as a reduction in MANTA-related bleeding complications to 5% p = .01. To the best of our knowledge, this is the lowest rate of MANTA-related vascular complication reported thus far. CONCLUSIONS Our strategy achieves low MANTA-related vascular and bleeding complication rates. Careful and critical examination of complications can lead to rapid identification of complication mechanism and its predictors. In turn, rapid implementation of these insights can lead to a decline in complication rates.
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Affiliation(s)
| | | | | | | | | | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Cardiology, Lucerne, Switzerland
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31
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Muntané-Carol G, Taramasso M, Miura M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Lubos E, Ludwig S, Kalbacher D, Estevez-Loureiro R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Harr C, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Philippon F, Praz F, Puri R, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Andreas M, Russo M, Thiele H, Unterhuber M, Himbert D, Urena M, von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension: Insights From the TriValve Registry. Circ Cardiovasc Interv 2021; 14:e009685. [PMID: 33541097 DOI: 10.1161/circinterventions.120.009685] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. METHODS This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. RESULTS Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2-12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002-1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22-4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17-3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I-II in 66% versus 7% at baseline, P<0.001). CONCLUSIONS In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03416166.
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Affiliation(s)
- Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mizuki Miura
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Hannes Alessandrini
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.)
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland (L.B., G.P.)
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy (P.D.)
| | - Florian Deuschl
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Edith Lubos
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Sebastian Ludwig
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Daniel Kalbacher
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Rodrigo Estevez-Loureiro
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Christian Frerker
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.).,Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Jean-Michel Juliard
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, NY (R.K.)
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Germany (F.K., R.S.V.B.)
| | - Claudia Harr
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany (A. Lauten)
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | | | - François Philippon
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Ulrich Schäfer
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany (J.S.)
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY (G.H.L.T.)
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.).,Cardiology Department (A.A.K.), University of Bern, Switzerland.,Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland (A.A.K.)
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Marina Urena
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada (A.A.-T., J.G.W.)
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
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Brinkert M, De Boeck B, Stämpfli SF, Wolfrum M, Moccetti F, Attinger-Toller A, Bossard M, Cuculi F, Kobza R, Toggweiler S. Predictors of paravalvular leak following implantation of the ACURATE neo transcatheter heart valve: the PREDICT PVL study. Open Heart 2020; 7:openhrt-2020-001391. [PMID: 33243930 PMCID: PMC7692991 DOI: 10.1136/openhrt-2020-001391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/05/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Report predictors and the natural course of paravalvular leak (PVL) following implantation of the ACURATE neo transcatheter heart valve (THV). Background Understanding the mechanisms of PVL may help to improve patient selection, patient outcomes and the design of next-generation THVs. Methods A total of 30 patients (mean age 81±5 years, 47% women) undergoing transcatheter aortic valve replacement with the ACURATE neo were enrolled in the PREDICT PVL study. The effective regurgitant orifice area (EROA, in mm2) of PVL was assessed by transthoracic and transoesophageal echocardiography before discharge and at 6 months follow-up. Results PVL was none/trace in 10 (33%), mild in 18 (60%) and moderate in 2 (7%) patients and occurred in distinct locations with largest EROAs in the area of the left coronary cusp and its adjacent commissures. Independent predictors for EROA were implantation depth (r coefficient −1.9 mm2 per mm implantation depth, p=0.01), leaflet calcification (6.2 mm2 per calcification grade, p=0.03) and THV size L (7.6 mm2 more than size S or M, p=0.01). At 6 months follow-up, EROA decreased by 29% from 13.7±9.7 mm2 to 9.5±7.9 mm2 (p<0.01). Patients with smaller EROAs were more likely to be in New York Heart Association class 1 than patients with larger EROAs (p<0.01). Conclusions PVL occurred predominantly in the region of the left coronary cusp and decreased by 29% during 6 months of follow-up. Our results underscore the importance of adequate patient selection and optimal implantation depth.
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Affiliation(s)
- Miriam Brinkert
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Bart De Boeck
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Simon F Stämpfli
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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Schukraft S, Carrel T, Togni M, Attinger-Toller A. Two ticking time bombs: giant coronary artery aneurysm and abdominal aortic aneurysm in the setting of urgent vascular surgery-a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33426462 PMCID: PMC7780498 DOI: 10.1093/ehjcr/ytaa232] [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] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/27/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Background Giant coronary artery aneurysms (CAAs) are rare and treatment strategies various, especially in the setting of a concomitant abdominal aortic aneurysm (AAA) which needs urgent repair. Case summary A 78-year-old Caucasian male was admitted for evaluation of a rapidly expanding AAA. In addition, computed tomography angiography revealed a 5 x 4 cm giant aneurysm of the right coronary artery. After interdisciplinary discussion, the patient underwent aorto-bi-iliac bypass grafting first. In a second step, CAA was successfully excluded and coronary artery bypass grafting of the right coronary artery was performed. Discussion Treatment strategy of CAA and timing of non-cardiac surgery is challenging. In order to minimize the overall risk of rupture interdisciplinary discussion is crucial. In our case, aorto-bi-iliac bypass grafting was safely performed, and the patient underwent successful CAA excision in a second step.
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Affiliation(s)
- Sara Schukraft
- Department of Cardiology, University and Hospital Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
| | - Thierry Carrel
- Heart and Vascular Surgery, University Hospital of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Mario Togni
- Department of Cardiology, University and Hospital Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
| | - Adrian Attinger-Toller
- Department of Cardiology, University and Hospital Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
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Miura M, Alessandrini H, Alkhodair A, Attinger-Toller A, Biasco L, Lurz P, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Loureiro R, Fam N, Frerker C, Gavazzoni M, Hausleiter J, Himbert D, Ho E, Juliard JM, Kaple R, Besler C, Kodali S, Kreidel F, Kuck KH, Latib A, Lauten A, Monivas V, Mehr M, Muntané-Carol G, Nazif T, Nickenig G, Pedrazzini G, Philippon F, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GH, Thiele H, Rommel KP, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Leon MB, Maisano F, Hahn RT, Taramasso M. Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2020; 13:1999-2009. [DOI: 10.1016/j.jcin.2020.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
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35
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Schukraft S, Puricel S, Togni M, Attinger-Toller A, Cook S. Spontaneous Recanalization of Coronary Thrombus in a Patient With Polycythemia Vera. JACC Case Rep 2020; 2:497-498. [PMID: 34317274 PMCID: PMC8311606 DOI: 10.1016/j.jaccas.2019.12.034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
Spontaneous recanalized coronary thrombi (SRCT), a rare and under-diagnosed entity, are old thrombus formations characterized by multiple communicating channels. We report the case of a 72-year-old female patient who presented with SRCT in the context of polycythemia vera. Optical coherence tomography (OCT) is the diagnostic method of choice. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | | | | | | | - Stéphane Cook
- Address for correspondence: Prof. Stéphane Cook, Cardiology, University and Hospital Fribourg, Chemin des Pensionnats 2-6, Fribourg, Switzerland.
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Webb JG, Murdoch DJ, Boone RH, Moss R, Attinger-Toller A, Blanke P, Cheung A, Hensey M, Leipsic J, Ong K, Sathananthan J, Wood DA, Ye J, Tartara P. Percutaneous Transcatheter Mitral Valve Replacement: First-in-Human Experience With a New Transseptal System. J Am Coll Cardiol 2020; 73:1239-1246. [PMID: 30898198 DOI: 10.1016/j.jacc.2018.12.065] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/14/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Severe mitral regurgitation (MR) conveys significant morbidity and mortality, and surgical repair or replacement may not be a desirable option. OBJECTIVES The purpose of this study was to evaluate the feasibility of a percutaneous transseptal transcatheter mitral valve replacement (TMVR) system. METHODS This first-in-human study was conducted between August 2017 and August 2018. The system comprises a nitinol dock, which encircles the chordae tendineae, and a balloon-expandable transcatheter heart valve. The dock and transcatheter heart valve form an ensemble, with the native mitral valve leaflets secured in between, thereby abolishing MR. Key inclusion criteria were severe symptomatic MR and high surgical risk; exclusion criteria included left ventricular ejection fraction <30% or screening suggesting unfavorable anatomy. The primary endpoint was technical success as defined by Mitral Valve Academic Research Consortium (MVARC) criteria at completion of the index procedure. The secondary endpoint was freedom from mortality, stroke, and device dysfunction (MR grade >1, mitral gradient >6 mm Hg, left ventricular outflow tract gradient >20 mm Hg) at 30 days. RESULTS Ten patients with severe MR of various etiologies (4 degenerative, 4 functional, and 2 mixed) were treated. The device was successfully implanted and the primary endpoint was achieved in 9 of 10 patients (90%). By transesophageal echocardiography, total MR was reduced to ≤ trivial in all implanted patients, and mean transmitral gradient was 2.3 ± 1.4 mm Hg. A pericardial effusion occurred in 1 patient: pericardiocentesis was performed, and the device was not implanted. Median length of hospital stay was 1.5 days. At 30 days, there was no stroke, myocardial infarction, rehospitalization, left ventricular outflow tract obstruction, device migration, embolization, or conversion to mitral surgery. One patient had recurrent regurgitation due to a paravalvular leak, treated with a closure device. All other treated patients had ≤1+ MR. No patients died. CONCLUSIONS Percutaneous transvenous transseptal TMVR is feasible and safe in patients with severe MR who are at high risk for mitral valve surgery. Further evaluation is warranted.
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Affiliation(s)
- John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert H Boone
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Moss
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Attinger-Toller
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Ong
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paolo Tartara
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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Witberg G, Shamekhi J, Van Mieghem NM, Ferrero-Guadagnoli A, Soendergaard L, Dvir D, Latib A, Testa L, Guerrero M, Piazza N, Bleiziffer S, Webb JG, Barbash I, Finkelstein A, Makkar R, Mylotte D, Sinning JM, El Faquir N, Masiano F, De Backer O, Birs A, Lanzillo G, Bedogni F, Iftikhar O, Pighi M, Deutsch MA, Attinger-Toller A, Maor E, Rozenbaum Z, Yoon SH, Neylon A, Kornowski R. Transcatheter Aortic Valve Replacement Outcomes in Patients With Native vs Transplanted Kidneys: Data From an International Multicenter Registry. Can J Cardiol 2019; 35:1114-1123. [DOI: 10.1016/j.cjca.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022] Open
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McNabney CG, Sellers SL, Wilson RJA, Hart S, Rosenblatt SA, Murphy DT, Blanke P, Ahmadi AA, Halankar J, Attinger-Toller A, Godoy Zamorano M, Li Yu JW, Nørgaard BL, Leipsic JA, Weir-McCall JR. Prognosis of CT-derived Fractional Flow Reserve in the Prediction of Clinical Outcomes. Radiol Cardiothorac Imaging 2019; 1:e190021. [PMID: 33778504 DOI: 10.1148/ryct.2019190021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/27/2019] [Accepted: 04/16/2019] [Indexed: 11/11/2022]
Abstract
Purpose To examine the prognostic implication of fractional flow reserve (FFR) derived from coronary CT (FFRCT) in routine clinical practice. Materials and Methods Patients referred for FFRCT analysis at a single center between October 2015 and June 2017 were retrospectively included and followed up for rates of invasive angiography and clinical events. Two hundred seven patients underwent successful FFRCT analysis with seven lost to follow-up, leaving 200 (mean age ± standard deviation, 62.4 years ± 10.0; 49 [24.5%] women) patients for analysis. At coronary CT angiography, patients were categorized as having significant stenosis (SS) in the presence of a diameter stenosis greater than or equal to 50% (hereafter, SS positive) and flow limitation in the presence of a postlesion (that is, FFRCT measured 2 cm to the distal aspect of the lesion) FFRCT less than 0.80 (hereafter, FFRCT positive). Vessel-oriented clinical events (VOCEs) were defined as vessel-related late revascularization (>90 days), myocardial infarction, and cardiac mortality. Results At CT angiography, 130 (65%) studies were SS positive and 63 (31.5%) were FFRCT positive. At median follow-up of 477 days (range, 252-859 days), there were 26 VOCE end points in 22 patients: 22 revascularizations and four nonfatal myocardial infarctions. VOCE end points occurred in zero of 58 (0%) of SS-negative and FFRCT negative patients, in eight of 79 (10.1%) of SS-positive and FFRCT-negative patients, in zero of 12 (0%) of SS-negative and FFRCT-positive patients, and in 18 of 51 (35.3%) of SS-positive and FFRCT-positive patients (log-rank χ2 = 30.1; P < .001). At multivariable Cox regression, both FFRCT (hazard ratio per 0.1 decrease, 1.54 [95% confidence interval: 1.1, 2.2] P = .013) and stenosis (hazard ratio per unit increase, 2.16 [95% confidence interval: 1.25, 3.72] P = .006) were independently associated with VOCE. Conclusion Stenosis and FFRCT are independent predictors of intermediate-term outcomes. In the absence of a stenosis greater than 50%, a positive FFRCT result is not associated with an increased intermediate risk.© RSNA, 2019Supplemental material is available for this article.See also commentary by Fairbairn and Bull in this issue.
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Affiliation(s)
- Charis G McNabney
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Stephanie L Sellers
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Ryan J A Wilson
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Shmuel Hart
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Samuel A Rosenblatt
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Darra T Murphy
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Philipp Blanke
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Amir A Ahmadi
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Jaydeep Halankar
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Adrian Attinger-Toller
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Marcelo Godoy Zamorano
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Janice Wong Li Yu
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Bjarne L Nørgaard
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Jonathon A Leipsic
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
| | - Jonathan R Weir-McCall
- Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.)
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Attinger-Toller A, Htun NM, Murdoch D, Perlman GY, Alenezi A, Sathananthan J, Blanke P, Leipsic J, Thompson C, Ye J, Cheung A, Wood D, Webb JG. Transcatheter aortic valve-in-valve implantation for failed surgical bioprosthetic valves. A minimalist approach without contrast aortography or echocardiographic guidance. Catheter Cardiovasc Interv 2019; 95:45-53. [PMID: 31038290 DOI: 10.1002/ccd.28299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/03/2019] [Accepted: 04/04/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To demonstrate safety, feasibility and short-term clinical outcomes after transcatheter aortic valve-in-valve (ViV) implantation under local anesthesia without contrast aortography or echocardiographic guidance. BACKGROUND Transcatheter ViV implantation is an emerging treatment modality for patients with degenerative surgical bioprostheses. Given the radiopaque properties of the surgical aortic valve (SAV) frame, ViV procedures can often be performed with fluoroscopic guidance alone. METHODS ViV implantation was performed in 37 patients with SAV failure under local anesthesia without contrast aortography. Clinical and echocardiographic data were obtained at baseline, discharge, and 30 days. RESULTS Mean age was 74 ± 10 years and STS predicted risk of mortality was 5.6 ± 2.4%. Mean transaortic gradient decreased from 39.4 ± 15.5 mmHg to 13 ± 6.3 mmHg at discharge (p < .001), and 20 ± 7.5 mmHg at 30 days (p < .001 compared to baseline), aortic valve area increased from 0.9 ± 0.3 cm2 to 1.2 ± 0.4 cm2 at 30 days (p = .007). No patient had more than mild aortic regurgitation. Hospital discharge occurred at a median of 2.6 ± 4.4 days. At 30-day follow-up there were no deaths, myocardial infarctions, strokes, repeat hospital admissions for heart failure, or renal failure. One patient (2.7%) required a new pacemaker. 93% of the patients were in New York Heart Association functional class I or II. CONCLUSIONS Transcatheter aortic ViV implantation for selected patients with degenerative surgical bioprostheses under local anesthesia without aortography or echocardiographic guidance is feasible and safe.
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Affiliation(s)
| | - Nay M Htun
- Department of Cardiology, Alfred Hospital and Frankston Hospital, Melbourne, Australia
| | - Dale Murdoch
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre For Heart Valve Innovation, the University of Queensland, Brisbane, Australia
| | - Gidon Y Perlman
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Abdullah Alenezi
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Philipp Blanke
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christopher Thompson
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David Wood
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
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41
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Taramasso M, Alessandrini H, Latib A, Asami M, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, Denti P, Deuschl F, Englmeier A, Fam N, Frerker C, Hausleiter J, Himbert D, Ho EC, Juliard JM, Kaple R, Kreidel F, Kuck KH, Ancona M, Lauten A, Lurz P, Mehr M, Nazif T, Nickening G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Sievert K, Tang GH, Tanner FC, Vahanian A, Webb JG, Windecker S, Yzeiray E, Zuber M, Maisano F, Leon MB, Hahn RT. Outcomes After Current Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2019; 12:155-165. [DOI: 10.1016/j.jcin.2018.10.022] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
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Taramasso M, Hahn RT, Alessandrini H, Latib A, Attinger-Toller A, Braun D, Brochet E, Connelly KA, Denti P, Deuschl F, Englmaier A, Fam N, Frerker C, Hausleiter J, Juliard JM, Kaple R, Kreidel F, Kuck KH, Kuwata S, Ancona M, Malasa M, Nazif T, Nickenig G, Nietlispach F, Pozzoli A, Schäfer U, Schofer J, Schueler R, Tang G, Vahanian A, Webb JG, Yzeiraj E, Maisano F, Leon MB. The International Multicenter TriValve Registry. JACC Cardiovasc Interv 2017; 10:1982-1990. [DOI: 10.1016/j.jcin.2017.08.011] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
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Affiliation(s)
- John G Webb
- Cardiology Division, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adrian Attinger-Toller
- Cardiology Division, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Haener J, Fuerholz M, Cherni T, Koskinas K, Piccolo R, Streit S, Praz F, Shakir S, Attinger-Toller A, Nietlispach F, Valgimigli M, Meier B, Windecker S, Gloekler S. P4891Procedural safety and long-term clinical outcome of left atrial appendage closure according to predefined stroke risk. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4891] [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] [Indexed: 11/12/2022] Open
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45
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Obeid S, Attinger-Toller A, Taramasso M, Pedrazzini G, Suetsch G, Landolt F, Karbeyaz F, Rodriguez H, Sürder D, Moccetti T, Nietlispach F, Maisano F. SYNTAX score II in patients with coronary artery disease undergoing percutaneous mitral repair with the MitraClip. Int J Cardiol 2017; 236:375-380. [DOI: 10.1016/j.ijcard.2017.02.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
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Coppetti T, Brauchlin A, Müggler S, Attinger-Toller A, Templin C, Schönrath F, Hellermann J, Lüscher TF, Biaggi P, Wyss CA. Accuracy of smartphone apps for heart rate measurement. Eur J Prev Cardiol 2017; 24:1287-1293. [PMID: 28464700 DOI: 10.1177/2047487317702044] [Citation(s) in RCA: 87] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Smartphone manufacturers offer mobile health monitoring technology to their customers, including apps using the built-in camera for heart rate assessment. This study aimed to test the diagnostic accuracy of such heart rate measuring apps in clinical practice. Methods The feasibility and accuracy of measuring heart rate was tested on four commercially available apps using both iPhone 4 and iPhone 5. 'Instant Heart Rate' (IHR) and 'Heart Fitness' (HF) work with contact photoplethysmography (contact of fingertip to built-in camera), while 'Whats My Heart Rate' (WMH) and 'Cardiio Version' (CAR) work with non-contact photoplethysmography. The measurements were compared to electrocardiogram and pulse oximetry-derived heart rate. Results Heart rate measurement using app-based photoplethysmography was performed on 108 randomly selected patients. The electrocardiogram-derived heart rate correlated well with pulse oximetry ( r = 0.92), IHR ( r = 0.83) and HF ( r = 0.96), but somewhat less with WMH ( r = 0.62) and CAR ( r = 0.60). The accuracy of app-measured heart rate as compared to electrocardiogram, reported as mean absolute error (in bpm ± standard error) was 2 ± 0.35 (pulse oximetry), 4.5 ± 1.1 (IHR), 2 ± 0.5 (HF), 7.1 ± 1.4 (WMH) and 8.1 ± 1.4 (CAR). Conclusions We found substantial performance differences between the four studied heart rate measuring apps. The two contact photoplethysmography-based apps had higher feasibility and better accuracy for heart rate measurement than the two non-contact photoplethysmography-based apps.
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Affiliation(s)
- Thomas Coppetti
- 1 University Heart Center, University Hospital of Zurich, Switzerland
| | - Andreas Brauchlin
- 1 University Heart Center, University Hospital of Zurich, Switzerland
| | - Simon Müggler
- 1 University Heart Center, University Hospital of Zurich, Switzerland
| | | | - Christian Templin
- 1 University Heart Center, University Hospital of Zurich, Switzerland
| | - Felix Schönrath
- 2 Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.,3 DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Jens Hellermann
- 4 Department of Internal Medicine and Cardiology, Schiers, Switzerland
| | - Thomas F Lüscher
- 1 University Heart Center, University Hospital of Zurich, Switzerland
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Kuwata S, Taramasso M, Zuber M, Suetsch G, Attinger-Toller A, Wicki D, Maisano F, Nietlispach F. Feasibility of concomitant MitraClip and left atrial appendage occlusion. EUROINTERVENTION 2017; 12:1940-1945. [DOI: 10.4244/eij-d-16-00784] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yoon JN, Frangieh AH, Attinger-Toller A, Gruner C, Tanner FC, Taramasso M, Corti R, Lüscher TF, Ruschitzka F, Bettex D, Maisano F, Gaemperli O. Changes in serum biomarker profiles after percutaneous mitral valve repair with the MitraClip system. Cardiol J 2016; 23:384-92. [DOI: 10.5603/cj.a2016.0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/10/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022] Open
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Wolfrum M, Attinger-Toller A, Shakir S, Gloekler S, Seifert B, Moschovitis A, Khattab A, Maisano F, Meier B, Nietlispach F. Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome. Catheter Cardiovasc Interv 2016; 88:656-664. [DOI: 10.1002/ccd.26646] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/15/2015] [Accepted: 06/04/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Mathias Wolfrum
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| | | | - Samera Shakir
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Steffen Gloekler
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology; Biostatistics and Prevention Institute, University of Zurich; Zurich Switzerland
| | - Aris Moschovitis
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Ahmed Khattab
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Francesco Maisano
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| | - Bernhard Meier
- Department of Cardiology; Bern University Hospital; Bern Switzerland
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Attinger-Toller A, Maisano F, Senn O, Taramasso M, Shakir S, Possner M, Gloekler S, Windecker S, Stortecky S, Lüscher TF, Meier B, Nietlispach F. “One-Stop Shop”. JACC Cardiovasc Interv 2016; 9:1487-95. [DOI: 10.1016/j.jcin.2016.04.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
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