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Pagnesi M, Kim WK, Baggio S, Scotti A, Barbanti M, De Marco F, Adamo M, Eitan A, Estévez-Loureiro R, Conradi L, Toggweiler S, Mylotte D, Veulemans V, Søndergaard L, Wolf A, Giannini F, Maffeo D, Pilgrim T, Montorfano M, Zweiker D, Ferlini M, Kornowski R, Hildick-Smith D, Taramasso M, Abizaid A, Schofer J, Sinning JM, Van Mieghem NM, Wöhrle J, Khogali S, Van der Heyden JAS, Wood DA, Ielasi A, MacCarthy P, Brugaletta S, Hamm CW, Costa G, Testa L, Massussi M, Alarcón R, Schäfer U, Brunner S, Reimers B, Lunardi M, Zeus T, Vanhaverbeke M, Naber CK, Di Ienno L, Buono A, Windecker S, Schmidt A, Lanzillo G, Vaknin-Assa H, Arunothayaraj S, Saccocci M, Siqueira D, Brinkmann C, Sedaghat A, Ziviello F, Seeger J, Rottbauer W, Brouwer J, Buysschaert I, Jelisejevas J, Bharucha A, Regueiro A, Metra M, Colombo A, Latib A, Mangieri A. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv 2023; 16:2004-2017. [PMID: 37480891 DOI: 10.1016/j.jcin.2023.05.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV). BACKGROUND Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI. METHODS This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated. RESULTS New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049). CONCLUSIONS New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | | | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany; MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Jan A S Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - David A Wood
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mauro Massussi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Stephanie Brunner
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matteo Saccocci
- Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Julia Seeger
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Julius Jelisejevas
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
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Di Giacomo C, Cornara S, Aiello M, Lanzillo G, Somaschini A, Gazzoli F, Belliato M, Visconti LO, Pelenghi S, Ferlini M. Neutrophil-to-lymphocyte ratio in patients undergoing transfemoral transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2023; 24:478-479. [PMID: 37285279 DOI: 10.2459/jcm.0000000000001478] [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: 06/09/2023]
Affiliation(s)
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
| | - Marco Aiello
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
| | - Fabrizio Gazzoli
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Mirko Belliato
- AR2 Anestesia e Terapia Intensiva Cardiotoracica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Stefano Pelenghi
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
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Bruno F, Munoz Pousa I, Saia F, Vaira MP, Baldi E, Leone PP, Cabanas-Grandio P, Corcione N, Spinoni EG, Annibali G, Russo C, Ziacchi M, Caruzzo CA, Ferlini M, Lanzillo G, De Filippo O, Dusi V, Gallone G, Castagno D, Patti G, La Torre M, Musumeci G, Giordano A, Stefanini G, Salizzoni S, Conrotto F, Rinaldi M, Rordorf R, Abu-Assi E, Raposeiras-Roubin S, Biffi M, D'Ascenzo F, De Ferrari GM. Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation. JACC Cardiovasc Interv 2023; 16:1081-1091. [PMID: 37164607 DOI: 10.1016/j.jcin.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/31/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Long-term right ventricular pacing (VP) has been related to negative left ventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients. OBJECTIVES The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR. METHODS PACE-TAVI is an international multicenter registry of all consecutive TAVR patients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF. RESULTS A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP ≥40%. After multivariable adjustment, VP ≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P = 0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P = 0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P = 0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80-5.90; P = 0.13). Patients with VP ≥ 40% showed a higher New York Heart Association functional class both at 1 year (P = 0.009) and at last available follow-up (P = 0.04) and a nonsignificant reduction of left ventricular ejection fraction (P = 0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P = 0.009). CONCLUSIONS In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization. These findings suggest the opportunity to minimize right VP through dedicated algorithms in post-TAVR patients without complete atrioventricular block and to evaluate a more physiological VP modality in patients with persistent complete atrioventricular block.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy.
| | - Isabel Munoz Pousa
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Pio Vaira
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Rome, Italy
| | - Enrico Guido Spinoni
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Gianmarco Annibali
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Caterina Russo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Alberto Caruzzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Michele La Torre
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Giuseppe Musumeci
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Rome, Italy
| | - Giulio Stefanini
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Roberto Rordorf
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | - Mauro Biffi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
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Baggio S, Pagnesi M, Kim WK, Scotti A, Barbanti M, Costa G, Adamo M, Kornowski R, Vaknin Assa H, Estévez-Loureiro R, Cedeño RA, De Marco F, Casenghi M, Toggweiler S, Veulemans V, Mylotte D, Lunardi M, Regazzoli D, Reimers B, Sondergaard L, Vanhaverbeke M, Nuyens P, Maffeo D, Buono A, Saccocci M, Giannini F, Di Ienno L, Ferlini M, Lanzillo G, Ielasi A, Schofer J, Brinkmann C, Van Der Heyden J, Buysschaert I, Eitan A, Wolf A, Adamaszek MM, Colombo A, Latib A, Mangieri A. Comparison of transcatheter aortic valve replacement with the ACURATE neo2 versus Evolut PRO/PRO+ devices. EUROINTERVENTION 2023; 18:977-986. [PMID: 36093795 PMCID: PMC9853030 DOI: 10.4244/eij-d-22-00498] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 06/03/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The ACURATE neo2 (NEO2) and Evolut PRO/PRO+ (PRO) bioprostheses are new-generation self-expanding valves developed for transcatheter aortic valve replacement (TAVR). AIMS We sought to compare the performance of the ACURATE neo2 and Evolut PRO/PRO+ devices. METHODS The NEOPRO-2 registry retrospectively included patients who underwent TAVR for severe aortic stenosis with either the NEO2 or PRO devices between August 2017 and December 2021 at 20 centres. In-hospital and 30-day Valve Academic Research Consortium (VARC)-3 defined outcomes were evaluated. Propensity score (PS) matching and binary logistic regression were performed to adjust the treatment effect for PS quintiles. A subgroup analysis assessed the impact of aortic valve calcification. RESULTS A total of 2,175 patients (NEO2: n=763; PRO: n=1,412) were included. The mean age was 82±6.2 years and the mean Society of Thoracic Surgeons score was 4.2%. Periprocedural complications were low, and both groups achieved high rates of technical success (93.1% vs 94.1%; p=0.361) and predischarge intended valve performance (96.0% vs 94.1%; p=0.056), both in the unmatched and matched analysis (452 pairs). Device success at 30 days was comparable (84.3% vs 83.6%; p=0.688), regardless of aortic valve calcification severity (p>0.05 for interaction). A suggestion for higher VARC-3 early safety in the NEO2 group was mainly driven by reduced rates of new permanent pacemaker implantation (7.7% vs 15.6%; p<0.001). CONCLUSIONS This retrospective analysis reports a similar short-term performance of the ACURATE neo2 platform compared with the new-generation Evolut PRO/PRO+ devices. Randomised studies are needed to confirm our exploratory findings.
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Affiliation(s)
- Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Matteo Pagnesi
- Cardiothoracic Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy and Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy and Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Robert Alarcón Cedeño
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Darren Mylotte
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Mattia Lunardi
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Clinical Institute Saint Ambrogio, Milan, Italy
| | | | | | | | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Brugge, Belgium
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Alexander Wolf
- Klinik für Kardiologie, Elisabeth-Krankenhaus Essen, Essen, Germany
| | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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5
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Scotti A, Baggio S, Pagnesi M, Barbanti M, Adamo M, Eitan A, Estévez-Loureiro R, Veulemans V, Toggweiler S, Mylotte D, De Marco F, Giannini F, Ferlini M, Naber CK, Buono A, Schofer J, Rottbauer W, Van Mieghem NM, Khogali S, Taramasso M, Pilgrim T, Sinning JM, Zweiker D, Montorfano M, Van der Heyden JAS, Brugaletta S, Ielasi A, Hamm CW, Vanhaverbeke M, Costa G, Massussi M, Alarcón R, Zeus T, Lunardi M, Testa L, Di Ienno L, Lanzillo G, Wolf A, Maffeo D, Ziviello F, Saccocci M, Windecker S, Sedaghat A, Schmidt A, Brouwer J, Regueiro A, Reimers B, Kim WK, Sondergaard L, Colombo A, Mangieri A, Latib A. Temporal Trends and Contemporary Outcomes After Transcatheter Aortic Valve Replacement With Evolut PRO/PRO+ Self-Expanding Valves: Insights From the NEOPRO/NEOPRO-2 Registries. Circ Cardiovasc Interv 2023; 16:e012538. [PMID: 36649387 DOI: 10.1161/circinterventions.122.012538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In recent years, transcatheter aortic valve replacement (TAVR) techniques and technology have continuously improved. Data regarding the impact of these advancements on outcomes in large real-world settings are still limited. The aim of this study was to investigate temporal trends and assess contemporary outcomes after TAVR with Evolut PRO/PRO+ supra-annular self-expanding valves. METHODS This study included patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries who underwent transfemoral TAVR with Evolut PRO/PRO+. Procedural dates (August 2017 through November 2021) were stratified in quartiles (Q) and used to investigate temporal trends in TAVR outcomes. Predischarge, 30-day Valve Academic Research Consortium-3 defined, and 1-year outcomes were evaluated. RESULTS In total, 1616 patients from 28 centers were included. Over time, patients had lower Society of Thoracic Surgeon-Predicted Risk of Mortality score (Q1-4, 4.1% [2.8-6.3%], 3.7% [2.6-5.3%], 3.3% [2.4-4.9%], 2.9% [2.2-4.3%]; P<0.001) and more moderate or heavy valve calcification (Q1-4, 80%, 80%, 82%, 88%; P=0.038). Overall Valve Academic Research Consortium-3 technical success was 94.1%, with 30-day and 1-year all-cause mortality of 2.4% and 10%, respectively. Throughout the study period, procedures were associated with higher rates of 30-day device success (Q1-4, 81.2%, 82.2%, 82.0%, 88.0%; Cochran-Armitage P=0.023) and early safety (Q1-4, 66.8%, 67.5%, 74.0%, 77.6%; Cochran-Armitage P<0.001), with fewer permanent pacemaker implantations (Q1-4: 15.3%, 20.0%, 12.1%, 11.6%; Cochran-Armitage P=0.023) and residual mild or greater paravalvular leaks (Q1-4, 50.4%, 42.1%, 36.5%, 35.8%; Cochran-Armitage P<0.001). CONCLUSIONS TAVR with Evolut PRO/PRO+ self-expanding valve is safe and effective. Despite the treatment of heavier calcified anatomies, procedural outcomes are improving over time with less need for pacemaker implantation and less significant paravalvular leaks.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Matteo Pagnesi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel (A.E.)
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland (S.T.)
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany (J.S.).,MVZ Department Structural Heart Disease, Asklepios St Georg Clinic, Hamburg, Germany (J.S.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Saib Khogali
- Heart and Lung Center, New Cross Hospital, Wolverhampton, UK (S.K.)
| | - Maurizio Taramasso
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.P.)
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (M. Montorfano)
| | - Jan A S Van der Heyden
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.).,Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium (J.A.S.V.d.H.)
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy (A.I.)
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Mauro Massussi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy (L.T.)
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Matteo Saccocci
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Stephan Windecker
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Jorn Brouwer
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.)
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
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Oliveri F, Montalto C, Tua L, Lanzillo G, Compagnoni S, Fasolino A, Gentile FR, Ferlini M, Pepe A, Visconti LO, Bongiorno A, Leonardi S. 757 DIRECT ORAL ANTICOAGULANTS OR VITAMIN K ANTAGONISTS IN AFTER TAVR. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Several patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral anticoagulants, DOACs, or vitamin K antagonists, VKA) is still unclear in this setting.
Method
We performed systematic literature research and meta-analysis in PubMed, Medline, and EMBASE databases for studies reporting either all-cause mortality, major/life-threatening bleeding or stroke events.
Results
Ten observational studies and one randomized controlled trial (RCT), including 29,333 patients, were eligible for inclusion. Compared to VKA, DOACs use after TAVR was associated with a modest but significantly lower rates of all-cause mortality (RR 0.88; 95% CI: 0.78-0.99, p-value 0.04). Total stroke events (RR 0.97; 95% CI: 0.76-1.23, p-value 0.79) and major/life-threatening bleeding (RR 0.94; 95% CI: 0.70-1.27, p-value 0.69) were comparable among the two treatments. In the following sensitivity analysis including observational studies only, results in terms stroke events were consistent (RR 1.00;95% CI: 0.75-1.34, p-value 0.99) . However, the overall mortality was comparable between the two treatments (RR 0.88; 95% CI: 0.77-1.00, p-value 0.99), while major/life-threatening bleeding occurred less in the DOACs group (RR 0.80; 95% CI: 0.68-0.94, p-value 0.006).
Conclusion
Considering the totality of published evidence in TAVR patients with a concomitant indication for OAC, DOACs use was associated with reduced all-cause mortality and comparable major/life-threatening bleeding and stroke events compared to VKA.
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7
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Sticchi A, Gitto M, Pagnesi M, Baggio S, Scotti A, Barbanti M, Costa G, Adamo M, Di Marco F, Casenghi M, Lunardi M, Regazzoli D, Reimers B, Maffeo D, Buono A, Saccocci M, Giannini F, Di Ienno L, Lanzillo G, Ferlini M, Ielasi A, Latib A, Mangieri A, Colombo A. 298 MPACT OF GUIDELINES-ORIENTED AGE CUT-OFF IN INTERMEDIATE TO LOWVRISK PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWEST GENERATION SELF-EXPANDING VALVES: A COMBINED ANALYSIS FROM NEOPRO AND NEOPRO-2 REGISTRIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
While randomized controlled trials have widely shown superiority or non-inferiority of transcatheter aortic valve replacement (TAVR) across the whole spectrum of surgical risks, 2021 ESC guidelines on valvular heart disease provide a class Ia indication for TAVR for patients at high surgical risk or, alternatively, aging >=75 years, irrespective of their surgical risk. Conversely, for patients aging <75 y and at low risk, surgical aortic valve replacement is recommended. Thus, in intermediate-low (IL) risk patients, the 75 y age cut-off is pivotal to guide the choice of intervention. The aim of the present study was to explore the impact on such cut-off on clinical outcomes in a real-world setting.
Methods
Consecutive IL surgical risk patients enrolled in the NEOPRO and NEOPRO-2 registries were included. A 1:1 propensity score matching (PSM) was used to match patients aged >= vs. <75 years old. The primary endpoint was the composite of all-cause death or cardiovascular hospitalizations.
Results
A total of 3642 patients undergoing TAVR with self-expanding transcatheter heart valves (THVs) from 2012 to 2021 were enrolled. After PSM, 484 patients (N=242 in both groups) were included in the final analysis. Mean age was 70.1±5.2 in patients aged <75 y and 81.56±4.18 in those aged >=75 y (p<0.001), while mean Society of Thoracic Surgeon (STS) score was 3.6±2.5%. Implanted THVs were Acurate Neo, Evolut Pro, Acurate Neo 2 and Evolut Pro+ in 199 (41.1%), 188 (38.8%), 73 (15.1%) and 24 (5%) patients respectively, with no between-groups differences. Rates of in-hospital complications were comparable across the two age categories. At 1-year follow-up, the cumulative incidence of all-cause death was 11% in patients aged >=75 y and 13% in those aged <75y (Log-Rank p=0.627); similarly, the composite of all-cause death or cardiovascular hospitalizations occurred in 14% vs. 16% of patients (Log-Rank p=0.554).
Conclusions
TAVI has comparable benefit across age strata in IL risk patients. The age cut-off suggested by current guidelines is not predictive of adverse events during hospital stay, neither of all-cause mortality through a mid-term follow-up. This opens the question to future studies focusing on lifetime management and not age cut-off.
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Affiliation(s)
| | | | - Matteo Pagnesi
- Cardiothoracic Department, Asst Spedali Civili Di Brescia, University Of Brescia , Brescia , Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center For Heart And Vascular Care , Bronx, Ny , Usa
| | - Marco Barbanti
- Division Of Cardiology, A.O.U. Policlinico ”G.Rodolico-San Marco” , Catania , Italy
| | - Giuliano Costa
- Division Of Cardiology, A.O.U. Policlinico ”G.Rodolico-San Marco” , Catania , Italy
| | - Marianna Adamo
- Cardiothoracic Department, Asst Spedali Civili Di Brescia, University Of Brescia , Brescia , Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Azeem Latib
- Montefiore-Einstein Center For Heart And Vascular Care , Bronx, Ny , Usa
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8
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Ferlini M, Munafò AR, Lanzillo G, Aiello M, Gazzoli F, Mirizzi AM, Magrini G, Pelenghi S, Visconti LO. Early surgical aortic valve replacement in asymptomatic patients with severe aortic stenosis: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2022; 23:632-634. [PMID: 35905003 DOI: 10.2459/jcm.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | | | - Giuseppe Lanzillo
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Marco Aiello
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
| | - Fabrizio Gazzoli
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
| | | | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
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9
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Oliveri F, Claudio M, Tua L, Lanzillo G, Compagnoni S, Fasolino A, Gentile FR, Ferlini M, Pepe A, Visconti LO, Bongiorno A, Leonardi S. Direct oral anticoagulants or vitamin K antagonists after TAVR: A systematic review and meta-analysis. Int J Cardiol 2022; 365:123-130. [PMID: 35901908 DOI: 10.1016/j.ijcard.2022.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral anticoagulants, DOACs, or vitamin K antagonists, VKA) is still unclear in this setting. METHOD We performed systematic literature research and meta-analysis in PubMed, Medline, and EMBASE databases for studies reporting either all-cause mortality, major/life-threatening bleeding or stroke events. RESULTS Ten observational studies and two randomized controlled trials (RCTs) including a total of 29,485 patients were eligible for inclusion. Compared to VKA, DOACs use after TAVR was associated with a modest but significantly lower rates of all-cause mortality (RR 0.90; 95% CI: 0.81-0.99, p-value 0.04) with results mainly driven by observational studies. Cardiovascular mortality (RR 1.03; 95% CI: 0.81-1.30; p-value 0.84), total stroke events (RR 0.97; 95% CI: 0.76-1.23, p-value 0.79), major/life-threatening bleeding (RR 0.93; 95% CI: 0.72-1.21, p-value 0.61) and minor bleeding (RR 0.96; 95% CI: 0.74-1.23; p-value 0.72) were similar between VKA and DOACs. CONCLUSION Considering the totality of available evidence, in patients underwent TAVR with a concomitant indication for OAC, DOACs-based strategy is an effective and safe anticoagulation strategy compared to VKA.
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Affiliation(s)
- Federico Oliveri
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.
| | - Montalto Claudio
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Lorenzo Tua
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Sara Compagnoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | | | - Marco Ferlini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Antonella Pepe
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Andrea Bongiorno
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Scelsi L, Lanzillo G, Arbustini E, Armini AD, Greco A, Meloni F, Turco A, Valentini A, Visconti LO, Ghio S. When you hear hoofbeats, think zebras ‐ pulmonary veno‐occlusive disease: a case report. Pulm Circ 2022; 12:e12095. [PMID: 35958437 PMCID: PMC9361796 DOI: 10.1002/pul2.12095] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/14/2022] [Accepted: 05/15/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo Division of Cardiology Pavia IT
| | - Giuseppe Lanzillo
- Fondazione IRCCS Policlinico San Matteo Division of Cardiology Pavia IT
| | - Eloisa Arbustini
- Fondazione IRCCS Policlinico San Matteo Center for Inherited Cardiovascular Diseases Pavia IT
| | - Andrea D Armini
- Fondazione IRCCS Policlinico San Matteo, Department of Cardio‐Thoracic and Vascular Surgery Heart and Lung Transplantation and Pulmonary Hypertension Unit Pavia IT
| | - Alessandra Greco
- Fondazione IRCCS Policlinico San Matteo Division of Cardiology Pavia IT
| | - Federica Meloni
- Fondazione IRCCS Policlinico San Matteo, Respiratory Disease Unit Department of Internal Medicine and Pharmacology Pavia IT
| | - Annalisa Turco
- Fondazione IRCCS Policlinico San Matteo Division of Cardiology Pavia IT
| | - Adele Valentini
- Fondazione IRCCS Policlinico San Matteo Department of Radiology Pavia IT
| | | | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo Division of Cardiology Pavia IT
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11
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Bruno F, Ascenzo FD, Muñoz-Pousa I, Saia F, Vaira MP, Baldi E, Leone PP, Cabanas-Grandio P, Corcione N, Spinoni E, Annibali G, Russo C, Ziacchi M, Caruzzo CA, Ferlini M, Lanzillo G, Filippo OD, Gallone G, Castagno D, Patti G, Musumeci G, Giordano A, Stefanini G, Salizzoni S, Rordorf R, Essi EA, Rubin SR, Biffi M, Conrotto F, Ferrari GMD. 302 Impact of right ventricular pacing in patients with TAVI underwent permanent pacemaker implantation: the Pace-TAVI International Multicentre Study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI) has emerged as a relevant issue, being more frequent than after surgery and the progressive shift towards low-risk patients stressed the importance to reduce the risk of complications that could impact patient’s long-term prognosis. Long-term right ventricular pacing has been related to an increased risk of electromechanical asynchrony, negative left-ventricular remodelling, atrial fibrillation and heart failure, but there is a lack of evidence regarding the prognostic impact on TAVI patients. The aim of this international multicentre study is to assess the impact of right ventricular pacing on prognosis of TAVI patients undergone pacemaker implantation after the procedure due to conduction disorders.
Methods and results
All the consecutive patients with severe aortic stenosis treated with TAVI and subsequently underwent pacemaker implantation in each participating centre were enrolled. Patients were divided into two subgroups according to the percentage of ventricular pacing (VP cut-off: 40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality and hospitalization for heart failure in subgroups based on the percentage of ventricular stimulation. All cause and cardiovascular mortality in the subgroups according to the percentage of ventricular pacing were the secondary endpoints. In total, 427 patients were enrolled, 153 patients with VP < 40% and 274 with a with VP ≥ 40%. Patients with VP ≥ 40% were older (81.16 ± 6.4 years vs. 80.51 ± 6.8 years), with higher NYHA class, a lower EF (55.26 ± 12.2 vs. 57.99 ± 11.3 P = 0.03), an increased end diastolic ventricular volume (112.11 ± 47.6 vs. 96.60 ± 40.4, P = 0.005) and diameter (48.89 ± 9.7 vs. 45.84 ± 7.5 P = 0.01). A higher incidence of moderate post-procedural paravalvular leak was observed in patients with VP ≥ 40% (37.5% vs. 26.85%, P = 0.03). Ventricular pacing ≥40% was associated with a higher incidence of the composite primary endpoint of CV mortality and HF hospitalization (p at log rank test = 0.006, adjusted HR: 2.41; 95% CI: 1.03–5.6; P = 0.04). Patients with ventricular pacing ≥ 40% had also a higher risk of all-cause (p at log rank test = 0.03, adjusted HR = 1.57; 95% CI: 1.03–2.38; P = 0.03) and cardiovascular (p at log ank test =0.008, adjusted HR: 3.77; CI: 1.32–10.78; P = 0.006) mortality compared to patients with a VP < 40%.
Conclusions
TAVI Patients underwent permanent pacemaker implantation after the procedure due to conduction disorders and with a VP ≥ 40% at follow-up are at increased risk of cardiovascular death and HF hospitalizations and of all-cause mortality compared to patients with a VP < 40%. It is mandatory to reduce the percentage of ventricular pacing at follow-up when possible or consider left ventricular branch pacing and biventricular pacing in TAVI patients.
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Affiliation(s)
- Francesco Bruno
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Fabrizio D’ Ascenzo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Isabel Muñoz-Pousa
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Matteo Pio Vaira
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Enrico Baldi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | | | - Pilar Cabanas-Grandio
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Nicola Corcione
- Unita Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Roma, Italy
| | - Enrico Spinoni
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Gianmarco Annibali
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Torino, Italy
| | - Caterina Russo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Carlo Alberto Caruzzo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Marco Ferlini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Lanzillo
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Ovidio De Filippo
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Guglielmo Gallone
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Davide Castagno
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Giuseppe Musumeci
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Torino, Italy
| | - Arturo Giordano
- Unita Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Roma, Italy
| | - Giulio Stefanini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefano Salizzoni
- Dipartimento di Cardiochirurgia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
| | - Roberto Rordorf
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Emad Abu Essi
- Servicio de Cardiologia, Hospital Universitario Alvaro Cunquerio, Vigo, Pontevedra, Spain
| | | | - Mauro Biffi
- Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola, Bologna, Italy
| | - Federico Conrotto
- Dipartimento di Cardiologia, A.O.U. Citta della Salute e della Scienza, Torino, Italy
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Lanzillo G, Mangieri A, Pagnesi M, Montalto C, Demir OM, Laricchia A, Curio J, Paglino G, Giannini F, Colombo A, Montorfano M, Latib A. Pacemaker-Related Complications in Patients Undergoing Transcatheter Aortic Valve Implantation: A Single-Center Experience. J Invasive Cardiol 2020; 32:E362-E369. [PMID: 33257585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The aim of this study was to describe the rate of complications secondary to permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI). METHODS Patients were identified by retrospective review of a dedicated TAVI database at a single center between 2008 and 2015. Clinical and procedural data were collected to determine the incidence and severity of the main adverse events following this procedure. The overall population included 736 patients and 123 (16.7%) underwent PPM implantation. Three patients were excluded from the final analysis due to PPM implantation occurring at other institutions post discharge. The final population consisted of 120 patients (16.3%). RESULTS Self- and mechanically expandable valves were associated with a higher risk of PPM after TAVI compared with balloon-expandable valves (23.9% vs 27.5% vs 7.6%, respectively; P<.001). Year of procedure and operator's experience did not affect the PPM-related complication rate. A high rate of major bleeding complications (n = 29; 24.1%) was observed. Major bleeding occurred more frequently in patients who received PPM implantation within the first 24 hours post TAVI than in the group of patients who required a PPM >24 hours post TAVI (38.2% vs 12.3%, respectively; P<.01). Patients who experienced a major bleeding event following PPM insertion were more frequently on triple-antithrombotic therapy (51.7% vs 9.9%; P<.001). CONCLUSIONS PPM-related complications are common in elderly patients after TAVI, and some of these adverse events can be life threatening. Particular attention is required in the periprocedural management of these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA.
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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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Curio J, Lanzillo G, Mangieri A, Pagnesi M, Montalto C, Demir OM, De Bonis M, Agricola E, Colombo A, Latib A. Transcatheter Interventions for Severe TR Patients Presenting to a Tertiary Care Setting. J Am Coll Cardiol 2019; 74:821-823. [DOI: 10.1016/j.jacc.2019.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 01/28/2023]
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Di Giovine G, Milazzo V, Poggio D, Grillo M, Greco P, Lanzillo G, Abete R, Mazzarola A, Mortara A, Khouri T. 350The great imitator. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - D Poggio
- Polyclinic of Monza, Monza, Italy
| | - M Grillo
- Polyclinic of Monza, Monza, Italy
| | - P Greco
- Polyclinic of Monza, Monza, Italy
| | | | - R Abete
- Polyclinic of Monza, Monza, Italy
| | | | | | - T Khouri
- Polyclinic of Monza, Monza, Italy
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Pagnesi M, Regazzoli D, Ancona MB, Mangieri A, Lanzillo G, Giannini F, Buzzatti N, Prendergast BD, Kodali S, Lansky AJ, Colombo A, Latib A. Cerebral Embolic Risk During Transcatheter Mitral Valve Interventions: An Unaddressed and Unmet Clinical Need? JACC Cardiovasc Interv 2019; 11:517-528. [PMID: 29566796 DOI: 10.1016/j.jcin.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [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: 08/30/2017] [Revised: 11/04/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
Abstract
As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.
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Affiliation(s)
- Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lanzillo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Alexandra J Lansky
- Division of Cardiovascular Medicine and Yale Cardiovascular Research Group, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, St Bartholomew's Hospital and William Harvey Research Institute and Queen Mary University of London, London, United Kingdom
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
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Mangieri A, Giannini F, Laricchia A, Romano V, Lanzillo G, Pagnesi M, Ponticelli F, Ancona M, Latib A, Colombo A. Transcatheter Treatment of Pure Aortic Regurgitation in a Horizontal Aorta Complicated by Valve Embolization and Aortic Dissection. Cardiovasc Revasc Med 2019; 20:535-536. [PMID: 30826205 DOI: 10.1016/j.carrev.2018.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
A 83-year-old female with severe aortic regurgitation (AR) and an horizontal ascending aorta was scheduled for a transcatheter aortic valve replacement. After the complete deployment, a Portico 29 mm valve embolized in the ascending aorta due to the unfavorable anatomy of the anchoring zone. A second Portico 29 mm was successfully implanted using the embolized valve for superior anchoring. The patient died 7 days after the procedure due to a retrograde aortic dissection. This case shows a rare but possible complication that occurs especially in unfavorable and complex aortic anatomies.
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Affiliation(s)
- Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Marco Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; San Raffaele Scientific Institute, EMO GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Cardiology, Montefiore Medical Center, New York, USA
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Montalto C, Mangieri A, Jabbour RJ, Pagnesi M, Buzzatti N, Leone P, Regazzoli D, Ancona F, Lanzillo G, Giannini F, Stella S, De Bonis M, Alfieri O, Camici PG, Margonato A, Colombo A, Agricola E, Latib A. Prevalence, Burden and Echocardiographic Features of Moderate to Severe Tricuspid Regurgitation: Insights from a Tertiary Referral Center. Structural Heart 2019. [DOI: 10.1080/24748706.2018.1563733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Claudio Montalto
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University of Pavia and Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Richard J. Jabbour
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Cardiology, Imperial College London, London, UK
| | - Matteo Pagnesi
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Pierpasquale Leone
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lanzillo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo G. Camici
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Cardiology, Montefiore Medical Center, New York, USA
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Demir O, Mitomo S, Mangieri A, Ancona M, Regazzoli D, Lanzillo G, Giannini F, Testa L, Wijns W, Colombo A, Latib A. TCT-465 Diagnostic Accuracy of Microcatheter Derived Fractional Flow Reserve: Systematic Review with Lesion Level Analysis. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1636] [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: 11/26/2022]
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Demir O, Lanzillo G, Mangieri A, Mitomo S, Gitto M, Pagnesi M, Ancona M, Regazzoli D, Giannini F, Colombo A, Latib A. TCT-571 Outcomes of percutaneous balloon aortic valvuloplasty for severe aortic stenosis in patients presenting with cardiogenic shock. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1762] [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: 10/28/2022]
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Regazzoli D, Mangieri A, Demir O, Ancona MB, Lanzillo G, Giannini F, Leone PP, Colombo A, Latib A. The future of percutaneous tricuspid valve interventions. Minerva Cardioangiol 2018; 66:735-743. [PMID: 29963813 DOI: 10.23736/s0026-4725.18.04757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tricuspid valve regurgitation has a high prevalence and, when severe, is associated with poor outcomes. Nevertheless, surgical repair or replacement (isolated or as a part of a combined procedure) is rarely performed due to high surgical risk. Therefore, there is a significant unmet clinical need for percutaneous transcatheter-based treatments. Significant development in percutaneous therapies for both aortic and mitral valve disease has been accomplished over the last two decades, while transcatheter therapies for the tricuspid valve are still at an early stage. We are today at a cross-road of new transcatheter devices that are becoming available for the treatment of tricuspid regurgitation; the current review evaluates the challenges that current and future technologies have to face in order to become a safer, less invasive and equally effective alternative to surgery.
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Affiliation(s)
- Damiano Regazzoli
- Unit of Cardiovascular Interventions, Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Ozan Demir
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Marco B Ancona
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Lanzillo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Pier P Leone
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, Colombo A, Latib A. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med 2018; 5:85. [PMID: 30018969 PMCID: PMC6038729 DOI: 10.3389/fcvm.2018.00085] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.
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Affiliation(s)
| | | | | | | | - Ozan Demir
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Azeem Latib
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Mangieri A, Montorfano M, Stella S, Regazzoli D, Ancona MB, Jabbour RJ, Mitomo S, Seresini G, Monaco F, Lanzillo G, Pagnesi M, Colombo A, Latib A. Severe Mitral Stenosis and Persistent Left Appendage Thrombosis. JACC Cardiovasc Interv 2018; 11:e11-e13. [DOI: 10.1016/j.jcin.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
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Lanzillo G, Bertoldi L, Montalto C, Pagnesi M, Jabbour R, Mitomo S, Giannini F, Regazzoli D, Ancona M, Montorfano M, Chieffo A, Colombo A. TCT-267 Pacemaker-related complications in patients undergoing transcatheter aortic valve implantation: a single-center experience. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Regazzoli D, Ancona MB, Mangieri A, Tanaka A, Romano V, Leone PP, Tresoldi M, Lanzillo G, Agricola E, Latib A, Colombo A, Montorfano M. Patent foramen ovale closure through inferior vena cava filter in a patient with deep venous thrombosis and recurrent ischemic events. J Cardiovasc Med (Hagerstown) 2017; 18:828-830. [PMID: 28368881 DOI: 10.2459/jcm.0000000000000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Damiano Regazzoli
- aInterventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department bDivision of Internal Medicine and Clinical Immunology cNoninvasive Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan dInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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de Jong A, Popa BA, Stelian E, Karazanishvili L, Lanzillo G, Simonini S, Renzi L, Diena M, Tesler UF. Perfusion techniques for minimally invasive valve procedures. Perfusion 2014; 30:270-6. [PMID: 25280878 DOI: 10.1177/0267659114550326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this paper, we present, in detail, the simplified perfusion technique that we have adopted since January 2009 and that we have utilized in 200 cases for cardiac minimally invasive valvular procedures that were performed through a right lateral mini-thoracotomy in the 3(rd)-4(th) intercostal space. Cardiopulmonary bypass was achieved by means of the direct cannulation of the ascending aorta and the insertion of a percutaneous venous cannula in the femoral vein. A flexible aortic cross-clamp was applied through the skin incision and cardioplegic arrest was obtained with the antegrade delivery of a crystalloid solution. Gravity drainage was enhanced by vacuum-assisted aspiration. There were no technical complications related to this perfusion technique that we have adopted in minimally invasive surgical procedures.
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Affiliation(s)
- A de Jong
- Service of Perfusion, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - B A Popa
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - E Stelian
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - L Karazanishvili
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - G Lanzillo
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - S Simonini
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - L Renzi
- Service of Perfusion, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - M Diena
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
| | - U F Tesler
- Department of Cardiac Surgery, Policlinico di Monza, Clinica San Gaudenzio, Novara, Italy
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Recio Vazquez M, Rincon L, Fernandez Golfin C, Zamorano Gomez J, Ledakowicz-Polak A, Polak L, Zielinska M, Kamiyama T, Nakade T, Nakamura Y, Ando T, Kirimura M, Inoue Y, Sasaki O, Nishioka T, Farouk H, Sakr B, Elchilali K, Said K, Sorour K, Salah H, Mahmoud G, Casanova Rodriguez C, Cano Carrizal R, Iglesias Del Valle D, Martin Penato Molina A, Garcia Garcia A, Prieto Moriche E, Alvarez Rubio J, De Juan Bagua J, Tejero Romero C, Plaza Perez I, Korlou P, Stefanidis A, Mpikakis N, Ikonomidis I, Anastasiadis S, Komninos K, Nikoloudi P, Margos P, Pentzeridis P. Poster session Thursday 12 December - AM: 12/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet203] [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: 11/14/2022] Open
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Luo X, Fang F, Sun J, Xie J, Lee A, Zhang Q, Yu C, Breithardt O, Schiessl S, Schmid M, Seltmann M, Klinghammer L, Zeissler C, Kuechle M, Daniel W, Ege M, Guray U, Guray Y, Demirkan B, Kisacik H, Kim SE, Hong JY, Lee JH, Park DG, Han KR, Oh DJ, Ege M, Demirkan B, Guray U, Guray Y, Tufekcioglu O, Kisacik H, Cozma DC, Mornos C, Ionac A, Petrescu L, Tutuianu C, Dragulescu SI, Guimaraes L, Tavares G, Rodrigues A, Nagamatsu C, Fischer C, Vieira M, Oliveira W, Wilberg T, Cordovil A, Morhy S, Muraru D, Peluso M, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Pizzuti A, Mabritto B, Derosa C, Tomasello A, Rovere M, Parrini I, Conte M, Lareva N, Govorin A, Cooper R, Sharif J, Somauroo JD, Hung JD, Porcelli V, Skevington R, Shahzad A, Scott S, Lindqvist P, Soderberg S, Gonzalez M, Tossavainen E, Henein M, Nciri N, Saad H, Nawas S, Ali A, Youssufzay A, Safi A, Faruk S, Yurdakul S, Erdemir V, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Gurel M, 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V, Acevedo O, Calli A, Barba M, Pintos G, Valverde V, Zamorano Gomez J, Marchel M, Kochanowski J, Piatkowski R, Madej A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Malev E, Zemtsovsky E, Reeva S, Timofeev E, Pshepiy A, Mihaila S, Rimbas R, Mincu R, Dulgheru R, Mihaila R, Badiu C, Cinteza M, Vinereanu D, Rodrigues A, Guimaraes L, Lira E, Lebihan D, Monaco C, Cordovil A, Oliveira W, Vieira M, Fischer C, Morhy S, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Pena M, Puentes M, Santisteban M, Lopez Granados A, Arizon Del Prado J, Suarez De Lezo J, Tsai WC, Shih JY, Huang TS, Liu YW, Huang YY, Tsai LM, Cho E, Choi K, Kwon B, Kim D, Jang S, Park C, Jung H, Jeon H, Youn H, Kim J, Rieck AE, Cramariuc D, Lonnebakken M, Lund B, Gerdts E, Moceri P, Doyen D, Cerboni P, Ferrari E, Li W, Silva D, Goncalves S, Ribeiro S, Santos L, Sargento L, Vinhais De Sousa G, Almeida AG, Nunes Diogo A, Hernandez Garcia C, De La Rosa Hernandez A, Arroyo Ucar E, Jorge Perez P, Barragan Acea A, Lacalzada Almeida J, Jimenez Rivera J, Duque Garcia A, Laynez Cerdena I, Arhipov O, Sumin AN, Campens L, Renard M, Trachet B, Segers P, De Paepe A, De Backer J, Purvis JA, Sharma D, Hughes SM, Marek D, Vindis D, Kocianova E, Taborsky M, Yoon H, Kim K, Ahn Y, Chung M, Cho J, Kang J, Rha W, Ozcan O, Sezgin Ozcan D, Candemir B, Aras M, Dincer I, Atak R, Gianturco L, Turiel M, Atzeni F, Tomasoni L, Bruschi E, Epis O, Sarzi-Puttini P, Aggeli C, Poulidakis E, Felekos I, Sideris S, Dilaveris P, Gatzoulis K, Stefanadis C, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Lipiec P, Peruga J, Krecki R, Kasprzak J, Ishii K, Suyama T, Kataoka K, Furukawa A, Nagai T, Maenaka M, Seino Y, Musca F, De Chiara B, Moreo A, Epis O, Bruschi E, Cataldo S, Parolini M, Parodi O, Bombardini T, Faita F, Picano E, Park SJ, Kil JH, Kim SJ, Jang SY, Chang SA, Choi JO, Lee SC, Park S, Park P, Oh J, Cikes M, Velagic V, Biocina B, Gasparovic H, Djuric Z, Bijnens B, Milicic D, Huqi A, Klas B, He A, Paterson I, Irween M, Ezekovitz J, Choy J, Becher H, Chen Y, Cheng L, Yao R, Yao H, Chen H, Pan C, Shu X, Sobkowicz B, Kaminska M, Musial W, Kaminska M, Sobkowicz B, Musial W, Buechel R, Sommer G, Leibundgut G, Rohner A, Bremerich J, Kaufmann B, Kessel-Schaefer A, Handke M, Kiotsekoglou A, Saha S, Toole R, Sharma S, Gopal A, Adhya S, Tsang W, Kenny C, Kapetanakis S, Lang R, Monaghan M, Smith B, Grapsa J, Dawson D, Coulter T, Rendon A, Cheung WS, Gorissen W, Nihoyannopoulos P, Ejlersen JA, May O, Van Slochteren FJ, Van Der Spoel T, Hanssen H, Doevendans P, Chamuleau S, De Korte C, Tarr A, Stoebe S, Trache T, Kluge JG, Varga A, Hagendorff A, Nagy A, Kovacs A, Apor A, Sax B, Becker D, Merkely B, Lindquist R, Miller A, Reece C, Eidem BW, Choi WG, Kim S, Oh S, Kim Y, Iacobelli R, Chinali M, D' Asaro M, Toscano A, Del Pasqua A, Esposito C, Seghetti G, Parisi F, Pongiglione G, Rinelli G, Omaygenc O, Bakal R, Dogan C, Teber K, Akpinar S, Sahin G, Ozdemir N, Penhall A, Joseph M, Chong F, De Pasquale C, Selvanayagam J, Leong D, Nyktari EG, Patrianakos AP, Goudis C, Solidakis G, Parthenakis F, Vardas P, Nestaas E, Stoylen A, Fugelseth D, Vitarelli A, Capotosto L, Bernardi M, Conde Y, Caranci F, Placanica G, Dettori O, Vitarelli M, De Chiara S, De Cicco V, Ancona R, Comenale Pinto S, Caso P, Severino S, Cavallaro M, Ferro' M, Calabro' R, Apostolakis S, Chalikias G, Tziakas D, Stakos D, Thomaidi A, Konstantinides S, Vitarelli A, Caranci F, Capotosto L, Iorio G, Rucos R, Continanza G, De Cicco V, D Ascanio M, Alessandroni L, Saponara M, Berry M, Nahum J, Zaghden O, Monin J, Couetil J, Lairez O, Macron L, Dubois Rande J, Gueret P, Lim P, Cameli M, Giacomin E, Lisi M, Benincasa S, Righini F, Menci D, Focardi M, Mondillo S, Bonello B, Fouilloux V, Philip E, Gorincour G, Fraisse A, Bellsham-Revell H, Bell AJ, Miller OI, Beerbaum P, Razavi R, Greil G, Simpson JM, Ann S, Youn H, Jung H, Kim T, Lee J, Chin J, Kim T, Cabeza Lainez P, Escolar Camas V, Gheorghe L, Fernandez Garcia P, Vazquez Garcia R, Gargani L, Caiulo V, Caiulo S, Fisicaro A, Moramarco F, Latini G, Sicari R, Picano E, Seale A, Carvalho J, Gardiner H, Roughton M, Simpson J, Tometzki A, Uzun O, Webber S, Daubeney P, Elnoamany MF, Dawood A, Dwivedi G, Mahadevan G, Jiminez D, Steeds R, Frenneaux M, Attenhofer Jost CH, Knechtle B, Bernheim A, Pfyffer M, Linka A, Faeh-Gunz A, Seifert B, De Pasquale G, Zuber M, Simova I, Hristova K, Georgieva S, Kostova V, Katova T, Tomaszewski A, Kutarski A, Tomaszewski M. Poster Session 2: Thursday 8 December 2011, 14:00-18:00 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Casalino S, Stelian E, Novelli E, De Jong A, Renzi L, Arellano F, Mangia F, Ricci I, Lanzillo G, Diena M, Tesler UF. Reduced transfusion requirements with a closed cardiopulmonary bypass system. J Cardiovasc Surg (Torino) 2008; 49:363-369. [PMID: 18446123] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The aim of this investigation is to reduce blood transfusion in cardiac surgery patients with preoperative conditions predictive for transfusion requirements. We compared the amount of blood transfused in two groups of patients undergoing cardiopulmonary bypass (CPB) with two different circuit systems. METHODS Sixty patients undergoing cardiac surgery were randomly assigned to two groups: in group A (N=30) cardiopulmonary bypass was accomplished with an open circuit and in group B (N=30) with a closed circuit. The open circuit consisted of a cardiotomy reservoir, a membrane oxygenator and an arterial line filter, while the closed circuit was made up of a collapsible venous reservoir, a membrane oxygenator, an arterial line filter and a cardiotomy reservoir. The amount of transfused packed red cells in each patient was measured until discharge from the hospital. RESULTS Groups were similar regarding age, gender, body surface area (BSA), New York Heart Association (NYHA) class and comorbidity risk factors. Moreover, there were no significant differences between groups regarding the type of procedures, CPB and aortic cross-clamp times, total amount of cardioplegia and urinary output during CPB. Priming volume was 1180+/-84 mL (group A) and 760+/-72 mL (group B) (P<0.001). Significant differences in transfusion requirements emerged in the two groups: the total volume of packed red cells transfused for each patient was significantly higher in the open system group compared to the closed system group (717+/-486 mL versus 378+/-364 mL) (P=0.003). Clinical outcomes were similar in both groups. CONCLUSION In patients with preoperative conditions predictive for the need of transfusions, the use of a closed cardiopulmonary bypass circuit can diminish the amount of transfused blood products.
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Affiliation(s)
- S Casalino
- Department of Anesthesia, San Gaudenzio Clinic, Novara, Italy.
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Dorobanţu LF, Lanzillo G, Cerin G, Casalino S, Stelian E, Novelli E, Diena M. [Off pump total arterial revascularization--clinical and technical considerations]. Chirurgia (Bucur) 2007; 102:581-584. [PMID: 18018360] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Integral arterial myocardial revascularization seems to become the standard method in coronary surgery, but the international experience is still limited. We are communicating our results in arterial off pump coronary artery grafting (OFF CABG) in a centre specialized in "on pump" total arterial revascularisation. Between January 2004 and June 2006 we performed off pump CABG in 58 patients, using skeletonized arterial grafts; the vein grafts was rarely used. In 94.95% of cases we used only arterial grafts, and we achieved complete arterial revascularization in 47 (81.03%) of cases. We didn't noted major postoperative complications, the mean UCU stay was 1.7 days, mean hospital stay was 7.3 days, and no postoperative deaths were noted. The off pump CABG using arterial grafts is a secure method, without postoperative complications, which offers viable solutions of complete revascularization of the heart.
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Affiliation(s)
- L F Dorobanţu
- Clinica de Chirurgie Cardiovasculară, Institutul de Boli Cardiovasculare Prof. Dr. C.C.Iliescu, Bucureşti, Romania
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Bartoccioni S, Lanzillo G, deJong AA, Fiaschini P, Martinelli G, Fedeli C, Di Lazarro D, Mercati U. New technique for retrograde cerebral perfusion during arch aneurysm repair. J Card Surg 1995; 10:592-3. [PMID: 7488786 DOI: 10.1111/j.1540-8191.1995.tb00640.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many techniques are used to reduce brain damage during surgery for dissecting aneurysms of the ascending aorta and arch. Recently, new techniques of protection were proposed, consistent with hypothermic circulatory arrest in association with retrograde cerebral perfusion via superior vena cava. We propose a simple, time-saving method, which does not require any manipulation of the heart. We use a multilumen cannula for cardioplegia (D 860-DIDECO FUNDARO') with pressure transducer. This cannula is inserted in superior vena cava by means of a simple purse-string, and linked to the arterial line with a "Y" derivation, allowing retrograde perfusion of the brain and monitoring the perfusion pressure at every moment. The superior vena cava placed downstream from the cannula is closed by a small vascular clamp, to avoid blood reflux in the right atrium. This method is time- and money-saving, is readily available, and can be prepared whenever necessary, also in the middle of the surgical procedure.
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Affiliation(s)
- S Bartoccioni
- Division of Cardiac Surgery, Ospedale R. Silvestrini, Perugia, Italy
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Bartoccioni S, Giombolini C, Fiaschini P, Martinelli G, Fedeli C, Di Lazzaro D, Lanzillo G, Possati G. Aortic coarctation, aortic valvular stenosis, and coronary artery disease: combined one-stage surgical therapy operation. J Card Surg 1995; 10:594-6. [PMID: 7488787 DOI: 10.1111/j.1540-8191.1995.tb00641.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The presentation of simultaneous severe coarctation of the descending aorta and severe aortic valve disease is uncommon. We describe the management of simultaneous association of aortic coarctation, aortic valve disease, and ischemic cardiomyopathy and describe a one-stage surgical approach for the correction of all pathologies. After performing the aortic valve replacement and myocardial revascularization, coarctation was solved by means of a prosthesis between the ascending aorta and the abdominal aorta. There were no evidence of myocardial ischemia during exercise testing and the blood pressure is normal.
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Affiliation(s)
- S Bartoccioni
- Division of Cardiac Surgery, Ospedale R. Silvestrini, Azienda Ospedaliera di Perugia, Italy
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Pragliola C, Kootstra GJ, Lanzillo G, Rose PA, Quafford M, Uitdenhaag G. Current results of coronary bypass surgery after failed angioplasty. J Cardiovasc Surg (Torino) 1994; 35:365-9. [PMID: 7995825] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Percutaneous Transluminal Coronary Angioplasty (PTCA) is a technique in continuous development. Since its introduction indications, number, quality of stenosis amenable to treatment and device employed have evolved leading to a change in the population undergoing treatment. Therefore surgical results obtained in the early 80's may not apply to the beginning of the 90's. This reason prompted us to review our recent experience. In the last 4 years (1989-1992) among 2563 PTCA procedures performed in our Institution, 114 patients (4.3%, CL 3.5%-5%) underwent urgent surgical revascularization because of failed angioplasty. Thirty-four patients (30%, CL 21%-38%) were older than 65 years; 68 patients (60%, CL 50%-68%) had multiple vessel disease; 63 patients (55%, CL 46%-64%) had previous Myocardial Infarction (M.I.); 20 patients (17%, CL 10%-24%) had already undergone a PTCA and 3 patients (2%, CL 0%-6%) had had coronary surgery. In 21 patients (18%, CL 11%-25%) the left ventricular Ejection Fraction (EF%) was below < 50%. Complete revascularization was always performed with an average of 2.2 +/- 1 graft/patient. A Left Internal Mammary Artery (LIMA) was implanted in 20 patients (17%, CL 10%-25%) of the patients and in 52% of cases requiring LAD grafts in the last two years. There were 2 deaths (1.7%, CL 0%-4%), both patients were in cardiac arrest before surgery (p < 0.001), 2 patients required a LVAD to be weaned from ECC and 7 patients (6%, CL 1%-10%) had an IABP inserted at the moment of surgery. Twenty-five patients (21%, CL 14%-29%) showed evidence of a new myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Pragliola
- Thoraxcentrum De Klokkenberg, Department of Cardiothoracic Surgery, Breda, The Netherlands
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Kootstra GJ, Pragliola C, Lanzillo G. Technique of sequential grafting the left internal mammary artery (LIMA) to the circumflex coronary system. J Cardiovasc Surg (Torino) 1993; 34:523-6. [PMID: 8300720] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The most common grafting technique performed with the IMA's is to anastomose the LIMA to the Left Anterior Descending (LAD) coronary system. With the expanded use of this conduit, the Right IMA (RIMA) can be used to graft the LAD system and the LIMA can be routed to the Circumflex (Cx) coronary system. This is the most common graft design in case of coronary disease affecting the LAD and the circumflex systems. The technique used at the Medical Center "The Klokkenberg" since 1989 to route the LIMA to the marginal arteries through a pericardial window is described in detail.
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Affiliation(s)
- G J Kootstra
- ThoraxCentrum De Klokkenberg, Breda, The Netherlands
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Santarelli P, Alessandrini F, Montenero AS, Natale A, Biscione F, Zamparelli R, Schiavello R, Lanzillo G, Manzoli A, Lanza GA. [Results of surgical treatment in supraventricular tachycardias]. G Ital Cardiol 1993; 23:9-18. [PMID: 8491349] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
From May 1989 to May 1992, 44 patients (mean age 41 years, range 15-66) underwent surgery for supraventricular tachycardias: in 35 patients with atrioventricular reentrant tachycardia or atrial fibrillation associated with accessory pathway and refractory to medical treatment, the epicardial approach was used; in 8 with atrioventricular nodal reentrant tachycardia, a perinodal cryosurgery of the atrioventricular node was used, and in 1 patient with atrial flutter a cryosurgical ablation around the orifice of the coronary sinus and surrounding tissues was performed. All 38 accessory pathways were successfully ablated in 35 patients and no recurrences of delta wave or tachycardia were observed during a mean follow-up of 17 +/- 10 months. Atrial perforation during surgery and pericarditis were the only complications observed. All 8 patients with atrioventricular nodal reentrant tachycardia were successfully treated: in 2 patients dual pathways persisted after surgery but tachycardia was no longer inducible. No recurrences were observed during a mean follow-up of 15 +/- 4 months. Since surgery (15 months), the patient with atrial flutter has been free of recurrent episodes of atrial flutter. In conclusion, surgical treatment of supraventricular tachycardias is highly successful, with no mortality and very low morbidity. Should transcatheter ablation fail, surgery should be the treatment of choice in patients with frequent and symptomatic supraventricular tachycardias.
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Affiliation(s)
- P Santarelli
- Istituto di Cardiologia e Cardiochirurgia, Università Cattolica, Roma
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Pragliola C, Allesandrini F, Lanzillo G, Cascarano MT, Bartoccioni S, Possati GF. Preliminary experience with a percutaneous cardiopulmonary support system. Appl Cardiopulm Pathophysiol 1992; 5:1-3. [PMID: 10171976] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Percutaneous cardiopulmonary bypass has been introduced to support circulation in critical patients. In our preliminary experience we resuscitated two patients who sustained a prolonged cardiac arrest (52 min. and 31 min.) after coronary angiography and elective cardiac surgery, respectively. Cannulation was achieved percutaneously within 10 min. in both cases. Pump flow ranged from 2 to 31/m. Total support lasted from 52 min. to 180 min.. Both patients were successfully weaned. Patient 1 was declared brain dead and expired 17 days later. Patient 2 was discharged from the hospital and is doing well. Cannulation was attempted in a third patient after 30 min. of cardiac arrest. Despite surgical cut down of the femoral vessels, it was impossible to advance the arterial cannula because of bilateral occlusive disease. We conclude that PCPS is a powerful technique in selected patients to recover a stable cardiac function after prolonged cardiac arrest.
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Alessandrini F, Santarelli P, Montenero AS, Zamparelli R, Bartoccioni S, Morelli M, Lanzillo G, Schiavello R, Possati GF. Surgical treatment of cardiac arrhythmias. Int J Card Imaging 1991; 7:243-8. [PMID: 1820405 DOI: 10.1007/bf01797758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This report describes 20 consecutive patients who underwent surgical procedures for treatment of cardiac arrhythmias. 16 patients have been operated for WPW syndrome, always using the epicardial approach, without extracorporeal circulation. Three patients underwent surgery for atrio-ventricular nodal reentrant tachycardia, using a discrete perinodal cryotreatment, during normothermic extracorporeal circulation. In one case we used cryoablation of the atrial myocardium below the coronary sinus to treat atrial flutter. This operation was performed under normothermic extracorporeal circulation. In our observations, there was no early or late death; postoperative complications developed in 1 patient (5%) due to pericarditis. Ablation of the AP was completely successful in all the cases (100%) operated for WPW as well as for AVNRT syndromes and atrial flutter.
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Affiliation(s)
- F Alessandrini
- Cardiology and Cardiac Surgery Department, Catholic University, Gemelli Hospital, Rome, Italy
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Lanzillo G, Alessandrini F, Bartoccioni S, Bombardieri G, Intonti MA, Pragliola C, Morelli M, Baruffi E. Surgical correction of congenital left coronary-pulmonary artery fistula and rheumatic mitral valve disease. Case report. Scand J Thorac Cardiovasc Surg 1989; 23:189-91. [PMID: 2749212 DOI: 10.3109/14017438909105993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 56-year-old woman with stenosis and incompetence of the mitral valve and clinical signs of congestive heart failure was found to have a communication between the left anterior descending coronary artery and the pulmonary trunk. A mitral valve prosthesis was inserted and the fistula was closed from within the pulmonary artery.
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Affiliation(s)
- G Lanzillo
- Division of Cardiac Surgery, Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Baruffi E, Intonti MA, Bartoccioni S, Lanzillo G, Cellini C. [Rupture of the ascending aorta during reintervention via a median longitudinal sternotomy]. Chir Patol Sper 1987; 35:93-8. [PMID: 3268400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lanzillo G, Breccia PA, Bartoccioni S, Intonti F. [Rupture of the left ventricle associated with mitral valve substitution]. MINERVA CHIR 1982; 37:883-6. [PMID: 7133459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lanzillo G, Breccia PA, Bartoccioni S, Morelli M, Sandric S, Intonti F. [Thrombosis of the Björk-Shiley aortic valve prosthesis. Clinical and therapeutic aspects]. Minerva Cardioangiol 1982; 30:259-61. [PMID: 7133413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lanzillo G, Breccia PA, Intonti F. Congenital quadricuspid aortic valve with displacement of the right coronary orifice. Scand J Thorac Cardiovasc Surg 1981; 15:149-51. [PMID: 7336186 DOI: 10.3109/14017438109101040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To date only five patients have undergone surgery for severe incompetence due to quadricuspid aortic valve (5-9). This report describes a new case of congenital quadricuspid aortic valve with severe regurgitation and associated displacement of the right coronary orifice, in which the abnormal valve was excised and replaced by a Björk-Shiley tilting disc valve prosthesis.
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