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Gonzalez-Urbistondo F, Alperi A, Moris C, Avanzas P. μQFR in ASET Pilot Studies: More Assets in the decision-making process for stable ischemic heart disease. Int J Cardiol 2024; 403:131880. [PMID: 38373682 DOI: 10.1016/j.ijcard.2024.131880] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain.
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Alperi A, Pascual I, Moris C, Avanzas P. Neo 2 transcatheter heart valve system: Direct towards a minimalistic procedure. Int J Cardiol 2024; 402:131883. [PMID: 38373684 DOI: 10.1016/j.ijcard.2024.131883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Alperi A, Moris C, Del Valle R, Pascual I, Antuna P, Almendárez M, Hernández-Vaquero D, Betanzos JL, Rodés-Cabau J, Avanzas P. Hemodynamic performance of self-expandable transcatheter aortic valve replacement systems during valve deployment. J Invasive Cardiol 2024. [PMID: 38489568 DOI: 10.25270/jic/23.00286] [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] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVES Little is known about valve hemodynamic performance during the Evolut and Neo deployment course. We aimed to evaluate transvalvular mean and peak-to-peak gradients over several intraprocedural timepoints during TAVR with Evolut PRO+ (Medtronic) and Neo (Boston Scientific) systems. METHODS This was single-center pilot sub-study from the SavvyWire EFficacy and SafEty in Transcatheter Aortic Valve Implantation Procedures (SAFE-TAVI) trial. Participants received either the Evolut PRO+ or Neo for native valve severe aortic stenosis and the SavvyWire (OpSens Medical) was used for device delivery, pacing, and continuous left ventricular and aortic pressure measurements. For the Evolut, evaluation was done for baseline, two-thirds of valve deployment (still recapturable), 90% of valve deployment (no longer recapturable), and post-deployment hemodynamics. For the Neo, analysis was done at baseline, after the first step (top-crown deployment), and at final status. RESULTS Nineteen patients were included (Evolut = 15; Neo = 4). There were no statistically significant changes in peak-to-peak gradients (44 mm Hg [IQR:33-69] vs 43 mm Hg [IQR:26-62], P = .41) between baseline and two-thirds of valve deployment in the Evolut patients. There was a significant decrease in mean (40 mm Hg [IQR:32-54] vs 14 mm Hg [IQR:10-18], P less than .001) and peak-to-peak (43 mmHg [IQRS:26-62] vs 9 mm Hg [IQR:8-13], P less than .001) transvalvular gradients between two-thirds and 90% of valve deployment for Evolut. Neo patients exhibited a decrease in transvalvular gradients after top-crown deployment (42.5 mm Hg baseline vs 13 mm Hg). CONCLUSIONS Transvalvular gradients did not vary between the point of "no-recapture" compared to baseline values in patients receiving the Evolut, whereas a significant reduction in transvalvular gradients was observed when the valve was deployed at 90% and fully deployed. The Neo valve was slightly obstructive after the first step of deployment.
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Affiliation(s)
- Alberto Alperi
- University Hospital of Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | - Cesar Moris
- University Hospital of Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain; University of Oviedo, Asturias, Spain
| | | | - Isaac Pascual
- University Hospital of Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain; University of Oviedo, Asturias, Spain
| | - Paula Antuna
- University Hospital of Asturias, Oviedo, Asturias, Spain
| | | | - Daniel Hernández-Vaquero
- University Hospital of Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pablo Avanzas
- University Hospital of Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain; University of Oviedo, Asturias, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). ; ;
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Mas-Peiro S, Alperi A, Avvedimento M, Regueiro A, Avanzas P, Angellotti D, Esposito G, Vidal-Cales P, Mohammadi S, Farjat J, Moris C, Rodés-Cabau J. Optimal oversizing in transcatheter aortic valve replacement with the self-expanding Evolut valve system. J Invasive Cardiol 2024. [PMID: 38446025 DOI: 10.25270/jic/24.00011] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Valve oversizing has been associated with reduced paravalvular leaks (PVL) and valve migration risk. However, no optimal cut-off oversizing value has been defined for the Evolut system (Medtronic). The aim of this study was to assess the relationship between the degree of oversizing and moderate-to-severe PVL and determine the optimal oversizing cut-off value. METHODS We conducted a multicenter study that included 740 consecutive patients with multidetector computed tomography (CT) data. Valve size was selected according to manufacturer recommendations, with oversizing ranging from 10% to 30%. The primary endpoint was moderate-to-severe PVL. RESULTS The median age was 84 years (79-87 years), with 58.4% women, and a median EuroSCORE II of 4.1% (2.4-7.3%). Moderate-to-severe PVL was observed in 7.0% of the patients. An inverse relationship was found between oversizing and both PVL (11.3%, 8.6%, 5.4%, and 2.7% for quartiles Q1 to Q4; P = .007) and the need for post-dilation (P = .016). The multivariable analysis showed an association between oversizing and PVL (OR: 0.915 for each 1%-increase, P = .002). The optimal oversizing cut-off value to predict PVL was 20%, and PVL was significantly higher in patients with oversizing less than 20% (10.5% vs.4.2%, P less than .001). There were no differences in major clinical events according to the degree of oversizing, and a higher oversizing did not translate into an increased risk of permanent pacemaker (18.4% vs18.3%, P = .976). CONCLUSIONS In TAVR with the Evolut valve, a higher oversizing was associated with lower rates of moderate-to-severe PVL and a lower need for post-dilation, with no negative impact on procedural and early clinical outcomes. A 20% oversizing threshold could be suggested to reduce PVLs. Further prospective studies are warranted to validate optimal oversizing for this valve system.
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Affiliation(s)
- Silvia Mas-Peiro
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Ander Regueiro
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Avanzas
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Pablo Vidal-Cales
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Julio Farjat
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Cesar Moris
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. E-mail:
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Rodés-Cabau J, Ribeiro HB, Mohammadi S, Serra V, Al-Atassi T, Iñiguez A, Vilalta V, Nombela-Franco L, Sáez de Ibarra Sánchez JI, Auffret V, Forcillo J, Conradi L, Urena M, Moris C, Muñoz-Garcia A, Paradis JM, Dumont E, Kalavrouziotis D, Maria Pomerantzeff P, Rosa VEE, Pezzute Lopes M, Sureda C, Diaz VAJ, Giuliani C, Avvedimento M, Pelletier-Beaumont E, Pibarot P. Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial. Circulation 2024; 149:644-655. [PMID: 37883682 DOI: 10.1161/circulationaha.123.067326] [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: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The optimal treatment in patients with severe aortic stenosis and small aortic annulus (SAA) remains to be determined. This study aimed to compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with a SAA. METHODS This prospective multicenter international randomized trial was performed in 15 university hospitals. Participants were 151 patients with severe aortic stenosis and SAA (mean diameter <23 mm) randomized (1:1) to TAVR (n=77) versus SAVR (n=74). The primary outcome was impaired valve hemodynamics (ie, severe prosthesis patient mismatch or moderate-severe aortic regurgitation) at 60 days as evaluated by Doppler echocardiography and analyzed in a central echocardiography core laboratory. Clinical events were secondary outcomes. RESULTS The mean age of the participants was 75.5±5.1 years, with 140 (93%) women, a median Society of Thoracic Surgeons predicted risk of mortality of 2.50% (interquartile range, 1.67%-3.28%), and a median annulus diameter of 21.1 mm (interquartile range, 20.4-22.0 mm). There were no differences between groups in the rate of severe prosthesis patient mismatch (TAVR, 4 [5.6%]; SAVR, 7 [10.3%]; P=0.30) and moderate-severe aortic regurgitation (none in both groups). No differences were found between groups in mortality rate (TAVR, 1 [1.3%]; SAVR, 1 [1.4%]; P=1.00) and stroke (TAVR, 0; SAVR, 2 [2.7%]; P=0.24) at 30 days. After a median follow-up of 2 (interquartile range, 1-4) years, there were no differences between groups in mortality rate (TAVR, 7 [9.1%]; SAVR, 6 [8.1%]; P=0.89), stroke (TAVR, 3 [3.9%]; SAVR, 3 [4.1%]; P=0.95), and cardiac hospitalization (TAVR, 15 [19.5%]; SAVR, 15 [20.3%]; P=0.80). CONCLUSIONS In patients with severe aortic stenosis and SAA (women in the majority), there was no evidence of superiority of contemporary TAVR versus SAVR in valve hemodynamic results. After a median follow-up of 2 years, there were no differences in clinical outcomes between groups. These findings suggest that the 2 therapies represent a valid alternative for treating patients with severe aortic stenosis and SAA, and treatment selection should likely be individualized according to baseline characteristics, additional anatomical risk factors, and patient preference. However, the results of this study should be interpreted with caution because of the limited sample size leading to an underpowered study, and need to be confirmed in future larger studies. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03383445.
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Affiliation(s)
- Josep Rodés-Cabau
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Henrique Barbosa Ribeiro
- Interventional Cardiology Department, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil (H.B.R., P.M.P., V.E.E.R., M.P.L.)
| | - Siamak Mohammadi
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Vicenç Serra
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain (V.S., C.S.)
| | - Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (T.A.-A.)
| | - Andres Iñiguez
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Spain (A.I., V.A.J.D.)
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (A.I., V.A.J.D.)
| | - Victoria Vilalta
- Department of Interventional Cardiology, Germans Trias i Pujol University Hospital, Badalona, Spain (V.V.)
| | - Luis Nombela-Franco
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain (L.N.-F.)
| | | | - Vincent Auffret
- Department of Cardiology, Rennes University Hospital, Rennes, France (V.A.)
| | - Jessica Forcillo
- Department of Cardiac Surgery, Centre Hospitalier Universitaire de Montreal, Montreal, Canada (J.F.)
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany (L.C.)
| | - Marina Urena
- Department of Cardiology, Hospital Bichat Claude-Bernard, Paris, France (M.U.)
| | - Cesar Moris
- Department of Cardiology, University Hospital Central de Asturias, Oviedo, Spain (C.M.)
| | - Antonio Muñoz-Garcia
- Cardiology Department, University Hospital Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Málaga, Spain (A.M.-G.)
| | - Jean-Michel Paradis
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Eric Dumont
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Dimitri Kalavrouziotis
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Pablo Maria Pomerantzeff
- Interventional Cardiology Department, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil (H.B.R., P.M.P., V.E.E.R., M.P.L.)
| | - Vitor Emer Egypto Rosa
- Interventional Cardiology Department, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil (H.B.R., P.M.P., V.E.E.R., M.P.L.)
| | - Mariana Pezzute Lopes
- Interventional Cardiology Department, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil (H.B.R., P.M.P., V.E.E.R., M.P.L.)
| | - Carles Sureda
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain (V.S., C.S.)
| | - Victor Alfonso Jimenez Diaz
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Spain (A.I., V.A.J.D.)
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (A.I., V.A.J.D.)
| | - Carlos Giuliani
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Marisa Avvedimento
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Emilie Pelletier-Beaumont
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
| | - Philippe Pibarot
- Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.)
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Regueiro A, Alperi A, Vilalta V, Asmarats L, Baz JA, Nombela-Franco L, Calabuig A, Muñoz-García A, Sabaté M, Moris C, Picard-Deland M, Pelletier-Beaumont E, Rodés-Cabau J. Safety and Efficacy of TAVR With a Pressure Sensor and Pacing Guidewire: SAFE-TAVI Trial. JACC Cardiovasc Interv 2023; 16:3016-3023. [PMID: 37902144 DOI: 10.1016/j.jcin.2023.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/03/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The SavvyWire (OpSens Inc) is a 0.035-inch preshaped guidewire with dedicated pacing properties and a distal pressure sensor allowing for continuous hemodynamic pressure monitoring. OBJECTIVES This study sought to determine the efficacy and safety of the guidewire during transcatheter aortic valve replacement (TAVR) procedures. METHODS This prospective, multicenter clinical study included patients with severe aortic stenosis undergoing TAVR in 8 European centers. The primary efficacy endpoint was defined as effective left ventricular rapid pacing runs with the guidewire translating into a significant systemic pressure drop (below 60 mm Hg). The safety outcome included the absence of major procedural complications related to the guidewire. RESULTS A total of 121 patients (mean age: 82.2 ± 5.9 years, 50% women) were included in the study, and 119 (98.3%) patients were finally treated with the study device. A balloon-expandable valve was implanted in 45 (37.8%) patients. Predilatation and postdilatation were performed in 89 (74.8%) and 14 (11.8%) patients, respectively. The primary efficacy endpoint was achieved in 116 (98.3%) patients, and the mean aortic systolic arterial pressure achieved during rapid pacing was 46.6 ± 11.3 mm Hg. Hemodynamic assessment with the use of the OptoMonitor 3 (OpSens Inc) without additional catheter exchange was achieved in 117 (99.2%) patients. The safety endpoint was achieved in 117 (99.2%) patients. No procedural mortality, stroke, or ventricular perforation was reported. CONCLUSIONS The use of the guidewire during TAVR procedures appeared to be efficacious and safe. This device could help minimize interventions during the procedure and improve the clinical decision making after transcatheter heart valve deployment. (SavvyWire Efficacy and Safety in Transcatheter Aortic Valve Implantation Procedures [SAFE-TAVI]; NCT05492383).
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Affiliation(s)
- Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
| | - Alberto Alperi
- Instituto de Investigación Sanitaria del Principado de Asturias, Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Victoria Vilalta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis Asmarats
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Jose Antonio Baz
- Interventional Cardiology Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - Alvaro Calabuig
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Antonio Muñoz-García
- Hospital Regional Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Málaga, Spain
| | - Manel Sabaté
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Cesar Moris
- Instituto de Investigación Sanitaria del Principado de Asturias, Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Alperi A, Pascual I, Moris C, Avanzas P. Neo to Neo 2 in horizontal aorta: From "impact" to "no impact" outcomes. Int J Cardiol 2023; 392:131297. [PMID: 37657672 DOI: 10.1016/j.ijcard.2023.131297] [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] [Received: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Alperi A, Avanzas P, Leon V, Silva I, Hernández-Vaquero D, Almendárez M, Álvarez R, Fernández F, Moris C, Pascual I. Current status of transcatheter mitral valve replacement: systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1130212. [PMID: 37234369 PMCID: PMC10206247 DOI: 10.3389/fcvm.2023.1130212] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Mitral Regurgitation (MR) has a strong impact on quality of life and on mid-term survival. Transcatheter mitral valve replacement (TMVR) is rapidly expanding and a growing number of studies have been published recently. Methods A systematic review of studies reporting on clinical data for patients with symptomatic severe MR undergoing TMVR was performed. Early- and mid-term outcomes (clinical and echocardiographic) were evaluated. Overall weighted means and rates were calculated. Risk ratios or mean differences were calculated for pre- and post-procedural comparisons. Results A total of 12 studies and 347 patients who underwent TMVR with devices clinically available or under clinical evaluation were included. Thirty-day mortality, stroke and major bleeding rates were 8.4%, 2.6%, and 15.6%, respectively. Pooled random-effects demonstrated a significant reduction of ≥ grade 3+ MR (RR: 0.05; 95% CI: 0.02-0.11; p < 0.001) and in the rates of patients in NYHA class 3-4 after the intervention (RR: 0.27; 95% CI: 0.22-0.34; p < 0.001). Additionally, the pooled fixed-effect mean difference for quality of life based on the KCCQ score yielded an improvement in 12.9 points (95% CI:7.4-18.4, p < 0.001), and exercise capacity improved by a pooled fixed-effect mean difference of 56.8 meters in the 6-minute walk test (95% CI 32.2-81.3, p < 0.001). Conclusions Among 12 studies and 347 patients comprising the updated evidence with current TMVR systems there was a statistically significant reduction in ≥ grade 3+ MR and in the number of patients exhibiting poor functional class (NYHA 3 or 4) after the intervention. Overall rate of major bleeding was the main shortcoming of this technique.
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Affiliation(s)
- Alberto Alperi
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Pablo Avanzas
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Iria Silva
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Marcel Almendárez
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Félix Fernández
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cesar Moris
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Alperi A, Pascual I, Moris C, Avanzas P. Another tool in the armamentarium for the percutaneous treatment of degenerated bioprosthetic valves and surgical rings. Int J Cardiol 2023; 376:46-47. [PMID: 36773758 DOI: 10.1016/j.ijcard.2023.02.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
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10
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Martinez J, Alperi A, Silva I, Pascual I, Ledesma D, Alvarez R, Almendarez M, Avanzas P, del Valle R, Moris C. Leaving obstacles aside: Antegrade paravalvular leakage closure after transcatheter aortic valve replacement. Clin Case Rep 2023; 11:e6971. [PMID: 36860724 PMCID: PMC9969761 DOI: 10.1002/ccr3.6971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
Paravalvular leakage (PVL) is yet a potential and serious complication after transcatheter aortic valve replacement. Percutaneous PVL closure may be the treatment of choice upon failure of balloon postdilation in patients with excessive surgical risk. If the retrograde approach fails, an antegrade strategy might provide the solution.
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Affiliation(s)
| | - Alberto Alperi
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain
| | - Iria Silva
- Hospital Universitario Central de AsturiasOviedoSpain
| | - Isaac Pascual
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
| | - David Ledesma
- Hospital Universitario Central de AsturiasOviedoSpain
| | - Rut Alvarez
- Hospital Universitario Central de AsturiasOviedoSpain
| | | | - Pablo Avanzas
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
| | - Raquel del Valle
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain
| | - Cesar Moris
- Hospital Universitario Central de AsturiasOviedoSpain,Instituto de Investigación Sanitaria del Principado de Asturias, ISPAOviedoSpain,University of OviedoOviedoSpain
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Cubero-Gallego H, Calvo-Fernandez A, Tizon-Marcos H, Aparisi A, Gomez-Lara J, Amat-Santos I, Fuertes M, Santos-Martinez S, Salvatella N, Garcia-Guimaraes M, Negrete A, Mohandes M, Gomez-Hospital JA, Moris C, Vaquerizo B. Real-World Multicenter Coronary Lithotripsy Registry: Long-Term Clinical Follow-Up. J Invasive Cardiol 2022; 34:E701-E708. [PMID: 36075883] [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: 06/15/2023]
Abstract
OBJECTIVES Coronary lithotripsy (CL) works by fracturing the calcified plaque, allowing mean area gain, enhancing vessel compliance, and facilitating stent deployment. This study reports the safety, effectiveness, and durability of the clinical benefit of CL at long-term follow-up of a real-world multicenter registry. METHODS This was a prospective, multicenter, single-arm study that included consecutive patients with calcified lesions undergoing CL from August, 2018 to October, 2020 with a clinical follow-up of 20 months (interquartile range, 14.5-25). Exclusion criteria were a target lesion located in a vessel <2.5 mm and/or the presence of dissection prior to CL. The primary endpoint was the rate of major adverse cardiovascular event (MACE, defined as death or target-lesion revascularization [TLR] or myocardial infarction [MI]) at follow-up. RESULTS This registry included 109 patients (128 lesions). The population was elderly (mean age, 74 years old), with high rates of diabetic patients (58%), renal insufficiency (32%), and multivessel disease (76%). Most of the lesions were predilated with semicompliant/noncompliant balloons (25 with cutting balloon). Rotational atherectomy was used in 20 lesions. On average, CL required the use of 1 balloon delivering a mean of 60 pulses. Twelve patients presented with ST-segment-elevation MI and a culprit calcified coronary lesion undergoing CL. Successful CL was achieved in 99% of cases. There were few procedural complications, with 30-day freedom from MACE rate of 98%. The MACE rate at long-term follow-up was 5.6%. CONCLUSION This is the first real-world, multicenter registry that confirms the safety and long-term efficacy of percutaneous coronary intervention for calcified lesions using CL in an unselected and high-risk population with a low long-term follow-up MACE rate.
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Affiliation(s)
- Hector Cubero-Gallego
- Hospital del Mar (Parc de Salut Mar), Passeig Maritim 25-29, 08003 Barcelona, Spain.
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Alperi A, Almendárez M, Álvarez R, Moris C, Leon V, Silva I, Hernández-Vaquero D, Pascual I, Avanzas P. Transcatheter tricuspid valve interventions: Current status and future perspectives. Front Cardiovasc Med 2022; 9:994502. [PMID: 36187002 PMCID: PMC9518720 DOI: 10.3389/fcvm.2022.994502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
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Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Isaac Pascual
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- *Correspondence: Pablo Avanzas ;
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Alperi A, Pascual I, Moris C, Avanzas P. New-generation Ultra and PRO devices: Latest device iterations but old valve type effects. Int J Cardiol 2022; 358:83-84. [PMID: 35469936 DOI: 10.1016/j.ijcard.2022.04.055] [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] [Received: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Alperi
- University Hospital of Asturias, Oviedo, Asturias, Spain.
| | - Isaac Pascual
- University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Cesar Moris
- University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- University Hospital of Asturias, Oviedo, Asturias, Spain
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Escalera A, Pascual I, Hernandez-Vaquero D, Formica F, Casares J, Diaz R, Alvarez R, Callejo F, Morales C, Moris C, Silva J. Association of the Surgical Technique With the Structural Valve Deterioration of a Bioprosthesis: A Prospective Cohort Study. Semin Thorac Cardiovasc Surg 2022; 35:647-655. [PMID: 35777692 DOI: 10.1053/j.semtcvs.2022.06.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
The Trifecta aortic valve is a prosthesis with externally mounted leaflets and a stent which may be deformed during implant. Our aim was to know if the use of the holder as a protection device during the knotting has an impact on the incidence of structural valve deterioration (SVD) or endocarditis. Prospective cohort study where all patients who underwent aortic valve replacement with a Trifecta aortic valve between 2013 and 2018 were included. The use of the holder as a protection device was collected in a database. Propensity-score matched methods were used and analyses were based on competing events. Death without SVD or prosthesis replacement not due to SVD was considered competing events. 782 patients were included, 352 pairs after the matching. Rates of SVD at 5 and 8 years were 5.8% (95% CI 3.5-8.7) and 13.6% (95% CI 9.2-18.9) in the group without holder and 2.3% (95% CI 1-4.5) and 7% (95% CI 4.2-10.8) in the group with holder; sHR = 0.49 (95% CI 0.27-0.86; P = 0.015). The risk of endocarditis at 8 years was 4.8% (95% CI 2.8-7.4) in the group without holder and 2.3% (95% CI 1.1-4.3) in the group with holder, sHR = 0.49 (95% CI 0.21-1.15, P = 0.1). The use of holder as a protection device during the knotting of the Trifecta aortic valve is associated with less risk of SVD.
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Affiliation(s)
- Alain Escalera
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain
| | - Isaac Pascual
- Department of Cardiology, Central University Hospital of Asturias. Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
| | - Francesco Formica
- University of Parma, Department of Medicine and Surgery, Cardiac Surgery Clinic, Parma, Italy
| | - Julio Casares
- Department of Cardiology, Medical Center of Asturias, Oviedo, Spain
| | - Rocio Diaz
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain
| | - Ruben Alvarez
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain
| | - Francisco Callejo
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain
| | - Carlos Morales
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain
| | - Cesar Moris
- Department of Cardiology, Central University Hospital of Asturias. Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Jacobo Silva
- Cardiac Surgery Department, Central University Hospital of Asturias. Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
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16
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Estévez-Loureiro R, Sánchez-Recalde A, Amat-Santos IJ, Cruz-González I, Baz JA, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Salido-Tahoces L, Santos-Martinez S, Núñez JC, Moris C, Goliasch G, Jimenez-Quevedo P, Ojeda S, Cid-Álvarez B, Santiago-Vacas E, Jimenez-Valero S, Serrador A, Martín-Moreiras J, Strouhal A, Hengstenberg C, Zamorano JL, Puri R, Íñiguez-Romo A. Six-Month Outcomes of the TricValve® System in Patients with Tricuspid Regurgitation: TRICUS EURO Study. JACC Cardiovasc Interv 2022; 15:1366-1377. [PMID: 35583363 DOI: 10.1016/j.jcin.2022.05.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [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: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients often deemed to be at high surgical risk. Heterotopic bi-caval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES To evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS TRICUS EURO is a non-blinded, non-randomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 to February 2021. High risk individuals with severe symptomatic TR despite optimal medical therapy were included. Primary end point was quality of life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire (KCCQ12) and New York Heart Association functional class (NYHA) improvement at 6-month follow-up. RESULTS 35 patients (mean age 76±6.8 years; 83% women) were treated with TricValve® system. All patients at baseline were at NYHA ≥ 3 status. At 30-days, procedural success was 94% with no procedural deaths or conversions to surgery. A significant increase in QOL at 6-months follow-up was observed (baseline and 6-month KCCQ: 42.01±22.3 vs. 59.7±23.6 respectively; p=0.004), correlating with a significant improvement in NYHA functional class with 79.4% of patients noted to be in class I or II at 6 months (p=0.0006). The 6-month all-cause mortality and heart failure hospitalization rates were 8.5% and 20%, respectively. CONCLUSIONS The dedicated bi-caval system for treating severe, symptomatic TR was associated with high procedural success rate and significant increase in both, QOL and functional improvements at 6-months follow-up.
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Affiliation(s)
| | | | | | | | - Jose A Baz
- Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julia Mascherbauer
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ramiro Trillo
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jean C Núñez
- Hospital Clinico Universitario de Salamanca, CIBERCV. IBSAL. Salamanca, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Georg Goliasch
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | | | - Belén Cid-Álvarez
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | | | | | - Ana Serrador
- CIBERCV. Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Christian Hengstenberg
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Almendarez M, Alvarez-Velasco R, Pascual I, Alperi A, Moris C, Avanzas P. Transseptal puncture: Review of anatomy, techniques, complications and challenges, a critical view. Int J Cardiol 2022; 351:32-38. [PMID: 35007652 DOI: 10.1016/j.ijcard.2022.01.011] [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: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 11/05/2022]
Abstract
Transseptal puncture (TSP) was initially described to gain access to the left heart for hemodynamic assessment. Continuous evolution from its origins allows interventionists to perform a myriad of procedures that otherwise would be impossible to accomplish. In the recent years, the number of procedures in cardiology that require TSP has grown exponentially. Namely, transcatheter mitral valve repair and replacement, pulmonary vein isolation and left atrium appendage occlusion. In skilled hands, it is a safe and straightforward procedure; however, a lack of knowledge of the materials, anatomy of the interatrial septum and the technique can be met with life-threatening complications. Therefore, it is imperative that interventional cardiologists master this technique to successfully overcome these obstacles and ensure clinical outcomes in patients requiring TSP. The purpose of the following review is to critically analyze the available evidence regarding TSP, provide a step-by-step approach to the technique, the available materials and tips and tricks to overcome difficulties and manage complications.
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Affiliation(s)
- Marcel Almendarez
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Rut Alvarez-Velasco
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Isaac Pascual
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Alberto Alperi
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Cesar Moris
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain.
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Alperi A, Pascual I, Moris C, Avanzas P. Valve type selection for bicuspid aortic valves in TAVR: Does the key lie in the annular size? Int J Cardiol 2021; 351:40-41. [PMID: 34973972 DOI: 10.1016/j.ijcard.2021.12.046] [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] [Received: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain
| | - Pablo Avanzas
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Spain; Universidad de Oviedo, Spain.
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Alperi A, Pascual I, Avanzas P, Moris C. Atrial-FMR: No longer the forgotten mechanism of functional mitral regurgitation. Int J Cardiol 2021; 348:113-114. [PMID: 34915078 DOI: 10.1016/j.ijcard.2021.12.007] [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] [Received: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alberto Alperi
- Heart Department, University Hospital of Asturias, Oviedo, Asturias, Spain.
| | - Isaac Pascual
- Heart Department, University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Heart Department, University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Cesar Moris
- Heart Department, University Hospital of Asturias, Oviedo, Asturias, Spain
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Alperi A, Mohammadi S, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Faroux L, Veiga G, Serra V, Fischer Q, Pascual I, Asmarats L, Gutiérrez E, Regueiro A, Vilalta V, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Metz D, De la Torre Hernandez JM, Rodenas-Alesina E, Urena M, Moris C, Arzamendi D, Perez-Fuentes P, Fernandez-Nofrerias E, Campanha-Borges DC, Mesnier J, Voisine P, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease. JACC Cardiovasc Interv 2021; 14:2490-2499. [PMID: 34794656 DOI: 10.1016/j.jcin.2021.08.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Henrique B Ribeiro
- Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic de Barcelona, Barcelona, Spain.
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Avanzas P, Kim WK, Moris C. Should we consider interventricular membranous septum length during TAVR pre procedural planning? Int J Cardiol 2021; 338:87-88. [PMID: 34153411 DOI: 10.1016/j.ijcard.2021.06.018] [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] [Received: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Pablo Avanzas
- Hospital Universitario Central de Asturias, Department of Cardiology, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain.
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Department of Cardiology, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
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Colunga S, Rolle V, Moris C, Calvo D. A comprehensive formula for computing corrected QT intervals in patients with wide QRS. J Electrocardiol 2021; 66:139-147. [PMID: 33957502 DOI: 10.1016/j.jelectrocard.2021.04.004] [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: 12/02/2020] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing interest in developing appropriate methods for correction of the QT intervals in patients with prolonged depolarization of the ventricles. From an experimental model of controlled heart rate and QRS widening, we aimed to develop a new formula with better performance. METHODS After exclusions, incremental pacing was performed (AAI mode; 50-120 bpm) in 17 patients admitted for self-expanding aortic valve implantation in two different phases: before and immediately after the release of the prosthesis. Mixed linear models were built to predict variation in QRS and JT intervals, and subsequently calculate the corrected QT (QTQRS-C). Internal and external validation on a new cohort of 48 patients was performed. RESULTS Significant QRS widening (32.5 ms; CI95%:31.5-33.6) and QT prolongation (35.4 ms; CI95%:33.4-37.4) was observed after the release of the prosthesis. The best fit formula was computed as QTQRS-C = QTmeasured - (1.058*QRSmeasured - 108.397) - (0.0496*JTmeasured - 11.038). Internal validation provided a good correlation between measured and predicted QT (Pearson's coefficient:0.76; CI95%:0.70-0.80). In an external cohort (n = 48), the QRS widening was 28.4 ms(CI95%:21.8-35.1) and the JT widening was 16.58 ms(CI95%:8.73-24.4). Compared to other formulas, our proposed formula tends to display better performance as a result of a combination of appropriate correlation (Pearson's:0.75), being the closer to identity line (slope 0.83) and minimizing the relative standard error of the estimates (RSE 0.11). CONCLUSIONS We developed a formula with better performance for QT correction in patients with wide QRS.
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Affiliation(s)
- Santiago Colunga
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Valeria Rolle
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Cesar Moris
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - David Calvo
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
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Lorca R, Pascual I, Aparicio A, Junco-Vicente A, Alvarez-Velasco R, Barja N, Roces L, Suárez-Cuervo A, Diaz R, Moris C, Hernandez-Vaquero D, Avanzas P. Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. J Clin Med 2021; 10:jcm10061314. [PMID: 33806738 PMCID: PMC8004961 DOI: 10.3390/jcm10061314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. METHODS A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014-31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). RESULTS Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. CONCLUSION Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04-98.04), 95.64% (95% CI 92.87-97.35), and 94.5% (95% CI 91.12-97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.
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Affiliation(s)
- Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
- Correspondence:
| | - Andrea Aparicio
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Alejandro Junco-Vicente
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rut Alvarez-Velasco
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Noemi Barja
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Luis Roces
- Anestesiología, Reanimación y Terapéutica del Dolor, Completo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Alfonso Suárez-Cuervo
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rocio Diaz
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
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Rozado Castano J, Garcia Iglesias D, Junco A, Soroa M, Barja N, Alvarez R, Adeba A, Vigil-Escalera M, Capin E, Fidalgo A, Martin M, Calvo D, Moris C, Delgado E, De La Hera J. Newer glucose-lowering drugs at discharge from cardiology hospitalization department: safetyness, effectiveness and mortality reduction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In recent years, the paradigm of glycemic treatment has changed due to the cardiovascular impact of newer glucose-lowering drugs (GLD) (sodium-glucosa cotransporter 2 inhibitor (SGLT2i) and GLP-1 receptor agonist (GLP1a)). The cardiological patient with type 2 diabetes (2DM) is a very high cardiovascular risk patient in which the benefit of these therapies is greater. However, to date, different studies have demonstrated the efficacy and safety of newer GLD only in the outpatient setting. So its impact when they are initiated to discharge after a cardiovascular event is unknown.
Objective
To evaluate the efficacy and safety of the onset of these newer GLD in 2DM patients at discharge from cardiology hospitalization. And to compare mortality and readmissions among patients treated with or without newer GLD.
Methods
Prospective, it includes patients admitted to cardiology at a 3er level hospital between April/2018 and February/2019 with a history of 2DM or diagnosed with 2DM during hospitalization. They were followed at 6, 12 and 18 months. The evolution of anthropometric parameters, glycemic profile, renal function and blood pressure were analyzed; renal events, readmissions, mortality and combined clinical outcome (mortality or readmission) were collected during follow-up. Quantitative variables are expressed in mean/SD and categorical variables in number of patients (%). For the comparison between the parameters at discharge and thefollow-up, a T student was used for paired data. Survival analysis by K-M was performed crude and adjusted data by propensity score matching (PSM).
Results
Population: Diagnoses at discharge: Acute coronary syndrome 66 (64%), Heart failure 22 (21%), Arrhythmias 16 (15%). 104 diabetic patients, 39 of them (38%) were treated on discharge with newer GLD. 35 Patients with SGLT2i without GLP1a, 3 patients with SGLT2i and GLP1a and 1 patient with GLP1a without SGLT2i. The mean follow-up was 16±2 months. Regarding the subgroup of patients with newer GLD: mean age was 65±21 y, male 26 (67%). A significant decrease was observed in glycated hemoglobin (7.6 to 6.9%, p=0.04) and weight (81 to 78 kg, p<0.01) without significant changes in blood pressure or glomerular filtration rate (GFR). Only 1 patient presented deterioration of their GFR that forced the transient suspension of newer GLD.
10 deaths were registered in the classical GLD group (15%) and none in the newer GLD group (HR 0.81 [0.71–0.92] p=0.002, Figure 1A, HR adjusted by PSM 0.9 [0.82–0.99], p=0.04), Figure 1B. The combined clinical outcome appeared in 38 patients (58%) in the the classical GLD group and in 9 (23%) in the newer GLD group (HR 0.70 [0.58–0.85] p<0.001, Figure 1C, PSM adjusted HR 0.75 [0.61–0.92], p=0.001), Figure 1D.
Conclusion
The use of newer GLD at discharge from cardiology hospitalization reduce mortality and readmissions. Newer GLD were safe and showed significant reduction in weigth and glycated hemoglobin.
Figure 1. Kaplan-Meier survival analysis crude and adjusted
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Rozado Castano
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - D Garcia Iglesias
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - A Junco
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - M Soroa
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - N Barja
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - R Alvarez
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - A Adeba
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - M Vigil-Escalera
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - E Capin
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - A Fidalgo
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - M Martin
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - D Calvo
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - C Moris
- University Hospital Central de Asturias, Division of Cardiology, Oviedo, Spain
| | - E Delgado
- University Hospital Central de Asturias, Endocrinology and nutrition, Oviedo, Spain
| | - J.M De La Hera
- Instituto de Investigaciόn Sanitaria del Principado de Asturias, Oviedo, Spain
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Lorca R, Aparicio A, Cuesta-Llavona E, Pascual I, Junco A, Hevia S, Villazón F, Hernandez-Vaquero D, Reguero JJR, Moris C, Coto E, Gómez J, Avanzas P. Familial Hypercholesterolemia in Premature Acute Coronary Syndrome. Insights from CholeSTEMI Registry. J Clin Med 2020; 9:E3489. [PMID: 33137929 PMCID: PMC7692119 DOI: 10.3390/jcm9113489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an underdiagnosed genetic inherited condition that may lead to premature coronary artery disease (CAD). FH has an estimated prevalence in the general population of about 1:313. However, its prevalence in patients with premature STEMI (ST-elevation myocardial infarction) has not been widely studied. This study aimed to evaluate the prevalence of FH in patients with premature STEMI. Cardiovascular risk factors, LDLc (low-density lipoprotein cholesterol) evolution, and differences between genders were also evaluated. Consecutive patients were referred for cardiac catheterization to our center due to STEMI suspicion in 2018. From the 80 patients with confirmed premature CAD (men < 55 and women < 60 years old with confirmed CAD), 56 (48 men and eight women) accepted to be NGS sequenced for the main FH genes. Clinical information and DLCN (Dutch Lipid Clinic Network) score were analyzed. Only one male patient had probable FH (6-7 points) and no one reached a clinically definite diagnosis. Genetic testing confirmed that the only patient with a DLCN score ≥6 has HF (1.8%). Smoking and high BMI the most frequent cardiovascular risk factors (>80%). Despite high doses of statins being expected to reduce LDLc levels at STEMI to current dyslipidemia guidelines LDL targets (<55 mg/dL), LDLc control levels were out of range. Although still 5.4 times higher than in general population, the prevalence of FH in premature CAD is still low (1.8%). To improve the genetic yield, genetic screening may be considered among patients with probable or definite FH according to clinical criteria. The classical cardiovascular risk factors prevalence far exceeds FH prevalence in patients with premature STEMI. LDLc control levels after STEMI were out range, despite intensive hypolipemiant treatment. These findings reinforce the need for more aggressive preventive strategies in the young and for intensive lipid-lowering therapy in secondary prevention.
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Affiliation(s)
- Rebeca Lorca
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Andrea Aparicio
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Elias Cuesta-Llavona
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Alejandro Junco
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Sergio Hevia
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Francisco Villazón
- Endocrinology Department, Hospital Universitario Central Asturias, 33014 Oviedo, Spain;
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Jose Julian Rodríguez Reguero
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Cesar Moris
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Eliecer Coto
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Juan Gómez
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
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Dominguez-Rodriguez A, Rodríguez S, Baez-Ferrer N, Abreu-Gonzalez P, Abreu-Gonzalez J, Avanzas P, Carnero M, Moris C, López-Darias J, Hernández-Vaquero D. Impact of Saharan dust exposure on airway inflammation in patients with ischemic heart disease. Transl Res 2020; 224:16-25. [PMID: 32504824 DOI: 10.1016/j.trsl.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/13/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
Epidemiological studies found that increases in the concentrations of airborne particulate matter (PM) smaller than 10 microns diameter (PM10) in the ambient air due to desert dust outbreaks contribute to global burden of diseases, primarily as a result of increased risk of cardiovascular morbidity and mortality. No studies have investigated the possible association between desert dust inhalation and airway inflammation in patients with ischemic heart disease (IHD). Induced sputum was collected in 38 patients and analyzed to determine markers of airway inflammation (Transforming Growth Factor-β1 [TGF-β1] and hydroxyproline) concentrations. For the purpose of the investigation, PM10 and reactive gases concentrations measured in the European Air Quality Network implemented in the Canary Islands were also used. We identified Saharan desert dust using meteorology and dust models. Patients affected by smoking, chronic obstructive pulmonary disease (COPD), asthma, pulmonary abnormalities, acute bronchial or pulmonary disease were excluded. The median of age of patients was 64.71 years (56.35-71.54) and 14 (38.84%) of them were women. TGF-β1 and hydroxyproline in sputum were highly associated to PM10 inhalation from the Saharan desert. According to a regression model, an increase of 1 µg/m3 of PM10 concentrations due to desert dust, results in an increase of 3.84 pg/gwt of TGF-β1 (R2 adjusted = 89.69%) and of 0.80 μg/gwt of hydroxyproline (R2 adjusted = 85.28%) in the sputum of patients. The results of this study indicate that the exposure to high PM10 concentrations due to Saharan dust events are associated with intense inflammatory reaction in the airway mucosae of IHD-patients.
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Affiliation(s)
- Alberto Dominguez-Rodriguez
- Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Sergio Rodríguez
- Experimental Station of Arid Zones, EEZA, CSIC, Almería, Spain; Institute of Natural Products and Agrobiology, IPNA, CSIC, Tenerife, Spain.
| | - Nestor Baez-Ferrer
- Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain
| | - Pedro Abreu-Gonzalez
- Department of Physiology, Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Juan Abreu-Gonzalez
- Hospital Universitario de Canarias, Department of Pneumology, Tenerife, Spain
| | - Pablo Avanzas
- Heart Area. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias
| | | | - Cesar Moris
- Heart Area. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias
| | - Jessica López-Darias
- Institute of Natural Products and Agrobiology, IPNA, CSIC, Tenerife, Spain; Departamento de Química, University of La Laguna, Tenerife, Spain
| | - Daniel Hernández-Vaquero
- Heart Area. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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Hernandez-Vaquero D, Vigil-Escalera C, Persia Y, Morales C, Pascual I, Domínguez-Rodríguez A, Rodríguez-Caulo E, Carnero M, Díaz R, Avanzas P, Moris C, Silva J. Perceval or Trifecta to Prevent Patient-Prosthesis Mismatch. J Clin Med 2020; 9:jcm9092964. [PMID: 32937912 PMCID: PMC7563879 DOI: 10.3390/jcm9092964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient-prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient-prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient-prosthesis mismatch: OR = 0.5 (95% CI 0.3-0.9, p = 0.02). Both prostheses led to a similar risk of severe patient-prosthesis mismatch: OR = 0.9 (95% CI 0.3-2.8, p = 0.79). Both prostheses provide a very low risk of severe patient-prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
- Correspondence: ; Tel.: +34-985274688
| | - Carlota Vigil-Escalera
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Yvan Persia
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Carlos Morales
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Isaac Pascual
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | | | | | - Manuel Carnero
- Cardiac Surgery Department, Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain;
| | - Rocío Díaz
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Pablo Avanzas
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Cesar Moris
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Jacobo Silva
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
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Rozado J, García Iglesias D, Soroa M, Junco-Vicente A, Barja N, Adeba A, Vigil-Escalera M, Alvarez R, Torres Saura F, Capín E, García L, Rodriguez ML, Calvo D, Moris C, Delgado E, de la Hera JM. Sodium-Glucose Cotransporter-2 Inhibitors at Discharge from Cardiology Hospitalization Department: Decoding A New Clinical Scenario. J Clin Med 2020; 9:jcm9082600. [PMID: 32796615 PMCID: PMC7464502 DOI: 10.3390/jcm9082600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/06/2020] [Revised: 08/02/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.
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Affiliation(s)
- José Rozado
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Daniel García Iglesias
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Miguel Soroa
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Alejandro Junco-Vicente
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Noemí Barja
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Antonio Adeba
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - María Vigil-Escalera
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Rut Alvarez
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Francisco Torres Saura
- Department of Cardiology, Hospital Universitario Vinalopo y Hospital Universitario Torrevieja, 03293 Torrevieja, Spain;
| | - Esmeralda Capín
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Laura García
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - María Luisa Rodriguez
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - David Calvo
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Medicine Department, University of Oviedo, 33011 Oviedo, Spain
| | - Elías Delgado
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Medicine Department, University of Oviedo, 33011 Oviedo, Spain
- Department of Endocrinology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jesús María de la Hera
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.R.); (D.G.I.); (M.S.); (A.J.-V.); (N.B.); (A.A.); (M.V.-E.); (R.A.); (E.C.); (L.G.); (M.L.R.); (D.C.); (C.M.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Correspondence:
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Cubero-Gallego H, Hernandez-Vaquero D, Avanzas P, Almendarez M, Adeba A, Lorca R, Rozado J, Escalera A, Silva J, Moris C, Pascual I. Outcomes with percutaneous mitral repair vs. optimal medical treatment for functional mitral regurgitation: systematic review. Ann Transl Med 2020; 8:962. [PMID: 32953762 PMCID: PMC7475445 DOI: 10.21037/atm.2020.03.202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Functional mitral regurgitation (MR) could be defined as a ventricular disease where mitral valve is structurally normal, left chambers are enlarged and mitral annulus is dilated with lack of coaptation of leaflets. Transcatheter mitral valve repair technique has broadened the therapeutic range in the treatment of severe MR. The aim of this study was to review outcomes of MitraClip vs. medical treatment for functional MR. We also planned to review the concept of functional MR, assessment of the degree, prognosis and therapy options. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline through PubMed database was used to search. The present review included manuscripts published between January 2009 and September 2019. Two authors independently screened titles and abstracts of all publications, and performed the selection of studies and data extraction. In the case of disagreements, consensus meetings reached the final decision. Inclusion criteria were: (I) randomized controlled trials and (II) works must compare MitraClip versus optimal medical treatment. Transcatheter mitral valve repair along optimal medical treatment has been compared with optimal medical therapy in two different randomized trials. In the COAPT trial, the MitraClip group showed a significant reduction in mortality and heart failure (HF) hospitalizations. In the MITRA-FR trial, no significant differences were observed between both groups. We reviewed important aspects of functional MR and performed a comprehensive review of both trials comparing them and focusing on their differences.
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Affiliation(s)
- Hector Cubero-Gallego
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Functional Biology Department, Universidad of Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Departamento de Medicina, Universidad of Oviedo, Oviedo, Spain
| | - Marcel Almendarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Antonio Adeba
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jose Rozado
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Alain Escalera
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jacobo Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Departamento de Medicina, Universidad of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Functional Biology Department, Universidad of Oviedo, Oviedo, Spain
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Pascual I, Carrasco-Chinchilla F, Benito-Gonzalez T, Li CH, Avanzas P, Nombela-Franco L, Pan M, Serrador Frutos A, Freixa X, Trillo-Nouche R, Hernández-Antolín RA, Andraka Ikazuriaga L, Cruz-Gonzalez I, López-Mínguez JR, Diez JL, Berenguer-Jofresa A, Sanchis J, Ruiz-Quevedo V, Urbano-Carrillo C, Dominguez JFO, Ortas-Nadal MR, Molina Navarro E, Carrillo X, Alonso-Briales JH, Fernández-Vázquez F, Asmarats Serra L, Hernandez-Vaquero D, Jimenez-Quevedo P, Mesa D, Rodríguez-Gabella T, Regueiro A, Martinez Monzonís A, Salido Tahoces L, Ruiz Gomez L, Trejo-Velasco B, Becerra-Muñoz VM, Garrote-Coloma C, Fernández Peregrina E, Lorca R, Agustín JAD, Romero M, Amat-Santos IJ, Sabaté M, Alvarez ABC, Hernandez-Garcia JM, Gualis J, Arzamendi D, Moris C, Tirado-Conte G, Sánchez-Recalde A, Estevez-Loureiro R. Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study. J Clin Med 2020; 9:E1792. [PMID: 32526978 PMCID: PMC7356666 DOI: 10.3390/jcm9061792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/24/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip® between two groups according to LVEF. METHODS In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. RESULTS Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. CONCLUSION FMR patients with LVEF <30% treated with MitraClip® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.
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Affiliation(s)
- Isaac Pascual
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Fernando Carrasco-Chinchilla
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Tomas Benito-Gonzalez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Chi Hion Li
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Pablo Avanzas
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Manuel Pan
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ana Serrador Frutos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Xavier Freixa
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ramiro Trillo-Nouche
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Rosa A. Hernández-Antolín
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Leire Andraka Ikazuriaga
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Ignacio Cruz-Gonzalez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | | | - Jose L. Diez
- Cardiology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | | | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, University of Valencia, INCLIVA, CIBERCV, 46010 Valencia, Spain;
| | | | | | - Juan F. Oteo Dominguez
- Cardiology Department, University Hospital Puerta de Hierro/Majadahonda, 28222 Madrid, Spain;
| | - Maria R. Ortas-Nadal
- Cardiology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain;
| | | | - Xavier Carrillo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain;
| | - Juan H. Alonso-Briales
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Felipe Fernández-Vázquez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Luis Asmarats Serra
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Daniel Hernandez-Vaquero
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Dolores Mesa
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Tania Rodríguez-Gabella
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Amparo Martinez Monzonís
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Luisa Salido Tahoces
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Lara Ruiz Gomez
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Blanca Trejo-Velasco
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | - Victor M. Becerra-Muñoz
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Carmen Garrote-Coloma
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | | | - Rebeca Lorca
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Jose A. De Agustín
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Miguel Romero
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ignacio J. Amat-Santos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Manel Sabaté
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ana B. Cid Alvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Jose M. Hernandez-Garcia
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Javier Gualis
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Dabit Arzamendi
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Cesar Moris
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Angel Sánchez-Recalde
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
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Hernandez-Vaquero D, Diaz R, Alperi A, Almendarez MG, Escalera A, Cubero-Gallego H, Avanzas P, Moris C, Pascual I. Life expectancy of patients undergoing surgical aortic valve replacement compared with that of the general population. Interact Cardiovasc Thorac Surg 2020; 30:394-399. [PMID: 31740947 DOI: 10.1093/icvts/ivz268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Surgical aortic valve replacement (SAVR) changes the natural history of severe aortic stenosis. However, whether the life expectancy of patients with severe aortic stenosis undergoing this surgical procedure is fully restored is unknown. The objective of this study was to assess if the life expectancy of patients aged >75 years is fully restored after undergoing surgery for severe aortic stenosis. METHODS We compared long-term survival of a group of patients aged >75 years, who underwent SAVR at our institution with the long-term survival of the general population. We matched each patient with 100 simulated individuals (control group) of the same age, sex and geographical region who died as indicated by the National Institute of Statistics. We compared survival curves and calculated hazard ratio (HR) or incidence rate ratio. Statistical significance existed if confidence intervals (CIs) did not overlap or did not include the value 1, as appropriate. RESULTS Average life expectancy of surgical patients who survived the postoperative period was 90.91 months (95% CI 82.99-97.22), compared to 92.94 months (95% CI 92.39-93.55) in the control group. One-, 5- and 8-year survival rates for SAVR patients who were discharged from the hospital were 94.9% (95% CI 92.74-96.43%), 71.66% (95% CI 67.37-75.5%) and 44.48% (95% CI 38.14-50.61%), respectively, compared to that of the general population: 95.8% (95% CI 95.64-95.95%), 70.64% (95% CI 70.28%-71%) and 47.91% (95% CI 47.52-48.31%), respectively (HR 1.07, 95% CI 0.94-1.22). CONCLUSION For patients over the age of 75 years who underwent SAVR and survived the postoperative period, life expectancy and survival rates were similar to that of the general population.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Rocio Diaz
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Alberto Alperi
- Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Marcel G Almendarez
- Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Alain Escalera
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain
| | | | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain.,University of Oviedo, Oviedo, Spain
| | - Cesar Moris
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain.,University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain.,University of Oviedo, Oviedo, Spain
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Hernandez-Vaquero D, Silva J, Escalera A, Álvarez-Cabo R, Morales C, Díaz R, Avanzas P, Moris C, Pascual I. Life Expectancy after Surgery for Ascending Aortic Aneurysm. J Clin Med 2020; 9:jcm9030615. [PMID: 32106425 PMCID: PMC7141111 DOI: 10.3390/jcm9030615] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction: The life expectancy of patients who undergo ascending aortic replacement is unknown. The life expectancy of a population depends on a collection of environmental and socio-economic factors of the territory where they reside. Our aim was to compare the life expectancy of patients undergoing surgery for ascending aortic aneurysm with that of the general population matching by age, sex, and territory. In addition, we aimed to know the late complications, causes of death and risk factors. Methods: All patients who underwent elective replacement of an ascending aortic aneurysm at our institution between 2000 and 2019 were included. The long-term survival of the sample was compared with that of the general population using data of the National Institute of Statistics. Results: For patients who survived the postoperative period, observed cumulative survival at three, five and eight years was 94.07% (95% CI 91.87%-95.70%), 89.96% (95% CI 86.92%-92.33%) and 82.72% (95% CI 77.68%-86.71%). Cumulative survival of the general population at three, five and eight years was 93.22%, 88.30%, and 80.27%. Cancer and cardiac failure were the main causes of death. Conclusions: Long-term survival of patients undergoing elective surgery for ascending aortic aneurysm who survive the postoperative period completely recover their life expectancy.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (C.M.); (I.P.)
- Correspondence: ; Tel.: +0034-985108000
| | - Jacobo Silva
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
- Department of Surgery, University of Oviedo, 33011 Oviedo, Spain
| | - Alain Escalera
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
| | - Rubén Álvarez-Cabo
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
| | - Carlos Morales
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
| | - Rocío Díaz
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (J.S.); (A.E.); (C.M.); (R.D.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (C.M.); (I.P.)
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (C.M.); (I.P.)
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain
- Department of Medicine, University of Oviedo, 33011 Oviedo, Spain
| | - Cesar Moris
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (C.M.); (I.P.)
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain
- Department of Medicine, University of Oviedo, 33011 Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (C.M.); (I.P.)
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain
- Department of Medicine, University of Oviedo, 33011 Oviedo, Spain
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Cubero-Gallego H, Avanzas P, Moris C. Guidewire Lost During the Deployment of a Nonretrievable Transcatheter Aortic Valve Prosthesis. JACC Cardiovasc Interv 2020; 13:e23-e24. [DOI: 10.1016/j.jcin.2019.10.029] [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: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
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Faroux L, Munoz-Garcia E, Serra V, Alperi A, Nombela-Franco L, Fischer Q, Veiga G, Donaint P, Asmarats L, Vilalta V, Chamandi C, Regueiro A, Gutiérrez E, Munoz-Garcia A, Garcia Del Blanco B, Bach-Oller M, Moris C, Armijo G, Urena M, Fradejas-Sastre V, Metz D, Castillo P, Fernandez-Nofrerias E, Sabaté M, Tamargo M, Del Val D, Couture T, Rodes-Cabau J. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008620. [PMID: 31992059 DOI: 10.1161/circinterventions.119.008620] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR. METHODS Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded. RESULTS The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P=0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P=0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P=0.026). CONCLUSIONS ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Erika Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Spain (E.M.-G., A.M.-G.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B., M.B.-O.)
| | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | - Gabriela Veiga
- Hospital Marques de Valdecilla, Santander, Spain (G.V., V.F.-S.)
| | | | - Lluis Asmarats
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | | | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Enrique Gutiérrez
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | | | | | | | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - German Armijo
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | | | - Damien Metz
- Reims University Hospital, Reims, France (P.D., D.M.)
| | - Pablo Castillo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Maria Tamargo
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
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Cubero-Gallego H, Pascual I, Rozado J, Ayesta A, Hernandez-Vaquero D, Diaz R, Alperi A, Avanzas P, Moris C. Cerebral protection devices for transcatheter aortic valve replacement. Ann Transl Med 2019; 7:584. [PMID: 31807565 DOI: 10.21037/atm.2019.09.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aortic stenosis is the most prevalent primary valve disease in developed countries. Its prevalence is increasing due to population aging. Transcatheter aortic valve replacement (TAVR) is a sterling therapy for symptomatic patients with severe aortic stenosis and high or intermediate surgery risk. The number of procedures has increased exponentially expanding to younger and lower risk patients. Despite new-generation TAVR devices and enhanced operator skills, cerebrovascular events (CVEs) carry on being one of the most severe complications, increasing morbi-mortality. CVE might be under reported because there are few studies with rigorous neurological clinical assessment. Several imaging studies show most of CVE after TAVR has a probable embolic etiology. The risk of CVE ranges from 2.7% to 5.5% at 30 days. As TAVR expands to younger and lower risk patients, the prevention of stroke plays an increasingly important role. Cerebral protection devices (CPD) were designed to reduce the risk of CVE during TAVR. This review describes the scientific evidence on CVE after TAVR and summarizes the performance and results of the main CPDs.
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Affiliation(s)
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
| | - José Rozado
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Ayesta
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Rocio Diaz
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Departamento de Medicina, Oviedo, Spain
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Kim WK, Schäfer U, Tchetche D, Nef H, Arnold M, Avanzas P, Rudolph T, Scholtz S, Barbanti M, Kempfert J, Mangieri A, Lauten A, Frerker C, Yoon SH, Holzamer A, Praz F, De Backer O, Toggweiler S, Blumenstein J, Purita P, Tarantini G, Thilo C, Wolf A, Husser O, Pellegrini C, Burgdorf C, Antolin RAH, Díaz VAJ, Liebetrau C, Schofer N, Möllmann H, Eggebrecht H, Sondergaard L, Walther T, Pilgrim T, Hilker M, Makkar R, Unbehaun A, Börgermann J, Moris C, Achenbach S, Dörr O, Brochado B, Conradi L, Hamm CW. Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration). Eur Heart J 2019; 40:3156-3165. [DOI: 10.1093/eurheartj/ehz429] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/09/2019] [Accepted: 05/30/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort.
Methods and results
We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective.
Conclusion
Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.
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Affiliation(s)
- Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Didier Tchetche
- Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France
| | - Holger Nef
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Tanja Rudolph
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Smita Scholtz
- Department of Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Alexander Lauten
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Sung-Han Yoon
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Ole De Backer
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Paola Purita
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Alexander Wolf
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Germany
| | - Oliver Husser
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Christof Burgdorf
- Department of Cardiology, Heart and Vascular Center Bad Bevensen, Bad Bevensen, Germany
| | | | - Victor A Jiménez Díaz
- Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Department of Cardiology, University Hospital of Vigo, Vigo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Frankfurt, Germany
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Pilgrim
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Hilker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Raj Makkar
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Axel Unbehaun
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Jochen Börgermann
- Herz- und Diabeteszentrum NRW, Department of Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Stephan Achenbach
- Department of Cardiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Bruno Brochado
- Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
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Hernandez-Vaquero D, Diaz R, Moris C. Should we modify the protocol of a systematic review to include a relevant study? J Thorac Cardiovasc Surg 2019; 157:e358-e360. [DOI: 10.1016/j.jtcvs.2019.02.036] [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: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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Hernandez-Vaquero D, Pascual I, Diaz R, Avanzas P, Moris C, Silva J. Surgical Explantation of a Transcatheter-Implanted Aortic Valve Prosthesis Is Feasible and Easy. Ann Thorac Surg 2019; 108:e173-e174. [PMID: 30794783 DOI: 10.1016/j.athoracsur.2019.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/29/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
This report describes a clinical case of a degenerated CoreValve (Medtronic, Minneapolis, MN) aortic prosthesis in a 59-year-old patient. Videos of a previously described surgical technique for late surgical explantation of a CoreValve are provided. This operation is feasible and easy to perform, partly because of the absence of adhesions at the coronary ostia. This report also comments on the controversy between mechanical and biologic prostheses in patients undergoing renal dialysis.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain.
| | - Rocio Diaz
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Cesar Moris
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Jacobo Silva
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Heart Area, Central University Hospital of Aturias, Oviedo, Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Fischer Q, Himbert D, Webb JG, Eltchaninoff H, Muñoz-García AJ, Tamburino C, Nombela-Franco L, Nietlispach F, Moris C, Ruel M, Dager AE, Serra V, Cheema AN, Amat-Santos IJ, de Brito FS, Ribeiro H, Abizaid A, Sarmento-Leite R, Dumont E, Barbanti M, Durand E, Alonso Briales JH, Bouleti C, Immè S, Maisano F, del Valle R, Miguel Benitez L, García del Blanco B, Côté M, Philippon F, Urena M, Rodés-Cabau J. Impact of Preexisting Left Bundle Branch Block in Transcatheter Aortic Valve Replacement Recipients. Circ Cardiovasc Interv 2018; 11:e006927. [DOI: 10.1161/circinterventions.118.006927] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/10/2023]
Affiliation(s)
- Quentin Fischer
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - Dominique Himbert
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - John G. Webb
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia Canada (J.G.W., M.B
| | - Helene Eltchaninoff
- Department of Cardiology, Hopital Charles Nicolle, University of Rouen, France (H.E., E.D.)
| | - Antonio J. Muñoz-García
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Universidad de Malaga, Spain (A.J.M.-G., J.H.A.B.)
| | - Corrado Tamburino
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F.)
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center, Transcatheter Valve Clinic, Zurich, Switzerland (F.N., F.M.)
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.M., R.d.V.)
| | - Marc Ruel
- Department of Cardiology, Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R.)
| | - Antonio E. Dager
- Department of Cardiology, Clinica de Occidente de Cali, Colombia (A.E.D., L.M.B.)
| | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Asim N. Cheema
- Department of Cardiology, St. Michael’s Hospital, Toronto University, Ontario, Canada (A.N.C.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S.)
| | - Fabio Sandoli de Brito
- Department of Cardiology, Hospital Israelita Albert Einstein, Sa.o Paulo, Brazil (F.S.d.B)
| | - Henrique Ribeiro
- Department of Cardiology, Heart Institute-InCor, University of Sa.o Paulo, Brazil (H.R.)
| | - Alexandre Abizaid
- Department of Cardiology, Instituto Dante Pazzanese de Cardiologia, Sa.o Paulo, Brazil (A.A.)
| | - Rogério Sarmento-Leite
- Department of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil (R.S.-L.)
| | - Eric Dumont
- Department of Cardiology, Hopital Charles Nicolle, University of Rouen, France (H.E., E.D.)
| | - Marco Barbanti
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia Canada (J.G.W., M.B
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | | | - Juan H. Alonso Briales
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Universidad de Malaga, Spain (A.J.M.-G., J.H.A.B.)
| | - Claire Bouleti
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - Sebastiano Immè
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | - Francesco Maisano
- Department of Cardiology, University Heart Center, Transcatheter Valve Clinic, Zurich, Switzerland (F.N., F.M.)
| | - Raquel del Valle
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.M., R.d.V.)
| | - Luis Miguel Benitez
- Department of Cardiology, Clinica de Occidente de Cali, Colombia (A.E.D., L.M.B.)
| | - Bruno García del Blanco
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Mélanie Côté
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - François Philippon
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
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Pascual Calleja I, Avanzas P, Hernandez-Vaquero D, Diaz R, Padron R, Lorca R, Leon V, Moris C. P2261Self-expanding transcatheter aortic valve implantation for degenerated mitroflow bioprosthesis: early outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2261] [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)
| | - P Avanzas
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | | | - R Diaz
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - R Padron
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - R Lorca
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - V Leon
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - C Moris
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
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Diaz-Chiron L, Negral L, Suarez A, Pascual I, Suarez-Pena B, Fernandez-Nava Y, Diaz R, Hernandez-Vaquero D, Rodriguez S, Abreu-Gonzalez P, Dominguez-Rodriguez A, Castrillon L, Moris C, Avanzas Fernandez P. P2517Influence of air pollution exposure on systemic inflammation and enzymatic infarct size in patients with STEMI successfully treated with primary PCI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2517] [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: 11/15/2022] Open
Affiliation(s)
- L Diaz-Chiron
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Negral
- University of Oviedo, Oviedo, Spain
| | - A Suarez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - R Diaz
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - S Rodriguez
- Izaña Atmospheric Research Centre, Santa Cruz de Tenerife, Spain
| | | | | | | | - C Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
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Hernandez-Vaquero D, Diaz R, Pascual I, Silva J, Moris C. Considerations When Evaluating Structural Valve Deterioration. J Am Coll Cardiol 2018; 72:586-587. [DOI: 10.1016/j.jacc.2018.04.081] [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: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
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Alperi A, Hernandez-Vaquero D, Pascual I, Diaz R, Silva I, Alvarez-Cabo R, Avanzas P, Moris C. Aortic valve replacement in young patients: should the biological prosthesis be recommended over the mechanical? Ann Transl Med 2018; 6:183. [PMID: 29951505 DOI: 10.21037/atm.2018.02.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocio Diaz
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
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Eggebrecht H, Vaquerizo B, Moris C, Bossone E, Lämmer J, Czerny M, Zierer A, Schröfel H, Kim WK, Walther T, Scholtz S, Rudolph T, Hengstenberg C, Kempfert J, Spaziano M, Lefevre T, Bleiziffer S, Schofer J, Mehilli J, Seiffert M, Naber C, Biancari F, Eckner D, Cornet C, Lhermusier T, Philippart R, Siljander A, Giuseppe Cerillo A, Blackman D, Chieffo A, Kahlert P, Czerwinska-Jelonkiewicz K, Szymanski P, Landes U, Kornowski R, D’Onofrio A, Kaulfersch C, Søndergaard L, Mylotte D, Mehta RH, De Backer O. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J 2017; 39:676-684. [DOI: 10.1093/eurheartj/ehx713] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
- Department of Cardiology, Herz- Thorax- Zentrum, Klinikum Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Departamento de Cardiología, Hospital del Mar, Passeig Marítim 25/29, 08003 Barcelona, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Roma s/n, 33011 Oviedo, Asturias, Spain
| | - Eduardo Bossone
- Cardiology Division “Cava de'Tirreni and Amalfi Coast” Heart Department, University Hospital, Via de Marinis 4, 84013 Cava de'Tirreni, Italy
| | - Johannes Lämmer
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Krankenhausstr. 9, 4021 Linz, Austria
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart Center, University of Cologne, Medizinische Klinik III, Kerpener Str. 3, 50937 Cologne, Germany
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jörg Kempfert
- Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marco Spaziano
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Thierry Lefevre
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Wördemannsweg 25-27, 22527 Hamburg, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University Munich and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45134 Essen, Germany
| | - Fausto Biancari
- Department of Cardiology, University of Oulu and Heart Center, University of Turku, Hämeentie 11 P.O. Box 52, 20521 Turku, Finland
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Medizinische Klinik 8, Breslauer Str. 201, 90471 Nürnberg, Germany
| | - Charles Cornet
- Cardiology Department. Interventional Cardiology Unit. University Hospital of Angers, 4 rue Larry, 49000 Angers, France
| | - Thibault Lhermusier
- Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, 1, Professeur Jean Poulhes Avenue, 31059 Toulouse, France
| | - Raphael Philippart
- Groupe Cardio-Vasculaire Interventionnel Clinique Pasteur, 45 avenue de Lombez BP 27617, 31076 Toulouse, France
| | - Antti Siljander
- Department of Cardiology, Kuopio University Hospital Heart Center, PL 100, 70029 KYS Kuopio, Finland
| | - Alfredo Giuseppe Cerillo
- UO Cardiochirurgia Ospedale del Cuore G. Pasquinucci Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Mass, Italy
| | - Daniel Blackman
- Department of Cardiology, Leeds Teaching Hospitals, LS23 6AL Leeds, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Hospital, Olgettina Street 60, 20132 Milan, Italy
| | - Philipp Kahlert
- Department of Cardiology, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | | | - Piotr Szymanski
- Valvular Heart Disease Department, National Institute of Cardiology, Alpejske 42, 06-628 Warsaw, Poland
| | - Uri Landes
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Augusto D’Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, Azienda Ospedaliera-University of Padova, 2 Via Nicolò Giustiniani, 35128 Padova, Italy
| | - Carl Kaulfersch
- Department of Cardiology, Klinikum Klagenfurt, Sankt Veiter Straβe 47, Klagenfurt am Wörthersee, Austria
| | - Lars Søndergaard
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Rajendra H Mehta
- Department of Internal Medicine Division of Cardiology Duke University Medical Center and Duke Clinical Research Institute, 2400 Pratt Street Durham NC 27715, Durham, NC, USA
| | - Ole De Backer
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
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Yoon SH, Schmidt T, Bleiziffer S, Schofer N, Fiorina C, Munoz-Garcia AJ, Yzeiraj E, Amat-Santos IJ, Tchetche D, Jung C, Fujita B, Mangieri A, Deutsch MA, Ubben T, Deuschl F, Kuwata S, De Biase C, Williams T, Dhoble A, Kim WK, Ferrari E, Barbanti M, Vollema EM, Miceli A, Giannini C, Attizzani GF, Kong WK, Gutierrez-Ibanes E, Jimenez Diaz VA, Wijeysundera HC, Kaneko H, Chakravarty T, Makar M, Sievert H, Hengstenberg C, Prendergast BD, Vincent F, Abdel-Wahab M, Nombela-Franco L, Silaschi M, Tarantini G, Butter C, Ensminger SM, Hildick-Smith D, Petronio AS, Yin WH, De Marco F, Testa L, Van Mieghem NM, Whisenant BK, Kuck KH, Colombo A, Kar S, Moris C, Delgado V, Maisano F, Nietlispach F, Mack MJ, Schofer J, Schaefer U, Bax JJ, Frerker C, Latib A, Makkar RR. Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation. J Am Coll Cardiol 2017; 70:2752-2763. [DOI: 10.1016/j.jacc.2017.10.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Alfonso F, Trillo R, Moris C. Shifting transcatheter aortic valve implantation to low-risk patients: a pilgrimage with no shortcuts. Eur Heart J Qual Care Clin Outcomes 2017; 3:258-261. [PMID: 29044401 DOI: 10.1093/ehjqcco/qcx026] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, IIS-IP, Diego de León 62, Madrid 28006, Spain
| | - Ramiro Trillo
- Department of Cardiology, Hospital Universitario de Santiago de Compostela, La Coruña, Spain
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
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Rozado J, Pascual I, Avanzas P, Hernandez-Vaquero D, Alvarez R, Díaz R, Díaz B, Martín M, Carro A, Muñiz G, Silva J, Moris C. Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction. J Thorac Dis 2017; 9:E827-E830. [PMID: 29221351 DOI: 10.21037/jtd.2017.08.164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/06/2022]
Abstract
Post-infarction ventricular septal defect (VSD) is a rare but potentially lethal complication of acute myocardial infarction. Medical management is usually futile, so definitive surgery remains the treatment of choice but the risk surgery is very high and the optimal timing for surgery is still under debate. A 55-year-old man with no previous medical history attended the emergency-room for 12 h evolution of oppressive chest pain and strong anginal pain 7 days ago. On physical examination, blood pressure was 96/70 mmHg, pansystolic murmur over left sternal border without pulmonary crackles. An electrocardiogram revealed sinus rhythm 110 bpm, elevation ST and Q in inferior-posterior leads. Transthoracic echocardiogram showed inferoposterior akinesia, posterior-basal septal rupture (2 cm × 2 cm) with left-right shunt. Suspecting VSD in inferior-posterior acute myocardial infarction evolved, we performed emergency coronarography with 3-vessels disease and complete subacute occlusion of the mid segment of the right coronary artery. Left ventriculography demonstrated shunting of contrast from the left ventricule to the right ventricule. He was rejected for heart transplantation because of his age. Considering the high surgical risk to early surgery and his hemodynamic and clinical stability, delayed surgical treatment is decided, and 4 days after admission the patient suffered hemodynamic instability so venoarterial extracorporeal membrane oxygenation system (ECMO) is implanted as a bridge to reparative surgery. The 9th day after admission double bypass, interventricular defect repair with pericardial two-patch exclusion technique, and ECMO decannulation were performed. The patient's postoperative course was free of complications and was discharged 10 days post VSD repair surgery. Follow-up 3-month later revealed the patient to be in good functional status and good image outcome with intact interventricular septal patch without shunt. ECMO as a bridge to reparative surgery in postinfarction VSD is an adequate option to stabilize patients until surgery.
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Affiliation(s)
- Jose Rozado
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Ruben Alvarez
- Cardiac Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Rocio Díaz
- Cardiac Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Beatriz Díaz
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Martín
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Guillermo Muñiz
- Acute Cardiac Care Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jacobo Silva
- Cardiac Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Cesar Moris
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Grube E, Van Mieghem NM, Bleiziffer S, Modine T, Bosmans J, Manoharan G, Linke A, Scholtz W, Tchétché D, Finkelstein A, Trillo R, Fiorina C, Walton A, Malkin CJ, Oh JK, Qiao H, Windecker S, Grube E, Windecker S, Bosmans J, Bleiziffer S, Manoharan G, Modine T, Van Mieghem N, Sinhal A, Gooley R, Walton T, Yong G, Bosmans J, Webb J, Chu M, Radhakrishnan S, Dager A, Branny M, Tchetche D, Modine T, Teiger E, Chevalier B, Himbert D, Schymik G, Zeus T, Jensen C, Rassaf T, Fichtlscherer S, Nickenig G, Linke A, Bleiziffer S, Kempfert J, Scholtz W, Harnath A, Strasser R, Frerker C, Spargias K, Merkely BP, Finkelstein A, Tamburino C, Colombo A, Petronio AS, Fiorina C, Bedogni F, Amoroso G, van der Heijden J, Van Mieghem N, Tonino P, Echeverria Beliz P, Witkowski A, Gama Ribeiro V, Al Abdullah M, Weich H, Trillo R, Hernández García JM, Moris C, Jönsson AL, Malkin CJ, Khogali S, Hildick-Smith D, Manoharan G. Clinical Outcomes With a Repositionable Self-Expanding Transcatheter Aortic Valve Prosthesis. J Am Coll Cardiol 2017; 70:845-853. [DOI: 10.1016/j.jacc.2017.06.045] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
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Hernandez-Vaquero D, Diaz R, Silva J, Pascual I, Alvarez-Cabo R, Rozado J, Moris C. 4801Real strutural valve deterioration of the mitroflow aortic prosthesis: competing risk analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4801] [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: 11/14/2022] Open
Affiliation(s)
| | - R. Diaz
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - J. Silva
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - I. Pascual
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - R. Alvarez-Cabo
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - J. Rozado
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
| | - C. Moris
- University Hospital Central de Asturias, Cardiology, Oviedo, Spain
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Abstract
The aortic disease comprises a group of different pathologies of high prevalence, seriousness and ever changing by the medical and surgical investigations. Therefore cardiovascular scientific societies in USA, Europe and Asia have created Task Force on practice guidelines (PG) to develop, update and revise PG for aortic diseases. These documents issue recommendations on the diagnosis and management of different aortic diseases. The three societies agree on the recommendations about diagnostic tests and on the value of computed tomography and magnetic resonance as the main tools for the diagnosis and follow-up of aortic disease. Concerning to acute aortic syndromes (AAS), American and European GPs recognize intramural hematoma (IMH) as a type of AAS with surgery indication; however Asian guidelines consider IMH a pathological process different from AAS and indicate medical treatment. In thoracic aortic aneurysms (TAA), all express the need for an adequate control of cardiovascular risk factors, emphasizing strict control of blood pressure, smoking cessation and recommend the use of beta-blockers and statins. The threshold for asymptomatic repair is 5.5 cm in European and American and 6 cm for Asian PG, with lower thresholds in Marfan and bicuspid aortic valve (BAV). As regards the abdominal aortic aneurysms (AAA), the PGs recognize the adequate control of cardiovascular risk factors, but there are differences in class of recommendation on statins, angiotensin-converting enzyme inhibitors or beta-blockers to prevent progression of AAA. For intervention, the threshold diameter in asymptomatic is 5.5 cm but can be reduced to 5 cm in women as recommended by Asian PG. Moreover the specific diseases such as Marfan, BAV, pregnancy or atherosclerosis aortic present specific recommendations with small differences between PGs. In conclusion, PGs are interesting and appropriate documents at present. They issue recommendations based on evidence that help the clinician and surgeon in their daily approach to aortic pathology.
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Affiliation(s)
- Jose Rozado
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Maria Martin
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Cesar Moris
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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