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Bohn C, Schaeffer T, Cuman M, Staehler H, Di Padua C, Heinisch PP, Piber N, Hager A, Ewert P, Hörer J, Ono M. Tachyarrhythmia after the total cavopulmonary connection: incidence, prognosis, and risk factors. Cardiol Young 2024; 34:713-721. [PMID: 37730655 DOI: 10.1017/s1047951123003141] [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] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the incidence and outcomes regarding tachyarrhythmia in patients after total cavopulmonary connection. METHODS A retrospective analysis of 620 patients who underwent total cavopulmonary connection between 1994 and 2021 at our institution was performed. Incidence of tachyarrhythmia was depicted, and results after onset of tachyarrhythmia were evaluated. Factors associated with the onset of tachyarrhythmia were identified. RESULTS A total of 52 (8%) patients presented with tachyarrhythmia that required medical therapy. Onset during hospital stay was observed in 27 patients, and onset after hospital discharge was observed in 32 patients. Freedom from late tachyarrhythmia following total cavopulmonary connection at 5, 10, and 15 years was 97, 95, and 91%, respectively. The most prevalent late tachyarrhythmia was atrial flutter (50%), followed by supraventricular tachycardia (25%) and ventricular tachycardia (25%). Direct current cardioversion was required in 12 patients, and 7 patients underwent electrophysiological study. Freedom from Fontan circulatory failure after onset of tachyarrhythmia at 10 and 15 years was 78% and 49%, respectively. Freedom from occurrence of decreased ventricular systolic function after the onset of tachyarrhythmia at 5 years was 85%. Independent factors associated with late tachyarrhythmia were dominant right ventricle (hazard ratio, 2.52, p = 0.02) and weight at total cavopulmonary connection (hazard ratio, 1.03 per kilogram; p = 0.04). Type of total cavopulmonary connection at total cavopulmonary connection was not identified as risk. CONCLUSIONS In our large cohort of 620 patients following total cavopulmonary connection, the incidence of late tachyarrhythmia was low. Patients with dominant right ventricle and late total cavopulmonary connection were at increased risk for late tachyarrhythmia following total cavopulmonary connection.
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Affiliation(s)
- Cornelius Bohn
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Magdalena Cuman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Helena Staehler
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Chiara Di Padua
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Bohn C, Schaeffer T, Staehler H, Heinisch PP, Piber N, Cuman M, Hager A, Ewert P, Hörer J, Ono M. Brady-arrhythmias requiring permanent pacemaker implantation during and after staged Fontan palliation. Cardiol Young 2024; 34:524-530. [PMID: 37496165 DOI: 10.1017/s1047951123002500] [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] [Indexed: 07/28/2023]
Abstract
BACKGROUND Brady-arrhythmia requiring pacemaker implantation remains one of the Fontan-specific complications before and after total cavopulmonary connection. METHODS A retrospective analysis of 620 patients who underwent total cavopulmonary connection between 1994 and 2021 was performed to evaluate the incidence of brady-arrhythmia and the outcomes after pacemaker implantation. Factors associated with the onset of brady-arrhythmia were identified. RESULTS A total of 52 patients presented with brady-arrhythmia and required pacemaker implantation. Diagnosis included 16 sinus node dysfunctions, 29 atrioventricular blocks, and 7 junctional escape rhythms. Pacemaker implantation was performed before total cavopulmonary connection (n = 16), concomitant with total cavopulmonary connection (n = 8), or after total cavopulmonary connection (n = 28, median 1.8 years post-operatively). Freedom from pacemaker implantation following total cavopulmonary connection at 10 years was 92%. Twelve patients needed revision of electrodes due to lead dysfunction (n = 9), infections (n = 2), or dislocation (n = 1). Lead energy thresholds were stable, and freedom from pacemaker lead revision at 10 years after total cavopulmonary connection was 78%. Congenitally corrected transposition of the great arteries (odds ratio: 6.6, confidence interval: 2.0-21.5, p = 0.002) was identified as a factor associated with pacemaker implantation before total cavopulmonary connection. Pacemaker rhythms for Fontan circulation were not a risk factor for survival (p = 0.226), protein-losing enteropathy/plastic bronchitis (p = 0.973), or thromboembolic complications (p = 0.424). CONCLUSIONS In our cohort of patients following total cavopulmonary connection, freedom from pacemaker implantation at 10 years was 92% and stable atrial and ventricular lead energy thresholds were observed. Congenitally corrected transposition of the great arteries was at increased risk for pacemaker implantation before total cavopulmonary connection. Having a pacemaker in the Fontan circulation had no adverse effect on survival, protein-losing enteropathy/plastic bronchitis, or thromboembolic complications.
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Affiliation(s)
- Cornelius Bohn
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Helena Staehler
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Magdalena Cuman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität, Munich, Germany
- University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Bilic C, Staehler H, Niedermaier C, Schaeffer T, Cuman M, Heinisch PP, Burri M, Piber N, Hager A, Ewert P, Hörer J, Ono M. Development of Weight and Height Age z-Score after Total Cavopulmonary Connection. Thorac Cardiovasc Surg 2023. [PMID: 37607685 DOI: 10.1055/a-2158-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE We aimed to analyze somatic growth of patients after total cavopulmonary connection (TCPC) as well as to identify factors influencing postoperative catch-up growth. METHODS A total of 309 patients undergoing TCPC at 4 years old or less between 1994 and 2021 were included. Weight for age z-score (WAZ) and height for age-z-score (HAZ) at TCPC and at postoperative time between 1 and 3 years were calculated. Factors influencing somatic growth were analyzed. RESULTS Most frequent diagnosis and initial palliation were hypoplastic left heart syndrome (HLHS) (34%) and the Norwood procedure (51%), respectively. Median age and weight at TCPC were 2.0 (IQR: 1.7-2.5) years and 11.3 (10.5-12.7) kg, respectively. Median 519 days after TCPC, a significant increase in WAZ (-0.4 to -0.2, p < 0.001) was observed, but not in HAZ (-0.6 to -0.6, p = 0.38). Older age at TCPC (p < 0.001, odds ratio [OR]: 2.6) and HLHS (p = 0.007, OR: 2.2) were risks for low WAZ after TCPC. Older age at TCPC (p = 0.009, OR: 1.9) and previous Norwood procedure (p = 0.021, OR: 2.0) were risks for low HAZ after TCPC. Previous bidirectional cavopulmonary shunt (BCPS) was a protective factor for both WAZ (p = 0.012, OR: 0.06) and HAZ (p = 0.028, OR: 0.30) at TCPC. CONCLUSION In patients undergoing TCPC at the age of 4 years or less, a significant catch-up growth was observed in WAZ after TCPC, but not in HAZ. Previous BCPS resulted to be a protective factor for a better somatic development at TCPC. HLHSs undergoing Norwood were considered as risks for somatic development after TCPC.
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Affiliation(s)
- Carlo Bilic
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Helena Staehler
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Carolin Niedermaier
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Magdalena Cuman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Fumanelli J, Garibaldi S, Castaldi B, Di Candia A, Pizzuto A, Sirico D, Cuman M, Mirizzi G, Marchese P, Cantinotti M, Piacenti M, Assanta N, Viacava C, Di Salvo G, Santoro G. Mid-Term Electrical Remodeling after Percutaneous Atrial Septal Defect Closure with GCO Device in a Pediatric Population. J Clin Med 2023; 12:6334. [PMID: 37834978 PMCID: PMC10573535 DOI: 10.3390/jcm12196334] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIM The GORE® CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population. METHODS We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation. RESULTS Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m2 respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h (p < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved (p = 0.018 and p < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, p = 0.9 and 81.0 ± 12.7, p = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure. CONCLUSIONS Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.
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Affiliation(s)
- Jennifer Fumanelli
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Biagio Castaldi
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Alessandra Pizzuto
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Magdalena Cuman
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Giuseppe Santoro
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
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Santoro G, Pizzuto A, Cuman M, Haxhiademi D, Marchese P, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. Transcatheter closure of "Surgical" ostium secundum atrial septal defects with GORE® Cardioform ASD Occluder. J Card Surg 2022; 37:3200-3206. [PMID: 35900295 DOI: 10.1111/jocs.16786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCA)(WL Gore & Associates) device for closure of ostium secundum atrial septal defects (ASDs) with predicted indication for surgical correction. BACKGROUND Closure of large ASD in small children by transcatheter approach is still challenging. This study evaluated the results of GCA in this subset of patients in a tertiary referral center. METHODS Between January 2020 and March 2022, 97 children underwent transcatheter ASD closure at our Institution. Of them, 38 had a large defect (diameter/weight > 1.2 or diameter/body surface area > 20 mm/m2 ), predicted suitable for surgery and underwent closure with GCA. Procedure results and midterm outcome are reported. RESULTS Patients' age and weight were 5.5 ± 1.5 years and 19.7 ± 4.7 kg, respectively. Absolute and relative ASD size was 21.5 ± 3.6 mm, 1.1 ± 0.2 mm/kg, and 27.7 ± 4.6 mm/m2 , respectively, resulting in QP/QS of 2.0 ± 0.8. Three patients were sent to surgery after balloon sizing. Four of the remaining 35 patients who underwent device deployment, needed rescue or elective surgery due to device embolization (n = 1), device instability (n = 2) or new-onset tricuspid valve regurgitation (n = 1). Procedure feasibility was 88.6%. Major complications were recorded in two patients (5.7%). Minor complications were recorded in five patients (14.3%). Complete closure at discharge was 90.3% (28/31 pts) rising to 100% at the last follow-up evaluation. Wireframe fracture rate at the 6 months examination was 52%, without clinical and instrumental consequences. CONCLUSIONS Percutaneous treatment with GCA device is effective and safe in a high percentage of ASD children with predicted indications for surgical correction.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Fumanelli J, Garibaldi S, Castaldi B, Di Candia A, Cuman M, Pizzuto A, Sirico D, Mirizzi G, Piacenti M, Cantinotti M, Assanta N, Di Salvo G, Santoro G. Short-term electrocardiographic atrial remodelling after asd closure with the gco device in a pediatric population. Europace 2022. [DOI: 10.1093/europace/euac053.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Aim
The GORE® CARDIOFORM septal occluder (GCO) is an atrial septal defect/patent foramen ovale (ASD/PFO) closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance.
Our aim was to evaluate the short and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population.
Methods
We enrolled 39 patients with isolated ASD submitted to trans-catheter closure with GCO from January 2020 to June 2021. EKG was performed before (T0), at 24 hours (T1) and 6 months (T2) after ASD transcatheter closure. P wave dispersion was calculated as the difference between maximum and minimum P- wave duration, PR interval as the interval between beginning of the P wave and beginning of the QRS complex and QT dispersion as the difference between maximun and minimun of QTc intervals. At 6-months from device implantation, the patients were submitted to ambulatory EKG Holter recording.
Results
Patients’ age and BSA were 8.2±4.2 years (IQR 4.2-8.3, median 7.0) and 1.0±0.3 m2 (IQR 0.7-1.7, median 0.9), respectively. The strectched ASD diameter was 16.3±4.5 mm (median 16), resulting in QP/QS of 1.7±0.6 (median 1.5). At the baseline mean P wave dispersion was 40±15 msec and decreased to 30±13 msec (p<0.002) at 24h, without any further change at 6 months (30±13 msec, p<0.002). PR conduction significantly improved at 24 h from device implantation (from 175.0±20.8 to 144.0±22.7 msec, p=0.018) and did not significantly change at 6 months (164.0±19.5 msec, p=NS). QTc dispersion decreased at 24 hours (31.7±.20.3, p<0.02) and at 6 months (28.0±18.1, p<0.002) from device implantation. After device deployment, 2 pts (5%) developed transient, self-limited junctional rhythm and one of them needed a short course of anti-arrhythmic therapy for supra-ventricular tachycardia. No tachy/brady-arrhythmias were recorded at the 6-months follow-up EKG Holter monitoring.
Conclusions
Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium term follow-up. It might be due to a favourable volumetric remodelling that was not hindered by mechanical impact of the occluding prosthesis and could explain the low rate of arrhythmias found at the mid-term EKG evaluation.
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Affiliation(s)
- J Fumanelli
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - S Garibaldi
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - B Castaldi
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - A Di Candia
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - M Cuman
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - A Pizzuto
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - D Sirico
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - G Mirizzi
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - M Piacenti
- University of Pisa, Pediatric Department, Pisa, Italy
| | - M Cantinotti
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - N Assanta
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
| | - G Di Salvo
- University of Padua, Pediatric Cardiology Department, Padova, Italy
| | - G Santoro
- S. Maria Alla Pinetaf. don Gnocchi Centre, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Massa, Italy
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7
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Castaldi B, Sirico D, Di Candia A, Cuman M, Cantinotti M, Di Salvo G, Santoro G. C36 ATRIAL SEPTAL DEFECT CLOSURE WITH A NEW OCCLUDER DEVICE, EXPERIENCE ON 100 PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore & Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD).
Methods
100 unselected patients with significant ASD were submitted to trans–catheter closure with GORE® Cardioform ASD Occluder at two high–volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1–month and 6–month follow–up.
Results
Patients‘age and weight were 7.8 (6.0–13.6)and 26.1 (20.0–54.0), respectively. ASD diameter was 17.4 + 4.4, resulting in QP/QS of 1.7 ± 0.7 (median 1.6). 33 patients presented an asd larger than 18mm in diameter. 58% of defects were considered complex based on the following characteristics: deficient rim(s) (except aortic rim), aneurismal/multi–fenestrated and ASD size/pt weight ratio >1.2. Device placement was successfully achieved in all but two patients (98%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross–over with different devices was recorded. Median procedure and fluoroscopy times were 54 and 11 min, respectively. Major adverse events were recorded in 7 pts. Complete closure rate was 87.3% at discharge, rising to 95.5% (39/42 pts) at 1 month evaluation, and 100% at 6 months without cardiac or extra–cardiac adverse events. “Complex” procedures were more time–consuming but as effective and safe as the “simple” ones.
Conclusions
The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.
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Affiliation(s)
- B Castaldi
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - D Sirico
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - A Di Candia
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - M Cuman
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - M Cantinotti
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - G Di Salvo
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
| | - G Santoro
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA; OSPEDALE “G. PASQUINUCCI”, MASSA
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8
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Santoro G, Rizza A, Pizzuto A, Berti S, Cuman M, Gasparotti E, Capellini K, Cantinotti M, Clemente A, Celi S. Transcatheter Treatment of Ascending Aorta Pseudoaneurysm Guided by 3D-Model Technology. JACC Case Rep 2022; 4:343-347. [PMID: 35495557 PMCID: PMC9040102 DOI: 10.1016/j.jaccas.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/08/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
Ascending aorta pseudoaneurysm is a rare but potentially life-threatening complication of atherosclerosis, infections, chest trauma, transcatheter or surgical interventions. Due to high surgical risk, percutaneous closure is considered a valuable cost-effective therapeutic alternative. In this setting, 3D printing technology is emerging as a powerful tool to plan transcatheter repair. (Level of Difficulty: Advanced.)
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9
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Ferrante E, Barbot M, Serban AL, Ceccato F, Carosi G, Lizzul L, Sala E, Daniele A, Indirli R, Cuman M, Locatelli M, Manara R, Arosio M, Boscaro M, Mantovani G, Scaroni C. Indication to dynamic and invasive testing in Cushing's disease according to different neuroradiological findings. J Endocrinol Invest 2022; 45:629-637. [PMID: 34699044 PMCID: PMC8850245 DOI: 10.1007/s40618-021-01695-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing's syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing's syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing's disease (CD). METHODS Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome. RESULTS Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6-10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%, p = 0.78). CONCLUSIONS CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.
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Affiliation(s)
- E Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - M Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - A L Serban
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - G Carosi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Lizzul
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - E Sala
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - A Daniele
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - R Indirli
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Cuman
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - M Locatelli
- Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - R Manara
- Department of Neurosciences, University of Padua, Padua, Italy
| | - M Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - G Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - C Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
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10
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Santoro G, Pizzuto A, Cuman M, Cantinotti M, Franchi E, Corana G, Viacava C, Assanta N. Rescue atrial septal defect closure with the new GORE ® cardioform atrial septal defect occluder. Ann Pediatr Cardiol 2022; 15:192-194. [PMID: 36246756 PMCID: PMC9564420 DOI: 10.4103/apc.apc_240_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
Atrioventricular block (AVB) is an infrequent but life-threatening complication of transcatheter closure of atrial septal defect (ASD), accounting for 0.1%–6.2% of cases in large series. It has been related to unfavorable defect anatomy as well as size and intrinsic stiffness of the occluding device. In this setting, the new GORE® cardioform ASD occluder (GCA) device could be an appealing technical advance in ASD treatment. We report a case of complete AVB after ASD closure with an Amplatzer septal occluding (Abbott, Plymouth MN, USA) device successfully treated by its percutaneous retrieval and “rescue” deployment of GCA device few months later.
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11
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Pizzuto A, Santoro G, Baldi C, Celi S, Cuman M, Anees AJ, Berti S, Gasparotti E, Capellini K, Clemente A. 3D model-guided transcatheter closure of left ventricular pseudoaneurysm: a case series. J Cardiovasc Med (Hagerstown) 2021; 22:e1-e7. [PMID: 32941328 DOI: 10.2459/jcm.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Left ventricular pseudoaneurysm (LVPsA) is a rare complication of myocardial infarction, cardiac surgery, chest trauma, infection or transcatheter interventions. It may cause arrhythmias, mass effect, thromboembolism and life-threatening rupture. The transcatheter approach is nowadays considered a cost-effective alternative to surgery. In this setting, 3D printing could be an emerging, powerful tool to plan transcatheter closure and choose the best occluding device. This study reports on three cases of complex LVPsA successfully treated by transcatheter device implantation guided by printed 3D heart models.
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Affiliation(s)
- Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | - Cesare Baldi
- Invasive Cardiology, 'S. Giovanni di Dio e Ruggi D'Aragona' Hospital, University of Salerno, Salerno
| | | | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | | | | | | | | | - Alberto Clemente
- Radio-diagnostic Unit, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
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12
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Santoro G, Cuman M, Pizzuto A, Haxhiademi D, Lunardini A, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. GORE® Cardioform ASD Occluder experience in transcatheter closure of "complex" atrial septal defects. Catheter Cardiovasc Interv 2021; 99:E22-E30. [PMID: 34652048 DOI: 10.1002/ccd.29977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for "complex" atrial septal defects (ASD) closure. BACKGROUND Transcatheter ASD closure is still challenging in "complex" clinical/anatomic settings. This study evaluated the results of GCO in closure of "complex" ASD in a tertiary referral center. METHODS Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as "complex" (n = 36, Group I) or "simple" (n = 36, Group II). We considered as "complex", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups. RESULTS Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of "surgical" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences. CONCLUSIONS Percutaneous treatment with GCO device is effective and safe in high percentage of "complex" ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessia Lunardini
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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13
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Cuman M, Clemente A, Celi S, Santoro G. 3D model-guided transcatheter closure of ascending aorta pseudoaneurysm with the novel Amplatzer Trevisio intravascular delivery system. Catheter Cardiovasc Interv 2021; 99:140-144. [PMID: 34463417 DOI: 10.1002/ccd.29937] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/07/2021] [Accepted: 08/21/2021] [Indexed: 11/12/2022]
Abstract
Ascending aorta pseudoaneurysm (AAP) is a rare but life-threatening complication of atherosclerosis, endocarditis, chest trauma, transcatheter or cardio-thoracic procedures. Since surgical repair is burdened by high morbidity and mortality, percutaneous closure is nowadays considered a valuable cost-effective therapeutic alternative. Due to unpredictability and complexity of local anatomy, no standardized technique and device are advised. In this setting, 3D printing technology could significantly help in planning trans-catheter approach. This article reports on a 3D printed model-guided percutaneous closure of a huge AAP using an Amplatzer Septal Occluder (Abbott, Plymouth MN) implanted by the recently commercialized Amplatzer Trevisio Intravascular Delivery System.
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Affiliation(s)
- Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alberto Clemente
- Radiodiagnostic Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Simona Celi
- Bioengineering Section, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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14
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Cuman M, Santoro G, Capellini K, Gasparotti E, Pizzuto A, Berti S, Celi S, Clemente A. 3D model-guided trans-catheter closure of a complex aortic paravalvular leak. J Cardiovasc Med (Hagerstown) 2021; 22:660-663. [PMID: 32858632 DOI: 10.2459/jcm.0000000000001082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alberto Clemente
- Radiodiagnostic Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
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15
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Santoro G, Pizzuto A, Rizza A, Cuman M, Federici D, Cantinotti M, Pak V, Clemente A, Celi S. Transcatheter Treatment of "Complex" Aortic Coarctation Guided by Printed 3D Model. JACC Case Rep 2021; 3:900-904. [PMID: 34317651 PMCID: PMC8311344 DOI: 10.1016/j.jaccas.2021.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/07/2021] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
The transcatheter approach is nowadays considered a cost-effective alternative to surgery in adults with "complex" aortic coarctation. The printed 3D model was crucial in planning transcatheter treatment of a complex case of postsurgical aortic re-coarctation, due to coexistence of transverse aortic arch stenosis and pseudoaneurysm as well as aneurysm of the descending aorta. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Giuseppe Santoro
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Alessandra Pizzuto
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Antonio Rizza
- Adult Invasive Cardiology Unit, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Magdalena Cuman
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Duccio Federici
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Massimiliano Cantinotti
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Vitali Pak
- Department of Pediatric Cardiology and Cardiac Surgery, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Alberto Clemente
- Radiodiagnostic Unit, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
| | - Simona Celi
- BioCardioLab-Bioengineering Unit, National Research Council-Tuscany Foundation “G. Monasterio”, Massa, Italy
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16
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Clemente A, Seitun S, Mantini C, Gentile G, Federici D, Barison A, Rossi A, Cuman M, Pizzuto A, Ait-Ali L, Bossone E, Cademartiri F, Chiappino D. Cardiac CT angiography: normal and pathological anatomical features-a narrative review. Cardiovasc Diagn Ther 2020; 10:1918-1945. [PMID: 33381435 DOI: 10.21037/cdt-20-530] [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] [Indexed: 12/12/2022]
Abstract
The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.
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Affiliation(s)
- Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Sara Seitun
- IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Gentile
- Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Duccio Federici
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Andrea Barison
- Cardiology Division, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Andrea Rossi
- Arrhythmology Unit, Department of Invasive Cardiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | | | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
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17
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Santoro G, Castaldi B, Cuman M, Di Candia A, Pizzuto A, Sirico D, Cantinotti M, Garibaldi S, Pak V, Di Salvo G. Trans-catheter atrial septal defect closure with the new GORE® Cardioform ASD occluder: First European experience. Int J Cardiol 2020; 327:68-73. [PMID: 33220363 DOI: 10.1016/j.ijcard.2020.11.029] [Citation(s) in RCA: 8] [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: 07/31/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore & Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD). METHODS Between January and June 2020, 43 unselected patients with -significant ASD were submitted to trans-catheter closure with GORE® Cardioform ASD Occluder at two high-volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1-month follow-up. RESULTS Patients' age and weight were 8.2 ± 3.9 years (range 3-21, median 9.9) and 29.6 ± 15.3 kg (range 16-57, median 33.3), respectively. ASD diameter was 16.6 ± 4.5 mm (median 10), resulting in QP/QS of 1.7 ± 0.7 (median 1.6). Seventeen pts. (39.5%) were considered "surgical" candidates due to challenging septum morphology, ASD rim deficiency or ASD diameter/patient weight ratio ≥ 1.2. Device placement was successfully achieved in all but one patient (97.7%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross-over with different devices was recorded. Median procedure and fluoroscopy times were 40 and 6.8 min, respectively. Major adverse events were recorded in 7.0% (3 pts). Complete closure rate was 78.5% at discharge, rising to 92.9% (39/42 pts) at 1 month evaluation, without cardiac or extra-cardiac adverse events. "Challenging" procedures were more time-consuming but as effective and safe as the "simple" ones. CONCLUSIONS The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy.
| | - Biagio Castaldi
- Pediatric Cardiology, University of Padua, Padua, Italy; Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Silvia Garibaldi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
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Pizzuto A, Calabri G, Cuman M, Santoro G. Very late trans-catheter recruitment of congenitally "absent" pulmonary artery. Ann Pediatr Cardiol 2020; 14:130-131. [PMID: 33679081 PMCID: PMC7918031 DOI: 10.4103/apc.apc_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/27/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alessandra Pizzuto
- Department of Cardiology and Cardiac Surgery of Congenital Heart Disease, Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy E-mail:
| | - Giovanbattista Calabri
- Department of Paediatrics, "Meyer" Paediatric Hospital, University of Florence, Florence, Italy
| | - Magdalena Cuman
- Department of Cardiology and Cardiac Surgery of Congenital Heart Disease, Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy E-mail:
| | - Giuseppe Santoro
- Department of Cardiology and Cardiac Surgery of Congenital Heart Disease, Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy E-mail:
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19
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Testa L, Pero G, Bollati M, Casenghi M, Popolo Rubbio A, Cuman M, Moreno R, Serra A, Gomez JA, Bedogni F. XLIMus drug eluting stent: A randomIzed controlled Trial to assess endothelialization. The XLIMIT trial. Int J Cardiol Heart Vasc 2019; 23:100363. [PMID: 31061876 PMCID: PMC6487315 DOI: 10.1016/j.ijcha.2019.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thin strut 3rd generation drug eluting stents offer the potential advantage over the previous generation of better technical performance and reduced neointimal proliferation parameters, which are linked to mid and late term device failure. AIM To evaluate the performance of the Xlimus sirolimus-eluting stent (SES) against the Synergy everolimus-eluting stent (EES) in terms of device reendothelialization in patients undergoing PCI for coronary artery disease (CAD). METHODS XLIMIT is a multicenter randomized controlled trial targeting 180 patients requiring percutaneous coronary interventions (PCI). Patients will be treated with Xlimus SES or Synergy EES implantation and randomization will be performed in a 2:1 ratio. The primary endpoint will be the reendothelialization grade of the Xlimus stent in terms of strut coverage and neointimal hyperplasia volume as compared to Synergy. Secondary endpoints will be represented by clinical and procedural outcomes. The first patient was enrolled on February 2019. CONCLUSIONS A clearer understanding of the endothelialization process of new generation DES could significantly impact the treatment with dual antiplatelet therapy in the future. Moreover, although not powered for clinical end-points, the XLIMIT trial will provide randomized data in a population with minimal exclusion criteria. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03745053. Registered on November 19, 2018.
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Affiliation(s)
- Luca Testa
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Gaetano Pero
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Mario Bollati
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Matteo Casenghi
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | | | - Magdalena Cuman
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | | | - Antoni Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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20
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Testa L, Pero G, Bollati M, Casenghi M, Popolo Rubbio A, Cuman M, Agnifili M, Pizzocri S, Bedogni F. [Epidemiology of stroke and cerebral protection in patients undergoing transcatheter aortic valve replacement]. G Ital Cardiol (Rome) 2019; 20:17S-22S. [PMID: 30855028 DOI: 10.1714/3121.31037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The introduction into clinical practice of transcatheter aortic valve implantation (TAVI) has led to a significant change in the therapeutic paradigm for patients with valvular aortic stenosis. However, in parallel with the benefits obtained in prognosis and quality of life, an inherent risk of major cerebral thromboembolic events has been observed. In different studies this risk has been estimated between 2% and 6%. In order to reduce the incidence of cerebrovascular accidents during TAVI, several brain protection systems have been developed but, to date, none has obtained sufficient clinical evidence to be implemented on a large scale, and they are therefore used only in selected cases. Furthermore, periprocedural drug therapy and follow-up are still the subject of extensive discussion in the scientific community. This paper reviews the topic of stroke prevention in patients undergoing TAVI for both the periprocedural and postprocedural aspects.
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Affiliation(s)
- Luca Testa
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Gaetano Pero
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Mario Bollati
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Matteo Casenghi
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Antonio Popolo Rubbio
- Dipartimento di Cardiologia, Policlinico Vittorio Emanuele, Università degli Studi, Catania
| | | | - Mauro Agnifili
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Samuele Pizzocri
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
| | - Francesco Bedogni
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, San Donato Milanese (MI)
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Borio G, Scarsini R, Rossi A, Cuman M, Piccoli A, Forni A, Pesarini G, Vassanelli C, Ribichini F. P2975Pulmonary arterial compliance is a major determinant of right ventricular dysfunction: an echocardiographic/invasive hemodynamic study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p2975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cuman M, Zivelonghi C, Benfari G, Ghione M, Fede A, Lunardi M, Cordone S, Botta M, Gambaro A, Maggio S, Zanetti C, Pacchioni A, Reimers B, Ribichini F. P6459Drug coating balloon: long-term outcome from a real world three-centers experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scarsini R, Cuman M, Rossi A, Pesarini G, Piccoli A, Setti E, Milano E, Forni A, Vassanelli C, Ribichini F. 4994Hemodynamic predictors of mortality in patients undergoing heart transplantation and left ventricular assist device. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zivelonghi C, Ghione M, Benfari G, Cuman M, Fede A, Lunardi M, Cordone S, Botta M, Pacchioni A, Bellone P, Reimers B, Ribichini FL. Drug-coated balloon: Long-term outcome from a real world three-center experience. J Interv Cardiol 2017; 30:318-324. [DOI: 10.1111/joic.12391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Carlo Zivelonghi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Matteo Ghione
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | - Giovanni Benfari
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Magdalena Cuman
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Alfredo Fede
- Department of Cardiology; Mirano Hospital; Mirano Italy
| | - Mattia Lunardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | | | - Marco Botta
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | | | - Pietro Bellone
- Department of Cardiology; Ospedale San Paolo; Savona Italy
| | | | - Flavio L. Ribichini
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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Maggio S, Zanetti C, Pesarini G, Zivelonghi C, Piccoli A, Gambaro A, Scarsini R, Cuman M, Vassanelli C, Ribichini F. Immediate and long-term clinical performance of bioresorbable vascular scaffolds in a real world population. Minerva Cardioangiol 2016; 64:404-410. [PMID: 26963445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and efficacy of bioresorbable vascular scaffolds (BVS) in terms of acute success and long-term clinical events in a real world population according to the most updated technical recommendations. METHODS Perspective, single-center registry involving symptomatic patients treated with BVS from February 2013 to January 2016. Primary end-point was the occurrence of MACCEs at one year: death, target vessel related myocardial infarction, target vessel revascularization, stroke, major bleeding. Secondary endpoints were acute device and procedural clinical success, and occurrence of MACCEs at long-term follow-up. RESULTS In total, 112 patients were treated on 173 lesions. Average age was 55.53±12.4 years and acute coronary syndrome was the admission diagnosis for 79.5% patients. Nine patients presented cardiac allograft vasculopathy after cardiac transplantation. Multi-vessel disease was treated in 50% of cases. Predilatation and post-dilatation were performed respectively in 96% and 88.4% of lesions. Intravascular imaging was used in 41 patients (37%). Angiographic success rate and procedural success rate were 100% and 97.3% respectively. Clinical follow-up was completed in 100 patients with an average follow-up of 10.5±8.3 months. Including peri-procedural and in-hospital MACCEs, target vessel failure was noticed in 7% of patients in the first year of follow up and in 11% of patients at long-term follow-up. Two cases of target lesion revascularization occurred 25 and 26 months after the index procedure. No cases of definite stent thrombosis were reported. CONCLUSIONS Strict adherence to expert recommendation for BVS placement may minimize device related peri-procedural and mid-to-long term MACCEs in a real world population.
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Affiliation(s)
- Silvia Maggio
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy -
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