Dott. Jacopo Oreglia
Pubblicazioni su PubMed
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[Contemporary diagnosis and treatment of tricuspid regurgitation: from neglected valve to primetime].
G Ital Cardiol (Rome)2024 Aug;25(8):576-589. doi: 10.1714/4309.42927.
Montalto Claudio, Tognola Chiara, Ghidini Simone, Monticelli Massimiliano, Nava Stefano, Soriano Francesco, Munafò Andrea R, Tavoletta Pasquale, Bruschi Giuseppe, Esposito Giuseppe, Mangieri Antonio, Giannattasio Cristina, De Marco Federico, Oliva Fabrizio, Oreglia Jacopo A
Abstract
Tricuspid insufficiency has long been considered an entity with low prognostic importance and associated with symptoms and signs only secondarily to left heart pathology. Scientific research in recent years has debunked this myth, demonstrating a key role in determining symptoms and signs of right heart failure, even in advanced stages. In parallel, advances in transcatheter technologies have opened up treatment options even for patients with increased surgical risk, who were previously excluded from traditional surgical options, with increasingly convincing results in reducing symptoms and improving the quality of life of our patients. The contemporary challenge is to translate these messages into everyday clinical practice and to encourage the centralization of patients in centers that currently have the expertise for feasibility evaluation and subsequent treatment. In this Review, we will analyze the most recent evidence on the pathophysiology and diagnosis of tricuspid insufficiency, the latest recommendations from European guidelines, and we will try to illustrate the most common technologies for percutaneous treatment and the abundant evidence supporting them.
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Impella versus VA-ECMO for the treatment of patients with cardiogenic shock: the Impella Network Project - observational study protocol for cost-effectiveness and budget impact analyses.
BMJ Open2024 Jun;14(6):e078358. doi: e078358.
Ardito Vittoria, Rognoni Carla, Pieri Marina, Barbone Alessandro, Briguori Carlo, Cigala Emanuele, Gerosa Gino, Iannaccone Mario, Loforte Antonio, Marini Marco, Montalto Andrea, Oreglia Jacopo, Pacini Davide, Pennacchi Mauro, Pestrichella Vincenzo, Porto Italo, Stefano Pierluigi, Tarantini Giuseppe, Valente Serafina, Vandoni Pietro, Tarricone Rosanna, Scandroglio Anna Mara
Abstract
INTRODUCTION:
The treatment of patients with cardiogenic shock (CS) encompasses several health technologies including Impella pumps and venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, while they are widely used in clinical practice, information on resource use and quality of life (QoL) associated with these devices is scarce. The aim of this study is, therefore, to collect and comparatively assess clinical and socioeconomic data of Impella versus VA-ECMO for the treatment of patients with severe CS, to ultimately conduct both a cost-effectiveness (CEA) and budget impact (BIA) analyses.
METHODS AND ANALYSIS:
This is a prospective plus retrospective, multicentre study conducted under the scientific coordination of the Center for Research on Health and Social Care Management of SDA Bocconi School of Management and clinical coordination of Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute in Milan. The Impella Network stemmed for the purposes of this study and comprises 17 Italian clinical centres from Northern to Southern Regions in Italy. The Italian network qualifies as a subgroup of the international Impella Cardiac Surgery Registry. Patients with CS treated with Impella pumps (CP, 5.0 or 5.5) will be prospectively recruited, and information on clinical outcomes, resource use and QoL collected. Economic data will be retrospectively matched with data from comparable patients treated with VA-ECMO. Both CEA and BIA will be conducted adopting the societal perspective in Italy. This study will contribute to generate new socioeconomic evidence to inform future coverage decisions.
ETHICS AND DISSEMINATION:
As of May 2024, most of the clinical centres submitted the documentation to their ethical committee (N=13; 76%), six centres received ethical approval and two centres started to enrol patients. Study results will be published in peer-reviewed publications and disseminated through conference presentations.
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Impact of Postprocedural Graft Flow on Outcomes Following Chronic Total Occlusion Intervention in Postcoronary Artery Bypass Graft Patients: A Detailed Angiographic Analysis.
Am J Cardiol2024 Sep;226():24-33. doi: 10.1016/j.amjcard.2024.06.015.
Poletti Enrico, Dens Jo, Egred Mohaned, Munafò Andrea Raffaele, Castaldi Gianluca, De Cock Emmanuel, Jossart Adrien, Poels Ella, Khandaker Azizul Hasan, Lesizza Pierluigi, Zivelonghi Carlo, Scott Benjamin, Haine Steven Els Frans, Kayaert Peter, Bataille Yoann, Cornelis Kristoff, Saad Georges, Coussement Patrick, Bennett Johan, Droogmans Steven, Oreglia Jacopo, Ungureanu Claudiu, Iqbal M Bilal, Agostoni Pierfrancesco
Abstract
Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI is unknown. We sought to evaluate the impact of post-PCI graft patency on the durability of CTO-PCI. In total, 259 patients with previous CABG who underwent CTO-PCI in 12 international centers in 2019 to 2023 were categorized into "grafted" and "ungrafted" groups based on the presence of graft on a CTO vessel. The grafted group was subdivided into "graft-occluded" and "graft-patent" groups, depending on graft patency. The primary end points were (1) technical success rate, (2) target vessel failure, and (3) CTO failure rates at 1 year. CTO failure was defined as target vessel revascularization and/or significant in-stent restenosis. A total of 199 patients (77%) were in the grafted group. Grafted CTOs showed higher complexity and lower technical success rates (70% vs 80%, p = 0.004) than nongrafted CTOs. Of the grafted CTOs, 140 (70%) were in the grafted-occluded group and 59 (30%) were in the grafted-patent group. The technical success was lower in the former group (65% vs 81%, p = 0.022). An occluded graft was an independent predictor of technical failure (odds ratio 2.04, 95% confidence interval 1.03 to 4.76, p = 0.049) and persistent post-PCI graft patency was a strong independent predictor of CTO failure at 1 year (hazard ratio 5.6, 95% confidence interval 1.2 to 27.5, log-rank p = 0.033). In conclusion, in patients with previous CABG who underwent CTO-PCI, post-PCI graft patency was a significant predictor of CTO failure.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Use of cangrelor for complex percutaneous coronary intervention in the context of concomitant severe aortic stenosis: a case series.
Eur Heart J Case Rep2024 May;8(5):ytae237. doi: ytae237.
Soriano Francesco, Munafò Andrea R, Baydaroglu Nurcan, Nava Stefano, Bruschi Giuseppe, Esposito Giuseppe, Oreglia Jacopo A, Montalto Claudio
Abstract
BACKGROUND:
There is a growing need for percutaneous coronary intervention (PCI) to be performed within the same transcatheter aortic valve implantation (TAVI) procedure. In such cases, cangrelor, a fast-acting intravenous P2Y12-inhibitor with a short offset, is potential clinical utility to minimize bleeding and vascular complications during large-bore arterial access (LBAA) as well as the thrombotic risk associated with concomitant PCI.
CASE SUMMARY:
We report two cases of TAVI with an indication to concomitant, high-risk PCI. In the first one, cangrelor was started only after LBAA was secured and TAVI completed, just before the initiation of complex PCI. In the second case, due to predicted complex coronary cannulation after TAVI, complex PCI was performed before TAVI and cangrelor started just after LBAA. In both cases, use of cangrelor (vs. pre-treatment with oral P2Y12-i) allowed for a tailored minimization of the risk of bleeding and vascular complications during LBAA while offering full platelet inhibition during a complex/high-risk PCI.
DISCUSSION:
In this case series, we illustrate a possible approach to the use of cangrelor for patients undergoing TAVI and complex/high-risk PCI. In such complex cases, thorough pre-procedural planning might include a cangrelor to minimize vascular, bleeding, and ischaemic complications.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Fighting Cardiac Thromboembolism during Transcatheter Procedures: An Update on the Use of Cerebral Protection Devices in Cath Labs and EP Labs.
Life (Basel)2023 Aug;13(9):. doi: 1819.
Preda Alberto, Montalto Claudio, Galasso Michele, Munafò Andrea, Garofani Ilaria, Baroni Matteo, Gigli Lorenzo, Vargiu Sara, Varrenti Marisa, Colombo Giulia, Carbonaro Marco, Della Rocca Domenico Giovanni, Oreglia Jacopo, Mazzone Patrizio, Guarracini Fabrizio
Abstract
Intraprocedural stroke is a well-documented and feared potential risk of cardiovascular transcatheter procedures (TPs). Moreover, subclinical neurological events or covert central nervous system infarctions are concerns related to the development of dementia, future stroke, cognitive decline, and increased risk of mortality. Cerebral protection devices (CPDs) were developed to mitigate the risk of cardioembolic embolism during TPs. They are mechanical barriers designed to cover the ostium of the supra-aortic branches in the aortic arch, but newer devices are able to protect the descending aorta. CPDs have been mainly designed and tested to provide cerebral protection during transcatheter aortic valve replacement (TAVR), but their use in both Catheterization and Electrophysiology laboratories is rapidly increasing. CPDs have allowed us to perform procedures that were previously contraindicated due to high thromboembolic risk, such as in cases of intracardiac thrombosis identified at preprocedural assessment. However, several concerns related to their employment have to be defined. The selection of patients at high risk of thromboembolism is still a subjective choice of each center. The aim of this review is to update the evidence on the use of CPDs in either Cath labs or EP labs, providing an overview of their structural characteristics. Future perspectives focusing on their possible future employment are also discussed.
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External validity of the PRECISE-DAPT score in patients undergoing PCI: a systematic review and meta-analysis.
Eur Heart J Cardiovasc Pharmacother2023 Dec;9(8):709-721. doi: 10.1093/ehjcvp/pvad063.
Munafò Andrea Raffaele, Montalto Claudio, Franzino Marco, Pistelli Lorenzo, Di Bella Gianluca, Ferlini Marco, Leonardi Sergio, D'Ascenzo Fabrizio, Gragnano Felice, Oreglia Jacopo A, Oliva Fabrizio, Ortega-Paz Luis, Calabrò Paolo, Angiolillo Dominick J, Valgimigli Marco, Micari Antonio, Costa Francesco
Abstract
AIMS:
To summarize the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets.
METHODS AND RESULTS:
We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratios (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of 21 studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high bleeding risk (PRECISE-DAPT score ?25), and when compared to those at low bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24-3.29; P-value
CONCLUSION:
This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Transcatheter aortic valve replacement with the self-expanding ACURATE Neo2 in patients with horizontal aorta: Insights from the ITAL-neo registry.
Int J Cardiol2023 Oct;389():131236. doi: 10.1016/j.ijcard.2023.131236.
Barki Monica, Ielasi Alfonso, Buono Andrea, Maffeo Diego, Montonati Carolina, Pellegrini Dario, Pellicano Mariano, Gorla Riccardo, Costa Giuliano, Cozzi Ottavia, Ancona Marco, Soriano Francesco, De Carlo Marco, Ferrara Erica, Giannini Francesco, Massussi Mauro, Fovino Luca Nai, Messina Antonio, Sgroi Carmelo, Gallo Francesco, Nerla Roberto, Saccocci Matteo, D'Ascenzo Fabrizio, Conrotto Federico, Bettari Luca, Fiorina Claudia, Castriota Fausto, Poli Arnaldo, Petronio Anna Sonia, Oreglia Jacopo, Montorfano Matteo, Regazzoli Damiano, Reimers Bernhard, Barbanti Marco, Tamburino Corrado, Bedogni Francesco, Tarantini Giuseppe, Tespili Maurizio
Abstract
BACKGROUND:
Horizontal aorta (HA), defined by an aortic angulation (AA) ?48°, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL).
OBJECTIVES:
Aim of the study was to assess the performance of ACURATE Neo2 in the setting of HA.
METHODS:
We performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes.
RESULTS:
Among 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing ? moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of ?moderate PVL vs. Neo: (5% vs. 15%; p
CONCLUSION:
In patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of ?moderate PVL, when compared with its predecessor.
Copyright © 2023 Elsevier B.V. All rights reserved.
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Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis.
J Cardiovasc Med (Hagerstown)2023 Sep;24(9):659-665. doi: 10.2459/JCM.0000000000001490.
Morelli Martina, Galasso Michele, Esposito Giuseppe, Soriano Francesco Stefano, Nava Stefano, Da Pozzo Caterina, Bossi Irene, Piccaluga Emanuela, Bruschi Giuseppe, Maloberti Alessandro, Oliva Fabrizio, Oreglia Jacopo Andrea, Giannattasio Cristina, Montalto Claudio
Abstract
AIMS:
The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis.
METHODS:
Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
RESULTS:
Fifteen studies and 11?596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P ?0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P ?=?0.4584 and P ?=?0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P ?=?0.0323).
CONCLUSION:
Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
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2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry.
Int J Cardiol2023 Nov;390():131139. doi: 10.1016/j.ijcard.2023.131139.
Munafò Andrea Raffaele, Scotti Andrea, Estévez-Loureiro Rodrigo, Adamo Marianna, Hernàndez Antonio Portolés, Peregrina Estefanìa Fernàndez, Gutierrez Lola, Taramasso Maurizio, Fam Neil P, Ho Edwin C, Asgar Anita, Vitrella Giancarlo, Raineri Claudia, Chizzola Giuliano, Pezzola Elisa, Le Ruz Robin, Montalto Claudio, Oreglia Jacopo A, Fraccaro Chiara, Giannini Cristina, Fiorelli Francesca, Rubbio Antonio Popolo, Ooms J F, Compagnone Miriam, Marcelli Chiara, Maffeo Diego, Bettari Luca, Fürholz Monika, Arzamendi Dabit, Guerin Patrice, Tamburino Corrado, Petronio A Sonia, Grasso Carmelo, Agricola Eustachio, Van Mieghem Nicolas M, Tarantini Giuseppe, Praz Fabien, Pascual Isaac, Potena Luciano, Colombo Antonio, Maisano Francesco, Metra Marco, Margonato Alberto, Crimi Gabriele, Saia Francesco, Godino Cosmo
Abstract
BACKGROUND:
In the first report from the MitraBridge registry, MitraClip as a bridge to heart transplantation (HTx) proved to be at 1-year an effective treatment strategy for 119 patients with advanced heart failure (HF) who were potential candidates for HTx. We aimed to determine if benefits of MitraClip procedure as a bridge-to-transplant persist up to 2-years.
METHODS:
By the end of the enrollment period, a total of 153 advanced HF patients (median age 59 years, left ventricular ejection fraction 26.9 ± 7.7%) with significant secondary mitral regurgitation, who were potential candidates for HTx and were treated with MitraClip as a bridge-to-transplant strategy, were included in the MitraBridge registry. The primary endpoint was the 2-year composite adverse events rate of all-cause death, first hospitalization for HF, urgent HTx or LVAD implantation.
RESULTS:
Procedural success was achieved in 89.5% of cases. Thirty-day mortality was 0%. At 2-year, Kaplan-Meier estimates of freedom from primary endpoint was 47%. Through 24 months, the annualized rate of HF rehospitalization per patient-year was 44%. After an overall median follow-up time of 26 (9-52) months, elective HTx was successfully performed in 30 cases (21%), 19 patients (13.5%) maintained or obtained the eligibility for transplant, and 32 patients (22.5%) no longer had an indication for HTx because of significant clinical improvement.
CONCLUSIONS:
After 2-years of follow-up, the use of MitraClip as a bridge-to-transplant was confirmed as an effective strategy, allowing elective HTx or eligibility for transplant in one third of patients, and no more need for transplantation in 22.5% of cases.
Copyright © 2023 Elsevier B.V. All rights reserved.
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Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry.
Am J Cardiol2023 Jul;198():1-8. doi: 10.1016/j.amjcard.2023.04.032.
Sardella Gennaro, Stefanini Giulio, Leone Pier Pasquale, Boccuzzi Giacomo, Fovero Natalia Tovar, Van Mieghem Nicolas, Giacchi Giuseppe, Escaned Javier, Fineschi Massimo, Testa Luca, Valenti Renato, Di Mario Carlo, Briguori Carlo, Cortese Bernardo, Ribichini Flavio, Oreglia Jacopo Andrea, Colombo Antonio, Sangiorgi Giuseppe, Barbato Emanuele, Sonck Jeroen, Ugo Fabrizio, Trani Carlo, Castriota Fausto, Paggi Anita, Porto Italo, Tomai Fabrizio, Mancone Massimo
Abstract
Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow
Copyright © 2023 Elsevier Inc. All rights reserved.
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Bi-Caval Valve Implantation to Palliate Symptoms in a Case of Massive Tricuspid Regurgitation.
Cardiovasc Revasc Med2023 Aug;53S():S139-S143. doi: 10.1016/j.carrev.2023.01.014.
Galasso Michele, Cartella Iside, Soriano Francesco, Nava Stefano, Tavoletta Pasquale, De Chiara Benedetta, Oliva Fabrizio, Bruschi Giuseppe, Oreglia Jacopo A, Giannattasio Cristina, Mangieri Antonio, Montalto Claudio
Abstract
Severe tricuspid regurgitation is associated with the occurrence of right failure and increased morbidity and mortality. Transcatheter heterotopic bi-caval valve implantation might offer symptom relief in these patients that are often at prohibitive surgical risk.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Physiology-guided revascularization of non-culprit lesions in patients with STEMI: Could vFFR be the way?
Int J Cardiol2023 May;378():20-21. doi: 10.1016/j.ijcard.2023.01.010.
Gragnano Felice, Montalto Claudio, Oreglia Jacopo A, Calabrò Paolo
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Standardized pre-procedural clinical workup for protected percutaneous coronary intervention.
Eur Heart J Suppl2022 Nov;24(Suppl J):J11-J16. doi: 10.1093/eurheartjsupp/suac061.
Al-Rashid Fadi, Van Mieghem Nicolas M, Bonello Laurent, Oreglia Jacopo, Romagnoli Enrico
Abstract
In addition to appropriate patient screening, pre-procedural preparation is essential to optimize both technical success and patient outcome for protected percutaneous coronary intervention (PCI). A critical component of optimization is the identification and preparation of a suitable femoral access site. Here, we describe several options for both imaging and image-guided access to optimize the approach.
© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.
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Handling high-risk patients in the catheterization laboratory.
Eur Heart J Suppl2022 Nov;24(Suppl J):J30-J36. doi: 10.1093/eurheartjsupp/suac063.
Ibrahim Karim, Tongers Jörn, Mangner Norman, Werner Nikos, Tycinska Agnieszka, Leick Jürgen, Oreglia Jacopo, Schröder Jörg
Abstract
Protected percutaneous coronary intervention is considered a life-saving procedure for high-risk patients. Therefore it is important that the interventional cardiology team is prepared, the procedure is planned, and potential complications, as well as bail out strategies are considered. Throughout the procedure, it is critical to monitor the patient to identify any early signs of deterioration or changes in patient well-being to avoid any potential complications.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Dual antiplatelet therapy duration after percutaneous coronary intervention in patients with indication to oral anticoagulant therapy. A systematic review and meta-analysis of randomized controlled trials.
Eur Heart J Cardiovasc Pharmacother2023 Apr;9(3):220-230. doi: 10.1093/ehjcvp/pvac065.
Montalto Claudio, Costa Francesco, Leonardi Sergio, Micari Antonio, Oreglia Jacopo A, Vranckx Pascal, Capodanno Davide, Ten Berg Jurriën, Lopes Renato D, Valgimigli Marco
Abstract
AIMS:
Optimal duration of dual antiplatelet therapy (DAPT) in patients with concomitant indication to oral anticoagulation (OAC) is still debated.
METHODS AND RESULTS:
A systematic review was performed on electronic databases to search for randomized controlled trials comparing an abbreviated or prolonged (?3 months) DAPT regimen in patients with OAC and they were analysed in the framework of standard and network meta-analyses. Co-primary endpoints were major or clinically relevant non-major bleedings (MCRB) and major bleeding, while the composite of major adverse cardiovascular events (MACE) was the key safety endpoint. Five studies and 7 665 patients (abbreviated DAPT n = 3 843; prolonged DAPT n = 3 822) were included. Both MCRB and major bleeding were lower with abbreviated DAPT [risk ratio (RR) 0.69 (0.52-0.91); P = 0.01 and 0.70 (0.52-0.95); P = 0.01, respectively] while MACE [RR: 0.96 (0.70-1.33); P = 0.6], all-cause death, cardiovascular death, stent thrombosis, or myocardial infarction did not differ. Network meta-analysis showed that peri-procedural DAPT had the highest probability to prevent MCRB and major bleeding (97.1 and 92.0% respectively) when compared with both short (4-6 weeks) and longer (?3 months) DAPT regimens. Sensitivity analyses and meta-regressions showed consistency in different clinical scenarios and suggested a larger bleeding reduction with P2Y12 inhibitors vs. aspirin after DAPT discontinuation.
CONCLUSION:
In patients undergoing PCI with concomitant OAC indication, an abbreviated DAPT regimen reduced MCRB and major bleeding without increasing MACE or other ischaemic events. Peri-procedural DAPT and P2Y12 inhibitor monotherapy after DAPT withdrawal appear to be the best strategies to optimize the bleeding and ischaemic risk tradeoff. Trial registration. PROSPERO CRD284001.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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In-hospital arrhythmic burden reduction in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: Insights from the SGLT2-I AMI PROTECT study.
Front Cardiovasc Med2022 ;9():1012220. doi: 1012220.
Cesaro Arturo, Gragnano Felice, Paolisso Pasquale, Bergamaschi Luca, Gallinoro Emanuele, Sardu Celestino, Mileva Niya, Foà Alberto, Armillotta Matteo, Sansonetti Angelo, Amicone Sara, Impellizzeri Andrea, Esposito Giuseppe, Morici Nuccia, Oreglia Jacopo Andrea, Casella Gianni, Mauro Ciro, Vassilev Dobrin, Galie Nazzareno, Santulli Gaetano, Pizzi Carmine, Barbato Emanuele, Calabrò Paolo, Marfella Raffaele
Abstract
BACKGROUND:
Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus (T2DM). They have also gained interest for their potential anti-arrhythmic role and their ability to reduce the occurrence of atrial fibrillation (AF) and ventricular arrhythmias (VAs) in T2DM and heart failure patients.
OBJECTIVES:
To investigate in-hospital new-onset cardiac arrhythmias in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-i vs. other oral anti-diabetic agents (non-SGLT2-i users).
METHODS:
Patients from the SGLT2-I AMI PROTECT registry (NCT05261867) were stratified according to the use of SGLT2-i before admission for AMI, divided into SGLT2-i users vs. non-SGLT2-i users. In-hospital outcomes included the occurrence of in-hospital new-onset cardiac arrhythmias (NOCAs), defined as a composite of new-onset AF and sustained new-onset ventricular tachycardia (VT) and/or ventricular fibrillation (VF) during hospitalization.
RESULTS:
The study population comprised 646 AMI patients categorized into SGLT2-i users (111 patients) and non-SGLT2-i users (535 patients). SGLT2-i users had a lower rate of NOCAs compared with non-SGLT2-i users (6.3 vs. 15.7%, = 0.010). Moreover, SGLT2-i was associated with a lower rate of AF and VT/VF considered individually ( = 0.032). In the multivariate logistic regression model, after adjusting for all confounding factors, the use of SGLT2-i was identified as an independent predictor of the lower occurrence of NOCAs (OR = 0.35; 95%CI 0.14-0.86; = 0.022). At multinomial logistic regression, after adjusting for potential confounders, SGLT2-i therapy remained an independent predictor of VT/VF occurrence (OR = 0.20; 95%CI 0.04-0.97; = 0.046) but not of AF occurrence.
CONCLUSIONS:
In T2DM patients, the use of SGLT2-i was associated with a lower risk of new-onset arrhythmic events during hospitalization for AMI. In particular, the primary effect was expressed in the reduction of VAs. These findings emphasize the cardioprotective effects of SGLT2-i in the setting of AMI beyond glycemic control.
TRIAL REGISTRATION:
Data are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov, identifier: NCT05261867.
Copyright © 2022 Cesaro, Gragnano, Paolisso, Bergamaschi, Gallinoro, Sardu, Mileva, Foà, Armillotta, Sansonetti, Amicone, Impellizzeri, Esposito, Morici, Oreglia, Casella, Mauro, Vassilev, Galie, Santulli, Pizzi, Barbato, Calabrò and Marfella.
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Transcatheter treatment of severe aortic stenosis in patients with complex coronary artery disease: case series and proposed therapeutic algorithm.
Eur Heart J Case Rep2022 Oct;6(10):ytac399. doi: ytac399.
Soriano Francesco, Montalto Claudio, Calderone Dario, Nava Stefano, Esposito Giuseppe, Saia Francesco, Oreglia Jacopo A, Søndergaard Lars
Abstract
BACKGROUND:
Patients with severe aortic stenosis (AS) and complex coronary artery disease with a clinical indication to both transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) pose a clinical dilemma since it is unclear which lesion should be treated first and careful planning is required.
CASE SUMMARY:
We report two cases of AS with complex PCI (ASCoP) features. In the first one, easy coronary cannulation with an Acurate Neo2 valve and commissural alignment was predicted; therefore, TAVI was performed first, and subsequently complex high-risk PCI of the left main was performed in the same procedure but without the burden of ongoing severe AS. In the second case, complex coronary cannulation after TAVI with an Evolut PRO valve was predicted; therefore, balloon aortic valvuloplasty and Impella placement were performed first to allow for complex, high-risk multivessel PCI and subsequent TAVI. In both cases, a single-stage approach was preferred to reduce the use of large-bore arterial access with possible consequent adverse events.
DISCUSSION:
In this case series, we illustrate a possible approach to the treatment of ASCoP patients. In such complex cases, a thorough preprocedural planning is mandatory, and clinical decision-making should be centred upon the predicted chance of cannulation of coronary arteries after TAVI.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease.
J Am Heart Assoc2022 Oct;11(19):e024589. doi: e024589.
Crimi Gabriele, De Marzo Vincenzo, De Marco Federico, Conrotto Federico, Oreglia Jacopo, D'Ascenzo Fabrizio, Testa Luca, Gorla Riccardo, Esposito Giuseppe, Sorrentino Sabato, Spaccarotella Carmen, Soriano Francesco, Bruno Francesco, Vercellino Matteo, Balbi Manrico, Morici Nuccia, Indolfi Ciro, De Ferrari Gaetano Maria, Bedogni Francesco, Porto Italo
Abstract
Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high-volume centers in Italy. AKI was defined according to Valve Academic Research Consortium-3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all-cause mortality after 1-year follow-up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1-year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95-3.80],
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Left Ventricular Unloading in Acute on Chronic Heart Failure: From Statements to Clinical Practice.
J Pers Med2022 Sep;12(9):. doi: 1463.
Sacco Alice, Morici Nuccia, Oreglia Jacopo Andrea, Tavazzi Guido, Villanova Luca, Colombo Claudia, Garatti Laura, Mondino Michele Giovanni, Nava Stefano, Pappalardo Federico
Abstract
Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the correct therapeutic strategy. Temporary mechanical circulatory support (tMCS) is the mainstay of management: identifying and selecting optimal patients through understanding of the hemodynamics and a prompt profiling and timing, is key for success. A recent statement from the American Heart Association provided pragmatic suggestions on tMCS device selection, escalation, and weaning strategies. However, several areas of uncertainty still remain in clinical practice. Accordingly, we present an overview of the main pitfalls that can occur during patients' management with tMCS through a clinical case. This case illustrates the strict interdependency between left ventricular unloading and right ventricular dysfunction in the case of low filling pressures. Moreover, it further illustrates the pivotal role of stepwise escalation of therapy in a patient with an ADHF-CS and its peculiarities as compared to other forms of acute heart failure.
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Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis.
Eur Heart J Open2022 Jul;2(4):oeac043. doi: oeac043.
Montalto Claudio, Munafò Andrea Raffaele, Arzuffi Luca, Soriano Francesco, Mangieri Antonio, Nava Stefano, De Maria Giovanni Luigi, Burzotta Francesco, D'Ascenzo Fabrizio, Colombo Antonio, Latib Azeem, Oreglia Jacopo Andrea, Banning Adrian P, Porto Italo, Crimi Gabriele
Abstract
AIMS:
As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR.
METHODS AND RESULTS:
We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR? XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide? suture-mediated closure system (Abbott), or MANTA vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints.
CONCLUSION:
Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.
Eur J Clin Invest2023 Jan;53(1):e13869. doi: e13869.
Tua Lorenzo, Mandurino-Mirizzi Alessandro, Colombo Claudia, Morici Nuccia, Magrini Giulia, Nava Stefano, Frassica Romina, Montalto Claudio, Ferlini Marco, Sacco Alice, Musca Francesco, Moreo Antonella, Ghio Stefano, Oreglia Jacopo, Oltrona-Visconti Luigi, Oliva Fabrizio, Crimi Gabriele
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Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project.
Front Cardiovasc Med2022 ;9():931207. doi: 931207.
Testa Luca, Casenghi Matteo, Criscione Enrico, Van Mieghem Nicolas M, Tchétché Didier, Asgar Anita W, De Backer Ole, Latib Azeem, Reimers Bernhard, Stefanini Giulio, Trani Carlo, Giannini Francesco, Bartorelli Antonio, Wojakowski Wojtek, Dabrowski Maciej, Jagielak Dariusz, Banning Adrian P, Kharbanda Rajesh, Moreno Raul, Schofer Joachim, Brinkmann Christina, van Royen Niels, Pinto Duane, Serra Antoni, Segev Amit, Giordano Arturo, Brambilla Nedy, Agnifili Mauro, Rubbio Antonio Popolo, Squillace Mattia, Oreglia Jacopo, Tanja Rudolph, McCabe James M, Abizaid Alexander, Voskuil Michiel, Teles Rui, Zoccai Giuseppe Biondi, Sondergaard Lars, Bedogni Francesco
Abstract
BACKGROUND:
A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown.
AIM:
We sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR.
MATERIALS AND METHODS:
The TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria.
RESULTS:
Among 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM ( = 0.016 and = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed
CONCLUSION:
After TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality.
CLINICAL TRIAL REGISTRATION:
[https://clinicaltrials.gov], identifier [NCT04500964].
Copyright © 2022 Testa, Casenghi, Criscione, Van Mieghem, Tchétché, Asgar, De Backer, Latib, Reimers, Stefanini, Trani, Giannini, Bartorelli, Wojakowski, Dabrowski, Jagielak, Banning, Kharbanda, Moreno, Schofer, Brinkmann, van Royen, Pinto, Serra, Segev, Giordano, Brambilla, Agnifili, Rubbio, Squillace, Oreglia, Tanja, McCabe, Abizaid, Voskuil, Teles, Zoccai, Sondergaard and Bedogni.
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Transcatheter Aortic Valve Replacement With Self-Expanding ACURATE neo2: Postprocedural Hemodynamic and Short-Term Clinical Outcomes.
JACC Cardiovasc Interv2022 Jun;15(11):1101-1110. doi: 10.1016/j.jcin.2022.02.027.
Buono Andrea, Gorla Riccardo, Ielasi Alfonso, Costa Giuliano, Cozzi Ottavia, Ancona Marco, Soriano Francesco, De Carlo Marco, Ferrara Erica, Giannini Francesco, Massussi Mauro, Fovino Luca Nai, Pero Gaetano, Bettari Luca, Acerbi Elena, Messina Antonio, Sgroi Carmelo, Pellicano Mariano, Sun Jinwei, Gallo Francesco, Franchina Antonio Gabriele, Bruno Francesco, Nerla Roberto, Saccocci Matteo, Villa Emmanuel, D'Ascenzo Fabrizio, Conrotto Federico, Cuccia Claudio, Tarantini Giuseppe, Fiorina Claudia, Castriota Fausto, Poli Arnaldo, Petronio Anna Sonia, Oreglia Jacopo, Montorfano Matteo, Regazzoli Damiano, Reimers Bernhard, Tamburino Corrado, Tespili Maurizio, Bedogni Francesco, Barbanti Marco, Maffeo Diego,
Abstract
BACKGROUND:
The first-generation ACURATE neo transcatheter heart valve (THV) (Boston Scientific) was associated with a non-negligible occurrence of moderate or greater paravalvular aortic regurgitation (AR) following transcatheter aortic valve replacement. To overcome this issue, the ACURATE neo2 iteration, which incorporates a taller outer skirt aimed at reducing the occurrence of paravalvular AR, has recently been developed.
OBJECTIVES:
The aim of this study was to assess the efficacy and safety of the ACURATE neo2 (Boston Scientific) THV in patients with severe aortic valve stenosis.
METHODS:
ITAL-neo was an observational, retrospective, multicenter registry enrolling consecutive patients with severe aortic valve stenosis, treated with first- and second-generation ACURATE neo THVs, via transfemoral and trans-subclavian access, in 13 Italian centers. One-to-one propensity score matching was applied to account for baseline characteristics unbalance. The primary endpoint was the occurrence of moderate or greater paravalvular AR on predischarge echocardiographic assessment. Secondary endpoints included postprocedural technical success and 90-day device success and safety.
RESULTS:
Among 900 patients included in the registry, 220 received the ACURATE neo2 THV, whereas 680 were treated with the first-generation device. A total of 410 patients were compared after 1:1 propensity score matching. The ACURATE neo2 THV was associated with a 3-fold lower frequency of postprocedural moderate or greater paravalvular AR (11.2% vs 3.5%; P
CONCLUSIONS:
Transfemoral transcatheter aortic valve replacement using the ACURATE neo2 was associated with a significant lower frequency of moderate or greater paravalvular AR compared with the earlier generation ACURATE neo device, with encouraging short-term safety and efficacy.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series.
J Clin Med2022 Mar;11(5):. doi: 1395.
Scavelli Francesca, Cartella Iside, Montalto Claudio, Oreglia Jacopo Andrea, Villanova Luca, Garatti Laura, Colombo Claudia, Sacco Alice, Morici Nuccia
Abstract
Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.
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Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy.
Minerva Cardiol Angiol2023 Feb;71(1):44-50. doi: 10.23736/S2724-5683.21.05839-7.
Sacco Alice, Montalto Claudio, Bravi Francesca, Ruzzenenti Giacomo, Garatti Laura, Oreglia Jacopo A, Bartorelli Antonio L, Crimi Gabriele, LA Vecchia Carlo, Savonitto Stefano, Leonardi Sergio, Oliva Fabrizio G, Morici Nuccia
Abstract
BACKGROUND:
The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD).
METHODS:
We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)
RESULTS:
We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR
CONCLUSIONS:
In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
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Percutaneous paravalvular leak closure after transcatheter aortic valve implantation: multiimage guidance.
J Cardiovasc Med (Hagerstown)2022 Mar;23(3):203-204. doi: 10.2459/JCM.0000000000001197.
Veas Nicolás, Soriano Francesco, Nava Stefano, Oreglia Jacopo
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Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients.
Eur J Intern Med2022 May;99():30-37. doi: 10.1016/j.ejim.2022.01.018.
Rebora Paola, Centola Marco, Morici Nuccia, Sacco Alice, Occhino Giuseppe, Viola Giovanna, Oreglia Jacopo, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Carugo Stefano, Valsecchi Maria Grazia, Oliva Fabrizio, Giannattasio Cristina, Maloberti Alessandro
Abstract
We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF). We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Median age was 68 (first-third quartile 59-77) years and males were 970 (76%). All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (UA higher than 6 mg/dL for females and 7 mg/dL for males, n = 292): acute HF 35.8 vs 11.1% (p
Copyright © 2022. Published by Elsevier B.V.
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Rare Causes of Acute Coronary Syndrome: The JAK2 V617F Mutation-Positive Myeloproliferative Neoplasms: A Cardio-Hematological Perspective.
Thromb Haemost2022 Aug;122(8):1429-1431. doi: 10.1055/a-1742-0361.
Cantoni Silvia, Colombo Claudia, Soriano Francesco, Oreglia Jacopo Andrea, Sacco Alice, Veronese Silvio, Brunelli Dario, Rubboli Andrea, Morici Nuccia
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Predictors of fractional flow reserve/instantaneous wave-free ratio discordance: impact of tailored diagnostic cut-offs on clinical outcomes of deferred lesions.
J Cardiovasc Med (Hagerstown)2022 Feb;23(2):106-115. doi: 10.2459/JCM.0000000000001264.
De Filippo Ovidio, Gallone Guglielmo, D'Ascenzo Fabrizio, Leone Antonio Maria, Mancone Massimo, Quadri Giorgio, Barbieri Lucia, Bossi Irene, Boccuzzi Giacomo, Montone Rocco Antonio, Burzotta Francesco, Iannaccone Mario, Montefusco Antonio, Carugo Stefano, Castelli Chiara, Oreglia Jacopo, Cerrato Enrico, Peirone Andrea, Zaccardo Giuseppe, Sardella Gennaro, Niccoli Giampaolo, Omedè Pierluigi, Varbella Ferdinando, Rognoni Andrea, Trani Carlo, Conrotto Federico, Escaned Javier, De Ferrari Gaetano Maria
Abstract
BACKGROUND:
Patient-related and lesion-related factors may influence instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) concordance, potentially affecting the safety of revascularization deferral.
METHODS:
Consecutive patients with at least an intermediate coronary stenosis evaluated by both iFR and FFR were retrospectively enrolled. The agreement between iFR and FFR at their diagnostic cut-offs (FFR 0.80, iFR 0.89) was assessed. Predictors of discordance were assessed using multivariate analyses. Tailored iFR cut-offs according to predictors of discordance best matching an FFR of 0.80 were identified. The impact of reclassification according to tailored iFR cut-offs on major cardiovascular events (MACE: cardiovascular death, myocardial infarction or target-lesion revascularization) among deferred lesions was investigated.
RESULTS:
Two hundred and ninety-nine intermediate coronary stenosis [FFR 0.84 (0.78-0.89), iFR 0.91 (0.87-0.95), 202 left main/left anterior descending (LM/LAD) vessels, 67.6%] of 260 patients were studied. Discordance rate was 23.4% (n?=?70, 10.7% iFR-negative discordant, 12.7% iFR-positive discordant). Predictors of discordance were LM/LAD disease, multivessel disease, non-ST-elevation myocardial infarction, smoking, reduced eGFR and hypertension. Lesion reclassification with tailored iFR cut-offs based on patient-level predictors carried no prognostic value among deferred lesions. Reclassification according to lesion location, which was entirely driven by LM/LAD lesions (iFR cut-offs: 0.93 for LM/LAD, 0.89 for non-LM/LAD), identified increased MACE among lesions deferred based on a negative FFR, between patients with a positive as compared with a negative iFR (19.4 vs. 6.1%, P?=?0.044), whereas the same association was not observed with the conventional 0.89 iFR cut-off (15 vs. 8.6%, P?=?0.303).
CONCLUSION:
Tailored vessel-based iFR cut-offs carry prognostic value among FFR-negative lesions, suggesting that a one-size-fit-all iFR cut-off might be clinically unsatisfactory.
Copyright © 2021 Italian Federation of Cardiology - I.F.C. All rights reserved.
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The Role of Uric Acid in Acute and Chronic Coronary Syndromes.
J Clin Med2021 Oct;10(20):. doi: 4750.
Maloberti Alessandro, Biolcati Marco, Ruzzenenti Giacomo, Giani Valentina, Leidi Filippo, Monticelli Massimiliano, Algeri Michela, Scarpellini Sara, Nava Stefano, Soriano Francesco, Oreglia Jacopo, Sacco Alice, Morici Nuccia, Oliva Fabrizio, Piani Federica, Borghi Claudio, Giannattasio Cristina
Abstract
Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
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Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy.
Cardiovasc Ultrasound2021 Aug;19(1):31. doi: 31.
Belli Oriana, Ardissino Maddalena, Bottiroli Maurizio, Soriano Francesco, Blanda Calogero, Oreglia Jacopo, Mondino Michele, Moreo Antonella
Abstract
BACKGROUND:
Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.
CONCLUSION:
This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
© 2021. The Author(s).
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Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project.
Circ Cardiovasc Interv2021 Jun;14(6):e010440. doi: 10.1161/CIRCINTERVENTIONS.120.010440.
Testa Luca, Agnifili Mauro, Van Mieghem Nicolas M, Tchétché Didier, Asgar Anita W, De Backer Ole, Latib Azeem, Reimers Bernhard, Stefanini Giulio, Trani Carlo, Colombo Antonio, Giannini Francesco, Bartorelli Antonio, Wojakowski Wojtek, Dabrowski Maciej, Jagielak Dariusz, Banning Adrian P, Kharbanda Rajesh, Moreno Raul, Schofer Joachim, van Royen Niels, Pinto Duane, Serra Antoni, Segev Amit, Giordano Arturo, Brambilla Nedy, Popolo Rubbio Antonio, Casenghi Matteo, Oreglia Jacopo, De Marco Federico, Tanja Rudolph, McCabe James M, Abizaid Alexander, Voskuil Michiel, Teles Rui, Biondi Zoccai Giuseppe, Bianchi Giovanni, Sondergaard Lars, Bedogni Francesco
Abstract
BACKGROUND:
Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with a degenerated TAV treated by means of a second TAVR.
METHODS:
The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40?000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%.
RESULTS:
Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded.
CONCLUSIONS:
Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population.
REGISTRATION:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04500964.
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Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
Nutr Metab Cardiovasc Dis2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
Abstract
BACKGROUND AND AIMS:
Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
METHODS AND RESULTS:
231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
CONCLUSIONS:
In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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Device entrapment during percutaneous coronary intervention of chronic total occlusions: incidence and management strategies.
EuroIntervention2021 Jun;17(3):212-219. doi: 10.4244/EIJ-D-20-00781.
Gasparini Gabriele-Luigi, Sanz-Sanchez Jorge, Regazzoli Damiano, Boccuzzi Giacomo, Oreglia Jacopo A, Gagnor Andrea, Mazzarotto Pietro, Belli Guido, Garbo Roberto
Abstract
BACKGROUND:
Equipment delivery in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging and it is associated with a higher risk of device entrapment. Data regarding the incidence of device entrapment during CTO PCI are lacking.
AIMS:
The aim of this study was to describe the incidence and procedural characteristics of device entrapment in patients undergoing PCI for CTOs and discuss management strategies for dealing with it.
METHODS:
Device entrapment was characterised in a large consecutive series of 2,361 CTO PCI cases performed by five high-volume CTO Italian operators between January 2015 and January 2020.
RESULTS:
Device entrapment occurred in 36 out of 2,361 cases (1.5%) and consisted of coronary guidewires in 13 (0.5%), microcatheters in 6 (0.2%), balloons in 6 (0.2%), rotational atherectomy burrs in 10 (0.4%) and guiding catheter extension in 1 patient (0.04%). Complete device retrieval was achieved in 63.9%, with at least partial removal of material in 97.2%. Vessel recanalisation was still possible in 86.1% of cases even after device entrapment. Intraprocedural myocardial infarction occurred in 3 patients (8.3%), tamponade with urgent pericardiocentesis in 1 (2.8%) and emergency surgical removal of the entrapped device in 1 patient (2.8%). Mean radiation dose was 4.7±2.3 Gy. At 30-day follow-up, one patient died with stent thrombosis of a non-target vessel and another required repeat percutaneous revascularisation.
CONCLUSIONS:
Device entrapment during CTO revascularisations is a rare but potentially severe complication. We describe and discuss current techniques of percutaneous retrieval that can be employed to achieve procedural success safely.
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Late-sequalae of Kawasaki disease characterized by optical coherence tomography.
J Cardiovasc Med (Hagerstown)2021 Jul;22(7):597-599. doi: 10.2459/JCM.0000000000001083.
Soriano Francesco, Veas Nicolas, Nava Stefano, Piccinelli Enrico, Pedrotti Patrizia, Oreglia Jacopo, Vignati Gabriele, Winter José, Ammirati Enrico, Burns Jane C, Gordon John B
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Management and outcomes of coronary artery perforations treated with the block and deliver technique.
Catheter Cardiovasc Interv2021 Aug;98(2):238-245. doi: 10.1002/ccd.29241.
Sanz Sanchez Jorge, Garbo Roberto, Gagnor Andrea, Oreglia Jacopo, Mazzarotto Pietro, Maurina Matteo, Regazzoli Damiano, Gasparini Gabriele L
Abstract
OBJECTIVES AND BACKGROUND:
Coronary artery perforation (CAP) is a potentially life-threatening complication during percutaneous coronary interventions (PCI) and the best strategy for its management is yet to be proved. We aimed to analyze the safety, efficacy, and long-term clinical outcomes of the block and deliver (BAD) technique, as only anecdotal cases are reported in literature.
METHODS:
From January 2016 to January 2020, all consecutive patients treated with the BAD technique at five high-volume centers in Italy were retrospectively identified.
RESULTS:
25?CAPs treated with the BAD technique were included. The most frequently perforated artery was the left anterior descending artery (32%) and spring-coil wires with a hydrophilic coating were the most common culprit wires (68%). Mean sealing time was 46.9?±?60.1 min, with no significant differences between CTO-PCIs and non-CTO PCIs (p = .921). Acute successful sealing of the CAP was achieved in 96% of the cases. Immediate cardiac tamponade occurred in 28% of patients, four during CTO PCI and three during non-CTO PCI (p = .55). Two patients required pericardiocentesis during hospitalization, one patient developed acute kidney injury, and one patient underwent cardiac surgery due to severe mitral regurgitation. At 1-year follow-up no significant differences were observed between groups in terms of POCE (25 vs 25%, p = .628) and its individual components.
CONCLUSION:
The BAD technique proved to be effective for the management of CAP, showing high successful sealing rates. Rates of in-hospital events and at 1-year follow-up did not significantly differ between patients suffering CAP during CTO revascularization or during non-CTO PCI.
© 2020 Wiley Periodicals LLC.
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Optimal P2Y12 inhibition in older adults with acute coronary syndromes: a network meta-analysis of randomized controlled trials.
Eur Heart J Cardiovasc Pharmacother2022 Jan;8(1):20-27. doi: 10.1093/ehjcvp/pvaa101.
Montalto Claudio, Morici Nuccia, Munafò Andrea Raffaele, Mangieri Antonio, Mandurino-Mirizzi Alessandro, D'Ascenzo Fabrizio, Oreglia Jacopo, Latib Azeem, Porto Italo, Colombo Antonio, Savonitto Stefano, De Servi Stefano, Crimi Gabriele
Abstract
AIMS:
Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor on top of aspirin is the cornerstone of therapy after acute coronary syndromes (ACS). Nonetheless, the safest and most efficacious P2Y12 for older patients who are both at high ischaemic and bleeding risk remains uncertain. We aimed to examine the effect of available P2Y12 inhibitors on ischaemic and bleeding endpoints in older adults with ACS.
METHODS AND RESULTS:
Randomized clinical trials that reported separately the results of adults older >70?years for at least the primary endpoint [composite of death, myocardial infarction (MI), and stroke]. Seven studies (14 485 patients-years) were included. Network meta-analysis showed that prasugrel was associated with similar occurrence of the primary endpoint and of a secondary ischaemic endpoint (composite of MI and stroke) and was most likely the best treatment [Surface Under the Cumulative Ranking curve Analysis (SUCRA) 54.5 and 59.8, respectively]. With regards to major bleedings, clopidogrel showed the highest likelihood of event reduction (SUCRA 70.1%), while ticagrelor of stent thrombosis (SUCRA 55.6%). Our meta-regression with a fixed proportion of patients managed invasively of 100% confirmed these trends with increasing SUCRA.
CONCLUSION:
Among older subjects with ACS, DAPT should be balanced upon ischaemic and bleeding risks as prasugrel is associated with the highest probability of reduction of ischaemic events and clopidogrel of bleedings. Ticagrelor had highest SUCRA for stent thrombosis reduction but seems suboptimal in older adults.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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[Iliac-femoral lithoplasty for a transcatheter aortic valve implantation. Report of one case].
Rev Med Chil2020 Apr;148(4):548-552. doi: 10.4067/s0034-98872020000400548.
Veas NicolÁs, Soriano Francesco, Winter JosÉ, Nava Stefano, Hameau RenÉ, Lidefjeld Dante, Valdebenito MartÍn, MuÑoz Rodrigo, Oreglia Jacopo
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[Combined use of left ventricular assist devices in cardiogenic shock. Report of one case].
Rev Med Chil2020 Mar;148(3):409-413. doi: 10.4067/S0034-98872020000300409.
Hameau D René, Soriano Francesco, Oreglia Jacopo, Muñoz Rodrigo, Winter José Luis, Valdebenito Martín, Quitral Jorge, Lindefjeld Dante, Veas Nicolas
Abstract
We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.
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Correction to: Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis.
J Nephrol2021 Feb;34(1):75-76. doi: 10.1007/s40620-020-00800-6.
Genovesi Simonetta, Porcu Luca, Slaviero Giorgio, Casu Gavino, Bertoli Silvio, Sagone Antonio, Buskermolen Monique, Pieruzzi Federico, Rovaris Giovanni, Montoli Alberto, Oreglia Jacopo, Piccaluga Emanuela, Molon Giulio, Gaggiotti Mario, Ettori Federica, Gaspardone Achille, Palumbo Roberto, Viazzi Francesca, Breschi Marco, Gallieni Maurizio, Contaldo Gina, D'Angelo Giuseppe, Merella Pierluigi, Galli Fabio, Rebora Paola, Valsecchi Mariagrazia, Mazzone Patrizio
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Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count.
Angiology2020 Oct;71(9):831-839. doi: 10.1177/0003319720938619.
Morici Nuccia, Molinari Valentina, Cantoni Silvia, Rubboli Andrea, Antolini Laura, Sacco Alice, Cattaneo Marco, Alicandro Gianfranco, Oreglia Jacopo A, Oliva Fabrizio, Giannattasio Cristina, Brunelli Dario, La Vecchia Carlo, Valgimigli Marco, Savonitto Stefano
Abstract
Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells' inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 10/L, discharge hemoglobin 250 × 10/L were defined as "high-risk CBC." Among 1076 patients with ACS discharged alive, 129 (12%) had a "high-risk CBC" and 947 (88%) had a "low-risk CBC." Patients with "high-risk CBC" were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to "low-risk CBC" patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient's risk and improve therapeutic management.
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The Double Trapping Balloon Technique to Facilitate Retrograde Wire Externalization During Chronic Total Occlusion Intervention.
JACC Cardiovasc Interv2020 Jul;13(14):e133-e135. doi: 10.1016/j.jcin.2020.03.044.
Gasparini Gabriele L, Sanz Sanchez Jorge, Oreglia Jacopo, Mazzarotto Pietro
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Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis.
J Nephrol2021 Feb;34(1):63-73. doi: 10.1007/s40620-020-00774-5.
Genovesi Simonetta, Porcu Luca, Slaviero Giorgio, Casu Gavino, Bertoli Silvio, Sagone Antonio, Buskermolen Monique, Pieruzzi Federico, Rovaris Giovanni, Montoli Alberto, Oreglia Jacopo, Piccaluga Emanuela, Molon Giulio, Gaggiotti Mario, Ettori Federica, Gaspardone Achille, Palumbo Roberto, Viazzi Francesca, Breschi Marco, Gallieni Maurizio, Contaldo Gina, D'Angelo Giuseppe, Merella Pierluigi, Galli Fabio, Rebora Paola, Valsecchi Mariagrazia, Mazzone Patrizio
Abstract
BACKGROUND:
In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk.
METHODS:
Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n?=?114) and the other not taking any OAT (no-therapy cohort, n?=?148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors.
RESULTS:
The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients.
CONCLUSIONS:
The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.
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ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinical and Angiographic Outcomes.
Circulation2020 Jun;141(25):2113-2116. doi: 10.1161/CIRCULATIONAHA.120.047525.
Stefanini Giulio G, Montorfano Matteo, Trabattoni Daniela, Andreini Daniele, Ferrante Giuseppe, Ancona Marco, Metra Marco, Curello Salvatore, Maffeo Diego, Pero Gaetano, Cacucci Michele, Assanelli Emilio, Bellini Barbara, Russo Filippo, Ielasi Alfonso, Tespili Maurizio, Danzi Gian Battista, Vandoni Pietro, Bollati Mario, Barbieri Lucia, Oreglia Jacopo, Lettieri Corrado, Cremonesi Alberto, Carugo Stefano, Reimers Bernhard, Condorelli Gianluigi, Chieffo Alaide
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[Concomitant deployment of MitraClip devices and left atrial appendage closure. Report of one case].
Rev Med Chil2019 Oct;147(10):1350-1354. doi: 10.4067/s0034-98872019001001350.
Veas Nicolás, Hameau René, Nava Stefano, Winter José, Soriano Francesco, Oreglia Jacopo
Abstract
We report a 65-years old woman with a history of permanent atrial fibrillation with high risk for ischemic and bleeding events. She developed a heart failure with severely impaired left ventricular ejection fraction and severe secondary mitral regurgitation. Given her high surgical risk, using transesophageal echocardiography guidance, a concomitant deployment of two MitraClip devices using a high-posterior septal puncture and a left atrial appendage closure with an Amplatzer Amulet occluder were performed through the same access.
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No-Reflow Complicating Chronic Total Occlusion Coronary Revascularization.
J Invasive Cardiol2020 Feb;32(2):58-63.
Dall'Ara Gianni, Testa Luca, Tumscitz Carlo, Mattesini Alessio, Gasparini Gabriele Luigi, Grotti Simone, Bollati Mario, Tarantino Fabio, Di Mario Carlo, Oreglia Jacopo Andrea
Abstract
OBJECTIVES:
To assess the incidence of no-reflow in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI), analyze possible causes and differential diagnoses, and identify useful management approaches.
METHODS:
In this multicenter observational study, all CTO-PCIs performed between January 2018 and April 2019 were reviewed to collect no-reflow complications, defined as Thrombolysis in Myocardial Infarction (TIMI) flow ?1 in a patent epicardial artery. Patient clinical, anatomical, and procedural characteristics were analyzed.
RESULTS:
Out of 461 PCIs, two (0.43%) were complicated by no-reflow. In 1 case, PCI was performed on a long segment of the right coronary artery, after use of a dissection-re-entry technique by knuckle wiring. In the second patient, no-reflow developed after proximal left anterior descending coronary artery stenting, with a short subintimal tracking. Intravascular ultrasound was used to exclude complications in the epicardial vessel in both cases. Distal embolization seems the most plausible cause, and intracoronary adenosine effectively improved flow. Both patients had a type 4a myocardial infarction, asymptomatic in the first case, and associated with chest pain, electrocardiographic changes, and new regional wall-motion abnormality at echocardiography in the second case.
CONCLUSIONS:
No-reflow in CTO recanalization is rare, but associated with a high risk of periprocedural myocardial infarction, with incomplete protection from ischemia offered by the pre-existing collateral network.
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[Relevance of complete blood count parameters in the assessment of acute coronary syndromes: a combined hematological and cardiological perspective].
G Ital Cardiol (Rome)2019 Dec;20(12):694-705. doi: 10.1714/3271.32379.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Viola Giovanna, De Stefano Valerio, Veas Nicolas, Oreglia Jacopo A, Esposito Giuseppe, Sacco Alice, Savonitto Stefano
Abstract
The aim of this review is to explore the available evidence concerning the relationship between the different parameters of the complete blood count, its pathophysiological changes and cardiovascular disease, specifically focusing on the acute ischemic setting. Erythrocytes, leukocytes and platelets undergo significant and more or less durable changes over time in response to conditions of systemic inflammatory, infectious and neoplastic disease. This is the reason why blood cell count parameters can (and should) be implemented in the global assessment of the patient with acute coronary syndrome.From the literature review it emerges that anemia and thrombocytopenia have an independent negative prognostic role in the medium and long term, being markers of the overall frailty of patients with ischemic heart disease. On the other hand, essential thrombocythemia and polycythemia vera, two chronic myeloproliferative neoplasms, are characterized by an important increase in thrombotic risk. Both conditions are given a brief description for the particular importance of the close collaboration between cardiologists and hematologists in the diagnosis and treatment of these diseases in the context of ischemic heart disease.
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Recurrent stent thrombosis in a patient with acute coronary syndrome and ischemic colitis: between life-threatening thrombosis and life-threatening bleeding.
Platelets2020 Aug;31(6):820-824. doi: 10.1080/09537104.2019.1678122.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Sacco Alice, Viola Giovanna, Esposito Giuseppe, Oreglia Jacopo A, Cattaneo Marco, Savonitto Stefano
Abstract
Complete blood count should always be considered to tailor diagnosis and appropriate management in patients with acute ischemic heart disease. We present a challenging case of recurrent acute coronary syndrome, in the context of very high thrombotic risk due to concomitant inflammatory disease. Although no general guidelines exist for the switch between antiplatelet agents, particularly in the acute setting, in specific cases, the availability of different orally- and i.v.-acting agents and platelet function tests may allow to discriminate among multiple possible mechanisms of drug failure or side effects in the individual patient.
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[Myocardial infarction with non-obstructive coronary arteries (MINOCA): diagnosis, pathogenesis, therapy and prognosis].
G Ital Cardiol (Rome)2019 Sep;20(9):499-511. doi: 10.1714/3207.31839.
Buono Andrea, Pedrotti Patrizia, Soriano Francesco, Veas Nicolas, Oliva Fabrizio, Oreglia Jacopo, Ammirati Enrico
Abstract
The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing
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Feasibility and safety of distal radial access for percutaneous coronary intervention using a 7 FR sheath.
Catheter Cardiovasc Interv2019 Nov;94(6):902. doi: 10.1002/ccd.28397.
Gasparini Gabriele L, Garbo Roberto, Gagnor Andrea, Oreglia Jacopo, Mazzarotto Pietro
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Persistent Cardiac Tamponade Due to Extrinsic Compression After Coronary Perforation.
Cardiovasc Revasc Med2020 Apr;21(4):562-564. doi: 10.1016/j.carrev.2019.06.016.
Sanz Sanchez Jorge, Oreglia Jacopo A, Regazzoli Lancini Damiano, Gasparini Gabriele L
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Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome.
Angiology2019 Oct;70(9):867-877. doi: 10.1177/0003319719848547.
Morici Nuccia, Tavecchia Giovanni A, Antolini Laura, Caporale Maria R, Cantoni Silvia, Bertuccio Paola, Sacco Alice, Meani Paolo, Viola Giovanna, Brunelli Dario, Oliva Fabrizio, Lombardi Federico, Segreto Antonio, Oreglia Jacopo A, La Vecchia Carlo, Cattaneo Marco, Valgimigli Marco, Savonitto Stefano
Abstract
The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ?25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT
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Acute myocardial infarction complicating ischemic stroke: is there room for cangrelor?
Platelets2020 ;31(1):120-123. doi: 10.1080/09537104.2019.1609663.
Morici Nuccia, Nava Stefano, Sacco Alice, Viola Giovanna, Oreglia Jacopo, Meani Paolo, Oliva Fabrizio, Ranucci Marco, Leonardi Sergio, Rossini Roberta
Abstract
Acute myocardial infarction (AMI) complicating ischemic stroke is a well known and undertreated event. A conservative management is not infrequent in these settings, due to the fear of hemorrhagic complications related to antithrombotic therapy. Notably, an invasive approach with a primary percutaneous coronary intervention (PCI) has been shown to be associated with a lower in-hospital mortality in patients with concomitant ischemic stroke and AMI. The optimal antiplatelet regimen in these cases has been not clearly defined, yet. We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay.
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Coronary dissection due to intravascular lithoplasty balloon rupture.
EuroIntervention2019 Aug;15(6):e558-e559. doi: 10.4244/EIJ-D-19-00383.
Soriano Francesco, Veas Nicolas, Piccinelli Enrico, Oreglia Jacopo
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Mycotic coronary aneurysms.
J Cardiovasc Med (Hagerstown)2019 Jan;20(1):10-15. doi: 10.2459/JCM.0000000000000734.
Buono Andrea, Maloberti Alessandro, Bossi Irene M, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo A, Moreo Antonella, Russo Claudio F, Oliva Fabrizio, Giannattasio Cristina
Abstract
: Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.
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First prospective multicentre experience with left distal transradial approach for coronary chronic total occlusion interventions using a 7 Fr Glidesheath Slender.
EuroIntervention2019 May;15(1):126-128. doi: 10.4244/EIJ-D-18-00648.
Gasparini Gabriele Luigi, Garbo Roberto, Gagnor Andrea, Oreglia Jacopo, Mazzarotto Pietro
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Antegrade fenestration and re-entry for bailout treatment of iatrogenic coronary dissection.
Cardiovasc Revasc Med2019 Feb;20(2):172-173. doi: 10.1016/j.carrev.2018.08.014.
Merella Pierluigi, Lorenzoni Giovanni, Gasparini Gabriele Luigi, Oreglia Jacopo Andrea, Casu Gavino
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[Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation].
G Ital Cardiol (Rome)2018 Sep;19(9):519-529. doi: 10.1714/2951.29672.
Tarantini Giuseppe, Esposito Giovanni, Musumeci Giuseppe, Fraccaro Chiara, Franzone Anna, Castiglioni Battistina, La Manna Alessio, Limbruno Ugo, Marchese Alfredo, Mauro Ciro, Rigattieri Stefano, Tarantino Fabio, Gandolfo Caterina, Santoro Gennaro, Violini Roberto, Airoldi Flavio, Albiero Remo, Balbi Manrico, Baralis Giorgio, Bartorelli Antonio Luca, Bedogni Francesco, Benassi Alberto, Berni Andrea, Bonzani Giulio, Bortone Alessandro Santo, Braito Giuseppe, Briguori Carlo, Brscic Elvis, Calabrò Paolo, Calchera Ivan, Cappelli Bigazzi Maurizio, Caprioglio Francesco, Castriota Fausto, Cernetti Carlo, Cicala Cinzia, Cioffi Paolo, Colombo Antonio, Colombo Virgilio, Contegiacomo Gaetano, Cremonesi Alberto, D'Amico Maurizio, De Benedictis Mauro, De Leo Alessandro, Di Biasi Maurizio, Di Girolamo Domenico, Di Lorenzo Emilio, Di Mario Carlo, Dominici Marcello, Ettori Federica, Ferrario Maurizio, Fioranelli Massimo, Fischetti Dionigi, Gabrielli Gabriele, Giordano Arturo, Giudice Pietro, Greco Cesare, Indolfi Ciro, Leonzi Ornella, Lettieri Corrado, Loi Bruno, Maddestra Nicola, Marchionni Niccolò, Marrozzini Cinzia, Medda Massimo, Missiroli Bindo, My Luigi, Oreglia Jacopo Andrea, Palmieri Cataldo, Pantaleo Paolo, Paparoni Saro Roberto, Parodi Guido, Petronio Anna Sonia, Piatti Luigi, Piccaluga Emanuela, Pierli Carlo, Perkan Andrea, Pitì Antonino, Poli Arnaldo, Ramondo Angelo Bruno, Reale Maurizio Alessandro, Reimers Bernhard, Ribichini Flavio Luciano, Rosso Roberta, Saccà Salvatore, Sacra Cosimo, Santarelli Andrea, Sardella Gennaro, Satullo Gaetano, Scalise Filippo, Siviglia Massimo, Spedicato Leonardo, Stabile Amerigo, Tamburino Corrado, Tesorio Tullio Nicola Maria, Tolaro Salvatore, Tomai Fabrizio, Trani Carlo, Valenti Renato, Valsecchi Orazio, Valva Giuseppe, Varbella Ferdinando, Vigna Carlo, Vignali Luigi, Berti Sergio
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
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[Paclitaxel-coated balloons for in-stent restenosis treatment: long-term clinical results and predictors of recurrent target lesion revascularization].
G Ital Cardiol (Rome)2018 Apr;19(4):232-238. doi: 10.1714/2898.29217.
Bossi Irene, D'Anna Margherita, Vaccaro Valentina, Caria Maria Paola, Colombo Paola, De Marco Federico, Oreglia Jacopo, Piccalò Giacomo, Piccaluga Emanuela, Soriano Francesco, Oliva Fabrizio, Klugmann Silvio
Abstract
BACKGROUND:
The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES).
METHODS:
Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB.
RESULTS:
At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p
CONCLUSIONS:
Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.
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Implant success and safety of left atrial appendage occlusion in end stage renal disease patients: Peri-procedural outcomes from an Italian dialysis population.
Int J Cardiol2018 Jul;262():38-42. doi: 10.1016/j.ijcard.2018.03.083.
Genovesi Simonetta, Slaviero Giorgio, Porcu Luca, Casu Gavino, Bertoli Silvio, Sagone Antonio, Pieruzzi Federico, Rovaris Giovanni, Buskermolen Monique, Danna Paolo, Montoli Alberto, Oreglia Jacopo, Contaldo Gina, Mazzone Patrizio
Abstract
AIMS:
To estimate the safety and the efficacy of the off label left atrial appendage (LAA) occlusion in chronic dialysis patients with atrial fibrillation (AF). In this preliminary paper, we report the design of the study and the data on peri-procedural complications.
METHODS:
This is a prospective cohort study. Primary endpoints are i) incidence of peri-procedural complications, ii) cumulative incidence of two-year thromboembolic events iii) cumulative incidence of two-year bleedings iiii) mortality at two years. Adverse events and death within 30?days of the procedure were recorded.
RESULTS:
Fifty patients who underwent LAA occlusion between May 2014 and September 2017 were recruited. Both the mean age of the sample study and the dialysis duration were high [71.8 (9.6) years and 59.4 (78.2) months, respectively]. Most patients (84%) were hypertensive and 62% suffered a previous major bleeding. About half of them presented cardiovascular diseases. CHADSVASCs and HASBLED scores were 4.0 (1.5) and 4.4 (0.9), respectively. Most patients (88%) showed atrial dilatation and 44% left ventricular hypertrophy; 32% had left ventricular ejection fraction
CONCLUSIONS:
Our preliminary data suggest the feasibility and safety of LAA occlusion in patients undergoing dialysis. Only the follow-up of these patients over time can provide evidence that LAA occlusion is effective in preventing of thromboembolic events in this very high-risk population.
Copyright © 2018 Elsevier B.V. All rights reserved.
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Retrograde approach-related epicardial collateral channel perforation successfully treated with simultaneous bilateral coils embolization: A case illustration and review.
Cardiovasc Revasc Med2018 ;19(7 Pt B):879-886. doi: 10.1016/j.carrev.2018.03.004.
Gasparini Gabriele L, Merella Pierluigi, Mazzarotto Pietro, Gagnor Andrea, Garbo Roberto, Oreglia Jacopo A
Abstract
Coronary perforation is a rare but potentially lethal complication of percutaneous coronary intervention. Management of coronary perforations is mainly conditioned by the extension of coronary rupture and location of the perforation. Successful treatment is highly affected by the operator's familiarity with tools and dedicated techniques to achieve prompt sealing of the disruption. We report a case of an epicardial collateral channel perforation occurred during a retrograde chronic total occlusion revascularization procedure that was promptly managed with bilateral coils embolization in the target and in the donor vessel. Based on medical literature an overview of the most helpful techniques to treat these complications is provided.
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Real-world application of currently available decision models for dual antiplatelet therapy duration in acute coronary syndrome.
J Cardiovasc Med (Hagerstown)2018 Jun;19(6):310-313. doi: 10.2459/JCM.0000000000000655.
Morici Nuccia, Piccinelli Enrico, Brunelli Dario, Sacco Alice, Viola Giovanna, Oreglia Jacopo A, Oliva Fabrizio, Valgimigli Marco
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Dual lumen microcatheters for complex percutaneous coronary interventions.
Cardiovasc Revasc Med2018 Apr;19(3 Pt A):298-305. doi: 10.1016/j.carrev.2017.09.016.
Oreglia Jacopo A, Garbo Roberto, Gagnor Andrea, Gasparini Gabriele L
Abstract
In some bifurcation anatomies side branch wiring can be difficult particularly when side branch is highly angulated. Furthermore a combination of bifurcations and chronic total occlusion can be a real challenge for interventional cardiologists. New devices have been produced to facilitate complex PCI and recently introduced dual lumen microcatheters can be really helpful in these scenarios. All these devices have both a rapid-exchange and an over-the-wire lumen. The rationale for dual lumen microcatheters is to preserve the highest number of side-branches. Nevertheless PCI should always aim to the most complete revascularization and to the lowest rate of side-branch loss. The purpose of this review is to describe current available dual lumen microcatheters, interventional scenarios in which their use may be helpful and basics of their proper use.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Self-apposing stent-assisted coil embolization for the treatment of coronary artery aneurysm.
Catheter Cardiovasc Interv2018 Feb;91(3):470-474. doi: 10.1002/ccd.27345.
Gasparini Gabriele L, Oreglia Jacopo A, Reimers Bernhard
Abstract
Coronary artery aneurysms (CAA) represent an uncommon disease with yet unclear standards of treatment. Clinical and anatomic characteristics determine choice of treatment. Stent-assisted coil embolization has been described as a valuable option for management of patients with wide-neck coronary aneurysms. Choice of appropriate stent sizing can be challenging particularly when there is a large difference between proximal and distal diameters. We report a case of stent-assisted coil embolization of a coronary aneurysm using a self-expandable stent. This type of stent can be helpful to treat CAA involving coronary sites where marked tapering of vessel diameter is often present.
© 2017 Wiley Periodicals, Inc.
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The trap and occlude technique for retrograde wire externalization during chronic total occlusion revascularization.
Catheter Cardiovasc Interv2018 Jan;91(1):57-63. doi: 10.1002/ccd.27250.
Gasparini Gabriele L, Oreglia Jacopo A, Garbo Roberto
Abstract
Different strategies of retrograde approach were introduced in recent years to improve the success rate of percutaneous coronary intervention for coronary chronic total occlusions. The aim of this report is to describe a new technique, called "Trap and Occlude Technique," for retrograde wire externalization during CTO percutaneous revascularization. This technique may save time and reduce radiation exposure and procedure-related bleeding.
© 2017 Wiley Periodicals, Inc.
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ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training.
Eur Heart J Suppl2017 May;19(Suppl D):D333-D353. doi: 10.1093/eurheartj/sux008.
Casu Gavino, Gulizia Michele Massimo, Molon Giulio, Mazzone Patrizio, Audo Andrea, Casolo Giancarlo, Di Lorenzo Emilio, Portoghese Michele, Pristipino Christian, Ricci Renato Pietro, Themistoclakis Sakis, Padeletti Luigi, Tondo Claudio, Berti Sergio, Oreglia Jacopo Andrea, Gerosa Gino, Zanobini Marco, Ussia Gian Paolo, Musumeci Giuseppe, Romeo Francesco, Di Bartolomeo Roberto
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at five-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban, and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centres and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.
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Coronary Artery Aneurysm After Bioresorbable Scaffold Implantation in a Woman With an Acute Coronary Syndrome.
J Invasive Cardiol2017 Jul;29(7):E77-E78.
Cereda Alberto F, Canova Paolo A, Oreglia Jacopo A, Soriano Francesco S
Abstract
We herein report the case of an ST-elevation myocardial infarction due to bioresorbable vascular scaffold (BRS) failure. Optical coherence tomography (OCT) revealed the exact mechanism of late BRS stent thrombosis due to an acquired coronary aneurysm related to BRS. A drug eluting OCT-guided stenting over a failed BRS in the context of an acute coronary syndrome, with the simultaneous presence of a BRS thrombosis and coronary artery aneurysm, proved to be effective.
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[SICI-GISE Position paper: Use of Absorb BVS in clinical practice].
G Ital Cardiol (Rome)2016 Oct;17(10 Suppl 1):28S-44. doi: 10.1714/2372.25480.
Tarantini Giuseppe, Saia Francesco, Capranzano Piera, Cortese Bernardo, Mojoli Marco, Boccuzzi Giacomo, Cuculo Andrea, Geraci Salvatore, Mattesini Alessio, Oreglia Jacopo, Summaria Francesco, Testa Luca, Berti Sergio, Esposito Giovanni, La Manna Alessio, Limbruno Ugo, Marchese Alfredo, Mauro Ciro, Tarantino Fabio, Salvi Alessandro, Santoro Gennaro, Varbella Ferdinando, Violini Roberto, Musumeci Giuseppe
Abstract
Drug-eluting stents (DES) are the current gold standard for percutaneous treatment of coronary artery disease. However, DES are associated with a non-negligible risk of long-term adverse events related to persistence of foreign material in the coronary artery wall. In addition, DES implantation causes permanent caging of the native vessel, thus impairing normal vasomotricity and the possibility of using non-invasive coronary imaging or preforming subsequent bypass surgery. On the contrary, coronary bioresorbable stents (BRS) may provide temporary mechanical support to coronary wall without compromising the subsequent recovery of normal vascular physiology, and have the potential to prevent late adverse events related to permanent elements. Several types of BRS have been introduced into clinical practice in Europe or are being tested. However, most of available clinical data relate to a single BRS, the Absorb bioresorbable Vascular Scaffold (Absorb BVS) (Abbott Vascular, Santa Clara, CA). Despite encouraging clinical results, no societal guidelines are available on the use of BRS in clinical practice.A panel of Italian expert cardiologists assembled under the auspices of the Italian Society of Interventional Cardiology (SICI-GISE) for comprehensive discussion and consensus development, with the aim to provide recommendations on the use of bioresorbable stents in terms of clinical indications, procedural aspects, post-percutaneous coronary angioplasty pharmacologic treatment and follow-up. Based on current evidence and BRS availability in Italian cath-labs, the panel decided unanimously to provide specific recommendations for the Absorb BVS device. These recommendations do not necessarily extend to other BRS, unless specified, although significant overlap may exist with Absorb BVS, particularly in terms of clinical rationale.
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[ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus document: Percutaneous left atrial appendage occlusion in patients with nonvalvular atrial fibrillation: indications, patient selection, competences, organization, and operator training].
G Ital Cardiol (Rome)2016 ;17(7-8):594-613. doi: 10.1714/2330.25054.
Casu Gavino, Gulizia Michele Massimo, Molon Giulio, Mazzone Patrizio, Audo Andrea, Casolo Giancarlo, Di Lorenzo Emilio, Portoghese Michele, Pristipino Christian, Ricci Renato Pietro, Themistoclakis Sakis, Padeletti Luigi, Tondo Claudio, Berti Sergio, Oreglia Jacopo Andrea, Gerosa Gino, Zanobini Marco, Ussia Gian Paolo, Musumeci Giuseppe, Romeo Francesco, Di Bartolomeo Roberto
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at 5-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centers and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.
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The Balloon-Microcatheter technique for treatment of coronary artery perforations.
Catheter Cardiovasc Interv2017 Feb;89(2):E75-E83. doi: 10.1002/ccd.26651.
Garbo Roberto, Oreglia Jacopo A, Gasparini Gabriele L
Abstract
Coronary perforation (CP) is a rare but potentially lethal complication of percutaneous coronary intervention (PCI). Management of CP is mainly conditioned by the extension of coronary rupture and location of the perforation. Successful treatment is highly affected by the operator's familiarity with tools and dedicated techniques to achieve prompt sealing of the disruption. We describe a "Balloon-Microcatheter" technique that may allow fast, safe, and effective management of CP with a single???6 Fr guiding catheter. © 2016 Wiley Periodicals, Inc.
© 2016 Wiley Periodicals, Inc.
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Embolic myocardial infarction due to coronary artery aneurysm in a patient with Loeys-Dietz syndrome.
EuroIntervention2016 May;12(1):61. doi: 10.4244/EIJV12I1A11.
Cereda Alberto, Garascia Andrea, Sormani Paola, Klugmann Silvio, Artioli Diana, Soriano Francesco, Oreglia Jacopo Andrea
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A case of retrograde left main primary percutaneous coronary intervention during cardiogenic shock: The added value of performing coronary chronic total occlusion procedures.
Int J Cardiol2016 Jul;215():396-8. doi: 10.1016/j.ijcard.2016.03.168.
Gasparini Gabriele L, Oreglia Jacopo A, Reimers Bernhard
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[The conundrum of therapeutic management in acute myocardial infarction complicated by endoventricular thrombosis: moving between different risks].
G Ital Cardiol (Rome)2015 ;16(7-8):437-41. doi: 10.1714/1954.21248.
Varrenti Marisa, Morici Nuccia, De Chiara Benedetta, Oreglia Jacopo Andrea, Pedrotti Patrizia, Giannattasio Cristina, Klugmann Silvio, Roghi Alberto
Abstract
Coronary artery disease is a rare entity in young patients and accurate assessment of its prevalence is difficult. Although coronary artery disease is frequently a silent process, it may also acutely present with myocardial infarction (MI). One of the most feared complications of MI is left ventricular thrombus formation. Transthoracic echocardiography is recommended for all patients with MI, and cardiac magnetic resonance should be considered because of its higher sensitivity if thrombus cannot clearly be demonstrated. The optimal treatment is based on anticoagulant therapy that should be started early and maintained for 3-4 months after the index event. We report the case of a 35-year-old male patient with anterior MI, complicated by left ventricular thrombus formation, extensive edema, microvascular obstruction and hemorrhagic core of the apical septum on cardiac magnetic resonance assessment.
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[A simple but very complicated angioplasty: management of coronary artery perforation and dual antiplatelet therapy. A case report and literature review].
G Ital Cardiol (Rome)2015 May;16(5):311-5. doi: 10.1714/1870.20436.
Soriano Francesco, Oreglia Jacopo, Bossi Irene, Colombo Paola, Piccalò Giacomo, De Marco Federico, Bruschi Giuseppe, Klugmann Silvio
Abstract
Coronary artery perforation is a rare but potentially fatal complication. Therefore, it is crucial for interventional cardiologists to have knowledge of this condition and what management strategies are available, particularly in the case of procedures with a high level of complexity. Notwithstanding this, even simple procedures are not immune to serious complications, as described in this case report where coronary angioplasty was complicated by left anterior descending artery perforation with cardiac tamponade, giving rise to multiple complications of difficult management. The case presented here also provides the opportunity to investigate the optimal duration of dual antiplatelet therapy after implantation of drug-eluting stents, a topic much debated in recent years.
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[Successful double retrograde approach for recanalization of double total chronic occlusions].
G Ital Cardiol (Rome)2015 Feb;16(2):108-11. doi: 10.1714/1798.19586.
Gasparini Gabriele L, Milone Francesco, Oreglia Jacopo A, Presbitero Patrizia
Abstract
Chronic total occlusions (CTO) still remain one of the most technically challenging scenarios in which interventions are performed. Although the antegrade approach is the most common method of CTO recanalization, management of CTOs has recently been refined through the development of a retrograde approach that offers an additional possibility of success after antegrade failure. Knowledge of the different devices and techniques along with awareness of the possible complications could result in the practical implementation of these techniques with high procedural success and low complication rates. We present a case of successful percutaneous coronary intervention of double CTOs in the left anterior descending artery, which were successfully recanalized step by step using two different retrograde approaches.
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Cardiogenic shock: How to overcome a clinical dilemma. Unmet needs in Emergency medicine.
Int J Cardiol2015 ;186():19-21. doi: 10.1016/j.ijcard.2015.02.111.
Morici Nuccia, Sacco Alice, Paino Roberto, Oreglia Jacopo Andrea, Bottiroli Maurizio, Senni Michele, Nichelatti Michele, Canova Paolo, Russo Claudio, Garascia Andrea, Kulgmann Silvio, Frigerio Maria, Oliva Fabrizio
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Avoid overtreatment in the setting of chronic total occlusions: The role of blood flow restoration in positive vascular remodeling.
Int J Cardiol2015 Apr;184():414-415. doi: 10.1016/j.ijcard.2015.02.107.
Gasparini Gabriele L, Oreglia Jacopo A, Milone Francesco, Presbitero Patrizia
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Coronary chronic total occlusion: Not only a therapeutic nihilism but also a lack of requisite expertise.
Int J Cardiol2015 Feb;181():344-6. doi: 10.1016/j.ijcard.2014.12.083.
Gasparini Gabriele L, Oreglia Jacopo A, Presbitero Patrizia
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Drug-eluting balloon versus second-generation drug-eluting stent for the treatment of restenotic lesions involving coronary bifurcations.
EuroIntervention2016 Jan;11(9):989-95. doi: 10.4244/EIJY14M11_01.
Naganuma Toru, Latib Azeem, Costopoulos Charis, Oreglia Jacopo, Testa Luca, De Marco Federico, Candreva Alessandro, Chieffo Alaide, Naim Charbel, Montorfano Matteo, Bedogni Francesco, Colombo Antonio
Abstract
AIMS:
To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion.
METHODS AND RESULTS:
Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9% vs. 6.7%, p
CONCLUSIONS:
DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.
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CoreValve implantation for severe aortic regurgitation: a multicentre registry.
EuroIntervention2014 Oct;10(6):739-45. doi: 10.4244/EIJV10I6A127.
Testa Luca, Latib Azeem, Rossi Marco Luciano, De Marco Federico, De Carlo Marco, Fiorina Claudia, Oreglia Jacopo, Petronio Anna Sonia, Ettori Federica, De Servi Stefano, Klugmann Silvio, Ussia Gian Paolo, Tamburino Corrado, Panisi Paolo, Brambilla Nedy, Colombo Antonio, Presbitero Patrizia, Bedogni Francesco
Abstract
We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS). From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6%) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95% vs. 73%, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31% vs. 10%, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79% vs. 96%, p=0.006). At one month, patients treated for AR had a higher overall mortality (23% vs. 5.9%; OR 4.22 [3.03-8.28], p
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Prasugrel and ticagrelor: is there a winner?
J Cardiovasc Med (Hagerstown)2014 Jan;15(1):8-18. doi: 10.2459/JCM.0b013e328364561b.
Morici Nuccia, Colombo Paola, Mafrici Antonio, Oreglia Jacopo A, Klugmann Silvio, Savonitto Stefano
Abstract
Clopidogrel is a prodrug that undergoes extensive enteric clearance and requires two-stage hepatic activation by cytochrome P450 (CYP) enzymes. This metabolic pathway is susceptible to genetic polymorphisms, resulting in a variable platelet inhibitory effect. A growing number of studies have linked poor antiplatelet response to clopidogrel to adverse clinical outcomes, particularly coronary ischemic events and stent thrombosis. This has prompted the development of new ADP receptor antagonists that inhibit platelets more effectively. Two of these agents, prasugrel and ticagrelor, have been investigated in two large randomized clinical trials, and both have shown superiority versus clopidogrel in reducing ischemic endpoints, with an increase in bleeding events, but a favorable final net clinical outcome. Since the publication of the main articles, several sub-analyses have been performed on the same data, and Guideline recommendations have largely endorsed these subgroup findings. Most clinicians have accepted the concept that we might consider approaching the patient differently, deserving a specific agent for each different settings. However, subgroup analyses of randomized trials are often post hoc, underpowered and prone to bias. Weighing efficacy and safety of the most commonly used antiplatelet agents will represent a clinical challenge over the next few years. Furthermore, individuals and organizations involved in formulary decisions will have to face economic constraints, also taking into account the availability of low-cost generic clopidogrel. In the following review, we have performed a critical appraisal of the current literature in order to outline lights and shadows on the most relevant clinical scenarios.
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Response to letter regarding article, "Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve revalving system".
Circulation2013 Nov;128(22):e444. doi: 10.1161/CIRCULATIONAHA.113.005705.
Bedogni Francesco, Latib Azeem, De Marco Federico, Agnifili Mauro, Oreglia Jacopo, Pizzocri Samuele, Latini Roberto A, Lanotte Stefania, Petronio Anna Sonia, De Carlo Marco, Ettori Federica, Fiorina Claudia, Poli Arnaldo, Cirri Silvia, De Servi Stefano, Ramondo Angelo, Tarantini Giuseppe, Marzocchi Antonio, Fiorilli Rosario, Klugmann Silvio, Ussia Gian Paolo, Tamburino Corrado, Maisano Francesco, Brambilla Nedy, Colombo Antonio, Testa Luca
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Transcatheter aortic valve implantation in patients with severe aortic valve stenosis and large aortic annulus, using the self-expanding 31-mm Medtronic CoreValve prosthesis: first clinical experience.
J Thorac Cardiovasc Surg2014 Aug;148(2):492-9.e1. doi: 10.1016/j.jtcvs.2013.09.059.
Nijhoff Freek, Agostoni Pierfrancesco, Amrane Hafid, Latib Azeem, Testa Luca, Oreglia Jacopo A, De Marco Federico, Samim Mariam, Bedogni Francesco, Maisano Francesco, Bruschi Giuseppe, Colombo Antonio, Van Boven Ad J, Stella Pieter R
Abstract
OBJECTIVES:
With the introduction of the 31-mm Medtronic CoreValve prosthesis, patients with large aortic annulus have become eligible for transcatheter aortic valve implantation. The aim of this study was to evaluate the feasibility, efficacy, and safety of transcatheter aortic valve implantation using the 31-mm Medtronic CoreValve in patients with severe aortic valve stenosis and large aortic annulus.
METHODS:
Five institutions in the Netherlands and Italy participated in a retrospective multicenter registry. Clinical, procedural, and imaging data of patients treated with the 31-mm Medtronic CoreValve were retrospectively collected in accordance with the Valve Academic Research Consortium-2 criteria.
RESULTS:
Between August 2011 and November 2012, 47 patients (44 men, mean age 77.6 ± 8.9 years) received the 31-mm Medtronic CoreValve prosthesis for severe aortic stenosis. Device success (correct positioning of a single valve with intended performance and no all-cause 30-day mortality) was achieved in 31 patients (66.0%). Reasons for failing the device success criteria were significant prosthetic aortic regurgitation in 3 patients (6.4%), second valve implantation in 10 patients (21.2%) (8 cases of malpositioning with high-grade aortic regurgitation, 1 acute valve dislocation, and 1 delayed valve dislocation), 1 of whom died intrahospital, and in-hospital mortality in a further 3 patients (6.4%). Peak and mean transaortic gradients decreased significantly (P
CONCLUSIONS:
In this retrospective multicenter registry, transcatheter treatment of severe aortic valve stenosis with the 31-mm Medtronic CoreValve seemed to be challenging, even in experienced hands. If the prosthesis is properly implanted, it offers adequate valve hemodynamics and proper functioning.
Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: a multicenter registry.
Circulation2013 Nov;128(19):2145-53. doi: 10.1161/CIRCULATIONAHA.113.001822.
Bedogni Francesco, Latib Azeem, De Marco Federico, Agnifili Mauro, Oreglia Jacopo, Pizzocri Samuele, Latini Roberto A, Lanotte Stefania, Petronio Anna Sonia, De Carlo Marco, Ettori Federica, Fiorina Claudia, Poli Arnaldo, Cirri Silvia, De Servi Stefano, Ramondo Angelo, Tarantini Giuseppe, Marzocchi Antonio, Fiorilli Rosario, Klugmann Silvio, Ussia Gian Paolo, Tamburino Corrado, Maisano Francesco, Brambilla Nedy, Colombo Antonio, Testa Luca
Abstract
BACKGROUND:
Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR.
METHODS AND RESULTS:
Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P
CONCLUSIONS:
Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
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Selection of Medications to Prevent Stroke Among Individuals With Atrial Fibrillation : Update on Prevention of Stroke in Patients with AF.
Curr Treat Options Neurol2013 Oct;15(5):583-92. doi: 10.1007/s11940-013-0248-3.
Testa Luca, Fasano Alfonso, De Sanctis Valerio, Latini Roberto Adriano, Latib Azeem, Oreglia Jacopo, De Marco Federico, Agnifili Mauro, Casavecchia Matteo, Talarico Giovanni Paolo, Lanotte Stefania, Pizzocri Samuele, Mattioli Roberto, Mantica Massimo, Bedogni Francesco
Abstract
Vitamin K antagonists have been the only available orally active anticoagulants for decades. Although effective, their numerous limitations have driven the introduction of new oral anticoagulants (NOAs) that showed effectiveness at fixed doses without the need for routine coagulation monitoring. However, the safety and efficacy observed in controlled clinical trials may be hard to translate in clinical practice. Clinical conditions as well as drug interactions may considerably impact on patient outcomes. Moreover, the inability to monitor the pharmacological activity of NOAs and the absence of any antidote in the setting of bleeding or emergent invasive procedures may limit their use. Vitamin K antagonists will be still used in many circumstances, including patients with an optimal control of the INR, with mechanical heart valves, and other indications for which these new agents have not been investigated. Nevertheless, these new agents will reduce the burden of anticoagulation management at the patient as well as Health Care level.
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Time from adenosine di-phosphate receptor antagonist discontinuation to coronary bypass surgery in patients with acute coronary syndrome: meta-analysis and meta-regression.
Int J Cardiol2013 Oct;168(3):1955-64. doi: 10.1016/j.ijcard.2012.12.087.
Morici Nuccia, Moja Lorenzo, Rosato Valentina, Oreglia Jacopo Andrea, Sacco Alice, De Marco Federico, Bruschi Giuseppe, Klugmann Silvio, La Vecchia Carlo, Savonitto Stefano
Abstract
BACKGROUND:
Adenosine di-phosphate receptor antagonists (ADPRAs) blunt hemostasis for several days after administration. This effect, aimed at preventing cardiac ischemic complications particularly in patients with acute coronary syndromes (ACS), may increase perioperative bleeding in the case of cardiac surgery. Practice Guidelines recommend withholding ADPRAs for at least 5days prior to surgery, though with a weak base of evidence. The purpose of this study was to systematically review observational and experimental studies of early or late preoperative discontinuation of ADPRAs prior to coronary artery bypass grafting (CABG) for patients with ACS.
METHODS:
MEDLINE, EMBASE, the Cochrane Library databases up to December 2011; and reference lists. Observational and experimental studies that compared early ADPRA discontinuation with late discontinuation, or no discontinuation, in patients with ACS undergoing CABG.
RESULTS:
There were 19 studies, including 14,046 participants, 395 deaths and 309 reoperations due to bleeding. ADPRA late discontinuation up to CABG was associated with an increased risk of postoperative mortality (OR 1.46, 95% confidence interval (CI) 1.10 to 1.93) and reoperations due to bleeding (OR 2.18; 95% CI 1.47 to 2.62). Between-study heterogeneity was low. Meta-analysis limited to high quality or prospective studies gave consistent results. In most instances, the 95% prediction intervals for summary risk estimates confirmed the risk across study groups.
CONCLUSIONS:
ADPRA late discontinuation prior to CABG is associated with an increased risk of death and reoperations due to bleeding in patients with ACS. The confidence in the estimates of risk for late discontinuation is moderate to high.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Direct aortic access for transcatheter self-expanding aortic bioprosthetic valves implantation.
Ann Thorac Surg2012 Aug;94(2):497-503. doi: 10.1016/j.athoracsur.2012.04.021.
Bruschi Giuseppe, de Marco Federico, Botta Luca, Cannata Aldo, Oreglia Jacopo, Colombo Paola, Barosi Alberto, Colombo Tiziano, Nonini Sandra, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
BACKGROUND:
Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for operation; however, these patients are also often affected by severe iliac-femoral arteriopathy that prohibits the transfemoral approach.
METHODS:
From May 2008 to January 2012, 400 patients were evaluated for TAVI at our center; of these, 141 patients (64 men; mean age 81.3±8 years) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were eligible for CoreValve (137 patients; Medtronic Inc, MN) or Sapien (Edwards Lifesciences, CA) implantation. Twenty-five patients (all affected by severe peripheral vasculopathy, including five re-do procedures), with a mean The Society of Thoracic Surgeons mortality score 11%±6%, underwent CoreValve implantation directly from the ascending aorta through a right anterior minithoracotomy. This case series was reviewed to evaluate the clinical outcomes of these patients. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
RESULTS:
In all patients after valve deployment, the mean aortic gradient immediately dropped to 5 mm Hg or less, and the angiographic grade aortic insufficiency was 1 or less in 22 patients. One patient was converted to the transfemoral approach due to an extremely fragile aortic wall, but the patient died of abdominal aorta aneurysm rupture on postoperative day 1. Procedural success was obtained in the remaining 24 patients. A left ventricle tear in 1 patient was successfully surgically treated. Four patients required a permanent pacemaker implantation. Thirty-day mortality was 8% (2 patients). All discharged patients improved their New York Heart Association functional class and functional capacity, and echocardiograms demonstrated good valve performance up to 2 years (mean valve gradient, 9 mm Hg). During follow-up, 1 patient died of cachexia and another of bone marrow aplasia.
CONCLUSIONS:
TAVI with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure, and has emerged as a valuable alternative route to transapical access.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Direct transatrial transcatheter SAPIEN valve implantation through right minithoracotomy in a degenerated mitral bioprosthetic valve.
Ann Thorac Surg2012 May;93(5):1708-10. doi: 10.1016/j.athoracsur.2011.08.084.
Bruschi Giuseppe, Barosi Alberto, Colombo Paola, Botta Luca, Oreglia Jacopo, De Marco Federico, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
Transcatheter valve implantation into failing surgical mitral bioprosthetic valves have been reported. This strategy avoids performing high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. All these patients have been treated by a transapical approach. We report a case of failing bioprosthetic mitral valve in an 82-year-old woman successfully treated with a 29-mm Edwards SAPIEN balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA) with direct left atrial approach through a right anterior thoracotomy. Our experience demonstrates the technical feasibility and safety of this approach. Therefore, mitral valve-in-surgical valve implantation may be a viable treatment alternative in carefully selected patients.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Percutaneous iatrogenic coronary fistula closure in heart transplant recipient.
Asian Cardiovasc Thorac Ann2012 Apr;20(2):188-90. doi: 10.1177/0218492311421456.
Bruschi Giuseppe, Oreglia Jacopo, Colombo Paola, De Marco Federico, Frigerio Maria, Martinelli Luigi, Klugmann Silvio
Abstract
A 61-year-old man with ischemic cardiomyopathy underwent orthotopic heart transplantation. On routine coronary angiography 1 year later, a huge fistula was seen between the left anterior descending coronary artery and the right ventricle. When the patient developed symptoms of ischemia 8 years later, the fistula was successfully closed percutaneously, using a covered stent.
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Direct transaortic CoreValve implantation through right minithoracotomy in patients with patent coronary grafts.
Ann Thorac Surg2012 Apr;93(4):1297-9. doi: 10.1016/j.athoracsur.2011.08.020.
Bruschi Giuseppe, De Marco Federico, Botta Luca, Oreglia Jacopo, Colombo Paola, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
Transcatheter aortic valve implantation has rapidly gained credibility as a valuable alternative to conventional aortic valve replacement in patients with severe aortic stenosis, who are otherwise left untreated owing to the perceived high risk of operative mortality. However, these patients are often also affected by severe iliofemoral arteriopathy, rendering the transfemoral approach unfeasible. Different alternative access routes have been used in these patients, such the transapical and the subclavian routes. We report our experience of direct aortic access through a right anterior minithoractomy to implant a self-expanding aortic valve bioprosthesis in two patients who had previously undergone coronary artery bypass graft surgery.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation.
Am Heart J2012 Mar;163(3):492-9. doi: 10.1016/j.ahj.2011.12.009.
De Carlo Marco, Giannini Cristina, Bedogni Francesco, Klugmann Silvio, Brambilla Nedy, De Marco Federico, Zucchelli Giulio, Testa Luca, Oreglia Jacopo, Petronio Anna Sonia
Abstract
BACKGROUND:
Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors.
METHODS:
We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing.
RESULTS:
Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction
CONCLUSION:
A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.
Copyright © 2012 Mosby, Inc. All rights reserved.
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How to remove the CoreValve aortic bioprosthesis in a case of surgical aortic valve replacement.
Ann Thorac Surg2012 Jan;93(1):329-30. doi: 10.1016/j.athoracsur.2011.07.059.
Bruschi Giuseppe, Oreglia Jacopo, De Marco Federico, Colombo Paola, Mondino Michele, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
Transcatheter aortic valve implantation has been introduced as a treatment modality applied to high-risk surgery patients with severe symptomatic aortic stenosis, and it has been demonstrated to be an efficient and safe treatment option. Litzler and colleagues reported a case of a bailout of a transcatheter aortic valve implantation because of severe paravalvular leaks, using a 23-mm Edwards-SAPIEN Valve (Edwards Lifesciences, Irvine, CA), with conversion to conventional surgical aortic valve replacement. The authors reported an easy valve removal despite the impaction of the stent in the cusps of the native valve. Thyregod and colleagues reported a surgical valve replacement in a patient with a dysfunctional CoreValve self-expanding aortic valve bioprosthesis 4 months after implantation.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Transcatheter self-expandable aortic valve implantation after undersized mitral annuloplasty.
Ann Thorac Surg2011 Nov;92(5):1881-3. doi: 10.1016/j.athoracsur.2011.04.045.
Bruschi Giuseppe, De Marco Federico, Oreglia Jacopo, Colombo Paola, Barosi Alberto, Einaudi Arturo, Paino Roberto, Martinelli Luigi, Klugmann Silvio
Abstract
No data are available in the literature regarding the effectiveness and safety of transcatheter aortic valve implantation in patients who underwent previous mitral valve ring repair. Concerns exist related to the possible interference between the percutaneous aortic valve and the mitral annuloplasty ring. We report our experience with percutaneous aortic self-expandable valve implantation in a 76-year-old woman affected by severe aortic stenosis, previously operated on for "undersized" mitral annuloplasty repair of severe functional mitral regurgitation in dilated cardiomyopathy. No deformation of the nitinol tubing of the CoreValve device (CoreValve, Inc, Irvine, CA), neither distortion nor malfunction nor change of the conformation of the mitral ring occurred. No change in mitral function and regurgitation was evident at echocardiography monitoring, which was performed during the implant.
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Influence of CoreValve ReValving System implantation on mitral valve function: an echocardiographic study in selected patients.
Catheter Cardiovasc Interv2011 Oct;78(4):638-44. doi: 10.1002/ccd.23045.
De Chiara Benedetta, Moreo Antonella, De Marco Federico, Musca Francesco, Oreglia Jacopo, Lobiati Elisabetta, Bruschi Giuseppe, Belli Oriana, Mauri Francesco, Klugmann Silvio
Abstract
OBJECTIVES:
The purpose of this study is to verify whether transcatheter aortic valve implantation (TAVI) determined changes in mitral valve (MV) function, in terms of mitral regurgitation (MR) and stenosis.
BACKGROUND:
Little data is available regarding the effects of TAVI on global MV function, often derived from analysis primarily focused on clinical and aortic related outcomes.
METHODS:
From May 2008 to March 2010, 73 patients with severe symptomatic aortic stenosis underwent TAVI with the CoreValve ReValving System. The study population consisted of 58 patients (27 males, mean age 82 ± 7 years) who underwent transthoracic echocardiography at least ?1 month after implantation (mean follow-up 7.8 ± 5.4 months).
RESULTS:
In patients with a left ventricular dysfunction (ejection fraction, EF,
CONCLUSIONS:
In the majority of patients no significant changes occurred in the degree of MR in native valve, but we found that if the aortic valve was deeply implanted in the left ventricle outflow tract, a worsening in MR can be observed. A mitral stenosis development must be sought in patients with heavy calcifications of the anterior leaflet.
Copyright © 2011 Wiley-Liss, Inc.
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Alternative approaches for trans-catheter self-expanding aortic bioprosthetic valves implantation: single-center experience.
Eur J Cardiothorac Surg2011 Jun;39(6):e151-8. doi: 10.1016/j.ejcts.2011.01.014.
Bruschi Giuseppe, De Marco Federico, Fratto Pasquale, Oreglia Jacopo, Colombo Paola, Botta Luca, Klugmann Silvio, Martinelli Luigi
Abstract
OBJECTIVE:
Trans-catheter aortic valve implantation has emerged and rapidly gained credibility as a valuable alternative to treat patients with severe aortic stenosis and no surgical option; however, these patients are often affected also by severe iliac-femoral arteriopathy, rendering the transfemoral approach unemployable. From May 2008, 92 patients with severe, symptomatic aortic stenosis and no reasonable surgical option because of excessive risk underwent trans-catheter aortic valve implantation at our center. Eighty patients (34 male) with mean age 82 ± 8 years were eligible for CoreValve percutaneous femoral implantation. Twelve patients, mean age 81 ± 8 years, were excluded from percutaneous femoral CoreValve implantation because of iliac-femoral arteriopathy.
METHODS:
These 12 patients underwent trans-catheter aortic valve implantation through the left axillary artery in six cases, the other six directly from the ascending aorta through a right anterior mini-thoracotomy. Procedures were performed by a combined team of cardiologists, cardiac surgeons, and anesthetists.
RESULTS:
Procedural success was obtained in 11 cases; all these patients were discharged in asymptomatic status, with midterm good prosthesis performance. Three patients required the implantation of a permanent pacemaker. One patient needed a subclavian covered stent implantation to treat a post-implant artery dissection. One patient of the direct aortic access group was converted to the femoral approach due to an extremely fragile aortic wall, but died in the intensive care unit of abdominal aortic aneurysm rupture. All discharged patients improved their New York Heart Association (NYHA) functional class and functional capacity, and echocardiograms evidenced good valve performance at 2 years.
CONCLUSIONS:
Trans-catheter aortic valve implantation with surgical subclavian or direct aortic approach seems safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, and has emerged as a valuable alternative route to trans-apical procedures.
Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Transcatheter aortic valve implantation after heart transplantation.
Ann Thorac Surg2010 Nov;90(5):e66-8. doi: 10.1016/j.athoracsur.2010.08.021.
Bruschi Giuseppe, De Marco Federico, Oreglia Jacopo, Colombo Paola, Moreo Antonella, De Chiara Benedetta, Paino Roberto, Frigerio Maria, Martinelli Luigi, Klugmann Silvio
Abstract
Conventional cardiac surgical procedures after orthotopic heart transplantation are generally uncommon. We report the case of a 67-year-old man who had severe symptomatic aortic stenosis develop 9 years after heart transplantation. After joint evaluation of the cardiovascular team, transcatheter aortic valve implantation was preferred due to patient medical conditions. The CoreValve prosthesis (Medtronic, Minneapolis, MN) was inserted percutaneously into the femoral artery. At 4 months postoperatively, the patient is asymptomatic in New York Heart Association functional class II. This case report provides evidence that transcatheter aortic valve implantation is safe and suitable for selected patients with severe aortic stenosis and a history of heart transplantation that must improve allograft function.
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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The trans-subclavian retrograde approach for transcatheter aortic valve replacement: single-center experience.
J Thorac Cardiovasc Surg2010 Oct;140(4):911-5, 915.e1-2. doi: 10.1016/j.jtcvs.2010.01.027.
Bruschi Giuseppe, Fratto Pasquale, De Marco Federico, Oreglia Jacopo, Colombo Paola, Botta Luca, Cannata Aldo, Moreo Antonella, De Chiara Benedetta, Lullo Francesca, Paino Roberto, Martinelli Luigi, Klugmann Silvio
Abstract
OBJECTIVE:
Aortic valve disease is the most common acquired valvular heart disease in adults. With the increasing elderly population, the proportion of patients with symptomatic aortic stenosis who are unsuitable for conventional surgery is increasing. Transcatheter aortic valve implantation has rapidly gained credibility as a valuable alternative to surgery to treat these patients; however, they often have severe iliac-femoral arteriopathy, which renders the transfemoral approach unusable. We report our experience with the trans-subclavian approach for transcatheter aortic valve implantation using the CoreValve (Medtronic CV Luxembourg S.a.r.l.) in 6 patients.
METHODS:
In May 2008 to September 2009, 6 patients (mean age of 82 ± 5 years), with symptomatic aortic stenosis and no reasonable surgical option because of excessive risk, were excluded from percutaneous femoral CoreValve implantation because of iliac-femoral arteriopathy. These patients underwent transcatheter aortic valve implantation via the axillary artery. Procedures were performed by a combined team of cardiologists, cardiac surgeons, and anesthetists in the catheterization laboratory. The CoreValve 18F delivery system was introduced via the left subclavian artery in 6 patients, 1 with a patent left internal thoracic to left anterior descending artery graft.
RESULTS:
Procedural success was obtained in all patients, and the mean aortic gradient decreased 5 mm Hg or less immediately after valve deployment. One patient required implantation of a permanent pacemaker. One patient required a subclavian covered stent implantation to treat a postimplant artery dissection associated with difficult surgical hemostasis. One patient was discharged in good condition but died of pneumonia 40 days after the procedure. All patients were asymptomatic on discharge, with good mid-term prosthesis performance.
CONCLUSIONS:
Transcatheter aortic valve implantation via a surgical subclavian approach seems safe and feasible, offering a new option to treat select, inoperable, and high-risk patients with severe aortic stenosis and peripheral vasculopathy.
Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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Percutaneous treatment of iatrogenic left-anterior descending artery to right ventricle fistula.
Catheter Cardiovasc Interv2010 Dec;76(7):975-7. doi: 10.1002/ccd.22551.
Oreglia Jacopo A, Bruschi Giuseppe, Klugmann Silvio
Abstract
Iatrogenic coronary fistula is a rare condition whose treatment strategy is not well established. We report the case of a 70-year-old patient who came to our attention with echocardiographic and scintigraphic signs of myocardial ischemia and who had undergone heart transplantation 10 years earlier. The coronary angiogram showed a coronary fistula connecting the left-anterior descending artery to the right ventricle via an enlarged septal branch. Because of the presence of myocardial ischemia, the patient was scheduled for percutaneous coronary intervention. The fistula was sealed with implant of two polytetrafluoroethylene (PTFE)-covered stents that excluded the septal branch. One-year follow-up showed persistence of the good result in terms of angiographic and clinical outcome.
Copyright © 2010 Wiley-Liss, Inc.
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Direct aortic access through right minithoracotomy for implantation of self-expanding aortic bioprosthetic valves.
J Thorac Cardiovasc Surg2010 Sep;140(3):715-7. doi: 10.1016/j.jtcvs.2010.02.030.
Bruschi Giuseppe, De Marco Federico, Fratto Pasquale, Oreglia Jacopo, Colombo Paola, Paino Roberto, Klugmann Silvio, Martinelli Luigi
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Percutaneous implantation of CoreValve aortic prostheses in patients with a mechanical mitral valve.
Ann Thorac Surg2009 Nov;88(5):e50-2. doi: 10.1016/j.athoracsur.2009.07.028.
Bruschi Giuseppe, De Marco Federico, Oreglia Jacopo, Colombo Paola, Fratto Pasquale, Lullo Francesca, Paino Roberto, Frigerio Maria, Martinelli Luigi, Klugmann Silvio
Abstract
Concerns exist in the field of transcatheter aortic valve implantation regarding the treatment of patients with mechanical mitral valve for possible interference between the percutaneous aortic valve and the mechanical mitral prosthesis. We report our experience with percutaneous aortic valve implantation in 4 patients with severe aortic stenosis, previously operated on for mitral valve replacement with a mechanical prosthesis. All patients underwent uneventful percutaneous retrograde CoreValve implantation (CoreValve Inc, Irvine, CA). No deformation of the nitinol tubing of the prostheses (ie, neither distortion nor malfunction of the mechanical valve in the mitral position) occurred in any of the patients. All patients are alive and asymptomatic at a mean follow-up of 171 days.
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Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated aortic bioprosthesis.
J Cardiovasc Med (Hagerstown)2010 Mar;11(3):182-5. doi: 10.2459/JCM.0b013e32832ffcb4.
Bruschi Giuseppe, DeMarco Federico, Oreglia Jacopo, Colombo Paola, Fratto Pasquale, Lullo Francesca, Paino Roberto, Martinelli Luigi, Klugmann Silvio
Abstract
In recent years percutaneous aortic valve implantation has emerged as an alternative therapy to treat patients with symptomatic aortic stenosis considered to be high-risk surgical candidates. We report our experience of a percutaneous retrograde CoreValve implantation in a 77-year-old female with aortic bioprosthesis structural degeneration. The patient underwent aortic valve replacement for aortic stenosis in 1999 with the implantation of a 23 mm Carpentier-Edwards; her last echocardiography showed a severe bioprosthesis stenosis. After evaluation by cardiac surgeons and cardiologist, considering the high risk re-do surgical procedure (Logistic Euroscore 30%) and severe comorbidities (severe pulmonary hypertension, hepatocellular carcinoma and severe osteoporosis), a percutaneous aortic valve-in-valve replacement was preferred. A successful percutaneous 26 mm CoreValve prosthesis implantation was performed with the patient awake with local anesthesia and mild sedation. The patient was discharged after 10 days of hospitalization and she is in NYHA functional class I at follow-up. Our experience, characterized by a multidisciplinary approach, necessary to offer the safest conditions and care for patients, demonstrates the feasibility of a new, promising indication for the use of a transcatheter valve implantation: percutaneous treatment of a degenerated aortic bioprosthesis.
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Impact of atherosclerotic disease progression on mid-term clinical outcome in diabetic patients in the drug-eluting stent era.
EuroIntervention2009 Mar;4(5):588-92.
Tousek Petr, Pavei Andrea, Oreglia Jacopo, Martin Guillaume, Sharif Faisal, Fajadet Jean, Farah Bruno
Abstract
AIMS:
To determine whether repeat revascularisation (RR) in diabetic patients treated with prior drug-eluting stents (DES) is the result of either DES restenosis or native progression of atherosclerotic disease in the coronary vasculature, and to evaluate the impact of atherosclerotic disease progression on the midterm clinical outcome.
METHODS AND RESULTS:
We followed 316 consecutive diabetic patients (227 men, age 69 +/- 9 years) treated between June 2005 and September 2006 with at least one DES. During the follow-up (mean 590 +/- 194 days) the cumulative incidence of major adverse clinical events (MACE; death, non-fatal myocardial infarction [MI] and target vessel revascularisation [TVR]) was 17.1%. Thirty-eight patients underwent RR (37 PCI, 1 coronary artery bypass graft [CABG]). In 22 patients RR was performed for restenosis (18 after DES implantation and 4 after BMS implantation); four of these patients also required treatment for atherosclerotic disease progression (ADP). In 16 patients, PCI was performed for symptomatic ADP without restenosis. Thus ADP contributed to 53% of RR procedures and to 42% of TVR. Furthermore, in 6 of 10 patients (60%) admitted for MI, the culprit lesion was the result of ADP. Only history of PCI and PCI of the left main before the index procedure were found to be independent predictors for development of significant de novo lesion at follow-up (OR 4.1, 95% CI 1.6-10.4, p = 0.002 and OR 4.7, 95% CI 0.003, p = 0.003). No traditional risk factors were found to be predictors.
CONCLUSIONS:
Atherosclerotic disease progression was the cause of repeat revascularisation in more than 50% of diabetic patients treated previously with DES and had an important impact on their mid-term clinical outcome. MACE rates in clinical trials with long-term follow-up of diabetic patients can thus be influenced by native disease progression rather than DES failure and therefore should be interpreted with caution when addressing comparison of DES efficacy in diabetic patients.
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Long-term follow-up of percutaneous coronary intervention of unprotected left main lesions with drug eluting stents: predictors of clinical outcome.
EuroIntervention2009 Jan;4(4):457-63.
Pavei Andrea, Oreglia Jacopo A, Martin Guillaume, Tousek Petr, Sharif Faisal, Farah Bruno, Sauguet Antoine, Fajadet Jean
Abstract
AIMS:
To evaluate the long-term follow-up of drug-eluting stents (DES) in the treatment of unprotected left main coronary artery (ULMCA).
METHODS AND RESULTS:
One hundred and forty-eight patients (mean age 71 +/- 10 years) with ULMCA stenoses underwent percutaneous coronary intervention (PCI) with DES. Mean ejection fraction (EF) was 63 +/- 13% and distal ULMCA was involved in 63.5% of cases. In-hospital outcome showed one intra-procedural death, no stent thrombosis and 2% non Q-wave myocardial infarction (MI). Clinical follow-up was available in all patients (874 +/- 382 days): 10.1% of them had died, 8.8% had target lesion revascularisation (TLR) and 4.1% experienced MI. Major adverse cardiac events (MACE) occurred in 20.3%. Mortality predictors were EF or = 6 (OR 3.9, 95%-CI 1.1-14.1, p = 0.037). TLR predictors were distal lesion (OR 8.5, 95%-CI 1.1-15, p = 0.041) and age
CONCLUSIONS:
ULMCA stenting with DES is safe, with favourable in-hospital outcome. Long-term results are acceptable with a mortality rate of 10%, a TLR rate of 9%, and a MACE rate of 20%. Low EF and high EuroSCORE predict mortality, while younger age and distal lesions predict TLR. Low EF also predicts MACE.
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Direct stenting after thrombus removal before primary angioplasty in acute myocardial infarction.
J Interv Cardiol2008 Aug;21(4):300-6. doi: 10.1111/j.1540-8183.2008.00371.x.
Silva-Orrego Pedro, Bigi Riccardo, Colombo Paola, De Marco Federico, Oreglia Jacopo Andrea, Klugmann Silvio, Gregori Dario
Abstract
OBJECTIVES:
To verify whether direct stenting (DS) after thrombus removal during primary angioplasty (PPCI) in patients with ST-elevation acute myocardial infarction (STEMI) can improve myocardial reperfusion and prevent distal embolization compared to conventional stent implantation.
BACKGROUND:
Both mechanical removal and DS reduce thrombus dislodgment and improve microcirculatory reperfusion during PPCI. However, the additional effect of DS after thrombus removal has not been definitely assessed.
METHODS:
The DEAR-MI study included 148 consecutive STEMI patients who were randomly assigned to undergo or not thrombus aspiration before PPCI. For the purpose of the present study, we interrogated the DEAR-MI data bank to compare the occurrence of complete (>70%) ST-segment resolution (STR), myocardial blush grade (MBG)-3, no-reflow, and angiographic embolization in patients treated and untreated with DS.
RESULTS:
Clinical and angiographic characteristics were similar in the two groups. Comparing DS and no-DS groups, complete STR was found in 67% versus 51% (P = 0.08), MBG-3 in 86% versus 49% (P
CONCLUSIONS:
DS during PPCI reduces distal embolization and improves myocardial reperfusion. This effect is significantly more relevant after thrombus aspiration.
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Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study.
J Am Coll Cardiol2006 Oct;48(8):1552-9.
Silva-Orrego Pedro, Colombo Paola, Bigi Riccardo, Gregori Dario, Delgado Anabella, Salvade Paolo, Oreglia Jacopo, Orrico Paola, de Biase Anna, Piccalò Giacomo, Bossi Irene, Klugmann Silvio
Abstract
OBJECTIVES:
This study sought to test the hypothesis that thrombus removal, with a new manual thrombus-aspirating device, before primary percutaneous coronary intervention (PPCI) may improve myocardial reperfusion compared with standard PPCI in patients with ST-segment elevation acute myocardial infarction (STEMI).
BACKGROUND:
In STEMI patients, PPCI may cause thrombus dislodgment and impaired microcirculatory reperfusion. Controversial results have been reported with different systems of distal protection or thrombus removal.
METHODS:
One-hundred forty-eight consecutive STEMI patients, admitted within 12 h of symptom onset and scheduled for PPCI, were randomly assigned to PPCI (group 1) or manual thrombus aspiration before standard PPCI (group 2). Patients with cardiogenic shock, previous infarction, or thrombolytic therapy were excluded. Primary end points were complete (>70%) ST-segment resolution (STR) and myocardial blush grade (MBG) 3.
RESULTS:
Baseline clinical and angiographic characteristics were similar in the 2 groups. Comparing groups 1 and 2: complete STR 50% versus 68% (p
CONCLUSIONS:
Manual thrombus aspiration before PPCI leads to better myocardial reperfusion and is associated with lower creatine kinase mass band fraction release, lower risk of distal embolization, and no reflow compared with standard PPCI. (Thrombus Aspiration Before Standard Primary Angioplasty Improves Myocardial Reperfusion in Acute Myocardial Infarction; http://clinicaltrials.gov/ct/show/NCT00257153).
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Exercise response after rapid intravenous infusion of saline in healthy humans.
J Appl Physiol (1985)2004 Aug;97(2):697-703.
Robertson H Thomas, Pellegrino Riccardo, Pini Daniela, Oreglia Jacopo, DeVita Stefano, Brusasco Vito, Agostoni PierGiuseppe
Abstract
Patients with chronic heart failure have an abnormal pattern of exercise ventilation (Ve), characterized by small tidal volumes (Vt), increased alveolar ventilation, and elevated physiological dead space (Vd/Vt). To investigate whether increased lung water in isolation could reproduce this pattern of exercise ventilation, 30 ml/kg of saline were rapidly infused into nine normal subjects, immediately before a symptom-limited incremental exercise test. Saline infusion significantly reduced forced vital capacity, 1-s forced expiratory volume, and alveolar volume (P
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[Alveolar-capillary dysfunction in heart failure].
Ital Heart J Suppl2002 Oct;3(10):1022-6.
De Vita Stefano, Guazzi Marco, Oreglia Jacopo, Guazzi Maurizio D
Abstract
Heart failure increases the resistance to gas transfer across the alveolar-capillary interface. In different experimental conditions of vascular capillary injury, peculiar anatomical and functional abnormalities of the alveolar unit have been reported and consist of a disruption of its anatomical configuration and of a loss of fluid-flux regulation and gas exchange efficiency (i.e. "stress failure" of the alveolar-capillary membrane). In heart failure, the pathophysiological relevance of these changes has been only recently appreciated. Alveolar-capillary membrane conductance and capillary blood volume are subcomponents of lung diffusion capacity. A reduction of the former with an increase of the latter and consequent impairment of gas exchange are typical of heart failure syndrome. Alveolar-capillary membrane conductance abnormalities have been shown to be a sensitive index of the underlying lung tissue damage, bring an independent prognostic information and play a significant role in the pathogenesis of exercise limitation and ventilatory abnormalities. This review examines the current knowledge on this topic.
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