Search

Objectives: To evaluate the safety and the feasibility of balloon aortic valvuloplasty (BAV) procedure made by trained operators in centers not performing transcatheter aortic valve implantation (TAVI)., Background: BAV is a valuable therapeutic tool for patients with symptomatic severe aortic valve stenosis (AS) at prohibitive risk for TAVI or surgery., Methods: Consecutive high-risk AS patients underwent BAV in five non-TAVI centers, where BAV operators had completed a 6-month training period in high-volume TAVI centers (Group A). All clinical, echocardiographic, and procedural data were prospectively collected and compared with data of patients treated in TAVI center (Group B)., Results: Between June 2016 and June 2017, 55 patients (83.9 ± 7.0 years) were enrolled: 25 in Group A and 30 in Group B. After BAV, a substantial reduction of the peak-to-peak aortic valve gradient was obtained in both groups (-35.3 ± 15.2 vs -28.8 ± 13.9 mmHg, P =0.25). No major bleeding or vascular complications occurred. In-hospital death was observed in three patients of Group A and two patients of Group B (P =0.493). The mean follow-up time was 303 ± 188 days; no patients were lost. The 1-year survival free from overall death (Group A 75.8% vs Group B 68.8%; P =0.682) and heart failure rehospitalization (Group A 73.0% vs Group B 66.8%; P =0.687) was similar in the two groups. At multivariable analysis, low left ventricular (LV) ejection fraction (HR: 0.943; P = 0.011) and cardiogenic shock (HR: 5.128; P = 0.002) at admission were independent predictors of mortality., Conclusions: BAV is a safe and effective procedure that can be performed by trained operators in centers not performing TAVI., (© 2018 Wiley Periodicals, Inc.)

Objective: To report, for the first time, angiographic and ECG results as well as in-hospital and 1-month clinical follow-up, after MGuard net protective stent (Inspire-MD, Tel-Aviv, Israel-MGS) implantation in consecutive, not randomized, STEMI patients undergoing primary or rescue PCI., Background: Distal embolization may decrease coronary and myocardial reperfusion after percutaneous coronary intervention (PCI), in ST-elevation myocardial infarction (STEMI) setting., Methods: One-hundred consecutive patients underwent PCI, with MGS deployment for STEMI, in five different high-volume PCI centres. Sixteen patients presented cardiogenic shock at admission., Results: All patients underwent successful procedures: mean TIMI flow grade and mean corrected TIMI frame count-cTFC(n)-improved from baseline values to 2.85 +/- 0.40 and to 17.20 +/- 10.51, respectively, with a mean difference in cTFC(n) between baseline and postprocedure of 46.88 +/- 31.86. High-myocardial blush grade (90% MBG 3; 10% MBG 2) was also achieved in all patients. Sixty minutes post-PCI, a high rate (90%) of complete (>or=70%) ST-segment resolution was achieved. At in-hospital follow-up, seven deaths occurred: noteworthy, 5 of 16 patients with cardiogenic shock at admission died. After hospital discharge, no Major Adverse Cardiac Events have been reported up to 30-day follow-up., Conclusions: MGS might represent a safe and feasible option for PCI in STEMI patients, providing high perfusional and ECG improvement. Further randomized trials comparing this strategy with the conventional one are needed in the near future to assess the impact on clinical practice of this strategy., ((c) 2009 Wiley-Liss, Inc.)

Background: Regurgitant orifice area (ROA) has been proposed as a marker of severity in patients with mitral regurgitation (MR). However, such fundamental quantitative echocardiographic parameter has failed to achieve widespread use, since it is difficult to measure. In the present study, we evaluated the accuracy and feasibility of a simplified method for quantification of ROA in patients with varying grades of MR., Methods: We studied two groups of individuals with echocardiographically diagnosed MR. Group I included 70 patients retrospectively evaluated, in whom we were able to obtain an adequate flow convergence region by color Doppler and recording of continuous-wave Doppler regurgitant jet. Group II included 32 MR patients prospectively evaluated. The degee of MR was assessed by two quantitative echocardiographic measures: the regurgitant fraction and the ROA, calculated either dividing peak flow rate by the maximal velocity through the orifice or with the simplified formula: r2/2., Results: In group I, the mechanism of MR was organic in 18 patients and ischemic/functional in 52 patients. ROA calculated by the simplified formula correlated well with the conventional one (r = 0.85) and with the regurgitant fraction (r = 0.72). In group II, we could calculate the ROA by the conventional method in 56% of patients, whereas use of the simplified approach allowed ROA evaluation in 78% of patients., Conclusion: Our data suggest that the use of a simplified formula may increase the number of patients having ROA, a fundamental parameter of MR severity, measured in clinical practice.