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3 results on '"Fernando L. M. Bernardi"'

1. Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self‐Expanding Valves During Transcatheter Aortic Valve Replacement

Author

Fernando L. M. Bernardi, Josep Rodés‐Cabau, Gabriela Tirado‐Conte, Ignacio J. Amat Santos, Claudia Plachtzik, Fernando Cura, Matias Sztejfman, Fernanda M. Mangione, Rogério Tumeleiro, Vinicius Borges Cardozo Esteves, Eduardo França Pessoa de Melo, Alejandro Alcocer Chauvet, Felipe Fuchs, Rogerio Sarmento‐Leite, Estêvão Carvalho de Campos Martins, Luis Nombela‐Franco, José Raul Delgado‐Arana, Wolfgang Bocksch, Pablo Lamelas, Carlos Giuliani, Diego Carter Campanha‐Borges, Jose A. Mangione, Fábio Sandoli de Brito, Alexandre C. Abizaid, and Henrique B. Ribeiro

Subjects
aortic valve stenosis, resheathing, self‐expanding valve, transcatheter aortic valve replacement, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self‐expanding valves. Methods and Results This study included a real‐world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1‐year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P

Published
2021
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2. Valve-in-Valve Challenges: How to Avoid Coronary Obstruction

Author

Fernando L. M. Bernardi, Danny Dvir, Josep Rodes-Cabau, and Henrique B. Ribeiro

Subjects
valve-in-valve, transcatheter aortic valve replacement, coronary obstruction, failed surgical bioprosthesis, transcatheter heart valve, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with ~6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures.

Published
2019
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3. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Author

Fernando L M, Bernardi, Wilton F, Gomes, Fabio S, de Brito, Jose A, Mangione, Rogério, Sarmento-Leite, Dimitry, Siqueira, Luiz A, Carvalho, Rogério, Tumelero, Enio E, Guerios, and Pedro A, Lemos

Subjects
Aged, 80 and over, Femoral Artery, Male, Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, Humans, Female, Aortic Valve Stenosis, Comorbidity, Registries, Brazil
Abstract

To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry.Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described.The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year.A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year.Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI.

Published
2014

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