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2. EURObservational Research Programme: the Chronic Ischaemic Cardiovascular Disease Registry: Pilot phase (CICD-PILOT)

Author

Komajda, Michel, Weidinger, Franz, Kerneis, Mathieu, Cosentino, Francesco, Cremonesi, Alberto, Ferrari, Roberto, Kownator, Serge, Steg, Philippe Gabriel, Tavazzi, Luigi, Valgimigli, Marco, Szwed, Hanna, Majda, Wojciech, Olivari, Zoran, Van Belle, Eric, Shlyakhto, Evgeny Vladimirovich, Mintale, Iveta, Slapikas, Rimvydas, Rittger, Harald, Mendes, Miguel, Tsioufis, Constantinos, Balanescu, Serban, Laroche, Cécile, Maggioni, Aldo Pietro, Komajda, Michel, Weidinger, Franz, Cosentino, Francesco, Cremonesi, Alberto, Ferrari, Roberto, Kownator, Serge, Maggioni, Aldo P., Steg, Gabriel, Tavazzi, Luigi, Valgimigli, Marco, Balanescu, Serban, Mendes, Miguel, Mintale, Iveta, Olivari, Zoran, Rittger, Harald, Shlyakhto, Evgeny V., Slapikas, Rimvydas, Szwed, Hanna, Van Belle, Éric, Laroche, Cécile, McNeill, Patti-Ann, Ferreira, Thierry, Vochelet, F., Tavildari, A., Silvestri, M., Maillard, L., Sevilla, J., Malaquin, D., Leborgne, L., Fournier, A., Jarry, G., Teiger, E., Marchant, B., Van Belle, E., Criquioche, A., Dupouy, P., Madiot, H., Lafitte, B., Belle, L., Cayla, G., Abouth-Benamara, S., Messas, E., Delarche, N., Bouvier, E., Couleru, J., Paparoni, F., Marchant, B., Bedossa, M., Lepage, Q., Le Bouquin, L., Auffret, V., Leurent, G., Boulmier, D., Le Breton, H., Vidal, C., Touet, M., Tron, C., Hemmerling, S., Flugel, P.-C., Beschorner, U., Noory, E., Strubin, J., Macharzina, R., Lindemann, C., Specht, T., Brantner, R., Zeller, T., Schwarzwalder, U., Hirschmann, S., Schonhardt, S., Slimack-Braun, S., Link, S., Hauk, M., Welslau, M., Henning, A., Menz, C., Buciuceanu, V., Rastan, A., Bschorr, R., Schmitt, C., Maas, C., Jacques, B., Bohme, T., Burgelin, K., Hoffmann, M., Pirzer, R., Brune, M., Braun, M., Stolte, D., Dietrich, A., Singh, A., Rittger, H., Schibgilla, V., Hopf, S., Fouridis, P., Fabiani, R., Jakob, A., Garlichs, C., Trautvetter, J., Schineis, N., Brugger, A., Bojanic, D., Matschke, C., Schmidt, A., Scheinert, D., Scheinert, S., Banning-Eichenseer, U., Stauffer, A., Straube, F., Hoffmann, E., Antoni, D., Rieber, J., Tomelden, J., Deichstetter, M., Landwehr, P., Reif, S., Kallikazaros, I., Tsioufis, C., Korkovili, M., Stamatelopoulos, K., Tsoumani, Z., Loizos, S., Kanakakis, I., Kampouridis, N., Simeonidis, D., Bougas, T., Chasapi, A., Alexopoulos, D., Xanthopoulou, I., Vogiatzi, X., Stavrou, K., Bampouri, T., Sicuro, M., Amato, G., Pisano, F., Casolati, D., Bare, C., Grotti, S., Angioli, P., Bolognese, L., Ducci, K., Porto, I., Falsini, G., Liisto, F., Manzi, R.C., Langiu, M., Lai, C., Lodolini, V., Biscaglia, S., Ferrari, R., Occhilupo, P., Tebaldi, M., Minarelli, M., Fileti, L., Campo, G., Sbarzaglia, P., Bonilla, N., Schiavina, G., dʼAlessandro, G., Borghesi, M., Cremonesi, A., Rota, I., Ghigliotti, G., Davi, F., Beccaria, F., Brunelli, C., Mussardo, M., Cisotta, F., Spagnolo, B., Liso, A., Dal Corso, L., Favretto, G., Borsatto, F., Benedetto, M., Cirrincione, G., Gandolfo, C., Caruso, M., Stabile, A., Lanteri, S., Riina, M., Lunetto, M.L., Vadala, G., Micari, A., Rossi, E., Griksteite, E., Cavallini, C., Longhi, S., Pasqualini, M., Negrelli, M., Pacchioni, E., Brunazzi, M.C., Marcomin, C., Neri, R., Cassin, M., Vendrametto, F., Macor, F., Nicolosi, G., Pavan, D., Piasentin, C., Roman-Pognuz, A., Taccheri, T., Calcagno, S., Pagliaro, M., Mancone, M., Fedele, F., Cinque, A., Armato, A., Tarducci, R., Della Bona, R., Brandini, R., Rossi, P., Fronticelli, M., Casavecchia, M., Olivari, Z., Calzolari, D., Daniotti, A., Balcere, K., Stirna, V., Libins, A., Zabunova, M., Silina, E., Ozola, G., Rancane, G., Babarskiene, R., Viezelis, M., Petrauskaite, J., Rumbinaite, E., Stankala, S., Juszczyk, Z., Karwowska Polecka, W., Oleksza, A., Bialek, P., Klimczuk, A., Poplawski, A., Aksiucik, A., Musial, W., Swiecki, P., Marcinkiewicz-Siemion, M., Ptaszynska-Kopczynska, K., Prokop, J., Kubica, J., Janiszewska, E., Kopczynska, A., Tarnawska, M., Gruchala, M., Pajkowski, M., Raczak, G., Wojtowicz, D., Strozyk, A., Miekus, P., Szyman, M., Glaza, M., Roszko-Grycner, E., Szpajer, M., Wroblewska, M., Zadrozny, J., Muller, H., Puzio, E., Lesinski, D., Borowski, B., Kowalska, A., Wojtyniak, I., Krzewinska, J., Borej, G., Czaja, P., Janion, M., Zandecki, L., Kuczerowska, R., Bogacki, P., Kafara, M., Rola, A., Podolec, P., Waligora, M., Brozda, M., Skrzynska, M., Glowa, B., Gawor, Z., Dejak, P., Brylka, A., Banasiak, M., Simiera, M., Krecki, R., Ojrzanowski, M., Jankowski, L., Kupczynska, K., Kasprzak, J.D., Zapolski, T., Zarczuk, R., Lukasik, D., Wysokinski, A., Zalewska-Nowak, G., Tarnolicki, M., Major, M., Gorny, J., Krzyzanowski, W., Muzyk-Osikowicz, M., Boltryk, K., Grajek, S., Maczynski, M., Lesiak, M., Komosa, A., Drewnicki, A., Wolniewicz, L., Komorowska, E., Gmyrek, N., Kowalik, M., Kostka, M., Kaminski, L., Mikolowicz-Mosiadz, A., Mazur, R., Kosztowniak, M., Pajaczkowski, K., Duda, K., Kosno-Zak, J., Dworak-Podlewska, E., Burchard, E., Wrzosek, B., Gurba, S., Wozniak, P., Dabek, M., Kuzniar, J., Lyczywek, M., Szubielski, M., Gajewski, M., Wasiak, D., Oscik-Lukasiewicz, M., Kawka-Urbanek, T., Diks, F., Przywoska-Para, B., Drazkowicz-Gozdzik, B., Kornacewicz-Jach, Z., Kula, L., Goracy, J., Chlasta, J., Tomaniak, M., Opolski, G., Serafin, A., Pietrasik, A., Kosek, M., Jastrzebski, J., Witkowski, A., Pruszczyk, P., Roik, M., Kostrubiec, M., Irzyk, K., Wretowski, D., Labyk, A., Budaj, A., Maciejewski, P., Szwed, H., Majda, W., Chojecka, M., Mosur, M., Gajer-Blaszczyk, K., Bociaga, Z., Loboz-Rudnicka, M., Loboz-Grudzien, K., Jaroch, J., Rzyczkowska, B., Chelstowski, W., Lewandowska, A., Darocha, A., Skowron, W., Polonski, L., Maciol-Skurk, K., Madeira, S., Mendes, M., Brito, J., Santos, M., Leite, L., Vicente, J., Calisto, J., Faria, H., Jorge, E., Mendes, A., Santos, R., Pinto, P., Guedes, H., Placido, R., Correia, M.J., Cabrita, I., Rodrigues, C., Nunes Diogo, A., Magalhaes, A., Canas da Silva, A., Selas, M., Portugal, G., Viveiros Monteiro, A., Timoteo, A.T., Ribeiro, M., Espregueira Mendes, D., Rodrigues, R., Lopes, R., Ribeiro, V., Melao, F., Magalhaes, D., Silva, J., Ribeiro, V. Gama, Braga, P., Goncalves, M., de Morais, G. Pires, Melica, B., Rodrigues, A., Santos, L., Cojocaru, L., Mazilu, L., Suceveanu, A.I., Rusali, A., Parepa, I.R., Maxim, R., Matei, L., Ioanovici, S., Buzas, R., Mihaela Iuliana, M., Susan, M., Ionita, M., Coceala, L., Suceava, I., Ciobotaru, G., Lighezan, D., Nicolescu, C., Mukhametgatova, D., Baleeva, L., Galyavich, A., Gratsiansky, N.A., Erlikh, A., Kondratenko, V., Libis, R., Vezikova, N., Skopets, I., Marusenko, I., Lapshin, K., Yakovlev, A., Lokhovinina, N., Alugishvili, M., Panov, A., Abesadze, I., Salakhova, J., Kondrateva, I., and Duplyakov, D.

Published
2016
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4. Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study

Author

De Luca, Leonardo, Leonardi, Sergio, Smecca, Ignazio Maria, Formigli, Dario, Lucci, Donata, Gonzini, Lucio, Tuccillo, Bernardino, Olivari, Zoran, Gulizia, Michele Massimo, Bovenzi, Francesco Maria, De Servi, Stefano, Caporale, R., Cavallini, C., Ceravolo, R., Lupi, A., Musumeci, G., Rakar, S., Maggioni, A. P., Lorimer, A., Orsini, G., Fabbri, Giorgio, Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, Giorgia, Misuraca, G., Manes, M. T., Irace, Lorenzo, Totis, O., Ledda, A., Mauro, C., Boccalatte, M., Iliceto, S., Cacciavillani, L., Savonitto, S., Tortorella, G., Esposito, L., DE ROSA, Paolo, Calabrò, P., Bianchi, R., Napoletano, C., Lalla Piccioni, L., Pavesi, P. C., Boni, Allegra, Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, Paolo, Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Grazioli Gauthier, L., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., Di Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, LAURA CATERINA, Pani, Luisa Anna, Serra, Eleonora, Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, Gabriele, Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Sleiman Helou, J., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, MICHELA MARIA, Caputo, M., Di Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., Di Clemente, D., Felis, S., Castini, D., Rota, C., Casu, Gabriella, Bonano, S., Margheri, M., Ricci Lucchi, G., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Marrara, F., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., Di Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Della Mattia, A., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., Di Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cotti Cometti, V., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., Di Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., Di Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., Di Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Della Casa, S., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., Di Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., and Levantesi, G.

Subjects
Male, Ticagrelor, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Conservative strategy, Population, Acute coronary syndromes, Revascularization, acute coronary syndromes, anticoagulant, antithrombotic therapy, conservative strategy, prasugrel, ticagrelor, aged, coronary care units, female, fibrinolytic agents, follow-up studies, hospital mortality, humans, iItaly, length of stay, male, myocardial revascularization, retrospective studies, survival rate, thrombolytic therapy, practice guidelines as topic, Fibrinolytic Agents, Anticoagulant, Antithrombotic therapy, Prasugrel, Acute Coronary Syndrome, Aged, Coronary Care Units, Female, Follow-Up Studies, Hospital Mortality, Humans, Italy, Length of Stay, Myocardial Revascularization, Retrospective Studies, Survival Rate, Thrombolytic Therapy, Practice Guidelines as Topic, Cardiology and Cardiovascular Medicine, Pharmacology (medical), Internal medicine, Antithrombotic, medicine, education, Survival rate, education.field_of_study, business.industry, Clopidogrel, medicine.disease, Cardiology, business, Fibrinolytic agent, medicine.drug
Abstract

Aims Patients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P < 0.0001 and 50 vs. 33, P < 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did. Clinical Trial Registration Unique identifier: [NCT02015624][1], . [10.1093/ehjcvp/pvv017][2] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02015624&atom=%2Fehjcardpharm%2F1%2F3%2F168.atom [2]: /lookup/doi/10.1093/ehjcvp/pvv017

Published
2015

5. Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units Registry

Author

De Luca, L., Musumeci, G., Leonardi, S., Gonzini, L., Cavallini, C., Calabro, P., Mauro, C., Cacciavillani, L., Savonitto, S., De Servi, S., Caporale, R., Ceravolo, R., Formigli, D., Lupi, A., Rakar, S., Smecca, I. M., Maggioni, A. P., Lucci, D., Lorimer, A., Orsini, G., Fabbri, G., Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, G., Misuraca, G., Manes, M. T., Tuccillo, B., Irace, L., Olivari, Z., Totis, O., Ledda, A., Boccalatte, M., Iliceto, S., Tortorella, G., Esposito, L., De Rosa, P., Bianchi, R., Napoletano, C., Piccioni, L. L., Pavesi, P. C., Bovenzi, F. M., Boni, A., Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, P., Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Gauthier, L. G., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., DI Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, L., Pani, A., Serra, E., Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, G., Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Helou, J. S., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, M., Caputo, M., DI Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., DI Clemente, D., Felis, S., Castini, D., Rota, C., Casu, G., Bonano, S., Margheri, M., Lucchi, G. R., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Santagostino, M., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., De Luca, M., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., DI Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Mattia, A. D., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., DI Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cometti, V. C., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., DI Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., DI Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., DI Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Casa, S. D., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., DI Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., Lupi, G., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., Levantesi, G., de Luca, Leonardo, Musumeci, Giuseppe, Leonardi, Sergio, Gonzini, Lucio, Cavallini, Claudio, Calabrò, Paolo, Mauro, Ciro, Cacciavillani, Luisa, Savonitto, Stefano, de Servi, Stefano, Caporale, Roberto, Ceravolo, Roberto, Formigli, Dario, Lupi, Alessandro, Rakar, Sadir, Smecca, Ivan, Maggioni, Aldo Pietro, Lucci, Donata, Lorimer, Andrea, Orsini, Giampietro, Fabbri, Gianna, Bianchini, Elisa, Abrignani, Maurizio Giuseppe, Bonura, Francesc, Trimarco, Bruno, Galasso, Gennaro, Misuraca, Gianfranco, Manes, Maria Teresa, Tuccillo, Bernardino, and Irace, Luigi.

Subjects
Male, Prasugrel, medicine.medical_treatment, Myocardial Infarction, antithrombotic therapy, 030204 cardiovascular system & hematology, acute coronary syndromes, bivalirudin, heparins, percutaneous coronary intervention, prasugrel, ticagrelor, 0302 clinical medicine, Antithrombotic, 80 and over, Bivalirudin, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, Aged, 80 and over, General Medicine, Hirudins, Middle Aged, Recombinant Proteins, Italy, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Platelet Glycoprotein GPIIb-IIIa Complex, NO, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, Acute Coronary Syndrome, Aged, Aspirin, business.industry, Heparin, Percutaneous coronary intervention, Anticoagulants, medicine.disease, Peptide Fragments, Clinical trial, Cross-Sectional Studies, Logistic Models, Conventional PCI, Multivariate Analysis, business
Abstract

Aims In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.

Published
2017

6. Clinical and procedural predictors of suboptimal outcome after treatment of drug-eluting stent restenosis in the unprotected distal left main stem. the Milan and New Tokyo (MITO) Registry

Author

Takagi K, Ielasi A, Shannon J, Latib A, Godino C, Davidavicius G, Mussardo M, Ferrarello S, Figini F, Carlino M, Montorfano M, Chieffo A, Nakamura S, COLOMBO , ANTONIO, Takagi, K, Ielasi, A, Shannon, J, Latib, A, Godino, C, Davidavicius, G, Mussardo, M, Ferrarello, S, Figini, F, Carlino, M, Montorfano, M, Chieffo, A, Nakamura, S, and Colombo, Antonio

Published
2012

7. COMPARISON OF TRANS-FEMORAL TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) PERFORMED WITH EDWARDS SAPIEN OR COREVALVE IMPLANTATION

Author

Godino C, Chieffo A, Maisano F, Montorfano M, Latib A, Ielasi A, Cioni M, Mussardo M, Denti P, Giacomini A, Taramasso M, Arendar I, Grimaldi A, Spagnolo P, La Canna G, ALFIERI , OTTAVIO, Colombo A., Godino, C, Chieffo, A, Maisano, F, Montorfano, M, Latib, A, Ielasi, A, Cioni, M, Mussardo, M, Denti, P, Giacomini, A, Taramasso, M, Arendar, I, Grimaldi, A, Spagnolo, P, La Canna, G, Alfieri, Ottavio, and Colombo, A.

Published
2011

8. Surgical vs. Transcatheter Aortic Valve Replacement with the Sapien XT Valve and NovoFlex Delivery System in High-risk patients with Severe Aortic Stenosis

Author

Latib A, Bertoldt LF, Giacomini A, Mussardo M, Cioni M, Ielasi A, Godino C, Covello RD, Takagi K, Shannon J, Buchanan GL, Sacco FM, Montorfano M, Chieffo A, Maisano F, Colombo A., ALFIERI , OTTAVIO, Latib, A, Bertoldt, Lf, Giacomini, A, Mussardo, M, Cioni, M, Ielasi, A, Godino, C, Covello, Rd, Takagi, K, Shannon, J, Buchanan, Gl, Sacco, Fm, Montorfano, M, Chieffo, A, Maisano, F, Alfieri, Ottavio, and Colombo, A.

Published
2011

9. PREDICTORS OF AVB AFTER TAVR WITH THE BOTH EDWARDS AND COREVALVE THV SYSTEM

Author

Mussardo M, Latib A, Radinovich A, Sala S, Gullace M, Ielasi A, Godino C, Bertoldi L, Takagi K, Shannon J, Buchanan GL, Ferrarello S, Chieffo A, Figini F, Cioni M, Montorfano M, Maisano F, Colombo A., ALFIERI , OTTAVIO, Mussardo, M, Latib, A, Radinovich, A, Sala, S, Gullace, M, Ielasi, A, Godino, C, Bertoldi, L, Takagi, K, Shannon, J, Buchanan, Gl, Ferrarello, S, Chieffo, A, Figini, F, Cioni, M, Montorfano, M, Maisano, F, Alfieri, Ottavio, and Colombo, A.

Published
2011

10. ONE-YEAR CLINICAL OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) WITH BOTH EDWARDS SAPIEN AND COREVALVE DEVICES IN A SINGLE CENTER: THE MILAN EXPERIENCE

Author

Godino C, Mussardo M, Ielasi A, Cioni M, Maisano F, Chieffo A, Montorfano M, Latib A, Denti P, Giacomini A, Taramasso M, Carlino M, Grimaldi A, Spagnolo P, La Canna G, ALFIERI , OTTAVIO, Colombo A., Godino, C, Mussardo, M, Ielasi, A, Cioni, M, Maisano, F, Chieffo, A, Montorfano, M, Latib, A, Denti, P, Giacomini, A, Taramasso, M, Carlino, M, Grimaldi, A, Spagnolo, P, La Canna, G, Alfieri, Ottavio, and Colombo, A.

Published
2011

11. VASCULAR COMPLICATIONS FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION WITH BOTH EDWARDS SAPIEN AND MEDTRONIC COREVALVE(R) BIOPROSTHESIS USING TRANSFEMORAL APPROACH SUPPORTED BY THE CROSS-OVER TECHNIQUE

Author

Godino C, Mussardo M, Ielasi A, Cioni M, Montorfano M, Maisano F, Chieffo A, Latib A, Carita P, Arioli F, Taramasso M, Arendar I, Denti P, Giacomini A, Spagnolo P, La Canna G, ALFIERI , OTTAVIO, Colombo A., Godino, C, Mussardo, M, Ielasi, A, Cioni, M, Montorfano, M, Maisano, F, Chieffo, A, Latib, A, Carita, P, Arioli, F, Taramasso, M, Arendar, I, Denti, P, Giacomini, A, Spagnolo, P, La Canna, G, Alfieri, Ottavio, and Colombo, A.

Published
2011

14. Poster Session 3

Author

Fabbri, G. M. T., primary, Baldasseroni, S., additional, Panuccio, D., additional, Zoni Berisso, M., additional, Scherillo, M., additional, Lucci, D., additional, Di Pasquale, G., additional, Mathieu, G., additional, Burazor, I., additional, Burazor, M., additional, Perisic, Z., additional, Atanaskovic, V., additional, Erakovic, V., additional, Stojkovic, A., additional, Vogtmann, T., additional, Schoebel, C., additional, Sogorski, S., additional, Sebert, M., additional, Schaarschmidt, J., additional, Fietze, I., additional, Baumann, G., additional, Penzel, T., additional, Mornos, C., additional, Ionac, A., additional, Cozma, D., additional, Dragulescu, D., additional, Mornos, A., additional, Petrescu, L., additional, Pescariu, L., additional, Brembilla-Perrot, B., additional, Khachab, H., additional, Lamberti, F., additional, Bellini, C., additional, Remoli, R., additional, Cogliandro, T., additional, Nardo, R., additional, Bellusci, F., additional, Mazzuca, V., additional, Gaspardone, A., additional, Aguinaga Arrascue, L. E., additional, Bravo, A., additional, Garcia Freire, P., additional, Gallardo, P., additional, Hasbani, E., additional, Quintana, R., additional, Dantur, J., additional, Inoue, K., additional, Ueoka, A., additional, Tsubakimoto, Y., additional, Sakatani, T., additional, Matsuo, A., additional, Fujita, H., additional, Kitamura, M., additional, Wegrzynowska, M., additional, Konduracka, E., additional, Pietrucha, A. Z., additional, Mroczek-Czernecka, D., additional, Paradowski, A., additional, Bzukala, I., additional, Nessler, J., additional, Igawa, O., additional, Adachi, M., additional, Atarashi, H., additional, Kusama, Y., additional, Kodani, E., additional, Okazaki, R., additional, Nakagomi, A., additional, Endoh, Y., additional, Baez-Escudero, J. L., additional, Dave, A. S., additional, Sasaridis, C. M., additional, Valderrabano, M., additional, Tilz, R., additional, Bai, R., additional, Di Biase, L., additional, Gallinghouse, G. J., additional, Gibson, D., additional, Pisapia, A., additional, Wazni, O., additional, Natale, A., additional, Arujuna, A., additional, Karim, R., additional, Rinaldi, A., additional, Cooklin, M., additional, Rhode, K., additional, Razavi, R., additional, O'neill, M., additional, Gill, J., additional, Kusa, S., additional, Komatsu, Y., additional, Kakita, K., additional, Takayama, K., additional, Taniguchi, H., additional, Otomo, K., additional, Iesaka, Y., additional, Ammar, S., additional, Reents, T., additional, Fichtner, S., additional, Wu, J., additional, Zhu, P., additional, Kolb, C., additional, Hessling, G., additional, Deisenhofer, I., additional, Gilbert, G., additional, Mohanty, P., additional, Cunningham, J., additional, Metz, T., additional, Horton, R., additional, Tao, S., additional, Yamauchi, Y., additional, Okada, H., additional, Maeda, S., additional, Obayashi, T., additional, Isobe, M., additional, Chan, J., additional, Johar, S., additional, Wong, T., additional, Markides, V., additional, Hussain, W., additional, Konstantinidou, M., additional, Wissner, E., additional, Fuernkranz, A., additional, Yoshiga, Y., additional, Metzner, A., additional, Kuck, K.- H., additional, Ouyang, F., additional, Kettering, K., additional, Gramley, F., additional, Mollnau, H., additional, Weiss, C., additional, Bardeleben, S., additional, Biasco, L., additional, Scaglione, M., additional, Caponi, D., additional, Di Donna, P., additional, Sergi, D., additional, Cerrato, N., additional, Blandino, A., additional, Gaita, F., additional, Fiala, M., additional, Wichterle, D., additional, Sknouril, L., additional, Bulkova, V., additional, Chovancik, J., additional, Nevralova, R., additional, Pindor, J., additional, Januska, J., additional, Choi, J. I., additional, Ban, J. E., additional, Yasutsugu, N., additional, Park, J. S., additional, Jung, J. S., additional, Lim, H. E., additional, Park, S. W., additional, Kim, Y. H., additional, Kuhne, M., additional, Reichlin, T., additional, Ammann, P., additional, Schaer, B., additional, Osswald, S., additional, Sticherling, C., additional, Ohe, M., additional, Goya, M., additional, Hiroshima, K., additional, Hayashi, K., additional, Makihara, Y., additional, Nagashima, M., additional, Fukunaga, M., additional, An, Y., additional, Dorwarth, U., additional, Schmidt, M., additional, Wankerl, M., additional, Krieg, J., additional, Straube, F., additional, Hoffmann, E., additional, Kathan, S., additional, Defaye, P., additional, Mbaye, A., additional, Cassagneau, R., additional, Gagniere, V., additional, Jacon, P., additional, Pokushalov, E., additional, Romanov, A., additional, Artemenko, S., additional, Shabanov, V., additional, Elesin, D., additional, Stenin, I., additional, Turov, A., additional, Losik, D., additional, Kondo, K., additional, Miake, J., additional, Yano, A., additional, Ogura, K., additional, Kato, M., additional, Shigemasa, C., additional, Sekiguchi, Y., additional, Tada, H., additional, Yoshida, K., additional, Naruse, Y., additional, Yamasaki, H., additional, Igarashi, M., additional, Machino, T., additional, Aonuma, K., additional, Chen, S., additional, Liu, S., additional, Chen, G., additional, Meng, W., additional, Zhang, F., additional, Yan, Y., additional, Sciarra, L., additional, Dottori, S., additional, Lanzillo, C., additional, De Ruvo, E., additional, De Luca, L., additional, Minati, M., additional, Lioy, E., additional, Calo', L., additional, Lin, J., additional, Nie, Z., additional, Zhu, M., additional, Wang, X., additional, Zhao, J., additional, Hu, W., additional, Tao, H., additional, Ge, J., additional, Johansson, B., additional, Houltz, B., additional, Edvardsson, N., additional, Schersten, H., additional, Karlsson, T., additional, Wandt, B., additional, Berglin, E., additional, Hoyt, R. H., additional, Jenson, B. P., additional, Trines, S. A. I. P., additional, Braun, J., additional, Tjon Joek Tjien, A., additional, Zeppenfeld, K., additional, Tavilla, G., additional, Klautz, R. J. M., additional, Schalij, M. J., additional, Krausova, R., additional, Cihak, R., additional, Peichl, P., additional, Kautzner, J., additional, Pirk, J., additional, Skalsky, I., additional, Maly, J., additional, Imai, K., additional, Sueda, T., additional, Orihashi, K., additional, Picarra, B. C., additional, Santos, A. R., additional, Dionisio, P., additional, Semedo, P., additional, Matos, R., additional, Leitao, M., additional, Banha, M., additional, Trinca, M., additional, Elder, D. H. J., additional, George, J., additional, Jain, R., additional, Lang, C. C., additional, Choy, A. M., additional, Konert, M., additional, Loescher, S., additional, Hartmann, A., additional, Aversa, E., additional, Chirife, R., additional, Sztyglic, E., additional, Mazzetti, H., additional, Mascheroni, O., additional, Tentori, M. C., additional, Pop, R. M., additional, Margulescu, A. D., additional, Dulgheru, R., additional, Enescu, O., additional, Siliste, C., additional, Vinereanu, D., additional, Menezes Junior, A., additional, Castro Carneiro, A. R., additional, De Oliveira, B. L., additional, Shah, A. N., additional, Kantharia, B., additional, De Lucia, R., additional, Soldati, E., additional, Segreti, L., additional, Di Cori, A., additional, Zucchelli, G., additional, Viani, S., additional, Paperini, L., additional, Bongiorni, M. G., additional, Kutarski, A., additional, Czajkowski, M., additional, Pietura, R., additional, Malecka, B., additional, Heintze, J., additional, Eckardt, L., additional, Bauer, A., additional, Meine, M., additional, Van Erven, L., additional, Bloch Thomsen, P. E., additional, Lopez Chicharro, M. P., additional, Merhi, O., additional, Soga, Y., additional, Andou, K., additional, Nobuyoshi, M., additional, Gonzalez-Mansilla, A., additional, Martin-Asenjo, R., additional, Unzue, L., additional, Torres, J., additional, Garralda, E., additional, Coma, R. R., additional, Rodriguez Garcia, J. E., additional, Yaegashi, T., additional, Furusho, H., additional, Kato, T., additional, Chikata, A., additional, Takashima, S., additional, Usui, S., additional, Takamura, M., additional, Kaneko, S., additional, Chudzik, M., additional, Mitkowski, P., additional, Przybylski, A., additional, Lewek, J., additional, Smukowski, T., additional, Maciag, A., additional, Castrejon Castrejon, S., additional, Perez-Silva, A., additional, Estrada, A., additional, Doiny, D., additional, Ortega, M., additional, Lopez-Sendon, J. L., additional, Merino, J. L., additional, O'mahony, C., additional, Coats, C., additional, Cardona, M., additional, Garcia, A., additional, Calcagnino, M., additional, Lachmann, R., additional, Hughes, D., additional, Elliott, P. M., additional, Conti, S., additional, Pruiti, G. P., additional, Puzzangara, E., additional, Romano, S. A., additional, Di Grazia, A., additional, Ussia, G. P., additional, Tamburino, C., additional, Calvi, V., additional, Radinovic, A., additional, Sala, S., additional, Latib, A., additional, Mussardo, M., additional, Sora, S., additional, Paglino, G., additional, Gullace, M., additional, Colombo, A., additional, Ohlow, M.- A. G., additional, Lauer, B., additional, Wagner, A., additional, Schreiber, M., additional, Buchter, B., additional, Farah, A., additional, Fuhrmann, J. T., additional, Geller, J. C., additional, Nascimento Cardoso, R. M., additional, Batista Sa, L. A., additional, Campos Filho, L. F. C., additional, Rodrigues, S. V., additional, Dutra, M. V. F., additional, Borges, T. R. S. A., additional, Portilho, D. R., additional, Deering, T., additional, Bernardes, A., additional, Veiga, A., additional, Gartenlaub, O., additional, Goncalves, A., additional, Jimenez, A., additional, Rousseauplasse, A., additional, Deharo, J. C., additional, Striekwold, H., additional, Gosselin, G., additional, Sitbon, H., additional, Martins, V., additional, Molon, G., additional, Ayala-Paredes, F., additional, Sancho-Tello, M. J., additional, Fazal, I. A., additional, Brady, S., additional, Cronin, J., additional, Mcnally, S., additional, Tynan, M., additional, Plummer, C. J., additional, Mccomb, J. M., additional, Val-Mejias, J. E., additional, Oliveira, R. M., additional, Costa, R., additional, Martinelli Filho, M., additional, Silva, K. R., additional, Menezes, L. M., additional, Tamaki, W. T., additional, Mathias, W., additional, Stolf, N. A. G., additional, Misawa, T., additional, Ohta, I., additional, Shishido, T., additional, Miyasita, T., additional, Miyamoto, T., additional, Nitobe, J., additional, Watanabe, T., additional, Kubota, I., additional, Thibault, B., additional, Ducharme, A., additional, Simpson, C., additional, Stuglin, C., additional, Gagne, C. E., additional, Williams, R., additional, Mcnicoll, S., additional, Silvetti, M. S., additional, Drago, F., additional, Penela, D., additional, Bijnens, B., additional, Doltra, A., additional, Silva, E., additional, Berruezo, A., additional, Mont, L., additional, Sitges, M., additional, Mcintosh, R., additional, Baumann, O., additional, Raju, P., additional, Gurunathan, S., additional, Furniss, S., additional, Patel, N., additional, Sulke, N., additional, Lloyd, G., additional, Mor, M., additional, Dror, S., additional, Tsadok, Y., additional, Bachner-Hinenzon, N., additional, Katz, A., additional, Liel-Cohen, N., additional, Etzion, Y., additional, Mlynarski, R., additional, Mlynarska, A., additional, Wilczek, J., additional, Sosnowski, M., additional, Sinha, A. M., additional, Sinha, D., additional, Noelker, G., additional, Brachmann, J., additional, Weidemann, F., additional, Ertl, G., additional, Jones, M., additional, Searle, N., additional, Cocker, M., additional, Ilsley, E., additional, Foley, P., additional, Khiani, R., additional, Nelson, K. E., additional, Turley, A. J., additional, Owens, W. A., additional, James, S. A., additional, Linker, N. J., additional, Velagic, V., additional, Cikes, M., additional, Pezo Nikolic, B., additional, Puljevic, D., additional, Separovic-Hanzevacki, J., additional, Lovric-Bencic, M., additional, Biocina, B., additional, Milicic, D., additional, Kawata, H., additional, Chen, L., additional, Phan, H., additional, Anand, K., additional, Feld, G., additional, Birgesdotter-Green, U., additional, Fernandez Lozano, I., additional, Mitroi, C., additional, Toquero Ramos, J., additional, Castro Urda, V., additional, Monivas Palomero, V., additional, Corona Figueroa, A., additional, Hernandez Reina, L., additional, Alonso Pulpon, L., additional, Gate-Martinet, A., additional, Da Costa, A., additional, Rouffiange, P., additional, Cerisier, A., additional, Bisch, L., additional, Romeyer-Bouchard, C., additional, Isaaz, K., additional, Morales, M.- A., additional, Bianchini, E., additional, Startari, U., additional, Faita, F., additional, Bombardini, T., additional, Gemignani, V., additional, Piacenti, M., additional, Adhya, S., additional, Kamdar, R. H., additional, Millar, L. M., additional, Burchardt, C., additional, Murgatroyd, F. D., additional, Klug, D., additional, Kouakam, C., additional, Guedon-Moreau, L., additional, Marquie, C., additional, Benard, S., additional, Kacet, S., additional, Cortez-Dias, N., additional, Carrilho-Ferreira, P., additional, Silva, D., additional, Goncalves, S., additional, Valente, M., additional, Marques, P., additional, Carpinteiro, L., additional, Sousa, J., additional, Keida, T., additional, Nishikido, T., additional, Fujita, M., additional, Chinen, T., additional, Kikuchi, T., additional, Nakamura, K., additional, Ohira, H., additional, Takami, M., additional, Anjo, D., additional, Meireles, A., additional, Gomes, C., additional, Roque, C., additional, Pinheiro Vieira, A., additional, Lagarto, V., additional, Reis, H., additional, Torres, S., additional, Ortega, D. F., additional, Barja, L. D., additional, Montes, J. P., additional, Logarzo, E., additional, Bonomini, P., additional, Mangani, N., additional, Paladino, C., additional, Chwyczko, T., additional, Smolis-Bak, E., additional, Sterlinski, M., additional, Pytkowski, M., additional, Firek, B., additional, Jankowska, A., additional, Szwed, H., additional, Nakajima, I., additional, Noda, T., additional, Okamura, H., additional, Satomi, K., additional, Aiba, T., additional, Shimizu, W., additional, Aihara, N., additional, Kamakura, S., additional, Brzozowski, W., additional, Tomaszewski, A., additional, Wysokinski, A., additional, Bertoldi, E. G., additional, Rohde, L. E., additional, Zimerman, L. I., additional, Pimentel, M., additional, Polanczyk, C. A., additional, Boriani, G., additional, Lunati, M., additional, Gasparini, M., additional, Landolina, M., additional, Lonardi, G., additional, Pecora, D., additional, Santini, M., additional, Valsecchi, S., additional, Rubinstein, B. J., additional, Wang, D. Y., additional, Cabreriza, S. 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L., additional, Zeljko, H., additional, Andreu, D., additional, Herzcku, C., additional, Boussy, T., additional, Brugada, J., additional, Obayahi, T., additional, Hegrenes, J., additional, Lim, E., additional, Mediratta, V., additional, Bautista, R., additional, Teplitsky, L., additional, Van Huls Van Taxis, C. F. B., additional, Wijnmaalen, A. P., additional, Gawrysiak, M., additional, Schuijf, J. D., additional, Bax, J. J., additional, Huo, Y., additional, Richter, S., additional, Arya, A., additional, Bollmann, A., additional, Akca, F., additional, Bauernfeind, T., additional, Schwagten, B., additional, De Groot, N. M. S., additional, Jordaens, L., additional, Szili-Torok, T., additional, Miller, S., additional, Kastner, G., additional, Maury, P., additional, Della Bella, P., additional, Delacretaz, E., additional, Sacher, F., additional, Maccabelli, G., additional, Brenner, R., additional, Rollin, A., additional, Jais, P., additional, Vergara, P., additional, Trevisi, N., additional, Ricco, A., additional, Petracca, F., additional, Bisceglia, C., additional, Baratto, F., additional, Salguero Bodes, R., additional, Fontenla Cerezuela, A., additional, De Riva Silva, M., additional, Lopez Gil, M., additional, Mejia Martinez, E., additional, Jurado Roman, A., additional, Montero Alvarez, M., additional, Arribas Ynsaurriaga, F., additional, Baszko, A., additional, Krzyzanowski, K., additional, Bobkowski, W., additional, Surmacz, R., additional, Zinka, E., additional, Siwinska, A., additional, Szyszka, A., additional, Perez Silva, A., additional, Estrada Mucci, A., additional, Ortega Molina, M., additional, Lopez Sendon, J. L., additional, Merino Llorens, J. L., additional, Kaitani, K., additional, Hanazawa, K., additional, Izumi, C., additional, Nakagawa, Y., additional, Yamanaka, I., additional, Hirahara, T., additional, Sugawara, Y., additional, Suga, C., additional, Ako, J., additional, Momomura, S., additional, Galizio, N., additional, Gonzalez, J., additional, Robles, F., additional, Palazzo, A., additional, Favaloro, L., additional, Diez, M., additional, Guevara, E., additional, Fernandez, A., additional, Greenberg, S., additional, Epstein, A., additional, Goldman, D. S., additional, Sangli, C., additional, Keeney, J. A., additional, Lee, K., additional, Piers, S. R. D., additional, Van Rees, J. B., additional, Thijssen, J., additional, Borleffs, C. J. W., additional, Van Der Velde, E. T., additional, Leclercq, C. H., additional, Hero, M., additional, Mizobuchi, M., additional, Enjoji, Y., additional, Yazaki, Y., additional, Shibata, K., additional, Funatsu, A., additional, Kobayashi, T., additional, Nakamura, S., additional, Amit, G., additional, Pertzov, B., additional, Zahger, D., additional, Medesani, L., additional, Rana, R., additional, Albano, F., additional, Fraguas, H., additional, Pedersen, S. S., additional, Hoogwegt, M. T., additional, Theuns, D. A. M. J., additional, Van Den Broek, K. C., additional, Tekle, F. B., additional, Habibovic, M., additional, Alings, M., additional, Van Der Voort, P., additional, Denollet, J., additional, Vrazic, H., additional, Jilek, C., additional, Lesevic, H., additional, Tzeis, S., additional, Semmler, V., additional, Gold, M. R., additional, Burke, M. C., additional, Bardy, G. H., additional, Varma, N., additional, Pavri, B., additional, Stambler, B., additional, Michalski, J., additional, Investigators, T. R. U. S. T., additional, Safak, E., additional, Schmitz, D., additional, Konorza, T., additional, Wende, C., additional, Schirdewan, A., additional, Neuzner, J., additional, Simmers, T., additional, Erglis, A., additional, Gradaus, R., additional, Goetzke, J., additional, Coutrot, L., additional, Goehl, K., additional, Bazan Gelizo, V., additional, Grau, N., additional, Valles, E., additional, Felez, M., additional, Sanjuas, C., additional, Bruguera, J., additional, Marti-Almor, J., additional, Chu, S. Y., additional, Li, P. W., additional, Ding, W. H., additional, Schukro, C., additional, Leitner, L., additional, Siebermair, J., additional, Stix, G., additional, Pezawas, T., additional, Kastner, J., additional, Wolzt, M., additional, Schmidinger, H., additional, Behar, N. A. T. H. A. L. I. E., additional, Kervio, G., additional, Petit, B., additional, Maison-Balnche, P., additional, Bodi, S., additional, Mabo, P., additional, Foley, P. W. X., additional, Mutch, E., additional, Brashaw-Smith, J., additional, Ball, L., additional, Leyva, F., additional, Kim, D. H., additional, Lee, M. J., additional, Lee, W. S., additional, Park, S. D., additional, Shin, S. H., additional, Woo, S. I., additional, Kwan, J., additional, Park, K. S., additional, Munetsugu, Y., additional, Tanno, K., additional, Kikuchi, M., additional, Ito, H., additional, Miyoshi, F., additional, Kawamura, M., additional, Kobayashi, Y., additional, Man, S., additional, Algra, A. M., additional, Schreurs, C. A., additional, Van Der Wall, E. E., additional, Cannegieter, S. C., additional, Swenne, C. A., additional, Iitsuka, K., additional, Kondo, T., additional, Goebbert, K., additional, Karossiene, Z., additional, Goldman, D., additional, Kallen, B., additional, Kerpi, E., additional, Sardo, J., additional, Arsenos, P., additional, Gatzoulis, K., additional, Manis, G., additional, Dilaveris, P., additional, Tsiachris, D., additional, Mytas, D., additional, Asimakopoulos, S., additional, Stefanadis, C., additional, Sideris, S., additional, Kartsagoulis, E., additional, Barbosa, O., additional, Marocolo Junior, M., additional, Silva Cortes, R., additional, Moraes Brandolis, R. A., additional, Oliveira, L. F., additional, Pertili Rodrigues De Resende, L. A., additional, Vieira Da Silva, M. A., additional, Dias Da Silva, V. J., additional, Hegazy, R. A., additional, Sharaf, I. A., additional, Fadel, F., additional, Bazaraa, H., additional, Esam, R., additional, Deshko, M. S., additional, Snezhitsky, V. A., additional, Stempen, T. P., additional, Kuroki, K., additional, Igawa, M., additional, Kuga, K., additional, Ferreira Santos, L., additional, Dionisio, T., additional, Nunes, L., additional, Machado, J., additional, Castedo, S., additional, Henriques, C., additional, Matos, A., additional, Oliveira Santos, J., additional, Kraaier, K., additional, Olimulder, M. A. G. M., additional, Galjee, M. A., additional, Van Dessel, P. F. H. M., additional, Van Der Palen, J., additional, Wilde, A. A. M., additional, Scholten, M. F., additional, Chouchou, F., additional, Poupard, L., additional, Philippe, C., additional, Court-Fortune, I., additional, Barthelemy, J.- C., additional, Roche, F., additional, Dolgoshey, T. S., additional, Madekina, G. A., additional, Sugiura, S., additional, Fujii, E., additional, Senga, M., additional, Dohi, K., additional, Sugiura, E., additional, Nakamura, M., additional, Ito, M., additional, Eitel, C., additional, Mendell, J., additional, Lasseter, K., additional, Shi, M., additional, Urban, L., additional, Hatala, R., additional, Hlivak, P., additional, De Melis, M., additional, Garutti, C., additional, Corbucci, G., additional, Mlcochova, H., additional, Maxian, R., additional, Arbelo, E., additional, Dogac, A., additional, Luepkes, C., additional, Ploessnig, M., additional, Chronaki, C., additional, Hinterbuchner, L., additional, Guillen, A., additional, Bun, S. S., additional, Latcu, D. G., additional, Franceschi, F., additional, Prevot, S., additional, Koutbi, L., additional, Ricard, P., additional, Saoudi, N., additional, Nazari, N., additional, Alizadeh, A., additional, Sayah, S., additional, Hekmat, M., additional, Assadian, M., additional, Ahmadzadeh, A., additional, Wnuk, M., additional, Jedrzejczyk-Spaho, J., additional, Kruszelnicka, O., additional, Piwowarska, W., additional, Fedorowski, A., additional, Burri, P., additional, Juul-Moller, S., additional, Melander, O., additional, Mitro, P., additional, Murin, P., additional, Kirsch, P., additional, Habalova, V., additional, Slaba, E., additional, Matyasova, E., additional, Barlow, M. A., additional, Blake, R. J., additional, Rostoff, P., additional, Wojewodka Zak, E., additional, Froidevaux, L., additional, Sarasin, F. P., additional, Louis-Simonet, M., additional, Hugli, O., additional, Yersin, B., additional, Schlaepfer, J., additional, Mischler, C., additional, Pruvot, E., additional, Occhetta, E., additional, Frascarelli, F., additional, Burali, A., additional, and Dovellini, E., additional

Published
2011
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17. Comparison of Incidence and Predictors of Left Bundle Branch Block After Transcatheter Aortic Valve Implantation Using the CoreValve Versus the Edwards Valve

Author

Silvia Ajello, Ottavio Alfieri, Santo Ferrarello, Massimo Slavich, Charis Costopoulos, Alessandro Sticchi, Matteo Montorfano, Irene Franzoni, Luca Testa, Manuela Giglio, Micaela Cioni, Andrea Radinovic, Marco Mussardo, Sandeep Basavarajaiah, Matteo Longoni, Antonio Colombo, Francesco Maisano, Alaide Chieffo, Simone Sala, Eustachio Agricola, Filippo Figini, Azeem Latib, Maurizio Taramasso, Francesco Giannini, Franzoni, I, Latib, A, Maisano, F, Costopoulos, C, Testa, L, Figini, F, Giannini, F, Basavarajaiah, S, Mussardo, M, Slavich, M, Taramasso, M, Cioni, M, Longoni, M, Ferrarello, S, Radinovic, A, Sala, S, Ajello, S, Sticchi, A, Giglio, M, Agricola, E, Chieffo, A, Montorfano, M, Alfieri, Ottavio, and Colombo, A.

Subjects
Male, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Sinus bradycardia, Bundle-Branch Block, Electrocardiography, Predictive Value of Tests, Internal medicine, Bradycardia, medicine, Humans, Aged, Cardiac catheterization, Heart Valve Prosthesis Implantation, Chi-Square Distribution, Bundle branch block, medicine.diagnostic_test, Left bundle branch block, business.industry, Incidence, Aortic Valve Stenosis, Right bundle branch block, medicine.disease, Surgery, Logistic Models, Treatment Outcome, First-degree atrioventricular block, Aortic Valve, Heart Valve Prosthesis, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrioventricular block
Abstract

Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p

Published
2013

18. Transcatheter valve-in-valve implantation with the Edwards SAPIEN in patients with bioprosthetic heart valve failure: the Milan experience

Author

Joanne Shannon, Azeem Latib, Letizia Bertoldi, Francesco Maisano, Micaela Cioni, Francesco Maria Sacco, Cosmo Godino, Antonio Grimaldi, Pietro Spagnolo, Ottavio Alfieri, Alaide Chieffo, Matteo Montorfano, Remo Daniel Covello, Antonio Colombo, Alfonso Ielasi, Filippo Figini, Marco Mussardo, Latib, A, Ielasi, A, Montorfano, M, Maisano, F, Chieffo, A, Cioni, M, Mussardo, M, Bertoldi, L, Shannon, J, Sacco, F, Covello, Rd, Figini, F, Godino, C, Grimaldi, A, Spagnolo, P, Alfieri, Ottavio, and Colombo, A.

Subjects
Male, Reoperation, Cardiac Catheterization, medicine.medical_specialty, Sedation, medicine.medical_treatment, Aortic Valve Insufficiency, Femoral vein, Postoperative Complications, Risk Factors, Interquartile range, Internal medicine, medicine, Humans, Heart valve, Aged, Cardiac catheterization, Bioprosthesis, Heart Valve Prosthesis Implantation, business.industry, Mortality rate, Acute kidney injury, Aortic Valve Stenosis, Femoral Vein, Middle Aged, medicine.disease, Prosthesis Failure, Clinical trial, medicine.anatomical_structure, Heart Valve Prosthesis, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Aims Reoperation for bioprosthetic heart valve failure is associated with significant morbidity and mortality, particularly in high-risk patients. Transcatheter valve-in-valve (VIV) implantation may offer a less invasive alternative. The aim of this study was to report our initial experience with transcatheter VIV implantation to treat degenerated tissue valves. Methods and results VIV implantation with the Edwards SAPIEN transcatheter heart valve (THV; Edwards Lifesciences Inc, Irvine, CA, USA) was performed in 18 high-risk patients (STS 8.2±5.2%; logistic EuroSCORE 37.4±20.8%) with symptomatic bioprosthetic failure (17 aortic, one mitral). Valve Academic Research Consortium (VARC) definitions were applied for endpoint adjudication. Transfemoral access was the preferred vascular approach (16 patients, with the mitral VIV delivered anterogradely through the femoral vein; one transaxillary and one transapical). The majority (83%) of procedures were performed under local anaesthesia and sedation. Device success was achieved in all but one patient who had a final transaortic gradient ≥20mmHg. Acute kidney injury occurred in three patients (Stage 3 in 1), life-threatening or major bleeding in four patients, while major vascular complications occurred in one patient. Permanent pacemaker implantation was required in two patients. There were no deaths or neurological events at 30-day follow-up. At a median follow-up of 11 months (interquartile range 6-16), the mortality rate was 5.6% and all patients were in NYHA class II or lower. Conclusions Transcatheter implantation of the Edwards THV within a degenerated aortic bioprosthesis, performed predominantly via the transfemoral route, is feasible and associated with good periprocedural and clinical outcomes in high-risk surgical patients.

Published
2012

19. Periprocedural and Short-Term Outcomes of Transfemoral Transcatheter Aortic Valve Implantation With the Sapien XT as Compared With the Edwards Sapien Valve

Author

Azeem Latib, Mauro Carlino, Ottavio Alfieri, Micaela Cioni, Pietro Spagnolo, Cosmo Godino, Francesco Maisano, Alaide Chieffo, Antonio Colombo, Kensuke Takagi, Matteo Montorfano, Annalisa Franco, Antonio Grimaldi, Giedrius Davidavicius, Marco Mussardo, Remo Daniel Covello, Alfonso Ielasi, Mussardo, M, Latib, A, Chieffo, A, Godino, C, Ielasi, A, Cioni, M, Takagi, K, Davidavicius, G, Montorfano, M, Maisano, F, Carlino, M, Franco, A, Covello, Rd, Spagnolo, P, Grimaldi, A, Alfieri, Ottavio, and Colombo, A.

Subjects
Male, medicine.medical_specialty, Time Factors, Femoral artery, Coronary Angiography, Prosthesis Design, Lower risk, Aortic valve replacement, medicine.artery, Internal medicine, Catheterization, Peripheral, Humans, Medicine, aortic valve replacement, Survival rate, Retrospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, transcatheter aortic valve implantation (TAVI), business.industry, aortic stenosis, Aortic Valve Stenosis, medicine.disease, Confidence interval, Surgery, Femoral Artery, Survival Rate, Treatment Outcome, medicine.anatomical_structure, Italy, Aortic valve stenosis, Relative risk, Preoperative Period, Cardiology, Female, business, Cardiology and Cardiovascular Medicine, Echocardiography, Transesophageal, Follow-Up Studies, Artery
Abstract

Objectives The aim of this study was to analyze the short-term outcomes after transcatheter aortic valve implantation with the Edwards Sapien THV (ESV), compared with the Sapien XT THV (SXT) (Edwards Lifesciences, Irvine, California). Background The SXT has been recently commercialized in Europe, but there are no studies analyzing the efficacy and safety of SXT, compared with ESV. Methods All consecutive patients (n = 120) who underwent transcatheter aortic valve implantation in our center via the transfemoral approach with either ESV (n = 66) or SXT (n = 54). Valve Academic Research Consortium endpoints were used. Results Mean age was 80 ± 8 years, and mean Logistic-European System for Cardiac Operative Risk Evaluation was 24.9 ± 17.0. The ilio-femoral artery minimal lumen diameter was smaller in patients treated with the SXT (7.27 ± 1.09 mm vs. 7.94 ± 1.08 mm, p = 0.002). Device success was high in both groups (96.3% vs. 92.4%, p = 0.45). Major vascular events were 3-fold lower in the SXT group (11.1% vs. 33.3%, relative risk: 0.40, 95% confidence interval: 0.28 to 0.57; p = 0.004). Life-threatening and major bleeding events were not significantly different between groups (18.5% vs. 27.3% and 35.2% vs. 40.9%, respectively). The SXT group had a lower 30-day Valve Academic Research Consortium combined safety endpoint (20.4% vs. 45.5%; relative risk: 0.44, 95% confidence interval: 0.24 to 0.80; p = 0.004). The 30-day mortality was 1.7% (n = 2). At 30 days, mean transaortic gradient was approximately 10 mm Hg in both groups and the aortic regurgitation was mild-to-moderate in 70.2% of SXT and 76.3% of ESV. Conclusions The new SXT valve has the same short-term performance as the ESV but seems to be associated with a lower risk of major vascular complications and thus has a broader clinical application.

Published
2011
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20. Computed tomography-based evaluation of aortic annulus, prosthesis size and impact on early residual aortic regurgitation after transcatheter aortic valve implantation

Author

Maurizio Taramasso, Micaela Cioni, Azeem Latib, Ottavio Alfieri, Marco Mussardo, Antonio Colombo, Nicola Buzzatti, Francesco Maisano, Buzzatti, N, Maisano, F, Latib, A, Cioni, M, Taramasso, M, Mussardo, M, Colombo, A, and Alfieri, Ottavio

Subjects
Male, Pulmonary and Respiratory Medicine, Cardiac Catheterization, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, Aortic Valve Insufficiency, Computed tomography, Regurgitation (circulation), Prosthesis, Internal medicine, Statistical significance, medicine, Humans, Cardiac skeleton, Aged, Retrospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, Annulus (mycology), Analysis of Variance, Ejection fraction, medicine.diagnostic_test, business.industry, General Medicine, Logistic Models, ROC Curve, Aortic Valve, Heart Valve Prosthesis, cardiovascular system, Cardiology, Female, Surgery, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES: Computed tomography (CT) is an increasingly utilized method for the evaluation of patient suitability for transcatheter aortic valve implantation (TAVI). The aim of this study was to analyse the role of CT in the choice of prosthesis and the prevention of residual aortic regurgitation (RAR). METHODS: From November 2007 to September 2010, 115 patients (median age 81 years, inter-quantile range (IQR) 76–85; median ejection fraction 55%, IQR 45–60; median logistic EuroSCORE 19.7, IQR 11.0–32.1) undergoing TAVI were evaluated with a pre-procedural CT. An aortic complex was evaluated with multi-planar reconstructions, and we defined significant early RAR as RAR ≥ 2, and prosthesis/annulus mismatch (PAM) as the ratio between prosthesis size and mean annular size. All analyses were conducted for the whole sample and then separately for the two types of prosthesis implanted. RESULTS: An Edwards-SAPIEN ® prosthesis was implanted in 62 patients (54.7%), and a Medtronic CoreValve ® in 52 (45.2%). Aortic annulus minimum and maximum diameters were 22.6 ± 2.1 and 26.0 ± 2.3 mm, respectively. The aortic annulus diameter and the length of the free edge of the aortic cusps were linearly related to a 1:1 ratio (P< 0.0001). Significant RAR (34 patients, 30%) appeared directly related to the annulus diameters (particularly maximum and medium diameters, P= 0.0003 and P= 0.0010, respectively) and cusp length (P= 0.0007) but inversely correlated with PAM (P= 0.0006). Prosthesis/annulus oversizing was associated with a reduction in RAR, with a cut-off of 7% as the limit below which RAR increases; moreover, we observed different cut-off values for the Edwards and CoreValve prostheses, although statistical significance was not reached for the CoreValve (respectively, 2% with P< 0.0001, 11% with P= 0.16). No association was found between PAM and possible PAM-related complications. CONCLUSIONS: CT evaluation prior to TAVI showed that RAR was directly correlated with aortic root dimensions (particularly maximum and medium annulus diameters and cusp lengths) and inversely correlated with PAM. Oversizing the prosthesis by at least 7% reduces the risk of RAR. CT is an essential and invaluable tool in the assessment of patients undergoing TAVI.

Published
2013

21. Predictors of moderate-to-severe paravalvular aortic regurgitation immediately after CoreValve implantation and the impact of postdilatation

Author

Francesco Maisano, Alaide Chieffo, Azeem Latib, Ottavio Alfieri, Rasha Al-Lamee, Cosmo Godino, Antonio Colombo, Kensuke Takagi, Matteo Montorfano, Marco Mussardo, Takagi, K, Latib, A, Al Lamee, R, Mussardo, M, Montorfano, M, Maisano, F, Godino, C, Chieffo, A, Alfieri, Ottavio, and Colombo, A.

Subjects
Male, medicine.medical_specialty, Cardiac Catheterization, Time Factors, medicine.medical_treatment, Aortic Valve Insufficiency, Regurgitation (circulation), Prosthesis Design, Prosthesis, Risk Assessment, Severity of Illness Index, Catheterization, Risk Factors, Internal medicine, medicine, Odds Ratio, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Chi-Square Distribution, business.industry, Vascular disease, valvular heart disease, General Medicine, Aortic Valve Stenosis, medicine.disease, Surgery, Echocardiography, Doppler, Color, Stenosis, Logistic Models, Treatment Outcome, Italy, Heart failure, Heart Valve Prosthesis, Cardiology, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business, Complication, Echocardiography, Transesophageal
Abstract

Objective: To investigate the predictors of moderate-to-severe aortic regurgitation (AR≥2+) after CoreValve implantation and evaluate the feasibility and safety of postdilatation in reducing the degree of AR. Background: Although transcatheter aortic valve implantation is an alternative treatment for high surgical risk patients with severe aortic stenosis, post-implantation paravalvular AR remains a complication. Methods: From July 2008 to July 2010, we enrolled 79 consecutive patients with severe aortic stenosis who underwent CoreValve implantation. Results: On univariable analysis, the predictors of AR≥2+ immediately after CoreValve implantation were: larger annulus size, low implantation, prosthesis mismatch, chronic renal insufficiency, a history of heart failure, and peripheral vascular disease. On multivariable analysis, the independent predictors of AR≥2+ were: larger annulus diameter (OR 1.78, 95%CI 1.25–2.55; P = 0.002), low implantation (OR 3.67, 95%CI 1.01–13.35, P = 0.05), and peripheral vascular disease (OR 3.54, 95%CI 1.19–10.56, P = 0.02). Post-CoreValve implantation, AR ≥ 2 was seen in 40.5% (32/79). Twenty-one patients underwent postdilatation with improvement in AR grade in the majority (17/21). Of the four patients who did not respond to postdilatation, two underwent valve-in-valve implantation. In one patient, the valve was pulled more proximally by the snare technique. The remaining 10 patients were treated conservatively. Conclusion: The appropriate strategy for treating patients with AR≥2+ depends on the causes and severity of AR post-TAVI. This study suggests that we should carefully select the size of CoreValve prosthesis to prevent prosthesis mismatch, especially when implanted in larger annulus sizes. For valves implanted in the appropriate position, postdilatation appears effective in reducing the degree of AR. © 2011 Wiley-Liss, Inc.

Published
2010

22. Outcomes after transcatheter aortic valve implantation with both Edwards-SAPIEN and CoreValve devices in a single center: the Milan experience

Author

Cosmo, Godino, Francesco, Maisano, Matteo, Montorfano, Azeem, Latib, Alaide, Chieffo, Iassen, Michev, Rasha, Al-Lamee, Marta, Bande, Marco, Mussardo, Francesco, Arioli, Alfonso, Ielasi, Micaela, Cioni, Maurizio, Taramasso, Irina, Arendar, Antonio, Grimaldi, Pietro, Spagnolo, Alberto, Zangrillo, Giovanni, La Canna, Ottavio, Alfieri, Antonio, Colombo, Godino, C, Maisano, F, Montorfano, M, Latib, A, Chieffo, A, Michev, I, Al Lamee, R, Bande, M, Mussardo, M, Arioli, F, Ielasi, A, Cioni, M, Taramasso, M, Arendar, I, Grimaldi, A, Spagnolo, P, Zangrillo, Alberto, La Canna, G, Alfieri, Ottavio, and Colombo, A.

Subjects
Aged, 80 and over, Heart Valve Prosthesis Implantation, Male, Cardiac Catheterization, Time Factors, Aortic Valve Stenosis, Prosthesis Design, Risk Assessment, Severity of Illness Index, Survival Analysis, Femoral Artery, Survival Rate, Logistic Models, Treatment Outcome, Italy, Thoracotomy, Risk Factors, Heart Valve Prosthesis, Axillary Artery, Humans, Female, Hospital Mortality, Aged, Retrospective Studies
Abstract

OBJECTIVES: Our aim was to assess clinical outcome after transcatheter aortic valve implantation (TAVI) performed with the 2 commercially available valves with 3 delivery approaches selected in a stepwise fashion.BACKGROUND: Limited data exist on the results of a comprehensive TAVI program using different valves with transfemoral, transapical, and transaxillary approaches for treatment of severe aortic stenosis.METHODS: We report 30-day and 6-month outcomes of high-risk patients consecutively treated in a single center with either the Medtronic-CoreValve (MCV) (Medtronic, Minneapolis, Minnesota) or Edwards-SAPIEN valve (ESV) (Edwards Lifesciences, Irvine, California) delivered via the transfemoral or transaxillary approaches and ESV via the transapical approach.RESULTS: A total of 137 patients underwent TAVI: 107 via transfemoral (46 MCV and 61 ESV), 15 via transaxillary (12 MCV and 3 ESV), and 15 via transapical approach. After the transfemoral approach, the procedural success rate was 93.5%, and major vascular complication rate was 20.6%. No intra-procedural deaths occurred. The procedural success rates of transapical and transaxillary approaches were 86.6% and 93.3%, respectively. The 30-day mortality rate was 0.9% in transfemoral group and 13.3% in transapical, and no deaths occurred after transaxillary access. Cumulative death rate at 6 months was 12.2% in transfemoral, 26.6% in transapical, and 18.2% in transaxillary groups. At multivariable analysis, logistic European System for Cardiac Operative Risk Evaluation, body surface area, and history of cerebrovascular disease were significantly associated with an increased risk of major adverse cardiac and cerebrovascular events.CONCLUSIONS: Routine TAVI using both MCV and ESV with a selection of approaches is feasible and allows treatment of a wide range of patients with good overall procedural success rates and 30-day and 6-month outcomes.

Published
2010

23. Frequency of slow coronary flow following successful stent implantation and effect of Nitroprusside

Author

John Cosgrave, Matteo Montorfano, Domenico Cianflone, Goran Stankovic, Cosmo Godino, Mauro Carlino, Attilio Maseri, Antonio Colombo, Marco Mussardo, Alaide Chieffo, Iassen Michev, Flavio Airoldi, Carlo Briguori, Airoldi, F, Briguori, C, Cianflone, Domenico, Cosgrave, J, Stankovic, G, Godino, C, Carlino, M, Chieffo, A, Montorfano, M, Mussardo, M, Michev, I, Colombo, A, and Cianflone, D.

Subjects
Male, Nitroprusside, medicine.medical_specialty, Vasodilator Agents, medicine.medical_treatment, Myocardial Infarction, Constriction, Pathologic, Coronary Artery Disease, Coronary Angiography, Angina Pectoris, Constriction, Blood Vessel Prosthesis Implantation, Nitroglycerin, Bolus (medicine), Predictive Value of Tests, Coronary Circulation, Internal medicine, medicine, Humans, Saphenous Vein, Prospective Studies, cardiovascular diseases, Myocardial infarction, Prospective cohort study, Aged, Aged, 80 and over, Analysis of Variance, business.industry, Stent, Thrombolysis, Middle Aged, medicine.disease, Stenosis, Logistic Models, Treatment Outcome, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, TIMI
Abstract

Nitroprusside (NTP) is used for the treatment of slow coronary flow (SCF) after coronary interventions. The wide variation in dosage, route, and timing of its administration in the reported studies prevents an objective assessment of its efficacy. We report the incidence and response to a standardized NTP protocol of SCF after successful stent implantation. Selective intracoronary administration of incremental doses (initial bolus of 80 microg incremented by 40 microg) of NPT was assessed in 21 patients who developed SCF in a series of 2,212 consecutive patients who underwent successful stent placement from January to October 2005. SCF was observed only in patients treated for acute myocardial infarction (AMI; 11.5%, 12 of 105) or saphenous vein graft (SVG) stenosis (8.2%, 9 of 109). An intracoronary bolus of nitroglycerin did not restore normal Thrombolysis In Myocardial Infarction (TIMI) flow in any patient. The first 80-microg dose of NTP restored normal TIMI flow in 58% of patients (7 of 12) with AMI and in 44% of patients (4 of 9)with SVG stenosis. The maximal dose (120/160 microg) restored normal TIMI flow in all remaining patients with AMI but in only 1 additional patient with SVG stenosis. At the end of the procedure, the percent decrease in corrected TIMI frame count was significantly larger in patients with AMI (-44+/-10%) than in those with SVG stenosis (-24+/-16%, p=0.02). In a large consecutive series of successful stent procedures, SCF was found only in patients with ST-elevation AMI (11.5%) or with a stenosed SVG (8.2%). In conclusion, the standardized protocol of intracoronary NTP administration succeeded in normalizing SCF in all patients with AMI but in only 5 of 9 patients with SVG stenosis. This latter subgroup requires other therapeutic strategies.

Published
2007

24. Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?

Author

Cafaro A, Rizzo F, Fischetti D, Quarta L, Mussardo M, Mandurino-Mirizzi A, Tondo A, Ciccone MM, Iacovelli F, and Colonna G

Abstract

Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.

Published
2023
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25. One-Year Results Following a Pre-Specified ABSORB Implantation Strategy in ST-Elevation Myocardial Infarction (BVS STEMI STRATEGY-IT Study).

Author

Ielasi A, Campo G, Cortese B, Leoncini M, Varricchio A, Brugaletta S, Favaretto E, Fineschi M, Piraino D, Calabria P, Granata F, Pisano F, Mussardo M, Latib A, and Tespili M

Subjects
Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Female, Humans, Italy, Male, Middle Aged, Prospective Studies, Prosthesis Design, Recurrence, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction mortality, Time Factors, Treatment Outcome, Absorbable Implants, Angioplasty, Balloon, Coronary instrumentation, ST Elevation Myocardial Infarction therapy
Abstract

Background: data from clinical experiences with Absorb bioresorbable scaffold (BRS) in STEMI raised concerns among clinicians about the device safety because a noteworthy scaffold thrombosis (ScT) rate was reported at early and long-term follow-up. Nevertheless, pre-specified technical suggestions of how to perform an optimal BRS procedure in STEMI were lacking. In this study we sought to assess the 1-year results following a pre-specified BRS implantation strategy in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI (pPCI)., Methods: This is a prospective, multicenter study on 505 STEMI patients undergoing pPCI with Absorb following a dedicated implantation protocol. The primary end-point (a device oriented composite end-point (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI) and ischemia-driven target lesion revascularization (ID-TLR) within 30 days) was already reported. We here present DOCE, its singular components and ScT rates (secondary end-points) at 1-year., Results: According to the study protocol direct Absorb implantation was feasible in 47 (9.3%) patients while post-dilatation was performed in 468 (92.7%) cases. The hierarchical DOCE rate at 1-year was 1.2% (0.4% cardiac death, 0.4% TV-MI and 0.8% ID-TLR) versus 0.6% at 30-day. Two episodes (0.4%) of ScT (one probable subacute and one late definite) were reported. At 1-year, 99.2% patients were on dual antiplatelet therapy (95% with ticagrelor or prasugrel)., Conclusions: A pre-specified Absorb implantation strategy in STEMI patients was associated with persistent low DOCE and ScT rates at 1-year. Longer term follow-up is needed to assess the role of this strategy on preventing very-late events (NCT02601781)., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Published
2019
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26. A Case of Very Late (3 Years) Transcatheter Heart Valve Thrombosis.

Author

Regazzoli D, Ancona MB, Mangieri A, Agricola E, Spagnolo P, Mussardo M, Colombo A, and Latib A

Subjects
Aged, Anticoagulants therapeutic use, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Cardiac Catheterization adverse effects, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation adverse effects, Humans, Male, Prosthesis Design, Thrombosis diagnostic imaging, Thrombosis drug therapy, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Warfarin therapeutic use, Aortic Valve Stenosis therapy, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Thrombosis etiology
Published
2016
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27. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve.

Author

Franzoni I, Latib A, Maisano F, Costopoulos C, Testa L, Figini F, Giannini F, Basavarajaiah S, Mussardo M, Slavich M, Taramasso M, Cioni M, Longoni M, Ferrarello S, Radinovic A, Sala S, Ajello S, Sticchi A, Giglio M, Agricola E, Chieffo A, Montorfano M, Alfieri O, and Colombo A

Subjects
Aged, Aortic Valve surgery, Bradycardia epidemiology, Bradycardia etiology, Bundle-Branch Block epidemiology, Cardiac Catheterization, Chi-Square Distribution, Electrocardiography, Female, Humans, Incidence, Logistic Models, Male, Predictive Value of Tests, Treatment Outcome, Aortic Valve Stenosis surgery, Bundle-Branch Block etiology, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects
Abstract

Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p <0.001). Persistent new-onset LBBB at discharge was not associated with overall (log-rank p = 0.42) or cardiovascular (log-rank p = 0.46) mortality. New-onset right bundle branch block was documented in 4.6% of patients (n = 11), with no statistically significant differences between the ESV and MCRS. In conclusion, new-onset LBBB is a frequent intraventricular conduction disturbance after TAVI with a higher incidence with the MCRS compared with the ESV. LBBB persists in most patients, but in this cohort, it was not a predictor of overall or cardiovascular mortality or permanent pacemaker implantation., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Published
2013
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28. Very long-term outcomes following drug-eluting stent implantation for unprotected left main coronary artery stenosis: a single center experience.

Author

Ielasi A, Latib A, Chieffo A, Takagi K, Mussardo M, Davidavicius G, Godino C, Carlino M, Montorfano M, and Colombo A

Subjects
Aged, Cohort Studies, Coronary Restenosis, Coronary Stenosis mortality, Female, Follow-Up Studies, Humans, Intra-Aortic Balloon Pumping, Kaplan-Meier Estimate, Long-Term Care, Male, Middle Aged, Percutaneous Coronary Intervention, Retrospective Studies, Risk Factors, Treatment Outcome, Coronary Stenosis therapy, Drug-Eluting Stents adverse effects, Drug-Eluting Stents statistics & numerical data
Abstract

Introduction and Objectives: Encouraging results at long-term follow-up have been reported from non-randomized registries and randomized trials following percutaneous coronary intervention with drug-eluting stent implantation for unprotected left main stenosis. However, information on very long-term (>5-year) outcomes is limited. The aim of this study was to assess the very long-term outcomes (6-years) following drug-eluting stent implantation for left main disease., Methods: All consecutive patients with unprotected left main stenosis electively treated with drug-eluting stent implantation, between March 2002 and May 2005, were analyzed according to the location of the left main lesion (distal bifurcation vs ostial/body)., Results: The study included 149 patients: 113 with distal bifurcation and 36 with ostial/body lesion. Triple-vessel disease was significantly higher in the distal than in the ostial/body group (52.2% vs 33.2%, P=.05). At 6-years of follow-up, the cumulative major adverse cardiovascular event rate was 41.6% (45.1% distal vs 30.6% ostial/body, P=0.1), including 18.8% any death (22.1% distal vs 8.3% ostial/body, P=.08), 3.4% myocardial infarction (3.5% distal vs 2.8% ostial/body, P=1), and 15.4% target lesion revascularization (18.6% distal vs 5.6% ostial/body, P=.06). The composite of cardiac death and myocardial infarction was 10.7% (13.3% distal vs 2.8% ostial/body, P=.1) while the definite/probable stent thrombosis rate was 1.4% (all in the distal group)., Conclusions: At 6-year clinical follow-up, percutaneous coronary intervention with drug-eluting stent implantation for unprotected left main disease was associated with acceptable rates of cardiac death, myocardial infarction and stent thrombosis. Favorable long-term outcomes in ostial/body lesions compared to distal bifurcation lesions were confirmed at long-term clinical follow-up., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Published
2013
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29. Computed tomography-based evaluation of aortic annulus, prosthesis size and impact on early residual aortic regurgitation after transcatheter aortic valve implantation.

Author

Buzzatti N, Maisano F, Latib A, Cioni M, Taramasso M, Mussardo M, Colombo A, and Alfieri O

Subjects
Aged, Aged, 80 and over, Analysis of Variance, Cardiac Catheterization, Female, Heart Valve Prosthesis Implantation adverse effects, Humans, Logistic Models, Male, ROC Curve, Retrospective Studies, Tomography, X-Ray Computed methods, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods
Abstract

Objectives: Computed tomography (CT) is an increasingly utilized method for the evaluation of patient suitability for transcatheter aortic valve implantation (TAVI). The aim of this study was to analyse the role of CT in the choice of prosthesis and the prevention of residual aortic regurgitation (RAR)., Methods: From November 2007 to September 2010, 115 patients (median age 81 years, inter-quantile range (IQR) 76-85; median ejection fraction 55%, IQR 45-60; median logistic EuroSCORE 19.7, IQR 11.0-32.1) undergoing TAVI were evaluated with a pre-procedural CT. An aortic complex was evaluated with multi-planar reconstructions, and we defined significant early RAR as RAR ≥ 2, and prosthesis/annulus mismatch (PAM) as the ratio between prosthesis size and mean annular size. All analyses were conducted for the whole sample and then separately for the two types of prosthesis implanted., Results: An Edwards-SAPIEN(®) prosthesis was implanted in 62 patients (54.7%), and a Medtronic CoreValve(®) in 52 (45.2%). Aortic annulus minimum and maximum diameters were 22.6 ± 2.1 and 26.0 ± 2.3 mm, respectively. The aortic annulus diameter and the length of the free edge of the aortic cusps were linearly related to a 1:1 ratio (P < 0.0001). Significant RAR (34 patients, 30%) appeared directly related to the annulus diameters (particularly maximum and medium diameters, P = 0.0003 and P = 0.0010, respectively) and cusp length (P = 0.0007) but inversely correlated with PAM (P = 0.0006). Prosthesis/annulus oversizing was associated with a reduction in RAR, with a cut-off of 7% as the limit below which RAR increases; moreover, we observed different cut-off values for the Edwards and CoreValve prostheses, although statistical significance was not reached for the CoreValve (respectively, 2% with P < 0.0001, 11% with P = 0.16). No association was found between PAM and possible PAM-related complications., Conclusions: CT evaluation prior to TAVI showed that RAR was directly correlated with aortic root dimensions (particularly maximum and medium annulus diameters and cusp lengths) and inversely correlated with PAM. Oversizing the prosthesis by at least 7% reduces the risk of RAR. CT is an essential and invaluable tool in the assessment of patients undergoing TAVI.

Published
2013
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30. Clinical and procedural predictors of suboptimal outcome after the treatment of drug-eluting stent restenosis in the unprotected distal left main stem: the Milan and New-Tokyo (MITO) registry.

Author

Takagi K, Ielasi A, Shannon J, Latib A, Godino C, Davidavicius G, Mussardo M, Ferrarello S, Figini F, Carlino M, Montorfano M, Chieffo A, Nakamura S, and Colombo A

Subjects
Aged, Angioplasty, Balloon, Coronary methods, Coronary Restenosis prevention & control, Coronary Vessels, Female, Follow-Up Studies, Humans, Italy epidemiology, Japan epidemiology, Male, Middle Aged, Myocardial Infarction mortality, Predictive Value of Tests, Proportional Hazards Models, Retrospective Studies, Risk Factors, Treatment Outcome, Angioplasty, Balloon, Coronary mortality, Coronary Artery Disease mortality, Coronary Artery Disease therapy, Coronary Restenosis mortality, Drug-Eluting Stents statistics & numerical data, Registries statistics & numerical data
Abstract

Background: Few data are available regarding the optimal revascularization strategy for unprotected distal left main coronary artery (UDLM) in-stent restenosis (ISR)., Methods and Results: Between April 2002 and December 2008, UDLM-ISR following drug-eluting stent (DES) implantation occurred in 92 of 474 patients (19.4%). Of these, 8 (8.7%) who underwent a coronary artery bypass graft (CABG) were excluded, and the remaining 84 (91.3%) who underwent percutaneous coronary intervention (PCI) (43 plain old balloon angioplasty [POBA] and 41 DES) were analyzed to assess the feasibility of PCI for UDLM-ISR. The overall cardiac death, myocardial infarction (MI), and major adverse cardiac events during the follow-up period (median, 24 months) occurred in 4, 2, and 31 patients, respectively. Repeat target lesion revascularization (TLR) occurred in 28 patients. The incidence of repeat TLR was higher following PCI with POBA than with DES (hazard ratio [HR], 2.79; 95% CI, 1.23-6.34; P=0.014). On Cox regression analysis, the independent predictors of repeat TLR were treatment with POBA (HR, 3.29; 95% CI, 1.41-7.69; P=0.006) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) >6 (HR, 2.53; 95% CI, 1.02-6.28; P=0.045). More complex lesions requiring a 2-stent strategy were associated with a higher occurrence of TLR for restenosis of the left circumflex coronary artery ostium (LCX-ISR) (HR, 2.51; 95% CI, 1.59-3.97; P=0.001) as well as repeat TLR for recurrent LCX-ISR (HR, 4.32; 95% CI, 0.97-19.20; P=0.05) compared to a 1-stent strategy. No cardiac death at 2 years occurred in patients with LCX-ISR., Conclusions: UDLM restenosis is better treated with DES than with POBA. The rate of recurrent ISR following repeat PCI was high, whereas the rates of MI and death were relatively low. Complex lesions requiring a 2-stent strategy had a higher recurrence rate at the ostial LCX but without an associated increased risk of MI and death.

Published
2012
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31. Incidence of overall bleeding in patients treated with intra-aortic balloon pump during percutaneous coronary intervention: 12-year Milan experience.

Author

Davidavicius G, Godino C, Shannon J, Takagi K, Bertoldi L, Mussardo M, Chieffo A, Arioli F, Ielasi A, Montorfano M, Latib A, and Colombo A

Subjects
Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary mortality, Chi-Square Distribution, Female, Hemorrhage mortality, Humans, Incidence, Intra-Aortic Balloon Pumping mortality, Italy, Kidney Diseases complications, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Punctures adverse effects, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Hemorrhage etiology, Intra-Aortic Balloon Pumping adverse effects
Abstract

Objectives: This study aims to report a "real-world" experience of in hospital complications and clinical outcome of a large cohort of consecutive patients who underwent percutaneous coronary intervention (PCI) with intra-aortic balloon pump counterpulsation (IABP) support, from a tertiary care center over a 12-year period., Background: The incidence of vascular complications in patients treated with PCI and IABP is expected to be higher due to simultaneous puncture of femoral arteries, larger IABP sheath size, and longer duration of IABP therapy., Methods: A total of 360 consecutive patients (mean age of 65.9 ± 11.2 years; 80.6% male) who required an IABP support during percutaneous PCI were classified into 3 groups: Urgent: 133 patients (36.9%) admitted with acute coronary syndrome in whom IABP therapy was started before urgent PCI; Emergent: 56 patients (15.6%) in whom emergent IABP insertion was required to manage hypotension during PCI; and Elective: 171 patients (47.5%) with stable angina pectoris in whom IABP was inserted before elective PCI. Overall bleeding was defined according to the newest the Bleeding Academic Research Consortium (BARC) definition criteria., Results: BARC bleeding occurred in 68 patients (19%), with the highest incidence noted in the Urgent group (31.1%), in comparison with the Emergent (26.8%) and Elective (7%) groups, p < 0.0001. Bleeding related to the IABP access site was 7.5%, which accounted for 82% of any access site-related bleeding. It was significantly higher in the Urgent group (12.8%) compared with the Elective (4.1%) and Emergent (5.4%) groups. At multivariate analysis, IABP treatment duration and renal impairment were the only independent predictors of BARC bleeding., Conclusions: Bleeding related to the IABP access site was significantly higher in the Urgent group and accounted for more than two-thirds of overall access site-related bleeding. IABP treatment duration and renal impairment were independent predictors of overall bleeding., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2012
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32. Transcatheter valve-in-valve implantation with the Edwards SAPIEN in patients with bioprosthetic heart valve failure: the Milan experience.

Author

Latib A, Ielasi A, Montorfano M, Maisano F, Chieffo A, Cioni M, Mussardo M, Bertoldi L, Shannon J, Sacco F, Covello RD, Figini F, Godino C, Grimaldi A, Spagnolo P, Alfieri O, and Colombo A

Subjects
Aged, Aortic Valve Insufficiency mortality, Aortic Valve Stenosis mortality, Bioprosthesis, Cardiac Catheterization, Female, Femoral Vein, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications mortality, Reoperation, Risk Factors, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation methods, Prosthesis Failure
Abstract

Aims: Reoperation for bioprosthetic heart valve failure is associated with significant morbidity and mortality, particularly in high-risk patients. Transcatheter valve-in-valve (VIV) implantation may offer a less invasive alternative. The aim of this study was to report our initial experience with transcatheter VIV implantation to treat degenerated tissue valves., Methods and Results: VIV implantation with the Edwards SAPIEN transcatheter heart valve (THV; Edwards Lifesciences Inc, Irvine, CA, USA) was performed in 18 high-risk patients (STS 8.2±5.2%; logistic EuroSCORE 37.4±20.8%) with symptomatic bioprosthetic failure (17 aortic, one mitral). Valve Academic Research Consortium (VARC) definitions were applied for endpoint adjudication. Transfemoral access was the preferred vascular approach (16 patients, with the mitral VIV delivered anterogradely through the femoral vein; one transaxillary and one transapical). The majority (83%) of procedures were performed under local anaesthesia and sedation. Device success was achieved in all but one patient who had a final transaortic gradient ≥20mmHg. Acute kidney injury occurred in three patients (Stage 3 in 1), life-threatening or major bleeding in four patients, while major vascular complications occurred in one patient. Permanent pacemaker implantation was required in two patients. There were no deaths or neurological events at 30-day follow-up. At a median follow-up of 11 months (interquartile range 6-16), the mortality rate was 5.6% and all patients were in NYHA class II or lower., Conclusions: Transcatheter implantation of the Edwards THV within a degenerated aortic bioprosthesis, performed predominantly via the transfemoral route, is feasible and associated with good periprocedural and clinical outcomes in high-risk surgical patients.

Published
2012
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33. A high dose of adenosine to induce transient asystole for valvuloplasty in patients undergoing transcatheter aortic valve implantation (TAVI): is it a valid alternative to rapid pacing? A prospective pilot study.

Author

Davidavicius G, Chieffo A, Shannon J, Arioli F, Ielasi A, Mussardo M, Takagi K, Maisano F, Montorfano M, Godino C, Latib A, and Colombo A

Subjects
Aged, Aged, 80 and over, Anti-Arrhythmia Agents adverse effects, Cardiac Output physiology, Cardiac Pacing, Artificial adverse effects, Dose-Response Relationship, Drug, Feasibility Studies, Female, Heart Arrest physiopathology, Humans, Male, Myocardial Ischemia epidemiology, Pilot Projects, Prospective Studies, Reproducibility of Results, Risk Factors, Treatment Outcome, Adenosine adverse effects, Aortic Valve, Aortic Valve Stenosis therapy, Cardiac Pacing, Artificial methods, Catheterization methods, Heart Arrest chemically induced, Heart Valve Prosthesis, Heart Ventricles physiopathology
Abstract

Background: Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine., Methods: The primary endpoint was successful valvuloplasty defined by complete balloon inflation and deflation across aortic valve during the transient asystole induced by adenosine. Secondary endpoints were defined as the failure of adenosine to induce asystole, the incidence of ventricular ectopic beats (VEB) during balloon inflation or deflation, and balloon displacement., Results: From November 2010 to January 2011, twenty consecutive patients who underwent TAVI were included. A balloon for valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n = 10) or high-dose (36 mg, n = 10) bolus of adenosine was administrated. A single bolus of adenosine-induced atrioventricular (AV) block (mean duration, 18.6 ± 6.6 seconds) followed by cardiac asystole in 16 patients (80%) (low-dose, n = 9). A successful BAV was achieved in 12 patients (60%) (low-dose, n = 8). Adenosine induced only bradycardia in 4 patients (20%) (low-dose, n = 1). A burst of VEB during BAV occurred in all patients. Balloon displacement occurred in 6 patients (37.5%)., Conclusion: BAV after administration of adenosine is feasible, safe, and may represent an option for high-risk TAVI patients in whom RRVP might not be well tolerated. The occurrence of ventricular ectopic contractions triggered by balloon inflation and deflations accounts for balloon displacement and crossover to RRVP.

Published
2011

34. Comparison of long-term clinical and angiographic outcomes following implantation of bare metal stents and drug-eluting stents in aorto-ostial lesions.

Author

Al-Lamee R, Ielasi A, Latib A, Godino C, Mussardo M, Arioli F, Figin F, Piraino D, Carlino M, Montorfano M, Chieffo A, and Colombo A

Subjects
Aged, Anastomosis, Surgical methods, Coronary Artery Disease diagnostic imaging, Coronary Restenosis diagnostic imaging, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Retrospective Studies, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Aorta, Thoracic surgery, Coronary Angiography, Coronary Artery Disease surgery, Coronary Restenosis epidemiology, Coronary Vessels surgery, Drug-Eluting Stents
Abstract

Percutaneous coronary intervention (PCI) to aorto-ostial (AO) lesions is technically demanding and associated with high revascularization rates. The aim of this study was to assess outcomes after bare metal stent (BMS) compared to drug-eluting stent (DES) implantation after PCI to AO lesions. A retrospective cohort analysis was conducted of all consecutive patients who underwent PCI to AO lesions at 2 centers. Angiographic and clinical outcomes in 230 patients with DES from September 2000 to December 2009 were compared to a historical control group of 116 patients with BMS. Comparison of the baseline demographics showed more diabetics (32% vs 16%, p = 0.001), lower ejection fractions (52.3 ± 9.7% vs 55.0 ± 11.5%, p = 0.022), longer stents (17.55 ± 7.76 vs 14.37 ± 5.60 mm, p <0.001), and smaller final stent minimum luminal diameters (3.43 ± 0.53 vs 3.66 ± 0.63 mm, p = 0.001) in the DES versus BMS group. Angiographic follow-up (DES 68%, BMS 66%) showed lower restenosis rates with DES (20% vs 47%, p <0.001). At clinical follow-up, target lesion revascularization rates were lowest with DES (12% vs 27%, p = 0.001). Cox regression analysis with propensity score adjustment for baseline differences suggested that DES were associated with a reduction in target lesion revascularization (hazard ratios 0.28, 95% confidence interval 0.15 to 0.52, p <0.001) and major adverse cardiac events (hazard ratio 0.50, 95% confidence interval 0.32 to 0.79, p = 0.003). There was a nonsignificantly higher incidence of Academic Research Consortium definite and probable stent thrombosis with DES (n = 9 [4%] vs n = 1 [1%], p = 0.131). In conclusion, despite differences in baseline characteristics favoring the BMS group, PCI with DES in AO lesions was associated with improved outcomes, with lower restenosis, revascularization, and major adverse cardiac event rates., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Published
2011
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35. Predictors of moderate-to-severe paravalvular aortic regurgitation immediately after CoreValve implantation and the impact of postdilatation.

Author

Takagi K, Latib A, Al-Lamee R, Mussardo M, Montorfano M, Maisano F, Godino C, Chieffo A, Alfieri O, and Colombo A

Subjects
Aged, Aged, 80 and over, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Stenosis diagnostic imaging, Chi-Square Distribution, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Feasibility Studies, Female, Humans, Italy, Logistic Models, Male, Odds Ratio, Prospective Studies, Prosthesis Design, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency therapy, Aortic Valve Stenosis therapy, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Catheterization, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation
Abstract

Objective: To investigate the predictors of moderate-to-severe aortic regurgitation (AR≥2+) after CoreValve implantation and evaluate the feasibility and safety of postdilatation in reducing the degree of AR., Background: Although transcatheter aortic valve implantation is an alternative treatment for high surgical risk patients with severe aortic stenosis, post-implantation paravalvular AR remains a complication., Methods: From July 2008 to July 2010, we enrolled 79 consecutive patients with severe aortic stenosis who underwent CoreValve implantation., Results: On univariable analysis, the predictors of AR≥2+ immediately after CoreValve implantation were: larger annulus size, low implantation, prosthesis mismatch, chronic renal insufficiency, a history of heart failure, and peripheral vascular disease. On multivariable analysis, the independent predictors of AR≥2+ were: larger annulus diameter (OR 1.78, 95%CI 1.25-2.55; P = 0.002), low implantation (OR 3.67, 95%CI 1.01-13.35, P = 0.05), and peripheral vascular disease (OR 3.54, 95%CI 1.19-10.56, P = 0.02). Post-CoreValve implantation, AR ≥ 2 was seen in 40.5% (32/79). Twenty-one patients underwent postdilatation with improvement in AR grade in the majority (17/21). Of the four patients who did not respond to postdilatation, two underwent valve-in-valve implantation. In one patient, the valve was pulled more proximally by the snare technique. The remaining 10 patients were treated conservatively., Conclusion: The appropriate strategy for treating patients with AR≥2+ depends on the causes and severity of AR post-TAVI. This study suggests that we should carefully select the size of CoreValve prosthesis to prevent prosthesis mismatch, especially when implanted in larger annulus sizes. For valves implanted in the appropriate position, postdilatation appears effective in reducing the degree of AR., (Copyright © 2011 Wiley-Liss, Inc.)

Published
2011
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36. Periprocedural and short-term outcomes of transfemoral transcatheter aortic valve implantation with the Sapien XT as compared with the Edwards Sapien valve.

Author

Mussardo M, Latib A, Chieffo A, Godino C, Ielasi A, Cioni M, Takagi K, Davidavicius G, Montorfano M, Maisano F, Carlino M, Franco A, Covello RD, Spagnolo P, Grimaldi A, Alfieri O, and Colombo A

Subjects
Aged, 80 and over, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Coronary Angiography, Echocardiography, Transesophageal, Female, Femoral Artery, Follow-Up Studies, Humans, Italy epidemiology, Male, Preoperative Period, Prosthesis Design, Retrospective Studies, Survival Rate trends, Time Factors, Treatment Outcome, Aortic Valve Stenosis surgery, Catheterization, Peripheral methods, Heart Valve Prosthesis Implantation methods
Abstract

Objectives: The aim of this study was to analyze the short-term outcomes after transcatheter aortic valve implantation with the Edwards Sapien THV (ESV), compared with the Sapien XT THV (SXT) (Edwards Lifesciences, Irvine, California)., Background: The SXT has been recently commercialized in Europe, but there are no studies analyzing the efficacy and safety of SXT, compared with ESV., Methods: All consecutive patients (n = 120) who underwent transcatheter aortic valve implantation in our center via the transfemoral approach with either ESV (n = 66) or SXT (n = 54). Valve Academic Research Consortium endpoints were used., Results: Mean age was 80 ± 8 years, and mean Logistic-European System for Cardiac Operative Risk Evaluation was 24.9 ± 17.0. The ilio-femoral artery minimal lumen diameter was smaller in patients treated with the SXT (7.27 ± 1.09 mm vs. 7.94 ± 1.08 mm, p = 0.002). Device success was high in both groups (96.3% vs. 92.4%, p = 0.45). Major vascular events were 3-fold lower in the SXT group (11.1% vs. 33.3%, relative risk: 0.40, 95% confidence interval: 0.28 to 0.57; p = 0.004). Life-threatening and major bleeding events were not significantly different between groups (18.5% vs. 27.3% and 35.2% vs. 40.9%, respectively). The SXT group had a lower 30-day Valve Academic Research Consortium combined safety endpoint (20.4% vs. 45.5%; relative risk: 0.44, 95% confidence interval: 0.24 to 0.80; p = 0.004). The 30-day mortality was 1.7% (n = 2). At 30 days, mean transaortic gradient was approximately 10 mm Hg in both groups and the aortic regurgitation was mild-to-moderate in 70.2% of SXT and 76.3% of ESV., Conclusions: The new SXT valve has the same short-term performance as the ESV but seems to be associated with a lower risk of major vascular complications and thus has a broader clinical application., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2011
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37. Long-term outcomes after the percutaneous treatment of drug-eluting stent restenosis.

Author

Latib A, Mussardo M, Ielasi A, Tarsia G, Godino C, Al-Lamee R, Chieffo A, Airoldi F, Carlino M, Montorfano M, and Colombo A

Subjects
Acute Coronary Syndrome etiology, Acute Coronary Syndrome therapy, Aged, Angina Pectoris etiology, Angina Pectoris therapy, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Chi-Square Distribution, Coronary Angiography, Coronary Restenosis diagnostic imaging, Coronary Restenosis etiology, Coronary Restenosis mortality, Female, Humans, Italy, Male, Middle Aged, Myocardial Infarction etiology, Myocardial Ischemia etiology, Myocardial Ischemia therapy, Proportional Hazards Models, Prosthesis Design, Registries, Retrospective Studies, Risk Assessment, Risk Factors, South Africa, Survival Analysis, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coronary Restenosis therapy, Drug-Eluting Stents
Abstract

Objectives: This study sought to evaluate the long-term angiographic and clinical outcomes after the treatment of drug-eluting stent in-stent restenosis (DES-ISR) based on the angiographic pattern of restenosis., Background: Long-term outcomes after percutaneous treatment of DES-ISR are unclear., Methods: This study performed a retrospective analysis of 481 consecutive de novo DES-ISR lesions (n = 392) treated percutaneously between August 2002 and July 2007. The lesions were divided based on the pattern of restenosis: focal (305; 63.4%), diffuse (120; 24.9%), and occlusive (56; 11.6%)., Results: The majority (65%) of patients had angina or ischemia on presentation and 13% had an acute coronary syndrome. Angiographic follow-up after treatment of DES-ISR was available in 65.5% of lesions. A second angiographic restenosis occurred in 29.1% of the focal group, 45.8% (p = 0.007) of the diffuse, and 65.6% (p < 0.0001) of the occlusive. The pattern of DES-ISR predicted the pattern of recurrence: occlusive reoccluded in 66.7%; diffuse recurred as diffuse or occlusive in 57.9%; focal as focal in 67.2%. During a median follow-up of 2.97 years (interquartile range: 2.37 to 3.89), major adverse cardiac events occurred in 32.8% of patients with no significant differences among the focal, diffuse, and occlusive groups (30.9%, 38.7%, 31.1%; p = 0.38). Diffuse restenosis was associated with a significantly higher target lesion revascularization rate compared with focal (27.1% vs. 15.8%; p = 0.008). A disparity between restenosis (65.6%) and target lesion revascularization (18.5%) rates for occlusive DES-ISR suggests that as many recurrent restenoses were occlusive, they were not retreated., Conclusions: DES-ISR identifies a high-risk cohort that is at an increased risk of events, in particular repeat revascularization, during long-term follow-up. The initial pattern of restenosis is the most important predictor of recurrent restenosis or the need for subsequent reintervention., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2011
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38. Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation.

Author

Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Mussardo M, Arioli F, Carlino M, Montorfano M, Chieffo A, and Colombo A

Subjects
Aged, Angioplasty, Balloon, Coronary instrumentation, Angioplasty, Balloon, Coronary mortality, Cardiopulmonary Resuscitation, Coronary Angiography, Coronary Artery Bypass, Coronary Vessels surgery, Embolization, Therapeutic, Female, Hemostatic Techniques, Hospital Mortality, Humans, Incidence, Italy, Logistic Models, Male, Middle Aged, Myocardial Infarction mortality, Recurrence, Retrospective Studies, Risk Assessment, Risk Factors, Thrombosis etiology, Time Factors, Treatment Outcome, Vascular System Injuries diagnostic imaging, Vascular System Injuries mortality, Vascular System Injuries therapy, Angioplasty, Balloon, Coronary adverse effects, Coronary Vessels injuries, Myocardial Infarction therapy, Vascular System Injuries etiology
Abstract

Objectives: The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention., Background: Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality., Methods: From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation., Results: Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤ 2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%., Conclusions: Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2011
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39. Clinical and angiographic outcomes after percutaneous recanalization of chronic total saphenous vein graft occlusion using modern techniques.

Author

Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Arioli F, Mussardo M, Piraino D, Figini F, Carlino M, Montorfano M, Chieffo A, and Colombo A

Subjects
Aged, Chronic Disease, Coronary Artery Bypass adverse effects, Coronary Restenosis therapy, Female, Follow-Up Studies, Graft Occlusion, Vascular therapy, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia surgery, Prospective Studies, Saphenous Vein physiopathology, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Angiography methods, Coronary Restenosis diagnostic imaging, Graft Occlusion, Vascular diagnostic imaging, Saphenous Vein transplantation, Stents, Transplantation Tolerance
Abstract

Poor long-term outcomes after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) of saphenous vein grafts (SVGs) have been reported. However, limited data are available evaluating the use of modern techniques in this group. The aim of the present study was to assess the efficacy and long-term outcomes of PCI in SVG CTO with the routine use of embolic protection devices and drug-eluting stents. A retrospective cohort analysis was conducted of all consecutive patients undergoing PCI to SVG CTO from May 2002 to July 2009 at 2 centers. The indication for PCI was the presence of angina or silent ischemia with evidence of inducible ischemia after functional testing in the territory supplied by the SVG, despite optimal medical therapy. We identified 34 patients with SVG CTO. Of the 34 patients, 23 (68%) underwent successful SVG recanalization with stent implantation. An embolic protection device was used in 78% and 95% of stents implanted were drug-eluting stents. No in-hospital major adverse cardiac events occurred in the successful PCI group; one myocardial infarction occurred in the unsuccessful group. At follow-up (median 18.0 months, interquartile range 10.4 to 48.3), 1 case of myocardial infarction had occurred in the successful group. The in-stent restenosis rate was 68% (n = 13), of which 77% were focal, with target vessel revascularization in 61%. In conclusion, despite the relatively low procedural success rates, the clinical outcomes after successful PCI to SVG CTO with modern techniques were favorable. The repeat revascularization rates were high; however, graft patency was achievable in most after reintervention., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Published
2010
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40. Outcomes after transcatheter aortic valve implantation with both Edwards-SAPIEN and CoreValve devices in a single center: the Milan experience.

Author

Godino C, Maisano F, Montorfano M, Latib A, Chieffo A, Michev I, Al-Lamee R, Bande M, Mussardo M, Arioli F, Ielasi A, Cioni M, Taramasso M, Arendar I, Grimaldi A, Spagnolo P, Zangrillo A, La Canna G, Alfieri O, and Colombo A

Subjects
Aged, Aged, 80 and over, Aortic Valve Stenosis mortality, Axillary Artery, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Cardiac Catheterization mortality, Female, Femoral Artery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Italy, Logistic Models, Male, Prosthesis Design, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Survival Analysis, Survival Rate, Thoracotomy, Time Factors, Treatment Outcome, Aortic Valve Stenosis therapy, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation
Abstract

Objectives: Our aim was to assess clinical outcome after transcatheter aortic valve implantation (TAVI) performed with the 2 commercially available valves with 3 delivery approaches selected in a stepwise fashion., Background: Limited data exist on the results of a comprehensive TAVI program using different valves with transfemoral, transapical, and transaxillary approaches for treatment of severe aortic stenosis., Methods: We report 30-day and 6-month outcomes of high-risk patients consecutively treated in a single center with either the Medtronic-CoreValve (MCV) (Medtronic, Minneapolis, Minnesota) or Edwards-SAPIEN valve (ESV) (Edwards Lifesciences, Irvine, California) delivered via the transfemoral or transaxillary approaches and ESV via the transapical approach., Results: A total of 137 patients underwent TAVI: 107 via transfemoral (46 MCV and 61 ESV), 15 via transaxillary (12 MCV and 3 ESV), and 15 via transapical approach. After the transfemoral approach, the procedural success rate was 93.5%, and major vascular complication rate was 20.6%. No intra-procedural deaths occurred. The procedural success rates of transapical and transaxillary approaches were 86.6% and 93.3%, respectively. The 30-day mortality rate was 0.9% in transfemoral group and 13.3% in transapical, and no deaths occurred after transaxillary access. Cumulative death rate at 6 months was 12.2% in transfemoral, 26.6% in transapical, and 18.2% in transaxillary groups. At multivariable analysis, logistic European System for Cardiac Operative Risk Evaluation, body surface area, and history of cerebrovascular disease were significantly associated with an increased risk of major adverse cardiac and cerebrovascular events., Conclusions: Routine TAVI using both MCV and ESV with a selection of approaches is feasible and allows treatment of a wide range of patients with good overall procedural success rates and 30-day and 6-month outcomes., (Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2010
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41. [Treatment of chronic total coronary occlusions by the subintimal tracking and reentry modified technique. The contrast-guided STAR technique].

Author

Garibaldi S, Godino C, Carlino M, Mussardo M, Latib A, Costanzo L, Tomasello D, Lo Schiavo AE, Evola R, Tamburino C, Galassi AR, and Colombo A

Subjects
Aged, Angioplasty, Balloon, Coronary instrumentation, Chronic Disease, Clinical Competence, Feasibility Studies, Female, Follow-Up Studies, Humans, Italy, Male, Middle Aged, Stents, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Drug-Eluting Stents, Radiography, Interventional
Abstract

Background: Previous data showed that recanalization of chronic total occlusions (CTO) with the subintimal tracking and reentry (STAR) technique is feasible. However, this technique is challenging and requires skilled operators to be performed. The aim of this study was to evaluate procedural and clinical outcomes of patients undergoing a contrast-guided STAR procedure., Methods: All consecutive patients (n=121) with coronary CTO treated with the contrast-guided STAR technique in three Italian centers were included in this study, after failure of conventional CTO approaches., Results: The right coronary artery was involved in 76.8%, with blunt morphology in 62.8%. Angiographic and procedural success rates were 82.6% and 64.4%, respectively, with a 69.4% rate of complete recanalization. Stent implantation was performed in 81.8% of cases, using drug-eluting stents in 94.4%. Procedural complications occurred in 7.4% of cases. During follow-up no episodes of myocardial infarction were observed, but one cardiac death (0.8%). No definite or probable stent thrombosis was reported. The overall rate of target lesion revascularization was 21.4%., Conclusions: This study demonstrated that the contrast-guided STAR technique appears to be a feasible and relatively safe procedure when performed as rescue technique after failure of conventional CTO approaches. However, this procedure is limited by a high rate of target lesion revascularization and a second procedure may be necessary to obtain a definitive result.

Published
2010

42. Frequency of slow coronary flow following successful stent implantation and effect of Nitroprusside.

Author

Airoldi F, Briguori C, Cianflone D, Cosgrave J, Stankovic G, Godino C, Carlino M, Chieffo A, Montorfano M, Mussardo M, Michev I, Colombo A, and Maseri A

Subjects
Aged, Aged, 80 and over, Analysis of Variance, Angina Pectoris physiopathology, Blood Vessel Prosthesis Implantation, Constriction, Pathologic physiopathology, Coronary Angiography, Coronary Artery Disease complications, Coronary Artery Disease surgery, Female, Humans, Logistic Models, Male, Middle Aged, Myocardial Infarction physiopathology, Nitroglycerin therapeutic use, Predictive Value of Tests, Prospective Studies, Saphenous Vein physiopathology, Saphenous Vein transplantation, Treatment Outcome, Coronary Artery Disease physiopathology, Coronary Circulation drug effects, Nitroprusside therapeutic use, Stents, Vasodilator Agents therapeutic use
Abstract

Nitroprusside (NTP) is used for the treatment of slow coronary flow (SCF) after coronary interventions. The wide variation in dosage, route, and timing of its administration in the reported studies prevents an objective assessment of its efficacy. We report the incidence and response to a standardized NTP protocol of SCF after successful stent implantation. Selective intracoronary administration of incremental doses (initial bolus of 80 microg incremented by 40 microg) of NPT was assessed in 21 patients who developed SCF in a series of 2,212 consecutive patients who underwent successful stent placement from January to October 2005. SCF was observed only in patients treated for acute myocardial infarction (AMI; 11.5%, 12 of 105) or saphenous vein graft (SVG) stenosis (8.2%, 9 of 109). An intracoronary bolus of nitroglycerin did not restore normal Thrombolysis In Myocardial Infarction (TIMI) flow in any patient. The first 80-microg dose of NTP restored normal TIMI flow in 58% of patients (7 of 12) with AMI and in 44% of patients (4 of 9)with SVG stenosis. The maximal dose (120/160 microg) restored normal TIMI flow in all remaining patients with AMI but in only 1 additional patient with SVG stenosis. At the end of the procedure, the percent decrease in corrected TIMI frame count was significantly larger in patients with AMI (-44+/-10%) than in those with SVG stenosis (-24+/-16%, p=0.02). In a large consecutive series of successful stent procedures, SCF was found only in patients with ST-elevation AMI (11.5%) or with a stenosed SVG (8.2%). In conclusion, the standardized protocol of intracoronary NTP administration succeeded in normalizing SCF in all patients with AMI but in only 5 of 9 patients with SVG stenosis. This latter subgroup requires other therapeutic strategies.

Published
2007
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