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1.
Future Cardiol ; 13(3): 229-237, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28585899

RESUMO

AIM: To assess the prevalence and postprocedural evolution of cognitive impairment (CI) in patients undergoing transcatheter aortic valve implantation. METHODS: 62 patients were enrolled. Mini Mental state examination (MMSE), verbal memory test (VMT), visual search test (VST) and phonemic verbal fluency (PVF) were used to evaluate the cognitive status. CI was considered when a pathological result of MMSE was confirmed by VMT, VST and PVF. RESULTS: A total of 26.2% patients had CI at baseline. MMSE, VMT, VST and PVF were pathologic in 39, 16.1, 8.1 and 22.6% of the patients, respectively. Overall, no significant differences in cognitive function in any dimension were observed from baseline up to 1-year follow-up. CONCLUSION: CI is frequent in patients undergoing transcatheter aortic valve implantation, though the procedure does not forge cognitive status.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Transtornos Cognitivos/diagnóstico , Cognição , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Testes de Estado Mental e Demência , Projetos Piloto , Resultado do Tratamento
2.
Cardiovasc Revasc Med ; 18(6): 425-430, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28363682

RESUMO

PURPOSE: To evaluate the outcome of patients with an established indication for oral anticoagulation (OAC) undergoing coronary stent implantation (PCI-S) and stratified by the baseline risk of bleeding. MATERIAL AND METHODS: The database of the prospective, multicentre, observational WAR-STENT registry (ClinicalTrials.gov identifier NCT00722319) was analyzed and patients with atrial fibrillation and CHA2DS2-VASc score ≥2, mechanical heart valve, prior cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism who were treated with either triple (warfarin, aspirin and clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and clopidogrel) therapy, identified. Patients were then sorted into two groups at non-low and low risk of bleeding, as defined by an ATRIA score >3 and ≤3 respectively, and compared regarding major adverse cardiac and vascular events (MACVE) and bleeding. RESULTS: At 12-month follow up, MACVE were comparable in the two groups, whereas total, major and minor bleeding, as well as combined MACVE and total bleeding, were significantly more frequent in the non-low bleeding risk group. Upon Cox univariate and multivariable analysis, non-low bleeding risk category confirmed as an independent predictor of major bleeding. The choice of antithrombotic therapy however, appeared not to be influenced by the bleeding risk category at baseline. CONCLUSIONS: In patients with an established indication for OAC undergoing PCI-S, non-low bleeding risk category is the most potent independent predictor of major bleeding. Stratification of the bleeding risk at baseline should therefore be regarded as an indispensable process to be carried out before selection of the antithrombotic therapy.


Assuntos
Anticoagulantes/uso terapêutico , Doença da Artéria Coronariana/cirurgia , Hemorragia/prevenção & controle , Inibidores da Agregação de Plaquetas/uso terapêutico , Stents , Ticlopidina/análogos & derivados , Varfarina/uso terapêutico , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Clopidogrel , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Stents/efeitos adversos , Terapia Trombolítica , Ticlopidina/administração & dosagem , Ticlopidina/uso terapêutico , Resultado do Tratamento , Varfarina/administração & dosagem , Adulto Jovem
3.
Catheter Cardiovasc Interv ; 89(4): E145-E152, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26714429

RESUMO

OBJECTIVES: To evaluate the incidence, treatment, and outcomes of acute aortic regurgitation (ARR) complicating BAV. BACKGROUND: In the transcatheter aortic valve implantation (TAVI) era, there is an increase of percutaneous balloon aortic valvuloplasty (BAV) procedures with different indications. METHODS: From the prospective BAV registry of the University of Bologna, which has enrolled patients between the year 2000 and the present, we selected those who suffered intraprocedural AAR with overt hemodynamic instability. Worsening of baseline aortic insufficiency without hemodynamic collapse, treatment of degenerated biological valve prosthesis, and BAV performed within a planned TAVI procedure were excluded. The main endpoints were in-hospital and 30-day mortality. RESULTS: Out of 1517 BAVs, we identified 26 cases of AAR (1.7%). This complication occurred in 80.8% of cases after one or two balloon inflations. Mean transaortic gradient decreased from 50.6 ± 19.3 to 26.0 ± 14.4 mm Hg (p < 0.01). In 8(30.8%) patients, AAR spontaneously resolved within few minutes; in 18 cases, the operators had to perform a rescue maneuver to reposition a valve leaflet got stuck in the opening position (this maneuver was successful in 13/18 of the cases, 72.2%). Out of 5 persistent AAR, 3 were managed with emergency TAVI or surgery, while 2 were unresolved. In-hospital mortality was 15.4% (n = 4), whereas no more deaths occurred up to 30 days. CONCLUSIONS: AAR is a fearsome complication of BAV and portends a grim prognosis. In some cases, it can be resolved with appropriate technical maneuvers; in others, a rescue TAVI or surgical valve replacement may be necessary. © 2015 Wiley Periodicals, Inc.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias , Doença Aguda , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
4.
J Invasive Cardiol ; 27(12): E277-84, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26378413

RESUMO

AIMS: A sizable group of patients with symptomatic aortic stenosis can undergo neither surgical aortic valve replacement nor transcatheter aortic valve implantation. The aim of this study was to assess the potential role of repeated balloon aortic valvuloplasty (BAV) in these patients. METHODS: Within our local prospective BAV registry, we retrospectively selected 105 patients who underwent ≥2 BAV procedures between 2005 and 2012 because of persisting contraindications to definitive treatment after first BAV. In-hospital outcome and incidence of adverse events at 1, 2, and 3 years were assessed. Mean age was 84 ± 6 years, mean logistic EuroSCORE was 23.6 ± 13.4%. RESULTS: No intraprocedural deaths occurred. In-hospital events for the 224 BAV procedures were: myocardial infarction, 4%; stroke, 0.9%; vascular complications, 8% (1.8% major); and bleedings, 5.9% (life threatening, 0.9%; major, 1.8%). Acute aortic regurgitation occurred in 6 cases and was always resolved during procedures. Median follow-up was 785 days. Second BAVs showed fewer vascular complications (P<.001) and bleedings (P<.001). Bleedings (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.58-29.88) and vascular complications (OR, 4.8; 95% CI, 1.19-19.31) occurring after the first procedure were independent predictors for subsequent adverse events. All-cause mortality at 1, 2, and 3 years was 15.2%, 41.3%, and 57.2%. Hospital readmission for heart failure was 40.7% at 1-year follow-up, 61.7% at 2-year follow-up, and 77.6% at 3-year follow-up. CONCLUSION: BAV is associated with poor long-term clinical outcome. However, when no other therapeutic options are feasible, a strategy of repeated palliative BAV appears to be safe and is potentially associated with improved clinical outcomes.


Assuntos
Estenose da Valva Aórtica/terapia , Valvuloplastia com Balão/métodos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
6.
JACC Cardiovasc Imaging ; 8(5): 566-575, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25890582

RESUMO

OBJECTIVES: The aim of this study was to evaluate the pathophysiological features and response to primary percutaneous coronary intervention (PCI) of nonruptured/eroded plaque versus ruptured plaque as a cause of ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Autopsy series identified nonruptured/eroded plaque and ruptured plaque as the principal pathological substrates underlying coronary thrombosis in STEMI. The real incidence of different plaque morphologies, associated biological factors, superimposed thrombus, and their interaction with primary PCI remain largely unknown. METHODS: In a prospective study, 140 patients with STEMI underwent optical coherence tomography of the infarct-related artery (IRA) before PCI, after everolimus-eluting stent implantation and at 9-month follow-up. Histopathology and immunohistochemistry of thrombus aspirates and serum biomarkers were assessed at baseline. RESULTS: Culprit plaque morphology was adjudicated in 97 patients: 32 plaques (33.0%) with an intact fibrous cap (IFC), 63 (64.9%) plaques with a ruptured fibrous cap (RFC), and 2 (2.1%) spontaneous dissections. Patients with an IFC and RFC had similar clinical characteristics, and serum inflammatory and platelets biomarkers. An IFC presented more frequently with a patent IRA (56.2% vs. 34.9%; p = 0.047), and had fewer lipid areas (lipid-rich areas: 75.0% vs. 100.0%; p < 0.001) and less residual thrombus before stenting (white thrombus: 0.41 mm(3) vs. 1.52 mm(3); p = 0.001; red thrombus: 0 mm(3) vs. 0.29 mm(3); p = 0.001) with a lower peak of creatine kinase-myocardial band (66.6 IU/l vs. 149.8 IU/l; p = 0.025). At the 9-month optical coherence tomography, IFC and RFC had similar high rates of stent strut coverage (92.5% vs. 91.2%; p = 0.15) and similar percentage of volume obstruction (12.6% vs. 10.2%; p = 0.27). No significant differences in clinical outcomes were observed up to 2 years. CONCLUSIONS: In the present study, an IFC was observed at the culprit lesion site of one-third of STEMIs. IFC, compared with RFC, was associated with higher rates of patent IRA at first angiography, fewer lipid areas, and residual endoluminal thrombus. However, no difference in vascular response to everolimus-eluting stent was observed. (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty [OCTAVIA]; NCT01377207).


Assuntos
Doença da Artéria Coronariana/terapia , Trombose Coronária/terapia , Vasos Coronários/patologia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Placa Aterosclerótica , Idoso , Biomarcadores/sangue , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Trombose Coronária/sangue , Trombose Coronária/complicações , Trombose Coronária/patologia , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/metabolismo , Stents Farmacológicos , Everolimo/administração & dosagem , Feminino , Fibrose , Humanos , Imuno-Histoquímica , Mediadores da Inflamação/sangue , Itália , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Intervenção Coronária Percutânea/instrumentação , Estudos Prospectivos , Desenho de Prótese , Ruptura Espontânea , Trombectomia , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento
8.
Monaldi Arch Chest Dis ; 82(2): 68-74, 2014 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-25845089

RESUMO

Life expectancy in patients affected by cancer has recently increased because of early diagnosis and actual therapies. In recent years, Oncology and Cardiology developed a tight relationship because of common risk factors (i.e., obesity, smoking, alcool intake, etc...), and for preventing the prothrombotic status due to cancer and the potential cardiotoxicity of chemotherapy. Cardiotoxicity incidence is reported from 1% up to 70% in retrospective analyses of drug protocols, mainly representing by left ventricular dysfunction (both reversible or irreversible), but also by arrhythmias, hypertension, atrioventricular block, coronary spasm, and arterial or venous thromboembolism. The early detection of the chemoterapy induced cardiotoxicity is now mandatory and can be obtained through a proper patients selection for different treatments and a strict monitoring during the follow-up period. The role of biomarkers of early cardiac damage, mainly, troponin I and brain natriuretic peptide-BNP, has been recently challenged, and algorithms are currently available. In the present paper, we propose how to perform a cardiological evaluation of patients undergoing chemotherapy tailored by the known adverse effects of the drugs.


Assuntos
Cardiotoxicidade , Cardiopatias/diagnóstico , Comorbidade , Coração/efeitos dos fármacos , Cardiopatias/induzido quimicamente , Cardiopatias/epidemiologia , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia
10.
EuroIntervention ; 8(12): 1388-97, 2013 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-23680956

RESUMO

AIMS: The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the treatment of high-risk patients with severe aortic stenosis. This study describes the indications and long-term outcome of balloon aortic valvuloplasty (BAV) in recent years. METHODS AND RESULTS: Between 2000 and 2010, 415 consecutive patients at our institution underwent BAV. The number of BAV per year increased sharply after the introduction of TAVI. Patients were 77.5±10.9 years old and showed important comorbidities (average logistic EuroSCORE=23.9±15.3%). We identified four cohorts according to the indications: 1) bridge for TAVI (B-TAVI; n=162); 2) bridge for aortic valve replacement (B-AVR, n=97); 3) cardiogenic shock (n=23); 4) palliation (n=133). Baseline characteristics were significantly different among groups. In-hospital mortality was 5.1%, and occurred predominantly in patients who underwent BAV in the setting of cardiogenic shock (56.5% vs. around 2% in the other subgroups). Other major events were stroke (0.5%), major vascular complications (2.2%), and life-threatening bleedings (1.5%). The cumulative one-year and two-year mortality rates were 33.2% and 57.4%, respectively, with the highest incidence in the shock group (70.7% and 80.4%) and the lowest in the B-AVR group (21.7% and 38.4%). Rehospitalisation for heart failure was 26.3% at one-year and 47.2% at two-year follow-up. CONCLUSIONS: The number of BAV is increasing, mainly due to increased referral of high-risk patients and to the emerging indication of bridge for TAVI. In this complex population, BAV is relatively safe but two-year survival remains poor, and more effective and definitive treatments should be pursued in a timely fashion.


Assuntos
Estenose da Valva Aórtica/terapia , Valvuloplastia com Balão , Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Valvuloplastia com Balão/efeitos adversos , Valvuloplastia com Balão/mortalidade , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Distribuição de Qui-Quadrado , Comorbidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
11.
G Ital Cardiol (Rome) ; 14(4): 262-8, 2013 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-23567767

RESUMO

BACKGROUND: There is a paucity of epidemiological data on the prevalence of degenerative aortic stenosis (AS) after the recent demographic changes and in the present therapeutic era. We sought to assess the prevalence of AS in an elderly population of an Italian urban area and to derive an epidemiological estimate of AS prevalence on a larger scale. METHODS: Elderly people (aged 75-95 years) of a 26 000 inhabitants town were clinically screened by general practitioners and classified into four groups: (1) no signs of AS; (2) known AS; (3) suspected AS (on the basis of the presence of a systolic murmur); (4) prior aortic valve replacement (AVR). Group 2 and 3 patients underwent physical examination and transthoracic echocardiography to confirm or rule out the diagnosis of AS, and to assess main comorbidities. RESULTS: Among the eligible patients, 2203 (93.7%) had no sign of AS; 49 (2.1%) had known AS; in 74 (3.1%) there was a systolic murmur suggesting AS, and 26 (1.1%) had previous AVR because of AS. Ten patients refused further screening, therefore 113 patients underwent transthoracic echocardiography. Among them, degenerative aortic disease without stenosis was observed in 22, and 63 had confirmed AS (severe in 21). Important comorbidities were frequently diagnosed in these patients. Including patients with previous AVR, AS was confirmed in 89/2350 patients (3.8%). On a regional scale, based on the demographics of this area, we estimated a prevalence of severe AS of 2248 cases per million inhabitants. CONCLUSIONS: The prevalence of AS in a population aged 75-95 years was 3.8%, and it was not previously diagnosed in a sizable proportion. More attention for early diagnosis of AS in the elderly is warranted.


Assuntos
Estenose da Valva Aórtica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estenose da Valva Aórtica/patologia , Feminino , Humanos , Masculino , Prevalência
12.
Int J Cardiol ; 168(2): 1034-40, 2013 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-23164594

RESUMO

BACKGROUND: Limited data exist on renal complications of transcatheter aortic valve implantation (TAVI) within a comprehensive program using different valves with transfemoral, transapical, and trans-subclavian approach. METHODS: Prospective single-center registry of 102 consecutive patients undergoing TAVI using both approved bioprostheses and different access routes. The main objective was to assess the incidence, predictors and the clinical impact of acute kidney injury (AKI). AKI was defined according to the valve academic research consortium (VARC) indications. RESULTS: Mean age was 83.7 ± 5.3 years, logistic EuroSCORE 22.6 ± 12.4%, and STS score 8.2 ± 4.1%. Chronic kidney disease at baseline was present in 87.3%. Periprocedural AKI developed in 42 patients (41.7%): 32.4% stage 1, 4.9% stage 2 and 3.9% stage 3. The incidence of AKI was 66.7% in transapical, 30.3% in transfemoral, and 50% in trans-subclavian procedures. The only independent predictor of AKI was transapical access, with a hazard ratio (HR) between 4.57 and 5.18 based on the model used. Cumulative 1-year survival was 88.2%. At Cox regression analysis, the only independent predictor of 30-day mortality was diabetes mellitus (HR 7.05, 95% CI 1.07-46.32; p=0.042), whilst the independent predictors of 1-year death were baseline glomerular filtration rate<30 mL/min (HR 5.74, 95% CI 1.42-23.26; p=0.014) and post-procedural AKI 3 (HR 8.59, 95% CI 1.61-45.86, p=0.012). CONCLUSIONS: TAVI is associated with a high incidence of AKI. Although in the majority of the cases AKI is of mild entity and reversible, AKI 3 holds a strong negative impact on 1-year survival. The incidence of AKI is higher with transapical access.


Assuntos
Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
14.
Catheter Cardiovasc Interv ; 79(2): 315-21, 2012 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-21523882

RESUMO

OBJECTIVES: To assess safety and effectiveness of balloon aortic valvuloplasty (BAV) in patients with symptomatic severe aortic stenosis (AS) and significant aortic regurgitation. BACKGROUND: BAV is a palliative procedure that has possibly been underused in patients with symptomatic AS not suitable for surgical aortic valve replacement or transcatheter aortic valve implantation. Significant aortic regurgitation is commonly perceived as a contraindication to BAV. METHODS: Among 416 consecutive patients undergoing BAV at our Institution, 73 patients showed moderate or severe AR before the procedure. Demographics and baseline characteristics, as well as in-hospital clinical outcome, have been prospectively collected in a dedicated database. Transthoracic echocardiography was regularly performed in all patients undergoing BAV before the procedure and at hospital discharge. RESULTS: Patients had a high-risk profile, confirmed by advanced age (77.2 ± 11.8 years) and important comorbidity (logistic Euroscore 26.5 ± 16.3%). Advanced heart failure was present in 73.9%. Indication to BAV was cardiogenic shock in 9.6%, palliation in 31.5%, bridge in 58.9% of the patients. BAV was performed with standard retrograde approach. Aortic valve area increased from 0.62 ± 0.15 cm(2) at baseline to 0.83 ± 0.17 cm(2) before discharge (P < 0.001). The degree of AR was improved or unchanged in 65 patients (89%). In-hospital mortality was 6.9%, mainly limited to terminal patients. Symptomatic status at discharge was improved in all surviving patients. Acute AR occurred in seven patients; in five of them it was successfully resolved in the catheterization laboratory. CONCLUSIONS: When clinically indicated, BAV can be safely performed in patients with combined aortic stenosis and significant aortic regurgitation.


Assuntos
Insuficiência da Valva Aórtica/terapia , Cateterismo/métodos , Idoso , Insuficiência da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Cuidados Paliativos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Catheter Cardiovasc Interv ; 79(5): 712-9, 2012 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-22109957

RESUMO

OBJECTIVE: To ascertain incidence and predictors of new permanent pacemaker (PPM) following transcatheter aortic valve implantation (TAVI) with the self-expanding aortic bioprosthesis. BACKGROUND: TAVI with the Medtronic Corevalve (MCV) Revalving System (Medtronic, Minneapolis, MN) has been associated with important post-procedural conduction abnormalities and frequent need for PPM. METHODS: Overall, 73 consecutive patients with severe symptomatic AS underwent TAVI with the MCV at two institutions; 10 patients with previous pacemaker and 3 patients with previous aortic valve replacement were excluded for this analysis. Clinical, echocardiographic, and procedural data were collected prospectively in a dedicated database. A standard 12-lead ECG was recorded in all patients at baseline, after the procedure and predischarge. Decision to implant PPM was taken according to current guidelines. Logistic multivariable modeling was applied to identify independent predictors of PPM at discharge. RESULTS: Patients exhibited high-risk features as evidenced by advanced age (mean = 82.1 ± 6.2 years) and high surgical scores (logistic EuroSCORE 23.0 ± 12.8%, STS score 9.4 ± 6.9%). The incidence of new PPM was 28.3%. Interventricular septum thickness and logistic Euroscore were the baseline independent predictors of PPM. When procedural variables were included, the independent predictors of PPM were interventricular septum thickness (OR 0.52; 95% CI 0.32-0.85) and the distance between noncoronary cusp and the distal edge of the prosthesis (OR 1.37; 95% CI 1.03-1.83). CONCLUSIONS: Conduction abnormalities are frequently observed after TAVI with self-expandable bioprosthesis and definitive pacing is required in about a third of the patients, with a clear association with depth of implant and small interventricular septum thickness.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Bioprótese , Estimulação Cardíaca Artificial/métodos , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Ligas , Análise de Variância , Estenose da Valva Aórtica/mortalidade , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Estimulação Cardíaca Artificial/estatística & dados numéricos , Estudos de Coortes , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Itália , Modelos Logísticos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Análise Multivariada , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Desenho de Prótese , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
16.
EuroIntervention ; 7(6): 723-9, 2011 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-21986330

RESUMO

AIMS: Many inoperable patients with severe aortic stenosis (AS) are not immediately eligible for transcatheter aortic valve implantation (TAVI). We evaluated the role of percutaneous balloon aortic valvuloplasty (BAV) in this setting. METHODS AND RESULTS: Among 210 consecutive patients referred to our institution for BAV, we identified three groups: immediately eligible for TAVI (n=65, 31%), excluded from TAVI (n=67, 32%), BAV as a bridge to TAVI (n=78, 37%). This last group comprised patients with low left ventricular ejection fraction, frailty or enfeebled status, symptoms of uncertain origin, critical conditions, moderate-to-severe mitral valve regurgitation, need of major non-cardiac surgery. Outpatient clinic visit and echocardiography were performed around one month after BAV to decide the final therapeutic strategy. Mean age was 81±8 years and the vast majority of patients had comorbidities and high-risk features. The incidence of periprocedural adverse events was 6.4%: 5.1% death (four patients: one procedural complication, three, natural disease progression), 1.3% minor stroke. After BAV, 46% of these patients were deemed eligible for TAVI, and 28% for cardiac surgery. Patients who underwent TAVI after bridge BAV showed 94% 30-day survival. CONCLUSIONS: BAV is a safe and effective tool to bridge selected patients to TAVI when indications are not obvious.


Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco , Cateterismo , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Cateterismo Cardíaco/mortalidade , Cateterismo/efeitos adversos , Cateterismo/mortalidade , Distribuição de Qui-Quadrado , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
17.
Future Cardiol ; 7(3): 321-31, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21627474

RESUMO

Inoperable or high-risk patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI) have better outcomes compared with those treated with standard medical therapy. As for any other invasive procedure, peri-procedural complications may occur, reducing the procedural success rate and potentially affecting short- and mid-term outcomes. The transfemoral approach prevails over other possible access-site options in most registries. The use of large introducer sheaths and the need for double arterial vascular access can lead to higher rates of vascular complications in this elderly population, with a high prevalence of baseline peripheral artery disease. In this article, we review the results of recent clinical trials and major registries using the two different bioprosthesis currently available for TAVI, focusing on access site-related complications with transfemoral TAVI, their management and relationship with in-hospital and 30-day survival. Awareness of the mechanisms behind these complications might help in their prevention, recognition and management and may ultimately improve the clinical outcome of TAVI procedures.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Feminino , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Itália , Assistência Perioperatória , Prevalência , Prognóstico , Fatores de Risco
18.
Rev. bras. cardiol. invasiva ; 19(1): 24-27, mar. 2011.
Artigo em Português | LILACS | ID: lil-591714

RESUMO

Introdução: O implante transcateter de prótese valvular aórtica (ITVA) tem sido utilizado em nosso meio e em diversos países do mundo como alternativa ao tratamento conservador em pacientes com estenose aórtica grave e elevado risco cirúrgico. Objetivou-se descrever o perfil clínico basal e a mortalidade a curto e médio prazos de uma série consecutiva de casos tratados com ITVA em dois centros localizados, respectivamente, na Itália e no Brasil. Métodos: A população de estudo foi composta pelos primeiros 75 pacientes consecutivos com estenose valvar aórtica grave tratados com a prótese Medtronic CoreValve TM Revalving System (MCV – Medtronic, Minneapolis, Estados Unidos). Tipicamente, a indicação para o ITVA foi motivada pelo alto risco cirúrgico. A média de idade era de 82 anos, 55% eram mulheres, um terço apresentava doença pulmonar grave e 95% apresentavam insuficiência cardíaca sintomática. Resultados: Após o ITVA, houve redução significativa do gradiente transvalvar aórtico máximo (basal: 95,8 + 32,3 mmHg; pós-procedimento: 18,5 + 6,1 mmHg) e médio (basal: 45,9 + 16,9 mmHg; pós-procedimento: 10,4 + 5,2 mmHg) (P < 0,01 para ambos). Insuficiência aórtica moderada ou acentuada foi evidenciada em 7% dos casos após ITVA. A taxa de sobrevida global aos 30 dias foi de 91,6% e aos 12 meses, de 79%. Conclusões: O ITVA surge como um método terapêutico de grande relevância para portadores de estenose aórtica de alto risco cirúrgico. As taxas de sobrevida precoce e a médio prazo indicam o benefício potencial do novo procedimento também para pacientes tratados no chamado mundo real.


Background: Transcatheter aortic valve implantation (TAVI) has been used in our country and in several differentcountries worldwide as an alternative to conservative treatment for patients with severe aortic stenosis and high surgicalrisk. This paper aimed at describing the baseline clinical profile and the short and medium-term mortality of a consecutive series of cases treated with TAVI in two centers in Italy and Brazil, respectively. Methods: The study population included the first 75 consecutive patients with severeaortic stenosis treated with the Medtronic CoreValveTM Revalving System (MCV – Medtronic, Minneapolis, USA). Typically, the indication for TAVI was motivated by high surgical risk. Mean age was 82 years, 55% were females, a third had severe lung disease, and 95% had symptomaticheart failure. Results: TAVI was associated with a significant reduction of peak (baseline: 95.8 + 32.3 mmHg; postprocedure: 18.5 + 6.1 mmHg) and mean (baseline: 45.9 + 16.9 mmHg; post-procedure: 10.4 + 5.2 mmHg) transaortic gradient (P < 0.01 for both). Moderate or severe aortic insufficiencywas observed in 7% of the cases. The overall survival rate at 30 days was 91.6% and at 12 months it was 79%.Conclusions: TAVI emerges as an important therapeutic option for high risk patients with aortic stenosis. The short and mediumterm survival rates suggest that the new procedure might beof benefit for patients treated in the real world context.


Assuntos
Humanos , Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Aspirina/administração & dosagem , Cateterismo , Heparina/administração & dosagem
19.
J Cardiovasc Med (Hagerstown) ; 11(10): 727-32, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20414120

RESUMO

OBJECTIVE: We sought to assess what proportion of patients with severe symptomatic aortic stenosis who are excluded from cardiac surgery are eligible for transcatheter aortic valve implantation (TAVI). METHODS: Between July 2007 and December 2008, 98 patients with severe symptomatic aortic stenosis judged inoperable were referred to our institution for percutaneous aortic balloon valvuloplasty (PABV). They entered a screening for TAVI with the CoreValve Revalving System or the Edwards-Sapien valve, comprising general clinical evaluation, echocardiogram, coronary angiography, angiography and angio-CT scan of thoracic aorta and ilio-femoral axes. RESULTS: Mean patients' age was 82 +/- 7 years; the vast majority presented relevant comorbidities. Mortality risk predicted by the logistic European System for Cardiac Operative Risk Evaluation was on average 25.3 +/- 14.5%. Overall, 45 (45.9%) patients met the criteria for TAVI: 29.6% for percutaneous transfemoral access, 6.1% for trans-subclavian and 10.2% for transapical approaches. Reason for exclusion was severe noncardiac comorbidity in around half of the cases. PABV allowed re-classification of several patients with very poor left ejection fraction and severe mitral regurgitation. Among the 39 patients undergoing TAVI after the screening, in-hospital mortality was 3.7% for transfemoral and 0 for trans-subclavian and transapical approaches. CONCLUSIONS: TAVI represents a viable therapeutic option for elderly patients with severe symptomatic aortic stenosis who are not candidates for surgical aortic valve replacement. However, presently less than half of them actually fulfil the criteria for these procedures.


Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco , Cateterismo , Definição da Elegibilidade , Implante de Prótese de Valva Cardíaca/métodos , Seleção de Pacientes , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/mortalidade , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Itália , Masculino , Guias de Prática Clínica como Assunto , Desenho de Prótese , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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