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2.
Can J Cardiol ; 35(9): 1114-1123, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202537

RESUMO

BACKGROUND: Chronic kidney disease (CKD) has a negative impact on outcomes after transcatheter aortic valve replacement (TAVR). Data on outcomes in renal transplant recipients (RTRs) undergoing TAVR are scarce. We compared the outcomes in RTRs undergoing TAVR with matched patients who have native kidneys and similar kidney function. METHODS: This retrospective cohort study used data from 16 TAVR centres (13,941 patients). The study cohort included 216 patients (72 RTRs and 144 matched controls). RESULTS: The mean estimated glomerular filtration rate (eGFR) was 39.2 ± 23.6 vs 44.5 ± 23.6 mL/min for RTRs and control patients (P = 0.149), with a similar CKD stage distribution. After TAVR, the eGFR declined among RTRs but remained stable for up to 1 year in controls (P = 0.021). Long-term hemodialysis was required in 19 (26.4%) RTRs and 20 (13.8%) controls (hazard ratio [HR] = 2.09 95% confidence interval [CI], 1.03-3.86; P = 0.039) and was most often initiated during the periprocedural period (14 RTRs vs 16 controls; P = 0.039). After a median follow-up of 2.3 years, risk of death (29.2% vs 31.9%) and death/hemodialysis (40.3% vs 36.8%) was similar between the groups. The contrast volume/eGFR ratio was the strongest predictor of hemodialysis initiation (odds ratio [OR] = 1.64; 95% CI, 1.36-1.97 per 1 unit increase; P < 0.001), with a greater effect among RTRs than controls (P for interaction = 0.022). CONCLUSION: s: TAVR appears safe in RTRs with mortality rates similar to matched patients with native kidneys. However, RTRs carry an increased risk of progressive renal impairment and need for hemodialysis initiation after TAVR. Our data highlight the importance of minimizing contrast load during TAVR, particularly in RTRs.

3.
Am J Cardiol ; 124(2): 183-189, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31104777

RESUMO

Microcatheter derived fractional flow reserve (FFRMC) system has an increased profile compared with pressure-wire derived fractional flow reserve (FFRW). Consequently, the FFRMC system itself may increase the degree of coronary artery stenosis and lower the measured FFR value. This can affect the diagnostic accuracy of the FFRMC system and inadvertently result in erroneous therapy for patients. Our aim was to evaluate the diagnostic accuracy FFRMC measurements and provide a means for clinicians to interpret individual FFRMC results with respect to FFRW. Correlation between FFR measurement techniques was analyzed in this lesion level analysis of 413 patients and 441 lesions from 6 studies. The reference standard to determine physiological significant stenosis was FFRW value ≤0.80. The mean values for FFRMC and FFRW were 0.80 ± 0.11 and 0.83 ± 0.09, respectively. Bland-Altman analysis demonstrated a bias toward overestimation of FFR by FFRMC (bias, -0.03 [0.05]). The overall lesion level diagnostic accuracy of the FFRMC system was 80.4% (95% confidence interval [CI] 76.2% to 84.0%). The diagnostic accuracy for FFRMC values <0.75, 0.75 to 0.85 and >0.85 were 83.7% (95% CI 71.4% to 92.4%), 72.3% (95% CI 59.8% to 75.6%), and 99.2% (95% CI 94.8% to 99.8%), respectively. Using the FFRW threshold of ≤0.80, 16.3% of lesions would have had inappropriate revascularization according to FFRMC measurements. Receiver-operating characteristics suggested the optimal cut-off value of FFRMC to determine ischemia was 0.78. In conclusion, the diagnostic accuracy of FFRMC varies markedly across the spectrum of disease with marked deterioration for values between 0.75 and 0.85. This may result in clinicians to inadvertently revascularize patients with FFR measurements >0.80.

4.
Cardiovasc Revasc Med ; 20(6): 535-536, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30826205

RESUMO

A 83-year-old female with severe aortic regurgitation (AR) and an horizontal ascending aorta was scheduled for a transcatheter aortic valve replacement. After the complete deployment, a Portico 29 mm valve embolized in the ascending aorta due to the unfavorable anatomy of the anchoring zone. A second Portico 29 mm was successfully implanted using the embolized valve for superior anchoring. The patient died 7 days after the procedure due to a retrograde aortic dissection. This case shows a rare but possible complication that occurs especially in unfavorable and complex aortic anatomies.

5.
JACC Cardiovasc Interv ; 11(15): 1519-1526, 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30093056

RESUMO

OBJECTIVES: This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). METHODS: Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length. RESULTS: Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 h after TAVR. The final analysis included 611 patients. Fifty-four patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 h following TAVR. Patients who required a late PPM implant had a wider QRS width (113 ± 25 ms vs. 105 ± 23 ms; p = 0.009) and a higher prevalence of baseline right bundle branch block (12.9% vs. 5.3%; p = 0.026) and were more likely to have a self-expandable valve implanted (51.8% vs. 31.9%; p = 0.003). The ΔPR was 40 ± 51 ms (p = 0.0001) and the ΔQRS was 22 ± 61 ms (p = 0.001). Multivariable analysis revealed that baseline right bundle branch block (odds ratio: 3.56; 95% confidence interval: 1.07 to 11.77; p = 0.037) and ΔPR (odds ratio for each 10-ms increase: 1.31; 95% confidence interval: 1.18 to 1.45; p = 0.0001) are independent predictors of delayed advanced conduction disturbances. CONCLUSIONS: This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR.

6.
Can J Cardiol ; 34(8): 1088.e1-1088.e2, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30056846

RESUMO

Surgical treatment of functional mitral regurgitation (MR) is usually based on the correction of both annular dilation and leaflet disease to minimize the risk of recurrence of MR at follow-up. This combined approach may also represent an interesting strategy during transcatheter mitral valve repair systems. We report a successful case of combined Cardioband (Edwards Lifesciences, Irvine, California) and MitraClip (Abbott, Santa Clara, California) implantation for the treatment of functional MR, with good acute and medium-term clinical and echocardiographic outcomes.

7.
Front Cardiovasc Med ; 5: 85, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30018969

RESUMO

Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.

8.
Minerva Cardioangiol ; 66(6): 735-743, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29963813

RESUMO

Tricuspid valve regurgitation has a high prevalence and, when severe, is associated with poor outcomes. Nevertheless, surgical repair or replacement (isolated or as a part of a combined procedure) is rarely performed due to high surgical risk. Therefore, there is a significant unmet clinical need for percutaneous transcatheter-based treatments. Significant development in percutaneous therapies for both aortic and mitral valve disease has been accomplished over the last two decades, while transcatheter therapies for the tricuspid valve are still at an early stage. We are today at a cross-road of new transcatheter devices that are becoming available for the treatment of tricuspid regurgitation; the current review evaluates the challenges that current and future technologies have to face in order to become a safer, less invasive and equally effective alternative to surgery.

9.
JACC Cardiovasc Interv ; 11(6): 517-528, 2018 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-29566796

RESUMO

As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.

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