Matteo Montorfano - Academia.edu (original) (raw)

Papers by Matteo Montorfano

Research paper thumbnail of TCT-866 Transcatheter Aortic Valve Implantation in Patients With Bicuspid Aortic Valve Disease: Results from the Milan Registry

Journal of the American College of Cardiology, 2012

Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patie... more Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patients with severe symptomatic tricuspid aortic valve stenosis. However, the role of TAVI in the treatment of the stenosed bicuspid aortic valve has not been clearly demonstrated. Methods: Consecutive patients with bicuspid aortic valve disease in our center treated with TAVI from November 2007 to May 2012 were included. All data was collected from a comprehensive prospective database and events were adjudicated according to the Valve Academic Research Consortium (VARC) definitions. Results: In total, 8 patients undergoing TAVI were identified to have an anatomical bicuspid aortic valve. The mean age was 75.8 Ϯ 5.5 years and 75.0% were female. The patients were deemed high risk for surgery, with a median STS score of 6.5 (interquartile range [IQR] 3.7-13.8). Of the patients nϭ5 (62.5%) underwent implantation of the Medtronic CoreValve® ReValving system device (Medtronic Inc., Minneapolis, MN) and nϭ3 (37.5%) the Edwards SAPIEN™/SAPIEN XT™ (Edwards Lifesciences, Irvine, California). At 30 days, there were 2 deaths, both secondary to aortic dissection (one peri-procedural and one 24 hours post-procedure). There were no events of myocardial infarction or stroke. With regards to the procedure, there were no cases of device embolization. The overall VARC device success was nϭ6 (75.0%), with both failures due to residual significant aortic regurgitation. At a median of 435 (IQR 399-507) days follow-up, there was one further death secondary to hepatic failure. One other patient was readmitted to hospital at day 75 due to acute cardiac compensation. This resulted in a combined efficacy endpoint of 50.0% at follow-up. Conclusions: Despite small numbers, the outcomes of TAVI for the stenosed bicuspid aortic valve may not be optimal and hence require further investigation prior to this becoming an acceptable treatment option in this group of patients.

Research paper thumbnail of Impella implantation as a rescue strategy in balloon aortic valvuloplasty complicated by acute aortic regurgitation

Journal of Cardiovascular Medicine

Research paper thumbnail of Role of Different Antithrombotic Regimens after Percutaneous Left Atrial Appendage Occlusion: A Large Single Center Experience

Journal of Clinical Medicine

Background: Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still n... more Background: Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still not clear. The aim of this study was to investigate the role of different antithrombotic regimens after the procedure. Methods and Results: We retrospectively analyzed data of 260 patients who underwent LAA occlusion and divided them into four groups according to therapy at discharge: dual antiplatelet therapy (group A, 71.5%); oral anticoagulants (group B, 19%); “minimal” antithrombotic therapy (single antiplatelet agent or without any antithrombotic therapy; group C, 4.5%) and other therapeutic regimens (such as a combination of antiplatelets and anticoagulants; group D, 4.5%). We analyzed baseline characteristics, procedural data, and clinical and transesophageal follow-up for each group. The incidence of adverse events was low in the whole population and had a similar distribution among groups. The majority of bleeding events was registered during the first 3 months after the procedur...

Research paper thumbnail of Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Journal of Cardiovascular Development and Disease

Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-... more Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.0...

Research paper thumbnail of Percutaneous Direct Annuloplasty With Edge-to-Edge Technique for Mitral Regurgitation: Replicating a Complete Surgical Mitral Repair in a One-Step Procedure

The Canadian journal of cardiology, 2018

Surgical treatment of functional mitral regurgitation (MR) is usually based on the correction of ... more 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.

Research paper thumbnail of Echocardiographic features of post-transcatheter aortic valve implantation thrombosis and endocarditis

Echocardiography (Mount Kisco, N.Y.), Mar 1, 2018

Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications ... more Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics. To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected. Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features. Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Inter...

Research paper thumbnail of Severe Mitral Stenosis and Persistent Left Appendage Thrombosis: When an Old Percutaneous Solution Meets New Percutaneous Strategies

JACC. Cardiovascular interventions, Jan 22, 2018

Research paper thumbnail of Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection

European heart journal cardiovascular Imaging, Jan 6, 2018

A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced.... more A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones. One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85...

Research paper thumbnail of Coronary Sinus Reducer Implantation for the Treatment of Chronic Refractory Angina: A Single-Center Experience

JACC. Cardiovascular interventions, Jan 23, 2018

The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort... more The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina. The coronary sinus Reducer is a novel device to aid in the management of patients with severe angina symptoms refractory to optimal medical therapy and not amenable to further revascularization. Fifty patients with refractory angina and objective evidence of myocardial ischemia who were judged unsuitable for revascularization were treated with coronary sinus Reducer implantation at a single center between March 2015 and August 2016. Safety endpoints were procedural success and the absence of device-related adverse events. Efficacy endpoints, assessed at 4- and 12-month follow-up, were a reduction in Canadian Cardiovascular Society angina class, improvement in quality of life assessed using the Seattle Angina Questionnaire, improvement in exercise tolerance assessed using the 6-min walk test, and reduction in pharmacological antianginal ther...

Research paper thumbnail of Percutaneous left atrial appendage occlusion with the Amulet device: The impact of device disc position upon periprocedural and long-term outcomes

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 5, 2018

To investigate the effect of left atrial appendage (LAA) occlusion device positioning upon peripr... more To investigate the effect of left atrial appendage (LAA) occlusion device positioning upon periprocedural and long-term outcomes. The Amulet device is designed to cover the ostium of the LAA. Prolapse of the device into the neck of the LAA is not uncommon resulting in incomplete coverage of the ostium. The clinical consequences of this remain uncertain. Outcomes of 87 patients with successful LAA closure were analyzed according to Amulet disc position: group A (n = 45) had complete LAA ostium coverage; group B (n = 42) had incomplete ostium coverage because of disc prolapse. Periprocedural major adverse events (MAE) (composite of all cause death, tamponade, device/air embolization, cerebrovascular events, myocardial infarction, and major bleeding not related to vascular access complications) and total device-related periprocedural adverse events (defined as MAE and pericardial effusion) were evaluated. All patients were followed up longitudinally with long-term events defined as a c...

Research paper thumbnail of Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 H) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement

JACC. Cardiovascular interventions, Jan 13, 2018

This study sought to determine predictors of advanced conduction disturbances requiring late (≥48... more This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). 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. 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...

Research paper thumbnail of Supra-Annular Transcatheter Aortic Valve Position May Correct Annular Under-Expansion Due to Valvular Asymmetry

Circulation journal : official journal of the Japanese Circulation Society, 2018

Research paper thumbnail of Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 4, 2018

This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) d... more This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side c...

Research paper thumbnail of Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry

International Journal of Cardiology

Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of smal... more Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis &gt; 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.

Research paper thumbnail of Observed versus predicted mortality after MitraClip treatment in patients with symptomatic heart failure and significant functional mitral regurgitation

European journal of heart failure, Jan 23, 2018

Research paper thumbnail of Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy

International journal of cardiology, Jan 12, 2018

MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patient... more MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patients with severe functional mitral regurgitation (FMR) due to dilated cardiomyopathy (DCM). Limited data are available regarding MitraClip outcomes comparing patients with ischemic and non-ischemic DCM. From 2008 to 2016, 314 patients received MitraClip for FMR at four institutions: Brescia, Zurich and Milan. Patients were stratified according to MR aetiology in non-ischemic FMR (n = 99) and ischemic FMR (n = 215). Preoperative risk factors, operative variables and outcomes up to 2-year were evaluated. A multivariable Cox Proportional Hazards survival model with covariate adjustments was used to assess the relationship between FMR aetiology and 2-year cardiac mortality. As expected, patients with ischemic FMR had significantly more risk factors and comorbidities. Overall procedural success rate was 80% and in-hospital cardiac mortality was 3% without significant differences between aetiolog...

Research paper thumbnail of Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: The LAAO Italian Multicenter Registry

JACC. Cardiovascular interventions, Jan 11, 2018

This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiogra... more This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)-guided versus transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry. TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO. Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed. CHADS-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascul...

Research paper thumbnail of Multimodality Imaging of a Very Late Thrombosis of a Sutureless Aortic Prosthesis

JACC. Cardiovascular interventions, Feb 26, 2018

Research paper thumbnail of Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement

JACC. Cardiovascular interventions, Feb 26, 2018

Research paper thumbnail of Transfemoral Lotus Valve Implantation for Treatment of Postendocarditis Stentless Prosthesis Degeneration With Pure Aortic Regurgitation

Canadian Journal of Cardiology

Research paper thumbnail of TCT-866 Transcatheter Aortic Valve Implantation in Patients With Bicuspid Aortic Valve Disease: Results from the Milan Registry

Journal of the American College of Cardiology, 2012

Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patie... more Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patients with severe symptomatic tricuspid aortic valve stenosis. However, the role of TAVI in the treatment of the stenosed bicuspid aortic valve has not been clearly demonstrated. Methods: Consecutive patients with bicuspid aortic valve disease in our center treated with TAVI from November 2007 to May 2012 were included. All data was collected from a comprehensive prospective database and events were adjudicated according to the Valve Academic Research Consortium (VARC) definitions. Results: In total, 8 patients undergoing TAVI were identified to have an anatomical bicuspid aortic valve. The mean age was 75.8 Ϯ 5.5 years and 75.0% were female. The patients were deemed high risk for surgery, with a median STS score of 6.5 (interquartile range [IQR] 3.7-13.8). Of the patients nϭ5 (62.5%) underwent implantation of the Medtronic CoreValve® ReValving system device (Medtronic Inc., Minneapolis, MN) and nϭ3 (37.5%) the Edwards SAPIEN™/SAPIEN XT™ (Edwards Lifesciences, Irvine, California). At 30 days, there were 2 deaths, both secondary to aortic dissection (one peri-procedural and one 24 hours post-procedure). There were no events of myocardial infarction or stroke. With regards to the procedure, there were no cases of device embolization. The overall VARC device success was nϭ6 (75.0%), with both failures due to residual significant aortic regurgitation. At a median of 435 (IQR 399-507) days follow-up, there was one further death secondary to hepatic failure. One other patient was readmitted to hospital at day 75 due to acute cardiac compensation. This resulted in a combined efficacy endpoint of 50.0% at follow-up. Conclusions: Despite small numbers, the outcomes of TAVI for the stenosed bicuspid aortic valve may not be optimal and hence require further investigation prior to this becoming an acceptable treatment option in this group of patients.

Research paper thumbnail of Impella implantation as a rescue strategy in balloon aortic valvuloplasty complicated by acute aortic regurgitation

Journal of Cardiovascular Medicine

Research paper thumbnail of Role of Different Antithrombotic Regimens after Percutaneous Left Atrial Appendage Occlusion: A Large Single Center Experience

Journal of Clinical Medicine

Background: Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still n... more Background: Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still not clear. The aim of this study was to investigate the role of different antithrombotic regimens after the procedure. Methods and Results: We retrospectively analyzed data of 260 patients who underwent LAA occlusion and divided them into four groups according to therapy at discharge: dual antiplatelet therapy (group A, 71.5%); oral anticoagulants (group B, 19%); “minimal” antithrombotic therapy (single antiplatelet agent or without any antithrombotic therapy; group C, 4.5%) and other therapeutic regimens (such as a combination of antiplatelets and anticoagulants; group D, 4.5%). We analyzed baseline characteristics, procedural data, and clinical and transesophageal follow-up for each group. The incidence of adverse events was low in the whole population and had a similar distribution among groups. The majority of bleeding events was registered during the first 3 months after the procedur...

Research paper thumbnail of Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Journal of Cardiovascular Development and Disease

Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-... more Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.0...

Research paper thumbnail of Percutaneous Direct Annuloplasty With Edge-to-Edge Technique for Mitral Regurgitation: Replicating a Complete Surgical Mitral Repair in a One-Step Procedure

The Canadian journal of cardiology, 2018

Surgical treatment of functional mitral regurgitation (MR) is usually based on the correction of ... more 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.

Research paper thumbnail of Echocardiographic features of post-transcatheter aortic valve implantation thrombosis and endocarditis

Echocardiography (Mount Kisco, N.Y.), Mar 1, 2018

Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications ... more Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics. To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected. Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features. Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Inter...

Research paper thumbnail of Severe Mitral Stenosis and Persistent Left Appendage Thrombosis: When an Old Percutaneous Solution Meets New Percutaneous Strategies

JACC. Cardiovascular interventions, Jan 22, 2018

Research paper thumbnail of Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection

European heart journal cardiovascular Imaging, Jan 6, 2018

A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced.... more A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones. One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85...

Research paper thumbnail of Coronary Sinus Reducer Implantation for the Treatment of Chronic Refractory Angina: A Single-Center Experience

JACC. Cardiovascular interventions, Jan 23, 2018

The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort... more The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina. The coronary sinus Reducer is a novel device to aid in the management of patients with severe angina symptoms refractory to optimal medical therapy and not amenable to further revascularization. Fifty patients with refractory angina and objective evidence of myocardial ischemia who were judged unsuitable for revascularization were treated with coronary sinus Reducer implantation at a single center between March 2015 and August 2016. Safety endpoints were procedural success and the absence of device-related adverse events. Efficacy endpoints, assessed at 4- and 12-month follow-up, were a reduction in Canadian Cardiovascular Society angina class, improvement in quality of life assessed using the Seattle Angina Questionnaire, improvement in exercise tolerance assessed using the 6-min walk test, and reduction in pharmacological antianginal ther...

Research paper thumbnail of Percutaneous left atrial appendage occlusion with the Amulet device: The impact of device disc position upon periprocedural and long-term outcomes

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 5, 2018

To investigate the effect of left atrial appendage (LAA) occlusion device positioning upon peripr... more To investigate the effect of left atrial appendage (LAA) occlusion device positioning upon periprocedural and long-term outcomes. The Amulet device is designed to cover the ostium of the LAA. Prolapse of the device into the neck of the LAA is not uncommon resulting in incomplete coverage of the ostium. The clinical consequences of this remain uncertain. Outcomes of 87 patients with successful LAA closure were analyzed according to Amulet disc position: group A (n = 45) had complete LAA ostium coverage; group B (n = 42) had incomplete ostium coverage because of disc prolapse. Periprocedural major adverse events (MAE) (composite of all cause death, tamponade, device/air embolization, cerebrovascular events, myocardial infarction, and major bleeding not related to vascular access complications) and total device-related periprocedural adverse events (defined as MAE and pericardial effusion) were evaluated. All patients were followed up longitudinally with long-term events defined as a c...

Research paper thumbnail of Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 H) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement

JACC. Cardiovascular interventions, Jan 13, 2018

This study sought to determine predictors of advanced conduction disturbances requiring late (≥48... more This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). 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. 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...

Research paper thumbnail of Supra-Annular Transcatheter Aortic Valve Position May Correct Annular Under-Expansion Due to Valvular Asymmetry

Circulation journal : official journal of the Japanese Circulation Society, 2018

Research paper thumbnail of Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 4, 2018

This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) d... more This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side c...

Research paper thumbnail of Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry

International Journal of Cardiology

Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of smal... more Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis &gt; 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.

Research paper thumbnail of Observed versus predicted mortality after MitraClip treatment in patients with symptomatic heart failure and significant functional mitral regurgitation

European journal of heart failure, Jan 23, 2018

Research paper thumbnail of Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy

International journal of cardiology, Jan 12, 2018

MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patient... more MitraClip implantation has evolved as a new tool for treatment of inoperable or high-risk patients with severe functional mitral regurgitation (FMR) due to dilated cardiomyopathy (DCM). Limited data are available regarding MitraClip outcomes comparing patients with ischemic and non-ischemic DCM. From 2008 to 2016, 314 patients received MitraClip for FMR at four institutions: Brescia, Zurich and Milan. Patients were stratified according to MR aetiology in non-ischemic FMR (n = 99) and ischemic FMR (n = 215). Preoperative risk factors, operative variables and outcomes up to 2-year were evaluated. A multivariable Cox Proportional Hazards survival model with covariate adjustments was used to assess the relationship between FMR aetiology and 2-year cardiac mortality. As expected, patients with ischemic FMR had significantly more risk factors and comorbidities. Overall procedural success rate was 80% and in-hospital cardiac mortality was 3% without significant differences between aetiolog...

Research paper thumbnail of Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: The LAAO Italian Multicenter Registry

JACC. Cardiovascular interventions, Jan 11, 2018

This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiogra... more This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)-guided versus transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry. TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO. Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed. CHADS-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascul...

Research paper thumbnail of Multimodality Imaging of a Very Late Thrombosis of a Sutureless Aortic Prosthesis

JACC. Cardiovascular interventions, Feb 26, 2018

Research paper thumbnail of Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement

JACC. Cardiovascular interventions, Feb 26, 2018

Research paper thumbnail of Transfemoral Lotus Valve Implantation for Treatment of Postendocarditis Stentless Prosthesis Degeneration With Pure Aortic Regurgitation

Canadian Journal of Cardiology