Melissa Fusari - Academia.edu (original) (raw)
Papers by Melissa Fusari
Anesthesia & Analgesia, 2013
Aortic stenosis is the most common form of valvular heart disease in the Western world and until ... more Aortic stenosis is the most common form of valvular heart disease in the Western world and until recently, surgical aortic valve replacement has been the only treatment available for patients with this disease that has been shown to improve both symptoms and survival. Transcatheter aortic valve replacement has emerged as a new therapy for patients with severe aortic stenosis who are poor surgical candidates due to their elevated surgical risk. As longer follow up is obtained and improvements continue to be made in the current available prostheses, transcatheter aortic valve replacement will likely become a treatment alternative for high-risk patients with severe aortic stenosis.
Circulation, 2012
Objective: Aim of this retrospective multicenter study was to assess how the introduction of tran... more Objective: Aim of this retrospective multicenter study was to assess how the introduction of transcatheter aortic valve implantation (TAVI) influenced the characteristics and the outcomes of patien...
Circulation, Nov 23, 2010
Trans-apical aortic valve implantation (TA-TAVI) is a good alternative in patients with severe ao... more Trans-apical aortic valve implantation (TA-TAVI) is a good alternative in patients with severe aortic valve stenosis (AS) who are inoperable or have a high surgical risk. Few data exist about hemod...
Innovations (Philadelphia, Pa.)
Vascular complications remain the main problem of transcatheter aortic valve replacement, despite... more Vascular complications remain the main problem of transcatheter aortic valve replacement, despite downsizing of delivery catheter diameter and judicious patient selection. In case of diffusely calcified and/or very tortuous access vessels, the SoloPath Balloon Expandable TransFemoral Introducer (Onset Medical Corporation, Irvine, CA USA), providing the smallest insertion profile of any sheath in its class, may enable exceptional trackability and offer the largest working diameter, thus helping to prevent feared vascular complications. We report the successful use of SoloPath sheath to face six cases of NovaFlex (Edwards Lifesciences Inc, Irvine, CA USA) sheath failed insertion due to vessel tortuosity and calcifications. In six patients enrolled for transfemoral transcatheter Edwards SAPIEN XT replacement, resistance to NovaFlex sheath pushing was encountered, subsequent to the bending of the distal portion of the sheath due to vessel tortuosity and calcifications. Damaged Edwards s...
The Journal of cardiovascular surgery, 2011
The Journal of cardiovascular surgery, 2001
The aim of this study was to identify and stratify the most important preoperative factors for in... more The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent pro...
The Journal of extra-corporeal technology, 2001
This study was performed to assess if the kind of pump used for CPB (roller vs. centrifugal) can ... more This study was performed to assess if the kind of pump used for CPB (roller vs. centrifugal) can influence neurological outcomes of adult cardiac surgery patients. Between 1994 and 1998, 3438 patients underwent coronary and/or valve surgery at our hospital; of these, 1805 (52.5%) underwent surgery with the use of a centrifugal pump, and 1633 (47.5%) were operated with a roller pump. The effect of the type of the pump and of common preoperative and intraoperative risk factors for five different neurological outcomes (permanent neurological deficit, coma, delirium, transient neurological deficit, overall neurological complications) were assessed with univariate and multivariate analyses in the whole patients population, in patients > or = 75 years old and in patients with histories of previous neurological events. Centrifugal pump use was the only protective factor for perioperative permanent neurological deficit in multivariable models developed for the whole patient population an...
Minerva cardioangiologica, 1997
The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associat... more The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage especially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a d...
The heart surgery forum, 2007
Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement ... more Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement with a tubular graft because the aortic wall is claimed to be genetically pathological. We describe 9 cases in which patients with an ascending aortic aneurysm and an associated diseased bicuspid valve underwent aneurysmal resection and end-to-end anastomosis. This technique permitted us to remove the entire aneurysmal wall, avoiding graft interposition.
The Journal of Thoracic and Cardiovascular Surgery, 2012
The aim of this propensity-matched, multicenter study was to compare early clinical and echocardi... more The aim of this propensity-matched, multicenter study was to compare early clinical and echocardiographic outcomes of patients undergoing transapical aortic valve implantation (TA-TAVI) versus patients undergoing sutureless aortic valve replacement (SU-AVR) for severe symptomatic aortic valve stenosis. Methods: We reviewed 468 TA-TAVIs performed in 20 centers from April 2008 to May 2011, and 51 SU-AVRs performed in 3 centers from March to September 2011. Based on a propensity score analysis, 2 groups with 38 matched pairs were created. Variables used in the propensity analysis were age, sex, body surface area, New York Heart Association class, logistic EuroSCORE, peripheral vascular disease, chronic obstructive pulmonary disease, aortic valve area, mitral regurgitation, and left ventricular ejection fraction.
The Journal of Thoracic and Cardiovascular Surgery, 2007
High-dose atorvastatin is associated with impaired myocardial angiogenesis in response to vascula... more High-dose atorvastatin is associated with impaired myocardial angiogenesis in response to vascular endothelial growth factor in hypercholesterolemic swine.
Journal of Cardiothoracic and Vascular Anesthesia, 2007
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Trans-apical aortic valve implantation (TA-AVI) has been shown to be a reproducible te... more Objective: Trans-apical aortic valve implantation (TA-AVI) has been shown to be a reproducible technique. Early results from the SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry identified major access complications associated with high 30-day mortality. Using the SOURCE Registry, we analyze the learning curve for TA-AVI over the first 2 years after commercialization. Methods: The SOURCE Registry gathered data for 2 consecutive years at European centers following commercialization of the Edwards SAPIEN TM bioprosthesis, totaling 2339 patients (1038 in COHORT 1 and 1301 in COHORT 2). Only data from centers that provided all of their consecutively treated patients were included in this study. We compared the 30-day results of TA
The Annals of Thoracic Surgery, 2010
Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implanta... more Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions.
The Annals of Thoracic Surgery, 2008
Background. The purpose of this study was to determine whether, in recent years, sex differences ... more Background. The purpose of this study was to determine whether, in recent years, sex differences in the type of care during coronary artery bypass graft surgery procedures occurred. Methods. Between 1995 and 2004, 5,935 consecutive patients (4,867 men and 1,068 women) underwent isolated coronary artery bypass graft surgery; propensity score matching was used to investigate whether sex adversely impacts standard care and early outcomes of coronary revascularization. Results. Of the 1,068 women undergoing isolated coronary artery bypass graft surgery, only 280 (26.2%) were matched on propensity scores with men. Distribution of preoperative variables among matched pairs was, on average, equal. Propensity-matched women received similar number of distal anastomoses as men (2.70 ؎ 0.89 versus 2.82 ؎ 0.97; p ؍ 0.13), had similar rates of complete revascularization (82.5% versus 81.6%; p ؍ 0.78), and of off-pump procedures (24.3% versus 27.5%; p ؍ 0.39); also, the rate of utilization of arterial grafts (left internal mammary artery 98.5% versus 98.2%; p ؍ 0.73; right internal mammary artery 3.2% versus 3.2%; p > 0.99; radial artery 8.2% versus 9.6%; p ؍ 0.55), as well as the number of distal anastomoses performed with arterial grafts (1.11 ؎ 0.36 versus 1.13 ؎ 0.39; p ؍ 0.47), were similar in women and men. No differences were detected in major complications (in-hospital mortality, perioperative myocardial infarction, and stroke) in propensitymatched pairs, whereas women had lower reexploration for bleeding and blood transfusion rates. Conclusions. The preoperative profiles of women and men were markedly different, as only one fourth of women could be matched. In the current era, after adjustment for preoperative variables, female patients received the same standard of care as men, with improved results in some minor early outcomes.
American Heart Journal, 2010
Background This study aimed to evaluate the impact of baseline left ventricular (LV) systolic fun... more Background This study aimed to evaluate the impact of baseline left ventricular (LV) systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation (TAVI). Survival of patients undergoing TAVI was also compared with that of a population undergoing surgical aortic valve replacement. Methods One hundred forty-seven consecutive patients (mean age = 80 ± 7 years) undergoing TAVI in 2 centers were included. Mean follow-up period was 9.1 ± 5.1 months. Results At baseline, 34% of patients had impaired LV ejection fraction (LVEF) (<50%) and 66% had normal LVEF (≥50%). Procedural success was similar in these 2 groups (94% vs 97%, P = .41). All patients achieved improvement in transvalvular hemodynamics. At follow-up, patients with a baseline LVEF <50% showed marked LV reverse remodeling, with improvement of LVEF (from 37% ± 8% to 51% ± 11%). Early and late mortality rates were not different between the 2 groups, despite a higher rate of combined major adverse cardiovascular events (MACEs) in patients with a baseline LVEF <50%. The predictors of cumulative MACEs were baseline LVEF (HR = 0.97, 95% CI = 0.94-0.99) and preoperative frailty (HR = 4.20, 95% CI = 2.00-8.84). In addition, long-term survival of patients with impaired or normal LVEF was comparable with that of a matched population who underwent surgical aortic valve replacement. Conclusions TAVI resulted in significant improvement in LV function and survival benefit in high-risk patients with severe aortic stenosis, regardless of baseline LVEF. Patients with a baseline LVEF <50% were at higher risk of combined MACEs.
American Heart Journal, 2011
Background The aim of this study was to assess the accuracy of a comprehensive multidetector comp... more Background The aim of this study was to assess the accuracy of a comprehensive multidetector computed tomography (MDCT) evaluation of the aortic annulus (AoA), coronary artery disease (CAD), and peripheral vessels in patients referred for transcatheter aortic valve implantation (TAVI). Methods In 60 patients referred for TAVI, the following parameters were assessed with 64-slices MDCT and compared with transesophageal echocardiography (TEE), invasive coronary angiography (ICA), and peripheral angiography: AoA maximum diameter (Max-AoA-D MDCT), minimum diameter (Min-AoA-D MDCT), and area; lumen morphology index ([Max-AoA-D MDCT /Min-AoA-D MDCT ]); length of the left, right, and non-coronary aortic leaflets; degree (grades 1-4) of aortic leaflet calcifications; distance between AoA and left main coronary ostium and between AoA and right coronary ostium CAD and peripheral vessel disease.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Reintervention in patients who have undergone an aortic homograft valve replacement remains a tec... more Reintervention in patients who have undergone an aortic homograft valve replacement remains a technical challenge. We report the case of a patient with multiple aortic valve replacements having an aortic homograft with severe calcific stenosis who successfully underwent transcatheter aortic valve insertion (TAVI). CLINICAL SUMMARY A 48-year-old woman was referred to our hospital with symptoms of ingravescent severe dyspnea. Fifteen years earlier, she had undergone placement of a 21-mm aortic valve Bravo 400 stentless xenograft (Cryolife International, Atlanta, Ga). Four years later, she underwent a valve replacement with a 21-mm mechanical prosthesis (Carbomedics, Austin, Tex) for valve degeneration, and subsequently, she received a homograft for aortic valve endocarditis. The echocardiographic control, performed during the last 15 years, showed progressive calcific valve degeneration FIGURE 1. Thoracic computed tomographic angiogram showing the extremely calcified aortic root (1).
Circulation, 2011
Background. Objective of this study was to assess clinical and hemodynamic outcomes of trans-apic... more Background. Objective of this study was to assess clinical and hemodynamic outcomes of trans-apical aortic valve implantation (TA-TAVI) in a large cohort of patients. Methods. We analyzed data from 566 high-risk or inoperable patients who underwent TA-TAVI from April 2008 through May 2011 in 20 cardiac surgery centers. Data were prospectively collected in our National Registry of Trans-Apical Aortic Valve Implantation. Outcomes were also analyzed according to the impact of intraoperative complications, procedural volume (high volume centers: >20 cases, low volume < 20 cases) and to the learning curve (first 50% cases vs. second 50% cases of each center). Results: Mean age was 81±7 years (Range: 44-95), 59.1% were female, mean logistic EUROscore was 26±14%. Preoperative peak (PG) and mean (MG) transaortic gradients were 82±24 and 51±16 mmHg, respectively. Mean follow-up was 10±8 months (range: 1-32). Hospital mortality was 7.7% (44 patients). Intraoperative severe complications...
Anesthesia & Analgesia, 2013
Aortic stenosis is the most common form of valvular heart disease in the Western world and until ... more Aortic stenosis is the most common form of valvular heart disease in the Western world and until recently, surgical aortic valve replacement has been the only treatment available for patients with this disease that has been shown to improve both symptoms and survival. Transcatheter aortic valve replacement has emerged as a new therapy for patients with severe aortic stenosis who are poor surgical candidates due to their elevated surgical risk. As longer follow up is obtained and improvements continue to be made in the current available prostheses, transcatheter aortic valve replacement will likely become a treatment alternative for high-risk patients with severe aortic stenosis.
Circulation, 2012
Objective: Aim of this retrospective multicenter study was to assess how the introduction of tran... more Objective: Aim of this retrospective multicenter study was to assess how the introduction of transcatheter aortic valve implantation (TAVI) influenced the characteristics and the outcomes of patien...
Circulation, Nov 23, 2010
Trans-apical aortic valve implantation (TA-TAVI) is a good alternative in patients with severe ao... more Trans-apical aortic valve implantation (TA-TAVI) is a good alternative in patients with severe aortic valve stenosis (AS) who are inoperable or have a high surgical risk. Few data exist about hemod...
Innovations (Philadelphia, Pa.)
Vascular complications remain the main problem of transcatheter aortic valve replacement, despite... more Vascular complications remain the main problem of transcatheter aortic valve replacement, despite downsizing of delivery catheter diameter and judicious patient selection. In case of diffusely calcified and/or very tortuous access vessels, the SoloPath Balloon Expandable TransFemoral Introducer (Onset Medical Corporation, Irvine, CA USA), providing the smallest insertion profile of any sheath in its class, may enable exceptional trackability and offer the largest working diameter, thus helping to prevent feared vascular complications. We report the successful use of SoloPath sheath to face six cases of NovaFlex (Edwards Lifesciences Inc, Irvine, CA USA) sheath failed insertion due to vessel tortuosity and calcifications. In six patients enrolled for transfemoral transcatheter Edwards SAPIEN XT replacement, resistance to NovaFlex sheath pushing was encountered, subsequent to the bending of the distal portion of the sheath due to vessel tortuosity and calcifications. Damaged Edwards s...
The Journal of cardiovascular surgery, 2011
The Journal of cardiovascular surgery, 2001
The aim of this study was to identify and stratify the most important preoperative factors for in... more The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent pro...
The Journal of extra-corporeal technology, 2001
This study was performed to assess if the kind of pump used for CPB (roller vs. centrifugal) can ... more This study was performed to assess if the kind of pump used for CPB (roller vs. centrifugal) can influence neurological outcomes of adult cardiac surgery patients. Between 1994 and 1998, 3438 patients underwent coronary and/or valve surgery at our hospital; of these, 1805 (52.5%) underwent surgery with the use of a centrifugal pump, and 1633 (47.5%) were operated with a roller pump. The effect of the type of the pump and of common preoperative and intraoperative risk factors for five different neurological outcomes (permanent neurological deficit, coma, delirium, transient neurological deficit, overall neurological complications) were assessed with univariate and multivariate analyses in the whole patients population, in patients > or = 75 years old and in patients with histories of previous neurological events. Centrifugal pump use was the only protective factor for perioperative permanent neurological deficit in multivariable models developed for the whole patient population an...
Minerva cardioangiologica, 1997
The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associat... more The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage especially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a d...
The heart surgery forum, 2007
Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement ... more Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement with a tubular graft because the aortic wall is claimed to be genetically pathological. We describe 9 cases in which patients with an ascending aortic aneurysm and an associated diseased bicuspid valve underwent aneurysmal resection and end-to-end anastomosis. This technique permitted us to remove the entire aneurysmal wall, avoiding graft interposition.
The Journal of Thoracic and Cardiovascular Surgery, 2012
The aim of this propensity-matched, multicenter study was to compare early clinical and echocardi... more The aim of this propensity-matched, multicenter study was to compare early clinical and echocardiographic outcomes of patients undergoing transapical aortic valve implantation (TA-TAVI) versus patients undergoing sutureless aortic valve replacement (SU-AVR) for severe symptomatic aortic valve stenosis. Methods: We reviewed 468 TA-TAVIs performed in 20 centers from April 2008 to May 2011, and 51 SU-AVRs performed in 3 centers from March to September 2011. Based on a propensity score analysis, 2 groups with 38 matched pairs were created. Variables used in the propensity analysis were age, sex, body surface area, New York Heart Association class, logistic EuroSCORE, peripheral vascular disease, chronic obstructive pulmonary disease, aortic valve area, mitral regurgitation, and left ventricular ejection fraction.
The Journal of Thoracic and Cardiovascular Surgery, 2007
High-dose atorvastatin is associated with impaired myocardial angiogenesis in response to vascula... more High-dose atorvastatin is associated with impaired myocardial angiogenesis in response to vascular endothelial growth factor in hypercholesterolemic swine.
Journal of Cardiothoracic and Vascular Anesthesia, 2007
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Trans-apical aortic valve implantation (TA-AVI) has been shown to be a reproducible te... more Objective: Trans-apical aortic valve implantation (TA-AVI) has been shown to be a reproducible technique. Early results from the SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry identified major access complications associated with high 30-day mortality. Using the SOURCE Registry, we analyze the learning curve for TA-AVI over the first 2 years after commercialization. Methods: The SOURCE Registry gathered data for 2 consecutive years at European centers following commercialization of the Edwards SAPIEN TM bioprosthesis, totaling 2339 patients (1038 in COHORT 1 and 1301 in COHORT 2). Only data from centers that provided all of their consecutively treated patients were included in this study. We compared the 30-day results of TA
The Annals of Thoracic Surgery, 2010
Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implanta... more Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions.
The Annals of Thoracic Surgery, 2008
Background. The purpose of this study was to determine whether, in recent years, sex differences ... more Background. The purpose of this study was to determine whether, in recent years, sex differences in the type of care during coronary artery bypass graft surgery procedures occurred. Methods. Between 1995 and 2004, 5,935 consecutive patients (4,867 men and 1,068 women) underwent isolated coronary artery bypass graft surgery; propensity score matching was used to investigate whether sex adversely impacts standard care and early outcomes of coronary revascularization. Results. Of the 1,068 women undergoing isolated coronary artery bypass graft surgery, only 280 (26.2%) were matched on propensity scores with men. Distribution of preoperative variables among matched pairs was, on average, equal. Propensity-matched women received similar number of distal anastomoses as men (2.70 ؎ 0.89 versus 2.82 ؎ 0.97; p ؍ 0.13), had similar rates of complete revascularization (82.5% versus 81.6%; p ؍ 0.78), and of off-pump procedures (24.3% versus 27.5%; p ؍ 0.39); also, the rate of utilization of arterial grafts (left internal mammary artery 98.5% versus 98.2%; p ؍ 0.73; right internal mammary artery 3.2% versus 3.2%; p > 0.99; radial artery 8.2% versus 9.6%; p ؍ 0.55), as well as the number of distal anastomoses performed with arterial grafts (1.11 ؎ 0.36 versus 1.13 ؎ 0.39; p ؍ 0.47), were similar in women and men. No differences were detected in major complications (in-hospital mortality, perioperative myocardial infarction, and stroke) in propensitymatched pairs, whereas women had lower reexploration for bleeding and blood transfusion rates. Conclusions. The preoperative profiles of women and men were markedly different, as only one fourth of women could be matched. In the current era, after adjustment for preoperative variables, female patients received the same standard of care as men, with improved results in some minor early outcomes.
American Heart Journal, 2010
Background This study aimed to evaluate the impact of baseline left ventricular (LV) systolic fun... more Background This study aimed to evaluate the impact of baseline left ventricular (LV) systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation (TAVI). Survival of patients undergoing TAVI was also compared with that of a population undergoing surgical aortic valve replacement. Methods One hundred forty-seven consecutive patients (mean age = 80 ± 7 years) undergoing TAVI in 2 centers were included. Mean follow-up period was 9.1 ± 5.1 months. Results At baseline, 34% of patients had impaired LV ejection fraction (LVEF) (<50%) and 66% had normal LVEF (≥50%). Procedural success was similar in these 2 groups (94% vs 97%, P = .41). All patients achieved improvement in transvalvular hemodynamics. At follow-up, patients with a baseline LVEF <50% showed marked LV reverse remodeling, with improvement of LVEF (from 37% ± 8% to 51% ± 11%). Early and late mortality rates were not different between the 2 groups, despite a higher rate of combined major adverse cardiovascular events (MACEs) in patients with a baseline LVEF <50%. The predictors of cumulative MACEs were baseline LVEF (HR = 0.97, 95% CI = 0.94-0.99) and preoperative frailty (HR = 4.20, 95% CI = 2.00-8.84). In addition, long-term survival of patients with impaired or normal LVEF was comparable with that of a matched population who underwent surgical aortic valve replacement. Conclusions TAVI resulted in significant improvement in LV function and survival benefit in high-risk patients with severe aortic stenosis, regardless of baseline LVEF. Patients with a baseline LVEF <50% were at higher risk of combined MACEs.
American Heart Journal, 2011
Background The aim of this study was to assess the accuracy of a comprehensive multidetector comp... more Background The aim of this study was to assess the accuracy of a comprehensive multidetector computed tomography (MDCT) evaluation of the aortic annulus (AoA), coronary artery disease (CAD), and peripheral vessels in patients referred for transcatheter aortic valve implantation (TAVI). Methods In 60 patients referred for TAVI, the following parameters were assessed with 64-slices MDCT and compared with transesophageal echocardiography (TEE), invasive coronary angiography (ICA), and peripheral angiography: AoA maximum diameter (Max-AoA-D MDCT), minimum diameter (Min-AoA-D MDCT), and area; lumen morphology index ([Max-AoA-D MDCT /Min-AoA-D MDCT ]); length of the left, right, and non-coronary aortic leaflets; degree (grades 1-4) of aortic leaflet calcifications; distance between AoA and left main coronary ostium and between AoA and right coronary ostium CAD and peripheral vessel disease.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Reintervention in patients who have undergone an aortic homograft valve replacement remains a tec... more Reintervention in patients who have undergone an aortic homograft valve replacement remains a technical challenge. We report the case of a patient with multiple aortic valve replacements having an aortic homograft with severe calcific stenosis who successfully underwent transcatheter aortic valve insertion (TAVI). CLINICAL SUMMARY A 48-year-old woman was referred to our hospital with symptoms of ingravescent severe dyspnea. Fifteen years earlier, she had undergone placement of a 21-mm aortic valve Bravo 400 stentless xenograft (Cryolife International, Atlanta, Ga). Four years later, she underwent a valve replacement with a 21-mm mechanical prosthesis (Carbomedics, Austin, Tex) for valve degeneration, and subsequently, she received a homograft for aortic valve endocarditis. The echocardiographic control, performed during the last 15 years, showed progressive calcific valve degeneration FIGURE 1. Thoracic computed tomographic angiogram showing the extremely calcified aortic root (1).
Circulation, 2011
Background. Objective of this study was to assess clinical and hemodynamic outcomes of trans-apic... more Background. Objective of this study was to assess clinical and hemodynamic outcomes of trans-apical aortic valve implantation (TA-TAVI) in a large cohort of patients. Methods. We analyzed data from 566 high-risk or inoperable patients who underwent TA-TAVI from April 2008 through May 2011 in 20 cardiac surgery centers. Data were prospectively collected in our National Registry of Trans-Apical Aortic Valve Implantation. Outcomes were also analyzed according to the impact of intraoperative complications, procedural volume (high volume centers: >20 cases, low volume < 20 cases) and to the learning curve (first 50% cases vs. second 50% cases of each center). Results: Mean age was 81±7 years (Range: 44-95), 59.1% were female, mean logistic EUROscore was 26±14%. Preoperative peak (PG) and mean (MG) transaortic gradients were 82±24 and 51±16 mmHg, respectively. Mean follow-up was 10±8 months (range: 1-32). Hospital mortality was 7.7% (44 patients). Intraoperative severe complications...