Stefano Cannata - Academia.edu (original) (raw)
Papers by Stefano Cannata
EuroIntervention, 2020
Aims: The aim of this study was to evaluate 30-day safety and efficacy outcomes of transcatheter ... more Aims: The aim of this study was to evaluate 30-day safety and efficacy outcomes of transcatheter aortic valve implantation (TAVI) performed with the SAPIEN 3 Ultra system. Methods and results: The S3U registry is a physician-led, post-approval, multicentre, observational registry of transfemoral TAVI with the SAPIEN 3 Ultra. New features include an improved sealing skirt, a 14 Fr expandable sheath and a new delivery catheter. Overall, 139 consecutive patients at nine participating centres were enrolled. Mean age was 81.4±8.3 years, average STS score 3.8±2.4%. The vast majority (97.2%) underwent TAVI with local anaesthesia (28.8%) or conscious sedation (68.3%). Balloon predilatation was performed in 30 patients (21.6%), post-dilatation in three (2.2%). In-hospital, there were no cases of death, stroke, or conversion to open heart surgery. Major vascular complications occurred in three patients (2.2%), as well as major or life-threatening bleedings in three patients (2.2%). There were two moderate (1.4%) and no moderate/severe paravalvular leaks. Median length of stay after TAVI was three days (IQR 3-5 days). At 30 days, there were no deaths, MI, or strokes, and the incidence of new permanent pacemaker implantation was 4.4%. Conclusions: This first multicentre international experience of transfemoral TAVI with the SAPIEN 3 Ultra transcatheter heart valve shows good in-hospital and 30-day clinical outcomes.
Lecture Notes in Mechanical Engineering, 2019
The current generation of transcatheter heart valves (THV), as the Edwards SAPIEN 3 Ultra (S3), i... more The current generation of transcatheter heart valves (THV), as the Edwards SAPIEN 3 Ultra (S3), is not specifically designed for mitral position implantation and has intrinsic design geometry that may make mitral implantation suboptimal. This study aimed to develop a computed-tomography (CT) based CAD workflow for the preoperative planning of transcatheter mitral valve replacement (TMVR) by evaluating the resulting obstruction in the left ventricular outflow tract (LVOT). Specifically, the computational framework to reconstruct heart anatomy and virtually deploy the THV into mitral valve annulus was developed and successively applied to the cases of two patients who experienced annuloplasty ring failure. Planimetric assessment of the cross-sectional area of the neo-LVOT was quantified at different anatomic levels of implanted THV. Findings revealed the importance of the proposed CAD modeling workflow to enable more informative pre-operative assessments of the risk related to the development of the neo-LVOT obstruction and even to guide the Heart Team regarding device selection, sizing and intended positioning for TMVR.
Medical Engineering & Physics, 2020
Left ventricular outflow tract (LVOT) obstruction is a feared complication of transcatheter mitra... more Left ventricular outflow tract (LVOT) obstruction is a feared complication of transcatheter mitral valve replacement (TMVR). This procedure leads to an elongation of LVOT in the left ventricle (namely, the neoLVOT), ultimately portending hemodynamic impairment and death. This study sought to understand the biomechanical implications of LVOT obstruction in two patients who underwent TMVR as an "off-label" application of the Edwards SAPIEN 3 (S3) Ultra transcatheter heart valve (THV). A computational framework of TMVR was developed to assess the neoLVOT area and quantify the sub-aortic flow structure. We observed that the annuloplasty ring serves as the key anchor zone of S3 Ultra THV. A good agreement was found between the numerically-predicted and CT-imaging measurements of neoLVOT area, with differences less than 10% in both patients. The pressure drop across the neoLVOT did not determine hemodynamic impairment in both patients. Quantification of structural and hemodynamic variables by computational modeling may facilitate more accurate predictions of the LVOT obstruction in TMVR, particularly for patients which are considered to have a borderline risk of obstruction
Journal of the American College of Cardiology, Jan 29, 2017
Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with fail... more Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]). From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower techn...
Journal of the American College of Cardiology, 2014
Background: Impaired right ventricular (RV) function markedly impacts the prognosis in patients (... more Background: Impaired right ventricular (RV) function markedly impacts the prognosis in patients (pts) with functional mitral regurgitation (FMR). In such pts, significant recovery of RV function after MitraClip (MC) therapy has been shown. We sought to identify echocardiographic and/or hemodynamic variables predicting recovery of RV function after MC therapy. Methods: Of 194 pts with significant FMR receiving MC therapy at our institution, impaired RV function (defined as tricuspid annular plane systolic excursion [TAPSE] < 18mm) was present at baseline in 78 (40%). Six-week echocardiographic follow-up was obtained from 36 pts (71 AE 11 years; 23 men [64%]). Results: Recovery of RV functiondefined as a change in TAPSE (DTAPSE) >3mmwas observed at 6 weeks in 8/36 pts (22%). These 8 pts (mean DTAPSE 5.6 AE 0.9mm) differed from the 28 pts with DTAPSE 3mm (mean DTAPSE 0.7 AE 2.4mm) in baseline TAPSE (9.4 AE 1.7mm vs. 12.2 AE 2.5mm, respectively; p¼0.005) and baseline cardiac output (4.4 AE 1.3L/min vs. 3.2 AE 1.0L/min, respectively; p¼0.01). Normal baseline cardiac output (!4.5L/min) was present in 50% of pts with DTAPSE >3mm, yet only in 14% of pts with DTAPSE 3mm (p¼0.054). No differences between the 2 groups were noted in terms of left ventricular (LV) enddiastolic diameter, LV ejection fraction, systolic pulmonary artery pressure, capillary wedge pressure, and MR severity at baseline. Univariate logistic regression analysis for the end point of DTAPSE >3mm at 6 weeks revealed odds ratios of 1.85 (95% confidence interval, 1.11-3.03; p¼0.017) associated with a 1-mm decrease in baseline TAPSE and 2.66 (1.15-6.18; p¼0.023) associated with a 1-L/min increase in baseline cardiac output. Conclusions: MC therapy for significant FMR apparently leads to recovery of RV function particularly in pts with markedly reduced baseline TAPSE yet unimpaired cardiac output. Further study is warranted to verify these observations.
Bioengineering, 2021
Bicuspid aortic valve (BAV) patients are conventionally not treated by transcathether aortic valv... more Bicuspid aortic valve (BAV) patients are conventionally not treated by transcathether aortic valve implantation (TAVI) because of anatomic constraint with unfavorable outcome. Patient-specific numerical simulation of TAVI in BAV may predict important clinical insights to assess the conformability of the transcathether heart valves (THV) implanted on the aortic root of members of this challenging patient population. We aimed to develop a computational approach and virtually simulate TAVI in a group of n.6 stenotic BAV patients using the self-expanding Evolut Pro THV. Specifically, the structural mechanics were evaluated by a finite-element model to estimate the deformed THV configuration in the oval bicuspid anatomy. Then, a fluid–solid interaction analysis based on the smoothed-particle hydrodynamics (SPH) technique was adopted to quantify the blood-flow patterns as well as the regions at high risk of paravalvular leakage (PVL). Simulations demonstrated a slight asymmetric and ellip...
European Heart Journal, 2020
Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. T... more Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome.
European Heart Journal, 2020
Medical & Biological Engineering & Computing, 2020
Bicuspid aortic valve (BAV) anatomy has routinely been considered an exclusion in the setting of ... more Bicuspid aortic valve (BAV) anatomy has routinely been considered an exclusion in the setting of transcatheter aortic valve implantation (TAVI) because of the large dimension of the aortic annulus having a more calcified, bulky, and irregular shape. The study aims to develop a patient-specific computational framework to virtually simulate TAVI in stenotic BAV patients using the Edwards SAPIEN 3 valve (S3) and its improved version SAPIEN 3 Ultra and quantify stent frame deformity as well as the severity of paravalvular leakage (PVL). Specifically, the aortic root anatomy of n.9 BAV patients who underwent TAVI was reconstructed from pre-operative CT imaging. Crimping and deployment of S3 frame were performed and then followed by fluid-solid interaction analysis to simulate valve leaflet dynamics throughout the entire cardiac cycle. Modeling revealed that the S3 stent frame expanded well on BAV anatomy with an elliptical shape at the aortic annulus. Comparison of predicted S3 deformity as assessed by eccentricity and expansion indices demonstrated a good agreement with the measurement obtained from CT imaging. Blood particle flow analysis demonstrated a backward blood jet during diastole, whereas the predicted PVL flows corresponded well with those determined by transesophageal echocardiography. This study represents a further step towards the use of personalized simulations to virtually plan TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of “off-label” applications as the TAVI in the setting of BAV patients. Graphical abstract Computational frameworks of TAVI in patients with stenotic bicuspid aortic valve
The American journal of cardiology, Jan 15, 2018
The pattern and reasons for re-hospitalization (RH) after MitraClip implantation are not well cha... more The pattern and reasons for re-hospitalization (RH) after MitraClip implantation are not well characterized. A total of 322 consecutive MitraClip patients were included, with data stratified by RH status. Multivariate analyses were conducted to identify predictors of early (30-day) and late (30-day to 12-month) RH. Eighty-nine patients (27.6%) were readmitted to hospital during the study period and early RH occurred in 27%. The median time from MitraClip to RH was 99 days. RH was mostly related to cardiovascular causes (66.3%). Anemia and gastrointestinal bleeding were the most frequent noncardiovascular causes. Independent predictors of early RH were length of stay ≥3 days during the index procedure (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.32 to 12.91), reduction of left ventricular ejection fraction ≥5% after MitraClip implantation (OR 4.88, 95% CI 1.36 to 18.91), and severe systolic pulmonary artery pressure ≥60 mm Hg at discharge (OR 3.72, 95% CI 1.23 to 11.26). Con...
Circulation: Cardiovascular Interventions, 2017
Background— We sought to describe an optimized approach to coronary artery disease (CAD) screenin... more Background— We sought to describe an optimized approach to coronary artery disease (CAD) screening and management in patients undergoing transcatheter aortic valve replacement (TAVR). Methods and Results— When invasive coronary angiography showed CAD, the treatment strategy and completeness of revascularization was determined based on coronary anatomy. TAVR was performed in the same setting if percutaneous coronary intervention (PCI) was uncomplicated; otherwise TAVR was postponed. A total of 604 patients undergoing CAD screening at the time of TAVR procedure were prospectively included in this study. Severe CAD was found in 136 patients (22.5%). Among patients with severe CAD, 53 patients (8.8%) underwent uncomplicated PCI. After PCI, TAVR was postponed in 2 patients (0.3%). In 83 patients (13.8%), coronary angiography showed severe CAD that was left untreated. After TAVR, all-cause and cardiovascular 30-day mortality rates were 2.4% and 1.4%, respectively. Disabling stroke, myocar...
EuroIntervention, 2016
The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical o... more The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains unknown. A total of 1463 patients underwent successful CTO-PCI between August 2004 and December 2014. Major adverse cardiovascular events (MACE) defined as the composite of all-cause death, myocardial infarction and target lesion revascularization (TLR), cardiac death, and stent thrombosis were compared between patients with and without CKD (555 and 908 patients, respectively). The results demonstrated higher risks of MACE (log-rank p=0.015), all-cause death (log-rank p<0.001), cardiac death (log-rank p<0.001) in CKD group as compared with non-CKD group. Multivariable analyses demonstrated that CKD was an independent predictor for MACE (hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 1.02-1.47, p=0.03). In regards to pharmacotherapy, statin use was associated with significantly lower rates of MACE in the CKD group (long-rank p=0.003). In conclusion, the presence of CKD would be an important predictor of long-term clinical outcomes in patients undergoing CTO-PCI and use of statin may influence in reducing the adverse clinical outcomes.
JACC: Cardiovascular Interventions, 2015
OBJECTIVES This study sought to compare, in high-risk patients with 3þ to 4þ mitral regurgitation... more OBJECTIVES This study sought to compare, in high-risk patients with 3þ to 4þ mitral regurgitation (MR) dichotomized by baseline echocardiographic features, acute, 30-day, and 12-month outcomes following percutaneous mitral valve repair using the MitraClip. BACKGROUND The feasibility and mid-term outcomes after MitraClip implantation in patients with echocardiographic features different from the EVEREST (Endovascular Valve Edge-to-Edge Repair) I and II trials have been scarcely studied. METHODS Clinical and echocardiographic outcomes through 12-month follow-up of consecutive patients who underwent MitraClip implantation were obtained from an ongoing prospective registry. Two different groups, divided according to baseline echocardiographic criteria (investigational group [EVEREST OFF ] and control group [EVEREST ON ]), were compared. RESULTS Seventy-eight patients were included in EVEREST OFF and 93 patients in EVEREST ON groups. Important and comparable acute reductions in MR and no clip-related complications were revealed. The primary safety endpoint at 30 days was comparable between groups (2.6% vs. 6.5%, respectively, p ¼ 0.204); in addition, MR reduction was mostly sustained, whereas equivalent improvement in New York Heart Association functional class were demonstrated. Kaplan-Meier freedom from death, surgery for mitral valve dysfunction, or grade $3þ MR at 12 months was demonstrated in 71.4% and 76.2%, respectively, in the EVEREST OFF and EVEREST ON groups (log rank p ¼ 0.378). Significant improvements in ejection fraction and reduction in left ventricle volumes were demonstrated in both groups over time, but the baseline between-group differences were sustained. CONCLUSIONS MitraClip implantation in patients with expanded baseline echocardiographic features, compared with the control group, was associated with similar rates of safety and efficacy through 12-month follow-up. Further validation of our findings is warranted.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 4, 2014
To assess the influence of patients' gender on the outcomes of percutaneous edge-to-edge mitr... more To assess the influence of patients' gender on the outcomes of percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip system. Although gender-related differences have been extensively documented in patients who undergo surgery for moderate-to-severe (3+) and severe (4+) mitral regurgitation (MR), studies assessing whether these differences exist after PMVR are lacking. Clinical and echocardiographic data through 12-month follow up from 171 consecutive patients whom underwent MitraClip implantation and were dichotomized by the gender (106 males and 65 females) were obtained. The primary safety endpoint was the incidence of major adverse events at 30 days and the primary efficacy endpoint was freedom from death, surgery for mitral valve dysfunction, or grade ≥ 3+ MR at 12-month follow up. The primary safety endpoint was observed in four males (3.8%) and four females (6.2%) (P = 0.358). Remarkable reduction in MR postprocedure was revealed in both groups, and thes...
European Heart Journal - Case Reports, 2021
Cardiology, 2017
Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, ... more Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is a valid therapeutic option for patients with severe mitral regurgitation (MR) deemed to be at high or prohibitive surgical risk. Despite the reassuring data on efficacy and long-term durability of the procedure, the proportion of patients with residual or relapsing severe MR after MitraClip therapy is not negligible. In light of the detrimental prognostic impact of severe MR, repeat interventions are increasingly performed in clinical practice using different techniques. In high-risk settings, percutaneous procedures have proven to be effective and safe at reducing MR. Building on this, we sought to summarize the current landscape and clinical experience of reinterventions after failed MitraClip therapy, so as to assist physicians facing the clinical hurdle of proper treatment management after failed PMVR.
International Journal of Cardiology, 2016
The Journal of invasive cardiology, 2015
Few clinical data about indications and prognoses of patients undergoing balloon aortic valvulopl... more Few clinical data about indications and prognoses of patients undergoing balloon aortic valvuloplasty (BAV) in the transcatheter aortic valve implantation (TAVI) era have been reported. Data from all consecutive patients undergoing BAV in seven European centers from 2006 to 2013 were collected. Acute results and long-term outcomes were assessed. A total of 811 patients aged 82 ± 9 years were included; 416 patients (51%) underwent BAV as palliative destination therapy, 320 patients (40%) as bridge to TAVI, and 75 patients (9%) as bridge to surgical aortic valve replacement (SAVR). Patients undergoing BAV as destination therapy had a higher risk profile (logistic EuroSCORE, 20 ± 17 vs 22 ± 14 vs 11 ± 8, respectively; P<.001). Post procedure, peak gradient decreased from 87 ± 22 mm Hg to 66 ± 22 mm Hg (P<.001) and aortic valve area increased from 0.61 ± 0.2 cm² to 0.8 ± 0.2 cm² (P<.001). At 30 days, the all-cause death rate (6.5% vs 6.2% vs 7.4%, respectively; P=.56) and the r...
EuroIntervention, 2020
Aims: The aim of this study was to evaluate 30-day safety and efficacy outcomes of transcatheter ... more Aims: The aim of this study was to evaluate 30-day safety and efficacy outcomes of transcatheter aortic valve implantation (TAVI) performed with the SAPIEN 3 Ultra system. Methods and results: The S3U registry is a physician-led, post-approval, multicentre, observational registry of transfemoral TAVI with the SAPIEN 3 Ultra. New features include an improved sealing skirt, a 14 Fr expandable sheath and a new delivery catheter. Overall, 139 consecutive patients at nine participating centres were enrolled. Mean age was 81.4±8.3 years, average STS score 3.8±2.4%. The vast majority (97.2%) underwent TAVI with local anaesthesia (28.8%) or conscious sedation (68.3%). Balloon predilatation was performed in 30 patients (21.6%), post-dilatation in three (2.2%). In-hospital, there were no cases of death, stroke, or conversion to open heart surgery. Major vascular complications occurred in three patients (2.2%), as well as major or life-threatening bleedings in three patients (2.2%). There were two moderate (1.4%) and no moderate/severe paravalvular leaks. Median length of stay after TAVI was three days (IQR 3-5 days). At 30 days, there were no deaths, MI, or strokes, and the incidence of new permanent pacemaker implantation was 4.4%. Conclusions: This first multicentre international experience of transfemoral TAVI with the SAPIEN 3 Ultra transcatheter heart valve shows good in-hospital and 30-day clinical outcomes.
Lecture Notes in Mechanical Engineering, 2019
The current generation of transcatheter heart valves (THV), as the Edwards SAPIEN 3 Ultra (S3), i... more The current generation of transcatheter heart valves (THV), as the Edwards SAPIEN 3 Ultra (S3), is not specifically designed for mitral position implantation and has intrinsic design geometry that may make mitral implantation suboptimal. This study aimed to develop a computed-tomography (CT) based CAD workflow for the preoperative planning of transcatheter mitral valve replacement (TMVR) by evaluating the resulting obstruction in the left ventricular outflow tract (LVOT). Specifically, the computational framework to reconstruct heart anatomy and virtually deploy the THV into mitral valve annulus was developed and successively applied to the cases of two patients who experienced annuloplasty ring failure. Planimetric assessment of the cross-sectional area of the neo-LVOT was quantified at different anatomic levels of implanted THV. Findings revealed the importance of the proposed CAD modeling workflow to enable more informative pre-operative assessments of the risk related to the development of the neo-LVOT obstruction and even to guide the Heart Team regarding device selection, sizing and intended positioning for TMVR.
Medical Engineering & Physics, 2020
Left ventricular outflow tract (LVOT) obstruction is a feared complication of transcatheter mitra... more Left ventricular outflow tract (LVOT) obstruction is a feared complication of transcatheter mitral valve replacement (TMVR). This procedure leads to an elongation of LVOT in the left ventricle (namely, the neoLVOT), ultimately portending hemodynamic impairment and death. This study sought to understand the biomechanical implications of LVOT obstruction in two patients who underwent TMVR as an "off-label" application of the Edwards SAPIEN 3 (S3) Ultra transcatheter heart valve (THV). A computational framework of TMVR was developed to assess the neoLVOT area and quantify the sub-aortic flow structure. We observed that the annuloplasty ring serves as the key anchor zone of S3 Ultra THV. A good agreement was found between the numerically-predicted and CT-imaging measurements of neoLVOT area, with differences less than 10% in both patients. The pressure drop across the neoLVOT did not determine hemodynamic impairment in both patients. Quantification of structural and hemodynamic variables by computational modeling may facilitate more accurate predictions of the LVOT obstruction in TMVR, particularly for patients which are considered to have a borderline risk of obstruction
Journal of the American College of Cardiology, Jan 29, 2017
Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with fail... more Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]). From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower techn...
Journal of the American College of Cardiology, 2014
Background: Impaired right ventricular (RV) function markedly impacts the prognosis in patients (... more Background: Impaired right ventricular (RV) function markedly impacts the prognosis in patients (pts) with functional mitral regurgitation (FMR). In such pts, significant recovery of RV function after MitraClip (MC) therapy has been shown. We sought to identify echocardiographic and/or hemodynamic variables predicting recovery of RV function after MC therapy. Methods: Of 194 pts with significant FMR receiving MC therapy at our institution, impaired RV function (defined as tricuspid annular plane systolic excursion [TAPSE] < 18mm) was present at baseline in 78 (40%). Six-week echocardiographic follow-up was obtained from 36 pts (71 AE 11 years; 23 men [64%]). Results: Recovery of RV functiondefined as a change in TAPSE (DTAPSE) >3mmwas observed at 6 weeks in 8/36 pts (22%). These 8 pts (mean DTAPSE 5.6 AE 0.9mm) differed from the 28 pts with DTAPSE 3mm (mean DTAPSE 0.7 AE 2.4mm) in baseline TAPSE (9.4 AE 1.7mm vs. 12.2 AE 2.5mm, respectively; p¼0.005) and baseline cardiac output (4.4 AE 1.3L/min vs. 3.2 AE 1.0L/min, respectively; p¼0.01). Normal baseline cardiac output (!4.5L/min) was present in 50% of pts with DTAPSE >3mm, yet only in 14% of pts with DTAPSE 3mm (p¼0.054). No differences between the 2 groups were noted in terms of left ventricular (LV) enddiastolic diameter, LV ejection fraction, systolic pulmonary artery pressure, capillary wedge pressure, and MR severity at baseline. Univariate logistic regression analysis for the end point of DTAPSE >3mm at 6 weeks revealed odds ratios of 1.85 (95% confidence interval, 1.11-3.03; p¼0.017) associated with a 1-mm decrease in baseline TAPSE and 2.66 (1.15-6.18; p¼0.023) associated with a 1-L/min increase in baseline cardiac output. Conclusions: MC therapy for significant FMR apparently leads to recovery of RV function particularly in pts with markedly reduced baseline TAPSE yet unimpaired cardiac output. Further study is warranted to verify these observations.
Bioengineering, 2021
Bicuspid aortic valve (BAV) patients are conventionally not treated by transcathether aortic valv... more Bicuspid aortic valve (BAV) patients are conventionally not treated by transcathether aortic valve implantation (TAVI) because of anatomic constraint with unfavorable outcome. Patient-specific numerical simulation of TAVI in BAV may predict important clinical insights to assess the conformability of the transcathether heart valves (THV) implanted on the aortic root of members of this challenging patient population. We aimed to develop a computational approach and virtually simulate TAVI in a group of n.6 stenotic BAV patients using the self-expanding Evolut Pro THV. Specifically, the structural mechanics were evaluated by a finite-element model to estimate the deformed THV configuration in the oval bicuspid anatomy. Then, a fluid–solid interaction analysis based on the smoothed-particle hydrodynamics (SPH) technique was adopted to quantify the blood-flow patterns as well as the regions at high risk of paravalvular leakage (PVL). Simulations demonstrated a slight asymmetric and ellip...
European Heart Journal, 2020
Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. T... more Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome.
European Heart Journal, 2020
Medical & Biological Engineering & Computing, 2020
Bicuspid aortic valve (BAV) anatomy has routinely been considered an exclusion in the setting of ... more Bicuspid aortic valve (BAV) anatomy has routinely been considered an exclusion in the setting of transcatheter aortic valve implantation (TAVI) because of the large dimension of the aortic annulus having a more calcified, bulky, and irregular shape. The study aims to develop a patient-specific computational framework to virtually simulate TAVI in stenotic BAV patients using the Edwards SAPIEN 3 valve (S3) and its improved version SAPIEN 3 Ultra and quantify stent frame deformity as well as the severity of paravalvular leakage (PVL). Specifically, the aortic root anatomy of n.9 BAV patients who underwent TAVI was reconstructed from pre-operative CT imaging. Crimping and deployment of S3 frame were performed and then followed by fluid-solid interaction analysis to simulate valve leaflet dynamics throughout the entire cardiac cycle. Modeling revealed that the S3 stent frame expanded well on BAV anatomy with an elliptical shape at the aortic annulus. Comparison of predicted S3 deformity as assessed by eccentricity and expansion indices demonstrated a good agreement with the measurement obtained from CT imaging. Blood particle flow analysis demonstrated a backward blood jet during diastole, whereas the predicted PVL flows corresponded well with those determined by transesophageal echocardiography. This study represents a further step towards the use of personalized simulations to virtually plan TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of “off-label” applications as the TAVI in the setting of BAV patients. Graphical abstract Computational frameworks of TAVI in patients with stenotic bicuspid aortic valve
The American journal of cardiology, Jan 15, 2018
The pattern and reasons for re-hospitalization (RH) after MitraClip implantation are not well cha... more The pattern and reasons for re-hospitalization (RH) after MitraClip implantation are not well characterized. A total of 322 consecutive MitraClip patients were included, with data stratified by RH status. Multivariate analyses were conducted to identify predictors of early (30-day) and late (30-day to 12-month) RH. Eighty-nine patients (27.6%) were readmitted to hospital during the study period and early RH occurred in 27%. The median time from MitraClip to RH was 99 days. RH was mostly related to cardiovascular causes (66.3%). Anemia and gastrointestinal bleeding were the most frequent noncardiovascular causes. Independent predictors of early RH were length of stay ≥3 days during the index procedure (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.32 to 12.91), reduction of left ventricular ejection fraction ≥5% after MitraClip implantation (OR 4.88, 95% CI 1.36 to 18.91), and severe systolic pulmonary artery pressure ≥60 mm Hg at discharge (OR 3.72, 95% CI 1.23 to 11.26). Con...
Circulation: Cardiovascular Interventions, 2017
Background— We sought to describe an optimized approach to coronary artery disease (CAD) screenin... more Background— We sought to describe an optimized approach to coronary artery disease (CAD) screening and management in patients undergoing transcatheter aortic valve replacement (TAVR). Methods and Results— When invasive coronary angiography showed CAD, the treatment strategy and completeness of revascularization was determined based on coronary anatomy. TAVR was performed in the same setting if percutaneous coronary intervention (PCI) was uncomplicated; otherwise TAVR was postponed. A total of 604 patients undergoing CAD screening at the time of TAVR procedure were prospectively included in this study. Severe CAD was found in 136 patients (22.5%). Among patients with severe CAD, 53 patients (8.8%) underwent uncomplicated PCI. After PCI, TAVR was postponed in 2 patients (0.3%). In 83 patients (13.8%), coronary angiography showed severe CAD that was left untreated. After TAVR, all-cause and cardiovascular 30-day mortality rates were 2.4% and 1.4%, respectively. Disabling stroke, myocar...
EuroIntervention, 2016
The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical o... more The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains unknown. A total of 1463 patients underwent successful CTO-PCI between August 2004 and December 2014. Major adverse cardiovascular events (MACE) defined as the composite of all-cause death, myocardial infarction and target lesion revascularization (TLR), cardiac death, and stent thrombosis were compared between patients with and without CKD (555 and 908 patients, respectively). The results demonstrated higher risks of MACE (log-rank p=0.015), all-cause death (log-rank p<0.001), cardiac death (log-rank p<0.001) in CKD group as compared with non-CKD group. Multivariable analyses demonstrated that CKD was an independent predictor for MACE (hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 1.02-1.47, p=0.03). In regards to pharmacotherapy, statin use was associated with significantly lower rates of MACE in the CKD group (long-rank p=0.003). In conclusion, the presence of CKD would be an important predictor of long-term clinical outcomes in patients undergoing CTO-PCI and use of statin may influence in reducing the adverse clinical outcomes.
JACC: Cardiovascular Interventions, 2015
OBJECTIVES This study sought to compare, in high-risk patients with 3þ to 4þ mitral regurgitation... more OBJECTIVES This study sought to compare, in high-risk patients with 3þ to 4þ mitral regurgitation (MR) dichotomized by baseline echocardiographic features, acute, 30-day, and 12-month outcomes following percutaneous mitral valve repair using the MitraClip. BACKGROUND The feasibility and mid-term outcomes after MitraClip implantation in patients with echocardiographic features different from the EVEREST (Endovascular Valve Edge-to-Edge Repair) I and II trials have been scarcely studied. METHODS Clinical and echocardiographic outcomes through 12-month follow-up of consecutive patients who underwent MitraClip implantation were obtained from an ongoing prospective registry. Two different groups, divided according to baseline echocardiographic criteria (investigational group [EVEREST OFF ] and control group [EVEREST ON ]), were compared. RESULTS Seventy-eight patients were included in EVEREST OFF and 93 patients in EVEREST ON groups. Important and comparable acute reductions in MR and no clip-related complications were revealed. The primary safety endpoint at 30 days was comparable between groups (2.6% vs. 6.5%, respectively, p ¼ 0.204); in addition, MR reduction was mostly sustained, whereas equivalent improvement in New York Heart Association functional class were demonstrated. Kaplan-Meier freedom from death, surgery for mitral valve dysfunction, or grade $3þ MR at 12 months was demonstrated in 71.4% and 76.2%, respectively, in the EVEREST OFF and EVEREST ON groups (log rank p ¼ 0.378). Significant improvements in ejection fraction and reduction in left ventricle volumes were demonstrated in both groups over time, but the baseline between-group differences were sustained. CONCLUSIONS MitraClip implantation in patients with expanded baseline echocardiographic features, compared with the control group, was associated with similar rates of safety and efficacy through 12-month follow-up. Further validation of our findings is warranted.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 4, 2014
To assess the influence of patients' gender on the outcomes of percutaneous edge-to-edge mitr... more To assess the influence of patients' gender on the outcomes of percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip system. Although gender-related differences have been extensively documented in patients who undergo surgery for moderate-to-severe (3+) and severe (4+) mitral regurgitation (MR), studies assessing whether these differences exist after PMVR are lacking. Clinical and echocardiographic data through 12-month follow up from 171 consecutive patients whom underwent MitraClip implantation and were dichotomized by the gender (106 males and 65 females) were obtained. The primary safety endpoint was the incidence of major adverse events at 30 days and the primary efficacy endpoint was freedom from death, surgery for mitral valve dysfunction, or grade ≥ 3+ MR at 12-month follow up. The primary safety endpoint was observed in four males (3.8%) and four females (6.2%) (P = 0.358). Remarkable reduction in MR postprocedure was revealed in both groups, and thes...
European Heart Journal - Case Reports, 2021
Cardiology, 2017
Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, ... more Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is a valid therapeutic option for patients with severe mitral regurgitation (MR) deemed to be at high or prohibitive surgical risk. Despite the reassuring data on efficacy and long-term durability of the procedure, the proportion of patients with residual or relapsing severe MR after MitraClip therapy is not negligible. In light of the detrimental prognostic impact of severe MR, repeat interventions are increasingly performed in clinical practice using different techniques. In high-risk settings, percutaneous procedures have proven to be effective and safe at reducing MR. Building on this, we sought to summarize the current landscape and clinical experience of reinterventions after failed MitraClip therapy, so as to assist physicians facing the clinical hurdle of proper treatment management after failed PMVR.
International Journal of Cardiology, 2016
The Journal of invasive cardiology, 2015
Few clinical data about indications and prognoses of patients undergoing balloon aortic valvulopl... more Few clinical data about indications and prognoses of patients undergoing balloon aortic valvuloplasty (BAV) in the transcatheter aortic valve implantation (TAVI) era have been reported. Data from all consecutive patients undergoing BAV in seven European centers from 2006 to 2013 were collected. Acute results and long-term outcomes were assessed. A total of 811 patients aged 82 ± 9 years were included; 416 patients (51%) underwent BAV as palliative destination therapy, 320 patients (40%) as bridge to TAVI, and 75 patients (9%) as bridge to surgical aortic valve replacement (SAVR). Patients undergoing BAV as destination therapy had a higher risk profile (logistic EuroSCORE, 20 ± 17 vs 22 ± 14 vs 11 ± 8, respectively; P<.001). Post procedure, peak gradient decreased from 87 ± 22 mm Hg to 66 ± 22 mm Hg (P<.001) and aortic valve area increased from 0.61 ± 0.2 cm² to 0.8 ± 0.2 cm² (P<.001). At 30 days, the all-cause death rate (6.5% vs 6.2% vs 7.4%, respectively; P=.56) and the r...