36 research outputs found
Changes in serum biomarker profiles after percutaneous mitral valve repair with the MitraClip system
BACKGROUND
Mitral regurgitation (MR) is one of the most common valvular diseases. Percu-taneous mitral valve repair with the MitraClipTM system is a novel percutaneous mitral valve repair (PMVR) technique for high-surgical-risk patients. However, the effect of PMVR on cir-culating cardiac or inflammatory biomarkers and their association with individual functional, echocardiographic and clinical outcomes is poorly investigated.
METHODS
A group of 144 patients with functional or degenerative MR (age, 75 ± 11 years; 41% females) underwent PMVR with the MitraClip system at the University Heart Center Zu-rich. Serum biomarkers as N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and creatinine were obtained from venous sampling at baseline and follow-up of 3-6 months.
RESULTS
Median NT-proBNP decreased insignificantly from 2,942 (IQR 1,596-5,722) to 2,739 (IQR 1,440-4,296) ng/L, p = 0.21. NT-proBNP changes did not correlate with baseline left ventricular (LV) ejection fraction or LV dimensions, with New York Heart Association class on follow-up, or with clinical events on follow-up. CRP levels reached a peak on the third postoperative day at 34.0 mg/L with a subsequent slow decrease over the ensuing days.
CONCLUSIONS
Despite successful PMVR, NT-proBNP remain fairly unchanged on follow-up and changes in NT-proBNP levels are poor predictors of functional improvement or clinical outcome after MitraClip treatment
Changes in serum biomarker profiles after percutaneous mitral valve repair with the MitraClip system
Background: Mitral regurgitation (MR) is one of the most common valvular diseases. PercuÂtaneous mitral valve repair with the MitraClipTM system is a novel percutaneous mitral valve repair (PMVR) technique for high-surgical-risk patients. However, the effect of PMVR on cirÂculating cardiac or inflammatory biomarkers and their association with individual functional, echocardiographic and clinical outcomes is poorly investigated.
Methods: A group of 144 patients with functional or degenerative MR (age, 75 ± 11 years; 41% females) underwent PMVR with the MitraClip system at the University Heart Center ZuÂrich. Serum biomarkers as N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and creatinine were obtained from venous sampling at baseline and follow-up of 3â6 months.
Results: Median NT-proBNP decreased insignificantly from 2,942 (IQR 1,596â5,722) to 2,739 (IQR 1,440â4,296) ng/L, p = 0.21. NT-proBNP changes did not correlate with baseline left ventricular (LV) ejection fraction or LV dimensions, with New York Heart Association class on follow-up, or with clinical events on follow-up. CRP levels reached a peak on the third postoperative day at 34.0 mg/L with a subsequent slow decrease over the ensuing days.
Conclusions: Despite successful PMVR, NT-proBNP remain fairly unchanged on follow-up and changes in NT-proBNP levels are poor predictors of functional improvement or clinical outcome after MitraClip treatment
Metal free percutaneous coronary interventions in all-comers: First experience with a novel sirolimus-coated balloon
Background: Limus-eluting stents have become the mainstay for percutaneous coronary intervention (PCI). However, even with the latest generation drug-eluting stent, in-stent restenosis and very late stent thrombosis remain a concern. The Selution SLRâą drug-coated balloon (DCB) is a novel sirolimus-coated balloon that provides a controlled release of the antiproliferative drug. Herein is evaluated its performance in a real-world patient cohort with complex coronary artery lesions. Methods: Patients undergoing PCI using the Selution SLRâą DCB were analyzed from the prospective SIROOP registry. We evaluated procedural success and clinical outcomes, including major adverse cardiovascular event (MACE), cardiac death, target vessel myocardial infarction and target lesion revascularization. Results: From September 2020 to April 2021, we enrolled 78 patients (87 lesions) treated using a âDCB onlyâ strategy. The mean age was 66.7 ± 10.4 years and 28 (36%) presented with an acute coronary syndrome. Almost all lesions were type B2/C 86 (99%) and 49 (63%) had moderate to severe calcifications. Procedural success was 100%. After a median follow-up of 11.2 months (interquartile range: 10.0â12.6), MACE occurred in 5 (6.8%) patients. No acute vessel closure was observed. Conclusions: In complex coronary lesions, a âDCB onlyâ strategy using the Selution SLRâą DCB is not just safe and feasible, but also seems to be associated with a low rate of MACE at 1-year follow-up. Our promising results warrant further evaluation in a dedicated comparative trial
Treatment of coronary lesions with a novel crystalline sirolimus-coated balloon
BackgroundThere is mounting data supporting the use of drug-coated balloons (DCB) not only for treatment of in-stent restenosis (ISR), but also in native coronary artery disease. So far, paclitaxel-coated balloons represented the mainstay DCBs. The SeQuentÂź crystalline sirolimus-coated balloon (SCB) (B.Braun Medical Inc, Germany) represents a novel DCB, which allows a sustained release of the limus-drug. We evaluated its performance in an all-comer cohort, including complex coronary lesions.MethodsConsecutive patients treated with the SeQuentÂź SCB were analyzed from the prospective SIROOP registry (NCT04988685). We assessed clinical outcomes, including major adverse cardiovascular events (MACE), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiovascular death. Angiograms and outcomes were independently adjudicated.ResultsFrom March 2021 to March 2023, we enrolled 126 patients and lesions, of which 100 (79%) treated using a âDCB-onlyâ strategy and 26 (21%) with a hybrid approach (DESâ+âDCB). The mean age was 68â±â10 years, 48 (38%) patients had an acute coronary syndrome. Regarding lesion characteristics, ISR was treated in 27 (21%), 11 (9%) underwent CTO-PCI and 59 (47%) of the vessels were moderate to severe calcified. Procedural success rate was 100%. At a median follow-up time of 12.7 (IQR 12; 14.2) months, MACE occurred in 5 patients (4.3%). No acute vessel closure was observed.ConclusionsOur data indicates promising outcomes following treatment with this novel crystalline SCB in an all-comer cohort with complex coronary lesions. These results require further investigation with randomized trials
Feasibility of concomitant MitraClip and left atrial appendage occlusion
AIMS: The aim of our study is to report our single-centre experience with concomitant MitraClip (MC) and left atrial appendage occlusion (LAAO) and further to assess the feasibility, safety and short-term outcome of such an approach.
METHODS AND RESULTS: Twenty-five consecutive patients underwent MC with concomitant LAAO at our hospital (combined group). As a control group, 25 consecutive patients with atrial fibrillation (AF) undergoing standalone MC were selected. Baseline parameters were equal between the two groups. Patients in the combined group had longer procedural time (90.0 min vs. 66.0 min, p=0.02) and radiation time (32.0 min vs. 18.0 min, p=0.01). There were no procedural deaths. At 30 days, one patient died due to cerebral haemorrhage (combined vs.
CONTROL: 4% vs. 0%, p=0.32) and two had acute kidney injury (combined vs.
CONTROL: 4% vs. 4%, p=1.00). In multivariate analysis, the association of LAAO with device or procedural success was not significant.
CONCLUSIONS: LAAO along with MC in a single stage procedure is feasible. These preliminary results have to be validated in a large randomised study, in order to assess the efficacy of combined LAAO that can be expected to become evident only after longer follow-up
LongâTerm Outcomes After Transcatheter Aortic Valve Implantation in Patients With Chronic Inflammatory Disease
Background Chronic inflammatory disease (CID) accelerates atherosclerosis and the development of aortic stenosis. Data on longâterm outcomes after transcatheter aortic valve implantation (TAVI) in those patients are missing. The aim of this study was to investigate the clinical longâterm outcomes of patients with and without autoimmuneârelated CID undergoing TAVI for the treatment of severe aortic stenosis. Methods and Results From a prospective registry, consecutive patients with TAVI were included. Baseline clinic and imaging data (echocardiographic and computed tomography) were analyzed. Longâterm (up to 5âyears) clinical and echocardiographic outcomes were studied. Of 1000 consecutive patients (mean age 81±6âyears, 46% female), 107 (11%) had CID; the most frequent entities included polymyalgia rheumatica (31%) and rheumatoid arthritis (28%). Patients with CID were predominantly female (60% versus 44%, P=0.002) and more often had pulmonary disorders (21% versus 13%, P=0.046) and atrial fibrillation (32% versus 20%, P=0.003). The presence of CID was associated with a higher rate of postinterventional infection (5% versus 1%, P=0.007) and further emerged as a risk factor for rehospitalization for bleeding or infection (hazard ratio, 1.93 and 1.62, respectively). Premature valve degeneration, endocarditis, and allâcause mortality were not increased among patients with CID. Conclusions This realâworld analysis found that patients with CID undergoing TAVI were associated with a higher risk of postinterventional infectious complications and rehospitalization due to infection. However, valve durability and survival seem not to differ between patients with TAVI with versus without CID