Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation in a Large and Noncalcified Annulus

none8non.dmixedOrzalkiewicz, Mateusz; Bruno, Antonio Giulio; Taglieri, Nevio; Ghetti, Gabriele; Marrozzini, Cinzia; Galiè, Nazzareno; Palmerini, Tullio; Saia, FrancescoOrzalkiewicz, Mateusz; Bruno, Antonio Giulio; Taglieri, Nevio; Ghetti, Gabriele; Marrozzini, Cinzia; Galiè, Nazzareno; Palmerini, Tullio; Saia, Francesc

[Endovascular repair of an aortic aneurysm by a custom-made three-inner branched endograft]

: We report the case of a total endovascular repair of an aortic arch aneurysm by a custom-made endograft with three inner branches for supra-aortic trunks in a high-risk patient unfit for open surgery. An 82-year-old female at high risk for open repair was treated for an asymptomatic aortic arch aneurysm (97 mm in diameter) by a custom-made three-inner branched endograft. Two anterograde branches were planned for the innominate trunk and the left carotid artery while a retrograde branch with a preloaded catheter was planned for the left subclavian artery. The procedure was successfully completed and postoperative course was uneventful. Computed tomography angiography demonstrated aneurysm exclusion, patency of the three supra-aortic branches and absence of cerebral ischemic lesion at 30 and 90 days. A custom-made endovascular device with three inner branches is a safe and effective option to guarantee a total endovascular repair of aortic arch aneurysm in high-risk patients in the presence of anatomical feasibility

Monocyte-derived tissue factor contributes to stent thrombosis in an in vitro system

none8sinonePalmerini T;Coller B;Cervi v; Tomasi L; Marzocchi A; Marrozzini C; Ortolani P; Branzi APalmerini T;Coller B;Cervi v; Tomasi L; Marzocchi A; Marrozzini C; Ortolani P; Branzi

Correlation between aortic root dimension and coronary ectasia

BACKGROUND: Aortic aneurysms are associated with coronary artery ectasia (CAE). However, the relation between the extent of CAE and the severity of aortic dilatation is not understood. This study was undertaken to investigate the relationship between angiographic extension of CAE and aortic dimension. PATIENTS AND METHODS: We retrospectively include 135 patients with angiographic diagnosis of CAE defined as dilatation of coronary segment more than 1.5 times than an adjacent healthy one. Study population was divided in four groups according to the maximum diameter of ascending aorta beyond sinus of Valsalva obtained in the parasternal long-axis view (group 1: <40 mm; group 2: 40-45 mm; group 3: 45-55 mm; group 4: >55 mm or previous surgery because of aortic aneurysm/dissection). The relationship between aortic dimension and the extension of CAE was investigated by means of multivariable linear regression, including variables selected at univariable analysis (P < 0.1). The total estimated ectatic area (EEA total) was used as dependent variable. RESULTS: Baseline characteristics of study groups were well balanced. Patients in group 4 were more likely to have both higher neutrophil count and neutrophil to lymphocyte ratio. On univariable analysis ascending aorta diameter [Coef. = 0.075; 95% confidence interval (CI) 0.052-0.103, P < 0.01] and c-reactive protein (CRP) values [Coef. = 0.033, 95% CI 0.003-0.174, P = 0.04] showed a linear association with total EEA. After adjustment for CRP values only the ascending aorta diameter was still associated with the extent of CAE (95% CI 0.025-0.063, P < 0.01). CONCLUSION: In patients with diagnosis of CAE, a strong linear association between aortic dimension and coronary ectasia extent exists

Biolimus-a9 eluting stent implantion for unprotected left main coronary artery stenosis: 9-month strut coverage as assessed by optical coherence tomography

OBJECTIVE: To evaluate strut coverage after biolimus-A9 eluting stent (BES) implantation for unprotected left main artery (ULMA) stenosis during follow-up and identify features associated with the length of uncovered stent segment, as assessed by frequency domain-optical coherence tomography (FD-OCT). BACKGROUND: Incomplete stent strut coverage is a risk factor for late stent thrombosis. Long-term interaction between vessel wall and BES in the context of ULMA stenting has not been investigated in depth. METHODS: We prospectively enrolled 32 patients with ULMA stenosis treated with BES. FD-OCT was performed at 9-month follow-up. Both malapposed and uncovered segment length were indexed for the segment between the distal and proximal cross-sections in which stent struts were circumferentially visible. Patients were divided into two groups according to the median value of maximal indexed uncovered segment length. Study endpoints were the rate of strut coverage and predictors of high uncovered segment length. RESULTS: We analyzed 3622 struts. The rate of covered struts was 87%. A high correlation was found between malapposed and uncovered segment length (r ≤ 0.82; P<.001). The median value of indexed-uncovered segment length was 0.308. On multivariable analysis, patients undergoing final kissing balloon were at lower risk of high uncovered segment length (odds ratio, 0.81; 95% confidence interval, 0.008-0.837; P≤.04). CONCLUSION: In patients undergoing BES implantation for treatment of ULMA stenosis, the rate of 9-month strut coverage is high. The use of final kissing balloon reduces the risk of high uncovered stent segment length

Incidence, treatment, and outcome of acute aortic valve regurgitation complicating percutaneous balloon aortic valvuloplasty

Objectives: To evaluate the incidence, treatment, and outcomes of acute aortic regurgitation (ARR) complicating BAV. Background: In the transcatheter aortic valve implantation (TAVI) era, there is an increase of percutaneous balloon aortic valvuloplasty (BAV) procedures with different indications. Methods: From the prospective BAV registry of the University of Bologna, which has enrolled patients between the year 2000 and the present, we selected those who suffered intraprocedural AAR with overt hemodynamic instability. Worsening of baseline aortic insufficiency without hemodynamic collapse, treatment of degenerated biological valve prosthesis, and BAV performed within a planned TAVI procedure were excluded. The main endpoints were in-hospital and 30-day mortality. Results: Out of 1517 BAVs, we identified 26 cases of AAR (1.7%). This complication occurred in 80.8% of cases after one or two balloon inflations. Mean transaortic gradient decreased from 50.6\ua0\ub1\ua019.3 to 26.0\ua0\ub1\ua014.4 mm\ua0Hg (p\ua0<\ua00.01). In 8(30.8%) patients, AAR spontaneously resolved within few minutes; in 18 cases, the operators had to perform a rescue maneuver to reposition a valve leaflet got stuck in the opening position (this maneuver was successful in 13/18 of the cases, 72.2%). Out of 5 persistent AAR, 3 were managed with emergency TAVI or surgery, while 2 were unresolved. In-hospital mortality was 15.4% (n\ua0=\ua04), whereas no more deaths occurred up to 30 days. Conclusions: AAR is a fearsome complication of BAV and portends a grim prognosis. In some cases, it can be resolved with appropriate technical maneuvers; in others, a rescue TAVI or surgical valve replacement may be necessary. \ua9 2015 Wiley Periodicals, Inc

Biolimus-a9 eluting stent implantion for unprotected left main coronary artery stenosis: 9-month strut coverage as assessed by optical coherence tomography

OBJECTIVE: To evaluate strut coverage after biolimus-A9 eluting stent (BES) implantation for unprotected left main artery (ULMA) stenosis during follow-up and identify features associated with the length of uncovered stent segment, as assessed by frequency domain-optical coherence tomography (FD-OCT). BACKGROUND: Incomplete stent strut coverage is a risk factor for late stent thrombosis. Long-term interaction between vessel wall and BES in the context of ULMA stenting has not been investigated in depth. METHODS: We prospectively enrolled 32 patients with ULMA stenosis treated with BES. FD-OCT was performed at 9-month follow-up. Both malapposed and uncovered segment length were indexed for the segment between the distal and proximal cross-sections in which stent struts were circumferentially visible. Patients were divided into two groups according to the median value of maximal indexed uncovered segment length. Study endpoints were the rate of strut coverage and predictors of high uncovered segment length. RESULTS: We analyzed 3622 struts. The rate of covered struts was 87%. A high correlation was found between malapposed and uncovered segment length (r 64 0.82; P<.001). The median value of indexed-uncovered segment length was 0.308. On multivariable analysis, patients undergoing final kissing balloon were at lower risk of high uncovered segment length (odds ratio, 0.81; 95% confidence interval, 0.008-0.837; P 64.04). CONCLUSION: In patients undergoing BES implantation for treatment of ULMA stenosis, the rate of 9-month strut coverage is high. The use of final kissing balloon reduces the risk of high uncovered stent segment length

Cognitive functions: Evaluation and changes after transcatheter aortic valve implantation in elderly patients

Aim: To assess the prevalence and postprocedural evolution of cognitive impairment (CI) in patients undergoing transcatheter aortic valve implantation. Methods: 62 patients were enrolled. Mini Mental state examination (MMSE), verbal memory test (VMT), visual search test (VST) and phonemic verbal fluency (PVF) were used to evaluate the cognitive status. CI was considered when a pathological result of MMSE was confirmed by VMT, VST and PVF. Results: A total of 26.2% patients had CI at baseline. MMSE, VMT, VST and PVF were pathologic in 39, 16.1, 8.1 and 22.6% of the patients, respectively. Overall, no significant differences in cognitive function in any dimension were observed from baseline up to 1-year follow-up. Conclusion: CI is frequent in patients undergoing transcatheter aortic valve implantation, though the procedure does not forge cognitive status

Long-Term Outcomes of Percutaneous Paravalvular Regurgitation Closure After Transcatheter Aortic Valve Replacement A Multicenter Experience

AbstractObjectivesThis study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR).BackgroundSevere symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes.MethodsThe study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography.ResultsTwenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes.ConclusionsTranscatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes