Publications by authors named "Bellini Barbara"
Transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and raphe-type bicuspid aortic valve (BAV) is still associated with poor outcomes in terms of increased risk of paravalvular regurgitation, stroke, and permanent pacemaker implantation. There is no definitive consensus on the optimal sizing method for prosthesis selection in this setting. The LIRA method is a supra-annular tailored sizing method specifically designed for bicuspid anatomy that might increase accuracy of prosthesis choice in BAV patients and improve TAVR outcomes.
View Article and Find Full Text PDFBackground: Left ventricular obstruction (LVO) is an infrequent complication following transcatheter aortic valve replacement (TAVR) that can lead to severe hemodynamic decompensation. Previous studies have analyzed the pathophysiology of this clinical entity; however, little is known about the anatomical characteristics as assessed by computational tomography (CT) of patients at risk.
Methods: Data from 349 patients were retrospectively analyzed from a single center registry of patients undergoing TAVR at San Raffaele Hospital, Milan, Italy, between January 2020 and December 2021.
Background: Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) disease is still burdened by a non-negligible rate of stroke and permanent pacemaker implantation (PPI). These suboptimal results, possibly related to the unique BAV anatomy, may suggest the use of a different sizing method in this setting. The aim of our study is to evaluate whether the application of the supra-annular LIRA method may improve clinical outcomes in this population.
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- The LANDMARK trial compared the balloon-expandable Myval transcatheter heart valve (THV) series to the SAPIEN and Evolut THV series in 768 patients to evaluate safety and effectiveness.
- Results showed that Myval achieved non-inferiority to SAPIEN (24.7% vs 24.1%) and Evolut (24.7% vs 30.0%) regarding a primary composite safety endpoint.
- Additionally, while Myval had better pressure gradient metrics compared to SAPIEN, Evolut showed slightly higher rates of prosthetic valve regurgitation compared to Myval but no significant difference between Myval and SAPIEN.
[The development of a Hub & Spoke network for transcatheter aortic valve replacement procedures: the operational model of the Interventional Cardiology Unit at the IRCCS San Raffaele Hospital (OSR Hub-Spoke)].
G Ital Cardiol (Rome)
November 2024
Recently, an increase in the number of patients with severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) has been observed worldwide. In order to reduce waiting lists, provide to all patients referred to us equal access to care and to further improve the collaboration with spoke centers, we developed a specific Hub & Spoke specific protocol for TAVI. According to our protocol, a clinical selection (with echo and computed tomography scan) is done by Spoke centers, the case is discussed with a multidisciplinary team online and the procedure is planned (access, valve type size).
View Article and Find Full Text PDFBackground: The ACURATE neo2 is a contemporary transcatheter aortic valve implantation (TAVI) system approved for the treatment of severe aortic stenosis in Europe. The ACURATE neo2 has not been evaluated in bicuspid aortic valve (BAV) stenosis.
Aims: We sought to evaluate the safety and efficacy of ACURATE neo2 in patients with BAV stenosis.
Article Synopsis
- Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are compared for their effects on patients with Sievers type 1 bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve replacement.
- The analysis, based on a registry of 955 patients, found no significant difference in midterm major adverse events or technical success between BEVs and SEVs after adjusting for baseline differences.
- However, BEVs had lower risks of new permanent pacemaker implantation and moderate or greater paravalvular regurgitation, but a higher risk of severe patient-prosthesis mismatch compared to SEVs.
The two surgical options for mitral valve regurgitation are replacement and repair, with annuloplasty being the cornerstone of correction. In cases of repair failure, especially in high surgical risk patients, transcatheter mitral valve-in-ring (MViR) procedures represent emerging and challenging options. Among the several complications linked to this treatment, this paper delves into the role that native mitral leaflets may play in precipitating acute bioprosthesis dysfunction in the MViR procedure.
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- A study collected data from 2,626 patients who underwent Transcatheter Aortic Valve Replacement (TAVR) in Italy from 2007 to 2017, focusing on those with normal or reduced Left Ventricular Ejection Fraction (LVEF).
- Reduced LVEF patients were further divided into ischemic and nonischemic groups, with the main goal being to track all-cause death and rehospitalizations over 8 years.
- Results showed that patients with reduced LVEF faced a higher risk of death and rehospitalizations, particularly those with an ischemic cause, highlighting the long-term challenges for these patients post-TAVR.
Article Synopsis
- The study examines the characteristics and outcomes of patients with tapered raphe-type bicuspid aortic valve (BAV) when undergoing trans-catheter aortic valve replacement (TAVR), focusing on the safety and effectiveness of modern heart valves.
- Researchers analyzed data from 897 patients, finding that those with tapered configurations showed similar success rates and safety between two sizing strategies: annular and supra-annular.
- The results indicate that TAVR is a safe and effective procedure for these patients, regardless of the sizing method used, maintaining a high rate of clinical efficacy at mid-term follow-up.
Background And Aims: Transcatheter aortic valve replacement (TAVR) determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis but data on very long-term durability are lacking. We sought to evaluate the clinical and hemodynamic outcomes of the CoreValve porcine pericardial self-expanding bioprosthesis at 12-year follow-up.
Methods: 882 inoperable or high-risk patients were treated with the CoreValve bioprosthesis in 8 Italian high-volume centers between 2007 and 2011.
Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative mitral stenosis (DMS). While rheumatic fever-induced RMS has declined in prevalence, DMS is rising with aging populations and comorbidities. Starting from a complex clinical case of DMS, the aim of this paper is to review the literature on mitral stenosis by analyzing the available tools and the differences in terms of diagnosis and treatment for rheumatic and degenerative stenosis.
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- Transcatheter aortic valve replacement (TAVR) for patients with bicuspid aortic valve (BAV) stenosis can lead to complications like paravalvular regurgitation (PVR), which is the leakage of blood around the valve.
- A study involving 946 patients aimed to understand how often PVR occurs after TAVR, what factors predict it, and its impact on patient outcomes, finding that 44.7% experienced some level of PVR.
- Moderate or severe PVR was linked to higher risks of major adverse events (MAEs) like death or hospitalization, highlighting the importance of careful monitoring and management in these patients.
Patent foramen ovale (PFO) is a remnant of normal fetal anatomy which may persist into adulthood, mostly asymptomatic. In some adults, PFO may result in a potential for shunting venous thromboembolism to the arterial circulation; less frequently it can cause interatrial, right-to-left shunting of deoxygenated blood. The pathogenesis of several medical conditions is related to the presence of PFO.
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- Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) is emerging as a safe alternative to traditional surgery for treating deteriorating bioprostheses.
- The current focus in the medical community is on challenges like coronary obstruction and patient-prosthesis mismatch, but there is insufficient data on the initial step of crossing a degenerated bioprosthesis.
- This review aims to assess existing knowledge on the crossing process, highlight the challenges faced by interventional cardiologists, and outline effective strategies for successful crossings.
Background: Microvascular resistance reserve (MRR) is a validated measure of coronary microvascular function independent of epicardial resistances.
Aims: We sought to assess whether MRR is associated with adverse cardiac remodelling, a low-flow phenotype and extravalvular cardiac damage (EVCD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
Methods: Invasive thermodilution-based assessment of the coronary microvascular function of the left anterior descending artery was performed in a prospective, multicentre cohort of patients undergoing TAVI.
Background: Balloon post-dilation (BPD) is a widely adopted strategy to optimize acute results of TAVI, with a positive impact on both paravalvular leak and mean gradients. On the other hand, the inflation of the balloon inside prosthetic leaflets may damage them increasing the risk of structural valve deterioration (SVD). Furthermore, the impact of BPD on long-term clinical outcomes and valve hemodynamics is yet unknown.
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- Ischemia with no obstructive coronary artery disease (INOCA) is frequently diagnosed in patients with chest pain, even when coronary angiography shows no blockages.
- Symptoms in INOCA patients can vary widely, which sometimes leads to misdiagnosis and lack of proper treatment.
- The text discusses three specific clinical cases of INOCA that were initially misdiagnosed, detailing how they were correctly reevaluated through the appropriate diagnostic procedures.
Mind the "commissural drop" when crossing the aortic valve!
Catheter Cardiovasc Interv
September 2023
Background: LAAO is an emerging option for thromboembolic event prevention in patients with NVAF. We previously reported data on comparison between LAAO and DOAC at two-year follow-up in NVAF patients at HBR (HAS-BLED ≥3).
Aims: Limited data are available on long term follow-up.