Publications by authors named "Bernhard Reimers"
Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCBs) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. This study aimed to evaluate the incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease.
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- Coronary artery dissections occur when there is a tear in the vessel lining, leading to blood pooling and formation of an intramural hematoma, which can obstruct blood flow.
- A new method called the "Cuttering Technique" was tested on seven patients to improve drainage of the hematoma and restore blood flow by creating tears between the false and true lumen of the artery.
- The results showed that five out of seven patients achieved significant improvement in blood flow, indicating that the "Cuttering Technique" is an effective way to manage complications from intramural hematomas.
Aims: Dual antiplatelet therapy (DAPT) can be shortened up to 1 month in high-bleeding risk (HBR) patients receiving a contemporary biodegradable-polymer sirolimus-eluting stent. We aimed to summarize the evidence on a similar DAPT regimen after biodegradable-polymer everolimus-eluting stent (EES) implantation in patients at HBR.
Methods And Results: We pooled the individual participant data from the available trials evaluating this strategy, namely, the SENIOR and the POEM trials.
Article Synopsis
- - Percutaneous left atrial appendage closure (LAAC) is being explored as a non-drug option for preventing strokes in patients with atrial fibrillation, but there’s still limited comparative data on its effectiveness versus traditional anticoagulants like vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs).
- - A meta-analysis of seven trials involving over 73,000 patients found that LAAC has similar rates of stroke or systemic embolism compared to VKAs and DOACs, and while bleeding risks were similar, LAAC was linked to lower bleeding risk after excluding procedural complications.
- - Ultimately, both LAAC and DOACs showed lower all-cause mortality compared to VK
Value-based preoperative assessment in a large academic hospital.
J Anesth Analg Crit Care
July 2024
Article Synopsis
- Value-based healthcare (VBHC) focuses on maximizing patient value and outcomes while minimizing costs, shifting the emphasis from the volume of services to the quality of care delivered.
- This study evaluated the impact of a VBHC-principled preoperative evaluation at Humanitas Research Hospital by comparing results from 2019 (preintervention) to 2021 (postintervention).
- The findings showed a significant reduction in preoperative tests and evaluation time, leading to lower healthcare costs without negatively affecting patient outcomes.
Article Synopsis
- A study examined the effects of short dual antiplatelet therapy (S-DAPT) following percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) using a specific heart health criteria (ARC-HBR).
- The research involved 356 patients with a high prevalence of risk factors, showing that 5.2% experienced serious cardiac events within 12 months, while 2.7% had significant bleeding complications.
- Findings suggest S-DAPT after using Synergy bioresorbable stents leads to favorable outcomes for both ischemic and bleeding events in high-risk patients, supporting previous positive results from the POEM trial.
Balloon angioplasty achieves luminal enlargement by fracturing the atherosclerotic intima at its point of least resistance, thereby creating a dissection plane and space with dehiscence of the intima from the media. This barotraumatic dissection triggers an inflammatory and proliferative reaction, resulting in a restenosis process at medium-term. In the era of plain old balloon angioplasty, quantitative angiographic studies at follow-up demonstrated that - the greater the acute luminal gain was after balloon angioplasty, the greater the late luminal loss was at follow-up.
View Article and Find Full Text PDFAn 81-year-old woman presented with acute pulmonary edema. Echocardiography revealed severe functional mitral regurgitation, the mechanism of which was unusual. An atypical bileaflet tethering caused by disharmonic annular remodeling, concomitant aortic dilatation, and reduced aorto-mitral angle without left ventricular dysfunction or dilatation was found.
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- Current European guidelines recommend TAVI for patients aged 75 and older, but its effectiveness based on age is uncertain.
- In a study of 2,685 intermediate-to-low-risk patients, mortality rates at a mean follow-up of 437 days were similar for those under and over 75 years old.
- The findings indicate that age does not significantly predict all-cause mortality for TAVI patients, suggesting that the age threshold in guidelines may not accurately reflect risk.
Article Synopsis
- * A systematic review including 68,653 patients found that GLP1-ra significantly reduced heart failure hospitalizations and cardiovascular deaths only in patients without previous HF history.
- * Despite the lack of benefits in HF patients regarding hospitalizations and deaths, GLP1-ra were effective in reducing major adverse cardiovascular events (MACE) for both groups without significant differences in treatment effect based on HF history.
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.
View Article and Find Full Text PDFBackground: Percutaneous treatment for ostial left circumflex artery (LCx) lesions is known to be associated with suboptimal results.
Aims: The present study aims to assess the procedural and long-term clinical outcomes of percutaneous coronary intervention (PCI) for de novo ostial LCx lesions overall and according to the coronary revascularization strategy.
Methods: Consecutive patients undergoing PCI with second generation drug eluting stents or drug coated balloons for de novo ostial LCx lesions in three high-volume Italian centers between 2012 and 2021 were retrospectively evaluated.
Article Synopsis
- Percutaneous closure of a patent foramen ovale (PFO) is a common procedure aimed at preventing recurrent strokes and treating related syndromes in specific patients.
- While disc-based devices have been widely used for the past two decades, new suture-based devices are emerging as a promising option, although their long-term efficacy is not fully established.
- The review covers current evidence on suture-based closure devices, including their characteristics, evaluation methods, patient selection guidelines, procedural steps, potential complications, and future advancements in the field.
Article Synopsis
- There is a lack of comparative data on the effectiveness of sirolimus-coated balloons (SCBs) versus paclitaxel-coated balloons (PCBs) in treating small vessel disease (SVD).
- The study involved 121 patients and aimed to compare angiographic outcomes after 6 months of treatment with either SCB or PCB, with a focus on net lumen gain.
- Results showed that SCBs did not meet the noninferiority criterion for net lumen gain compared to PCBs, demonstrating less improvement and higher rates of restenosis.
Article Synopsis
- Drug-coated balloons (DCB) show promise for treating de novo lesions in large vessels, but there is limited evidence on their effectiveness compared to drug-eluting stents (DES).
- A study comparing 147 patients treated with DCB to 701 patients receiving DES found no significant difference in target lesion failure rates after 2 years.
- After adjusting for patient characteristics, DCB treatment was associated with a significantly lower risk of target lesion failure, primarily due to reduced need for revascularization.
Article Synopsis
- Diabetic patients are more vulnerable to complications after percutaneous coronary intervention (PCI), and the effectiveness of new drug-eluting stents is still questionable for this group.
- This study aimed to compare the Abluminus drug-eluting stent with a durable polymer everolimus-eluting stent in reducing neointimal hyperplasia among diabetic patients.
- Results indicated no significant difference in neointimal volume or related outcomes between the two stent types, suggesting that the Abluminus stent did not outperform the DP-EES for this patient population.
Article Synopsis
- * 443 patients were enrolled, with no significant differences in the rates of serious heart issues like cardiac death and heart attacks between the ACS and CCS groups after 12 months.
- * Both groups showed similar rates of bleeding complications, indicating that a 1-month DAPT approach is safe for HBR patients undergoing PCI with a specific type of stent (BP-EES).
Article Synopsis
- * A prospective study included 106 patients, with a focus on outcomes like cardiac death and revascularization, showing high procedural success and improvement in vessel dimensions post-treatment.
- * The study concluded that combining drug-eluting stents and drug-coated balloons could be a promising and safe alternative treatment method for de novo diffuse CAD.