Publications by authors named "Conrotto F"
Introduction: In patients with chronic coronary syndromes (CCS), the benefit of percutaneous coronary intervention (PCI) added to optimal medical therapy (OMT) remains unclear. The indication to PCI may be driven either by angiographic evaluation or ischemia assessment, thus depicting different potential strategies which have not yet been thoroughly compared.
Methods: Randomized controlled trials (RCTs) comparing OMT versus PCI angio-guided or versus PCI non-invasive or invasive ischemia guided were identified and compared via network meta-analysis.
Article Synopsis
- The study evaluates the performance of ultrathin drug-eluting stents (DES) versus thin-strut DES and drug-eluting balloons (DEB) in treating in-stent restenosis (ISR) in patients.
- Results show that ultrathin DES significantly lowers the risk of adverse events, including cardiac death and need for revascularization, when compared to both thin-strut DES and DEBs after three years of follow-up.
- Additionally, in patients with diffuse ISR, ultrathin DES outperformed thin-strut DES in reducing risks of target lesion revascularization (TLR) and target vessel revascularization (TVR).
Article Synopsis
- The study investigates the effects of red blood cell (RBC) transfusion on short-term mortality in patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI), where bleeding is common.
- Out of 11,265 TAVI participants, 548 had TA-TAVI, with 209 receiving RBC transfusions, and the study found a significant association between transfusion and increased 30-day mortality.
- The research concluded that RBC transfusion independently predicts higher short-term mortality in TA-TAVI patients, regardless of other factors like major bleeding and kidney injury.
Article Synopsis
- The study investigates the prevalence and impact of prosthesis-patient mismatch (PPM) in patients undergoing transcatheter aortic valve replacement (TAVR) on heart damage and mortality.
- A cohort of 963 patients was analyzed, revealing that 18% experienced PPM post-TAVR, with 7.7% having severe cases.
- Those with PPM exhibited significant heart changes after one year, including increased left ventricle size and more paravalvular aortic regurgitation compared to those without PPM.
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.
Article Synopsis
- Dialysis is a serious but rare complication following transcatheter aortic valve replacement, and researchers analyzed the TRITAVI registry to develop a clinical score for assessing this risk.
- They identified various preprocedural factors (like male sex, diabetes, and anemia) and procedural features (like contrast volume and need for transfusion) that contribute to the risk, resulting in two scoring systems (TRITAVIpre and TRITAVIpost) which demonstrated strong predictive power.
- The study confirmed that the need for dialysis significantly increases mortality rates, emphasizing the importance of the developed scores in predicting dialysis risk before the procedure.
Article Synopsis
- The study evaluates the long-term impact of IntraVascular UltraSound (IVUS) on outcomes for patients with Unprotected Left Main (ULM) coronary artery disease undergoing Percutaneous Coronary Intervention (PCI).
- Conducted across 13 European centers from 2002 to 2015, the research involved 627 patients, comparing those who received IVUS guidance to those who had traditional angiography.
- Results showed that patients in the IVUS group experienced significantly fewer major adverse cardiovascular events (MACEs), all-cause death, and the need for further revascularization, suggesting that IVUS-guided PCI improves long-term patient outcomes.
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
- - The study focused on evaluating the performance of the ACURATE Neo2 transcatheter heart valve (THV) in patients with a horizontal aorta (HA), which is linked to worse outcomes after heart valve procedures.
- - Results showed that while both ACURATE Neo and Neo2 valves had similar success rates, the Neo2 valve significantly reduced the occurrence of moderate or severe paravalvular leak (PVL) compared to the Neo valve (5% vs. 15%).
- - The findings suggest that the Neo2 valve is a better option for patients with HA, offering improved PVL rates without compromising device success in the shorter term follow-up.
Article Synopsis
- The study investigates the prevalence of transthyretin cardiac amyloidosis (ATTR-CA) in patients undergoing transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis (AS), noting that detection is often challenging among this group.
- Out of 107 patients evaluated, 6 were confirmed to have ATTR-CA, resulting in a prevalence rate of 7.1%, with ATTR-CA patients being older and exhibiting more severe heart and kidney damage compared to those without the condition.
- The research highlights unique ECG features, such as bifascicular block, that are significantly associated with dual pathology (both AS and ATTR-CA), indicating the need for improved detection methods in these patients.
Background: Data about the long-term performance of new-generation ultrathin-strut drug-eluting stents (DES) in challenging coronary lesions, such as left main (LM), bifurcation, and chronic total occlusion (CTO) lesions are scant.
Methods: The international multicenter retrospective observational ULTRA study included consecutive patients treated from September 2016 to August 2021 with ultrathin-strut (<70 µm) DES in challenging de novo lesions. Primary endpoint was target lesion failure (TLF): composite of cardiac death, target-lesion revascularization (TLR), target-vessel myocardial infarction (TVMI), or definite stent thrombosis (ST).
Article Synopsis
- Long-term right ventricular pacing (VP) can lead to negative outcomes like heart failure and cardiovascular mortality in patients who have undergone transcatheter aortic valve replacement (TAVR).
- The PACE-TAVI registry studied 377 TAVR patients with pacemakers, comparing those with VP below 40% to those at or above 40% to see how this affects their health outcomes.
- Results showed that patients with VP ≥40% had a significantly higher risk of cardiovascular death and heart failure hospitalization, emphasizing the need for closer monitoring of these patients after TAVR.
Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI.
Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV).
Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers.
Background: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion significantly reduces the risk of cardiovascular death. However, the management of non-culprit lesions in patients with the multivessel disease remains a matter of debate in this setting. It's still unclear if a morphological OCT-guided approach, identifying coronary plaque instability, may provide a more specific treatment compared with a standard angiographic/functional approach.
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- - Transcatheter aortic valve implantation (TAVI) is the go-to treatment for patients with severe aortic stenosis who can't have surgery, and a study was done to assess changes in heart function following the procedure using echocardiography.
- - The study involved 25 patients with a mean age of 83, and measurements of hemodynamic forces (HDFs) and left ventricular (LV) function showed significant improvements in HDF parameters post-TAVI.
- - Despite these improvements in HDFs, conventional measures like global longitudinal strain and left ventricular ejection fraction did not change much, suggesting that HDF analysis might be more effective in predicting recovery of LV function post-TAVI.
Aims: The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS.
Methods And Results: Patients were categorized according to SVi (<35 mL/m2) and FR (<200 mL/s).
Article Synopsis
- Patients with a history of acute coronary syndrome (ACS) have a high risk of recurring cardiovascular issues, and recent therapies aim to lower these risks but may increase bleeding.
- In a study of over 10,000 ACS patients, it was found that 53.4% qualified for the PEGASUS strategy, while 38.2% were eligible for the COMPASS strategy, with a notable overlap of 34.4% between the two.
- Overall, about one-third of the patients could benefit from either prolonged dual antiplatelet therapy or dual pathway inhibition, indicating varying eligibility for these treatments among ACS patients.
Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings.
View Article and Find Full Text PDFStratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet clinical need that may be fulfilled through the adoption of machine learning (ML) algorithms to refine outcome predictions. We sought to develop an ML-based risk stratification model built on clinical, anatomical, and procedural features to predict all-cause mortality following contemporary bifurcation PCI. Multiple ML models to predict all-cause mortality were tested on a cohort of 2393 patients (training, n = 1795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real-world RAIN registry.
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- Transcatheter aortic valve implantation (TAVI) using a percutaneous axillary approach is being evaluated for its safety and effectiveness compared to traditional surgical access.
- An international study analyzed data from 432 patients, revealing that while the percutaneous approach had a higher rate of primary hemostasis failure, it led to shorter hospital stays and lower risks of major complications.
- The findings suggest that percutaneous axillary access is as effective or potentially superior to surgical access for TAVI, especially for patients who cannot use the femoral approach.
Background: The first-generation ACURATE neo transcatheter heart valve (THV) (Boston Scientific) was associated with a non-negligible occurrence of moderate or greater paravalvular aortic regurgitation (AR) following transcatheter aortic valve replacement. To overcome this issue, the ACURATE neo2 iteration, which incorporates a taller outer skirt aimed at reducing the occurrence of paravalvular AR, has recently been developed.
Objectives: The aim of this study was to assess the efficacy and safety of the ACURATE neo2 (Boston Scientific) THV in patients with severe aortic valve stenosis.
Introduction: Despite limited to short and midterm outcomes, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a valid alternative to re-surgical aortic valve replacement (re-SAVR) for high- and intermediate-risk patients with degenerated surgical bioprosthesis.
Methods: All studies comparing multivariate adjustment between ViV TAVI and re-SAVR were screened. The primary end-points were all-cause and cardiovascular (CV) mortality at 30 days and at Midterm follow-up.