Publications by authors named "Juan Francisco Oteo"
Introduction And Objectives: The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria.
Methods: We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR.
Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs.
Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in aortic stenosis patients. However, the factors associated with poorer outcomes among AF patients in contemporary TAVR practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.
Methods: Multicenter study including consecutive patients with a history of AF, evaluating the clinical outcomes and predictors of mortality, and HF-related hospitalization, who underwent TAVR with newer-generation devices using balloon or self-expandable valves.
The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk (HBR) in patients undergoing transcatheter aortic valve replacement (TAVR). The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale TAVR population. Multicenter study including 10,449 patients undergoing TAVR.
View Article and Find Full Text PDFIntroduction And Objectives: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.
Methods: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *10/L.
Introduction And Objectives: Impact of gender on long-term outcomes after transcatheter aortic valve implantation (TAVI) remains uncertain. We aimed to investigate gender-specific differences in TAVI and its impact on outcomes.
Methods: This analysis used data from the prospective Spanish TAVI registry, which included consecutive TAVI patients treated in 46 Spanish centers from 2009 to 2021.
Optical Coherence Tomography (OCT) imaging is a valuable tool for complex coronary interventions. While complications are rare, the occurrence of ventricular arrhythmias during its use is one of the most feared. Unfortunately, the mechanism by which these arrhythmias arise remains unclear.
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- Intravascular lithotripsy (IVL) is effective for treating calcified coronary lesions in patients with stable coronary disease, as shown in a study involving 426 patients across 26 centers in Spain.
- The study found that IVL was successfully delivered in 99% of cases, achieving procedural success in 66% of patients and similar outcomes for both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) groups.
- The safety analysis showed a relatively low rate of major adverse cardiovascular events (MACE) at 30 days, with 3% overall (1% for CCS and 5% for ACS), indicating that IVL is both safe and effective in real-life clinical settings.
Article Synopsis
- The study investigates the factors contributing to impaired functional status (NYHA class III-IV) after transcatheter aortic valve replacement (TAVR) and its impact on patient outcomes.
- It involved 3,462 patients and found that 6% had impaired functional status one month post-procedure, with predictors including poor baseline functional class, chronic obstructive pulmonary disease, and severe mitral regurgitation.
- Patients in the impaired functional status group faced significantly higher risks of death and heart failure-related hospitalizations within a year following TAVR.
Very long-term efficacy and safety of paclitaxel-eluting balloon after a bare-metal stent for the treatment of ST-elevation myocardial infarction: 8-year results of a randomized clinical trial (PEBSI study).
Cardiovasc Diagn Ther
October 2023
Background: Drug-eluting stents (DES) are considered the therapy of choice in ST-segment elevation myocardial infarction (STEMI); however, a low persistent rate of revascularizations and stent thrombosis exist over the time. We have previously shown that a paclitaxel (PTX)-drug-coated balloon (DCB) after a bare-metal stent (BMS) implantation (DCB-combined strategy) yields superior angiographic and clinical results compared to BMS in the short term. However, the long-term safety and efficacy of this approach remain uncertain.
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- This study examined the rates and causes of sudden cardiac death (SCD) and heart failure (HF)-related deaths in 5,421 patients who underwent transcatheter aortic valve replacement (TAVR) using newer devices.
- Findings revealed that 18% of patients died within two years, with over half of those deaths attributed to cardiovascular issues, notably advanced HF and SCD.
- Key predictors for HF-related death included atrial fibrillation and reduced heart function, while factors linked to increased SCD risk included certain procedural complications like periprocedural ventricular arrhythmias.*
Coronary artery aneurysm (CAA) presenting as an ST-elevation myocardial infarction (STEMI) represents a clinical challenge due to the technical difficulties in the percutaneous management of this specific situation. Appropriate treatment for CAA depends on the precise clinical situation and consists of medical management, surgical resection, or/and stent placement. The high rate of complications during percutaneous intervention (distal thrombus embolization, no-reflow phenomenon, stent malposition, or dissection) makes emergent surgery a frequent situation in these cases.
View Article and Find Full Text PDFEndothelial dysfunction in patients with angina and non-obstructed coronary arteries is associated with an increased risk of mayor cardiovascular events. Results of the Spanish ENDOCOR registry.
Int J Cardiol
January 2023
Background: Coronary endothelial dysfunction and vasospasm are potential causes of ischemia in patients without obstructive coronary stenoses (INOCA).
Objective: To evaluate the prevalence of endothelial dysfunction and the clinical profile of patients with INOCA in Spain, as well as to identify the predictors and the prognostic impact of endothelial dysfunction in this scenario.
Methods: A total of 438 consecutive patients with INOCA in whom the acetylcholine test was performed were prospectively enrolled.
Background: TiNO-coated BAS have demonstrated competitive outcomes compared to drug-eluting stents (DES). These devices allow short antiplatelet regimens and may be a good option for the growing elderly population undergoing percutaneous coronary intervention (PCI).
Methods: Multicenter observational trial in routine clinical practice.
Coronary Guidewire Fractured in the Aorta Outside the Guide Catheter: Acute Stent Thrombosis and Successful Guidewire Retrieval Using a Novel "Spaghetti Technique".
Cardiovasc Revasc Med
July 2021
Early coronary healing in ST segment elevation myocardial infarction: sirolimus-eluting stents vs. drug-coated balloons after bare-metal stents. The PEBSI-2 optical coherence tomography randomized study.
Coron Artery Dis
December 2021
Objectives: Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES.
Methods: pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy.
Article Synopsis
- The study examines how the COVID-19 outbreak affected the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) in Spain, focusing on changes in patient care before and after the pandemic.
- Results showed a 27.6% decrease in STEMI patient treatments and a significant rise in in-hospital mortality during COVID-19 (7.5% vs 5.1%) despite consistent use of primary percutaneous coronary intervention as a treatment strategy.
- The findings indicate that COVID-19 led to longer ischemic times for patients and a notable incidence of confirmed SARS-CoV-2 infections during hospitalization, highlighting the challenges faced in managing STEMI cases during the pandemic.
Article Synopsis
- The study evaluated the impact of the COVID-19 outbreak on the treatment and outcomes of patients with STEMI in Spain, comparing cohorts treated before and after the pandemic began.
- It found a significant decrease in both suspected and confirmed STEMI patients, along with a longer ischemic time for those treated during COVID-19; however, the reperfusion strategy remained largely unchanged.
- In-hospital mortality increased during the COVID-19 period, with a reported rate rising from 5.1% to 7.5%, highlighting a concerning trend in patient outcomes despite consistent treatment methods.
Objective: The aim of this work is to assess the relationship between significant paravalvular leak (SPL) after transcatheter aortic valve implantation (TAVI) on anaemia and their impact on prognosis.
Methods: Observational analytic study developed at two university hospitals, including all consecutive patients who underwent TAVI during a 10-year period (2009 to 2018). A logistic regression model was created to determine independent predictors of anaemia at 3 months.
Article Synopsis
- Cardiac amyloidosis (CA) is caused by amyloid fiber buildup in the heart, primarily from light chains (AL) or transthyretin (ATTR), and this study aimed to describe its diagnosis and treatment outcomes in a Spanish hospital.
- The study involved 180 patients diagnosed with CA, where the majority were diagnosed with ATTR, showing that heart failure was the most common symptom, but AL patients had higher mortality rates.
- The research highlighted significant diagnostic delays for ATTR patients and identified key mortality predictors, emphasizing the need for improved early detection and treatment strategies for CA.
Objectives: The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis.
Methods: This is a cost-utility analysis from the perspective of the Spanish National Health Service.
The clinical impact of in-stent thrombosis is high because it is associated with high mortality and 20 % of the patients suffer a recurrent event within the two following years. The aim of this study was to characterise the morphologic and proteomic profile of in-stent thrombi (IST) in comparison to thrombi developed on native coronary arteries (CT) to identify a differential molecular signature. The study included 45 patients with ST-elevation-myocardial-infarction (STEMI) treated by primary-percutaneous-intervention and thrombus aspiration: 21 had IST and 24 had CT.
View Article and Find Full Text PDFObjectives: The aim of this study was to analyze the operator radiation exposure (ORE) and the image quality in a coronary angiography (CA) of the standard left lateral view (LLV) and compare it with an alternative right lateral view (RLV).
Background: Interventional cardiologists are exposed to high doses of scatter radiation, especially in angulated projections.
Methods: We prospectively included consecutive patients who underwent diagnostic CA.