Publications by authors named "Luca Branca"
Article Synopsis
- Patients with a heart condition called atrial fibrillation (AF) who have strokes can still be at very high risk of having more strokes, even when taking medication to prevent them.
- Left atrial appendage occlusion (LAAO) is a special procedure aimed at helping these patients avoid future strokes.
- A study compared two groups – one that had LAAO and one that only continued their usual medication – and found that there was still a risk of strokes in both groups over a two-year period.
Article Synopsis
- Patients who underwent left atrial appendage occlusion (LAAO) have an increased risk of bleeding and thromboembolic events, leading researchers to investigate the role of hematological markers in predicting these risks.
- Data from 1,315 patients revealed that while the platelet count was somewhat associated with thromboembolic events, none of the hematological markers were linked to major bleeding events.
- Key factors influencing thromboembolism included age and previous thromboembolic history, while major bleeding risks were tied to prior events, renal disease, and dual antiplatelet therapy upon discharge.
Article Synopsis
- Left atrial appendage occlusion (LAAO) is a treatment for patients with atrial fibrillation (AF) who can't use oral anticoagulation therapy (OAT) and those who face recurring thrombotic events despite OAT.
- This study compared the efficacy of LAAO in patients experiencing thrombotic events while on OAT against those who had contraindications for OAT, using data from a large registry and propensity score matching for accuracy.
- Results showed no significant difference in ischemic stroke rates between the two groups, but the LAAO patients on OAT had a higher thromboembolic risk but lower bleeding risk, suggesting LAAO is a viable option for these patients.
Background: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited.
Aims: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function.
Methods: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI).
Article Synopsis
- The study assesses the effectiveness of self-expanding (SE) Evolut PRO/PRO+ versus balloon-expandable (BE) SAPIEN ULTRA valves in patients with small aortic annuli, using data from the OPERA-TAVI registry.
- It finds that the 1-year primary effectiveness outcomes are similar for both valve types, but the SE group shows better results for 30-day device-related outcomes.
- The SE valves have higher rates of disabling strokes and paravalvular leaks, while the BE valves exhibit more issues with prosthesis-patient mismatch and elevated residual mean gradients.
Evidence regarding gender-related differences in response to transcatheter aortic valve implantation according to the valve type is lacking. This study aimed to evaluate the impact of gender on the treatment effect of Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices on clinical outcomes. The Comparative Analysis of Evolut PRO vs SAPIEN 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation (OPERA-TAVI) is a multicenter, multinational registry including patients who underwent the latest-iteration PRO or ULTRA implantation.
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- This study investigates device-related thrombus (DRT) occurrences after left atrial appendage closure (LAAC), focusing on how often it persists or recurs.
- It found that about 29% of DRT cases persist, with being female and having a larger initial thrombus size being significant predictors.
- Unfavorable DRT evolution is linked to a higher rate of thromboembolic events, emphasizing the importance of monitoring thrombus size post-LAAC.
Article Synopsis
- - The study compares 1-year clinical outcomes of TAVI patients using Evolut PRO/PRO+ and SAPIEN 3 Ultra devices, addressing a lack of midterm comparative analyses in current real-world practice.
- - Using data from the OPERA-TAVI registry, 587 matched pairs of patients were analyzed, showing no significant difference in the primary endpoint (composite of death, disabling stroke, and rehospitalization), but higher rates of disabling stroke in the PRO group.
- - Overall, while the clinical outcomes were similar between the two devices, patients receiving PRO experienced notably higher rates of disabling stroke, particularly within the first 30 days following the procedure.
Treatment of aortic stenosis in dialysis: a necessary update in a challenging population.
J Cardiovasc Med (Hagerstown)
September 2023
Article Synopsis
- The study aimed to assess how tricuspid regurgitation (TR) changes in the short term after mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR), as well as the factors influencing these changes and their impact on mortality.
- Among 503 SMR patients, 35% showed improvements in TR after M-TEER, while 19% experienced worsening, and 46% remained unchanged; smaller left atrial size and minimal residual mitral regurgitation predicted better TR outcomes.
- Notably, patients who improved their TR had lower all-cause mortality rates over the long term, indicating that achieving TR ≤2+ post-M-TEER significantly reduces mortality risk
Impact and predictors of device-related thrombus after percutaneous left atrial appendage closure.
J Cardiovasc Med (Hagerstown)
January 2023
Article Synopsis
- Device-related thrombus (DRT) can occur in up to 7% of patients after percutaneous left atrial appendage closure (LAAC), raising significant concerns since these patients often can't use oral anticoagulants.
- Recent studies indicate a stronger link between DRT and neurological ischemic events, suggesting that DRT might negatively impact patient outcomes.
- It’s essential to consider various patient and procedural factors as predictors of DRT, leading to the recommendation of a tailored approach in selecting patients for LAAC and during their follow-up care.
Article Synopsis
- Malnutrition is prevalent in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER), with 74.4% showing some level of malnutrition, but only 20% classified as moderate-severe.
- In a study of 892 patients from the MIVNUT registry, moderate-severe malnutrition was found to significantly increase the risk of mortality (hazard ratio of 2.1) and heart failure admissions (subdistribution hazard ratio of 1.6) during a follow-up period averaging 1.6 years.
- The findings suggest that evaluating nutritional status in patients undergoing TEER could enhance risk assessment and potentially improve patient outcomes.
Background: The latest iterations of devices for transcatheter aortic valve replacement (TAVR) have brought refinements to further improve patient outcomes.
Objectives: This study sought to compare early outcomes of patients undergoing TAVR with the self-expanding (SE) Evolut PRO/PRO+ (Medtronic, Inc) or balloon-expandable (BE) Sapien 3 ULTRA (Edwards Lifesciences) devices.
Methods: The OPERA-TAVI (Comparative Analysis of Evolut PRO vs Sapien 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation) registry collected data from 14 high-volume centers worldwide on patients undergoing TAVR with SE or BE devices.
Acute pulmonary embolism (PE) is a common disease associated with high mortality rates that vary widely according to patient clinical presentation and hemodynamic status. According to international guidelines, systemic thrombolysis (ST) is the mainstem treatment in patients with high risk PE and intermediate-high risk PE evolving towards hemodynamic decompensation, showing lower mortality compared with anticoagulant therapy alone despite a high rate of bleeding events. Considering that a large proportion of patients presents contraindication to ST, catheter-directed therapies (CDTs) could tackle some unsolved issues, targeting the treatment to the pulmonary arteries, avoiding the dreaded complications of ST.
View Article and Find Full Text PDFAims: The aim of this study was to minimize the procedure, and reduce the length of hospital stay (LoS) is the future objective for transcatheter aortic valve replacement (TAVI).Aims of the study are to identify procedural and electrocardiographical predictors of fast-track discharge in patients who underwent TAVI.
Methods: Patients treated with TAVI included in the One Hospital ClinicalService project were categorized according to the LoS.
Article Synopsis
- - This study investigates the outcomes of transcatheter aortic valve replacement (TAVR) using two types of valves: balloon-expandable valves (BEVs) and self-expandable valves (SEVs), focusing on how the preference of the medical center affects these outcomes!* - Researchers analyzed data from over 7,500 TAVR procedures across 13 medical centers, finding that SEVs were linked to higher rates of complications like pacemaker implantation and aortic regurgitation, especially in centers that predominantly favored BEVs!* - Conclusions suggest that while SEVs show worse outcomes at BEV-dominant centers in terms of periprocedural complications and 2-year mortality, patients experience similar outcomes regardless of valve type at SEV
Background: Risk stratification for transcatheter edge-to-edge mitral valve repair (TEER) is paramount in the decision-making process for treating severe mitral regurgitation (MR).
Objectives: This study sought to create and validate a user-friendly score (MitraScore) to predict the risk of mortality in patients undergoing TEER.
Methods: The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012 and 2020.
Background: Procedural success after transcatheter edge-to-edge mitral valve repair (TEER) is defined as a reduction of mitral regurgitation (MR) degree to
Aim: To evaluate predictors and prognostic impact of optimal procedural result (MR 0/1+) after TEER.
Background: The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing.
Aims: The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old.
Methods: All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (70).
Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort.
Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019.
Background: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.
Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.
Objectives: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).
Background: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.
Article Synopsis
- This study aimed to assess the effects of edge-to-edge percutaneous mitral valve repair (PMVR) on short and mid-term outcomes in patients experiencing cardiogenic shock (CS) with severe mitral regurgitation (MR).
- In the context of severe MR, CS significantly increases the death risk within a year, making PMVR a possible treatment.
- The results indicated a high procedural success rate (87.1%) with survival rates of 78.4% at 30 days and 45.2% at 6 months, suggesting PMVR could be a viable emergency treatment for these patients.