Publications by authors named "Mangieri A"
Tricuspid regurgitation (TR) is a potentially lethal condition and represents a significant clinical challenge both for clinical and interventional cardiologists. Traditionally managed medically and surgically, transcatheter therapies are now an emerging option, especially in patients with prohibitive surgical risk due to age or comorbidities. Transcatheter tricuspid valve replacement (TTVR) is emerging as a potential solution for patients suffering from TR with positive clinical data supporting its use in a wide range of anatomies and clinical settings.
View Article and Find Full Text PDFAims: To evaluate the association between transcatheter edge-to-edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post-MI MR in high-risk surgical patients.
Methods And Results: The International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post-MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR.
Article Synopsis
- Heavily calcified coronary artery disease complicates percutaneous coronary intervention (PCI), requiring advanced techniques like cutting balloons (CB), which need standardization for better effectiveness.
- The study presents the RODIN-CUT technique, which involves sequential CB inflations guided by intravascular ultrasound (IVUS) to improve plaque modification and stent expansion in difficult cases.
- Results indicate that RODIN-CUT achieved high procedural success rates and minimal complications, suggesting it could be a simple and cost-effective method for treating calcified lesions, though larger studies are needed to confirm its validity.
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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- 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 growing awareness of tricuspid regurgitation (TR) and the fast-expanding array of devices aiming to percutaneously repair or replace the tricuspid valve have underscored the central role of multi-modality imaging in comprehensively assessing the anatomical and functional characteristics of TR. Accurate phenotyping of TR, the right heart, and pulmonary vasculature via echocardiography, computed tomography, and, occasionally, cardiovascular magnetic resonance and right heart catheterization is deemed crucial in choosing the most suitable treatment strategy for each patient and achieving procedural success. In the first part of the present review, key imaging factors for patient selection will be discussed.
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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.
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.
Article Synopsis
- - The study compares the outcomes of different balloon-expandable (BE) transcatheter heart valve (THV) devices used to treat high-risk patients with severe pure native aortic valve regurgitation (NAVR), revealing suboptimal results with both device types.
- - Out of 144 patients treated, those with the MyVal device had more frequent extra-large annuli, yet technical success rates were similar between MyVal (90%) and Sapien (81%).
- - Overall, while BE devices might offer a treatment option for high-risk patients with NAVR, their effectiveness is limited and highlights the need for dedicated devices, as larger sizes might improve outcomes for traditionally unsuitable patients.
Early and late hospital readmissions after percutaneous left atrial appendage closure.
Rev Esp Cardiol (Engl Ed)
August 2024
Article Synopsis
- Percutaneous left atrial appendage closure (LAAC) is a procedure to prevent blood clots in patients with nonvalvular atrial fibrillation, but there is limited information on readmission rates following the procedure.
- A study of 1419 patients found that 18.1% were readmitted within a year, primarily due to bleeding and heart failure, with specific health conditions increasing the likelihood of readmission.
- Both early and late readmissions were linked to a higher risk of mortality within two years, highlighting the importance of managing patient health before and after LAAC.
Article Synopsis
- Tricuspid insufficiency used to be thought of as not very important, but new research shows it actually plays a big role in causing problems with the right side of the heart.
- New technology is making it possible to treat patients who were too risky for regular surgery, helping them feel better and live better lives.
- The focus now is on getting patients the right care by sending them to specialized centers that know how to diagnose and treat this condition effectively.
Article Synopsis
- Device-related thrombosis (DRT) occurs frequently after left atrial appendage closure (LAAC), with notable differences in diagnosis timing and outcomes between men and women.
- Women make up 34.7% of DRT patients in the study and tend to be older and have fewer comorbidities compared to men, but DRT in women is diagnosed significantly later.
- Both genders have similar treatment outcomes and overall mortality rates, indicating that treatment strategies are equally effective regardless of sex.
Early Nonprocedural Bleeding After Left Atrial Appendage Occlusion.
JACC Cardiovasc Interv
August 2024
Article Synopsis
- The study examined early nonprocedural bleeding in patients who underwent left atrial appendage occlusion (LAAO), finding that about 7% experienced bleeding unrelated to the procedure within three months, with more than half categorized as major bleeding.
- Key predictors for early bleeding included receiving dual antiplatelet therapy at discharge, a history of gastrointestinal bleeding, and multiple previous bleeding episodes.
- Furthermore, early nonprocedural bleeding was linked to a higher risk of all-cause mortality, emphasizing the serious implications of such events, regardless of their severity.
Tricuspid regurgitation (TR) is common both in patients with left side valvular heart disease and in patients with permanent atrial fibrillation and is associated with increased mortality, morbidity, and an increased risk of hospitalization. Surgery for isolated tricuspid repair is a viable option but burdened by a high-operative risk and a post-operative course characterized by high morbidity. Recently, percutaneous interventional techniques have emerged as a viable option in selected high-risk patients who may clinically benefit from tricuspid valve repair.
View Article and Find Full Text PDFInferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs.
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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.
Article Synopsis
- Coronary obstruction (CO) is a serious risk during transcatheter aortic valve replacement (TAVR), prompting the development of two techniques: chimney stenting and BASILICA, aimed at preventing CO.* -
- This study compared the outcomes of these two methods in high-risk TAVR patients, finding that both techniques had similar rates of clinical success and periprocedural complications.* -
- After one year, the rates of major adverse cardiovascular events were nearly identical between the chimney and BASILICA groups, although chimney stenting showed higher cardiovascular mortality, suggesting both methods are effective but may have different long-term risks.*
Article Synopsis
- This study compares the outcomes of two self-expanding transcatheter heart valve systems (ACURATE and EVOLUT) in patients undergoing valve-in-valve (ViV) procedures for degenerated surgical prostheses.
- A total of 835 patients across 20 centers were analyzed, with key outcomes including technical success, device success, and 30-day mortality rates evaluated between the two groups.
- Results showed that while overall procedural outcomes were similar, specific diameter measurements influenced device success differently between the two valve systems.
Article Synopsis
- Acute ischemic stroke is a significant risk following transcatheter aortic valve replacement (TAVR), prompting the development of cerebral embolic protection devices (CEPD) to reduce this risk.
- A study compared patients who underwent TAVR without CEPD (CEPD-) to those with CEPD (CEPD+) to assess characteristics and outcomes related to stroke.
- Findings indicated no significant differences in stroke rates, severity, or disability outcomes between the two groups, although the CEPD+ group had notably different types of strokes, suggesting that the efficacy of CEPD in preventing acute ischemic stroke is still questionable.