Publications by authors named "Paolo Ferraro"
Background: Tethering is a common condition of the mitral valve apparatus in the presence of significant regurgitation. Its impact on outcomes of transcatheter edge-to-edge repair (TEER) remains poorly characterized.
Methods: We appraised the prevalence, features, procedural details, and outcomes of patients with or without mitral valve tethering in a prospective multicenter observational study.
Article Synopsis
- Transcatheter mitral edge-to-edge repair (TEER) is a minimally invasive option for treating severe mitral regurgitation in patients with high surgical risk, but there are concerns regarding the risk of cerebrovascular accidents (CVAs) after the procedure.
- In a study of 2,238 patients, the incidence of CVAs was found to be low at 1.47%, with the majority occurring after hospital discharge and linked to preexisting conditions like atrial fibrillation and renal dysfunction.
- While CVAs did not significantly increase the risk of long-term or cardiac death, the study suggests the need for proactive antithrombotic therapy for patients at higher risk before and after TEER.
Article Synopsis
- * The experience from 25 years at two hospitals in Italy highlights significant advancements in cardiology, including different types of stents and transcatheter valve procedures, alongside challenges and improvements in patient care.
- * This overview aims to inform readers about the evolution and future trends in interventional cardiology, emphasizing the importance of clinical experiences and research insights in advancing cardiovascular care.
Article Synopsis
- Minimally invasive mitral valve repair using the MitraClip device shows beneficial outcomes in patients with significant mitral regurgitation, including those who have had prior valve repairs.
- A study involving 2,238 patients highlighted that while device and procedural success rates are slightly lower for those with previous valve procedures, overall outcomes such as death and rehospitalization rates remain similar across groups.
- The findings suggest that transcatheter edge-to-edge repair is a viable option for carefully selected patients even after previous mitral valve interventions.
Article Synopsis
- Transcatheter edge-to-edge repair (TEER) is an effective, minimally invasive method for treating significant mitral regurgitation and has seen advancements in device technology, specifically the NT, NTr, and XTr MitraClip devices.
- A study analyzed data from a large patient registry to compare these devices, focusing on patient outcomes after the procedure, specifically looking at complications and hospital discharge.
- Results showed that while the NT group faced worse outcomes initially, adjusted analyses indicated no significant differences in long-term results among the devices, suggesting that newer MitraClip devices provide better outcomes even when used on patients with more complex cases.
Article Synopsis
- - The study aimed to evaluate the long-term effectiveness of the Portico valve in transcatheter aortic valve implantation (TAVI) for elderly patients with severe aortic valve stenosis, focusing on outcomes like death and complications.
- - Data from 803 patients, mainly older adults with a median age of 82, showed that over three years, 37.5% experienced major adverse events, with all-cause death at 35.1% and low rates for stroke (3.4%) and myocardial infarction (1.0%).
- - Results indicate that the Portico valve provides favorable long-term outcomes, though risk factors such as peripheral artery disease and chronic obstructive pulmonary disease significantly influenced patient prognosis. *
Aim: Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry.
View Article and Find Full Text PDFBackground: The clinical impact of coronary artery disease (CAD) on the prognosis of patients undergoing MitraClip implantation is still unclear.
Methods: One thousand nine hundred fifty-three patients undergoing MitraClip implantation included in the multicenter GIOTTO Registry were stratified according to CAD. Endpoints were all-cause death, cardiac death, and re-hospitalization for heart failure at follow-up (median 15.
Background: Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis. We aimed at appraising effectiveness of a new self-expandable TAVI device.
Methods: We retrospectively analyzed our institutional experience with Allegra (Biosensors, Morges, Switzerland) for TAVI, focusing on procedural outcomes and 1-month adverse events.
Article Synopsis
- 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.
Article Synopsis
- Transcatheter aortic valve implantation (TAVI) using the Navitor, a third-generation device, showed positive outcomes in patients with severe aortic stenosis between June and December 2021.
- The study included 39 patients with an average age of 80, achieving device and procedural success in all, with a hospital stay averaging 6.6 days and only one needing a permanent pacemaker.
- Follow-up results at one month indicated no cases of moderate or severe aortic regurgitation, suggesting the Navitor device has the potential to broaden TAVI applications and improve patient outcomes.
Article Synopsis
- The study evaluates clinical outcomes in patients with mixed aortic valve disease (MAVD) versus pure aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), using data from the RISPEVA registry.
- Among 3,263 patients analyzed, the MAVD group showed higher 30-day mortality compared to the AS group, but this difference disappeared after adjusting for other factors.
- Overall, MAVD doesn't seem to worsen prognoses, but these patients tend to have more complex health issues and a higher likelihood of postprocedural complications, though using balloon-expandable valves may reduce risks.
Article Synopsis
- Transcatheter aortic valve implantation (TAVI) requires detailed planning using non-invasive imaging, primarily CT scans, which can be overwhelming due to the amount of data they provide.
- A new scoring system, the TAVI-CT score, was developed to simplify and summarize CT exam details for decision-making related to TAVI procedures, focusing on features of the heart and arteries.
- In a study of 200 patients, the scoring system helped differentiate procedural choices and outcomes, indicating that higher scores were associated with more vascular complications, while overall success rates remained consistent across all score groups.
Background: The next iteration of drug-eluting stents (DESs) for percutaneous coronary intervention (PCI) has focused on bioresorbable polymers and thin struts. The Alex Plus DES is a new-generation sirolimus-eluting device with 70-μm cobalt chromium struts, a 5-μm bioresorbable polymer and a very small profile. Despite such favorable features, limited data are available to estimate the risk-benefit profile of Alex Plus.
View Article and Find Full Text PDFBackground: Transcatheter aortic valve implantation (TAVI) is emerging as an appealing management strategy for patients with severe aortic stenosis at intermediate, high or exceedingly high risk, but its risk-benefit profile in younger patients is less certain. We aimed to explore the outlook of patients aged 70 years or less and undergoing TAVI at 2 high-volume Italian institutions.
Methods: We retrospectively collected baseline, imaging, procedural and outcome features of patients with age ≤70 years in whom TAVI was attempted at participating centers between 2012 and 2021.
Article Synopsis
- The study analyzed the outcomes of patients receiving MitraClip treatment for mitral valve regurgitation, comparing those under 80 years old to octogenarians (80+ years).
- A total of 1853 patients were included, with similar in-hospital mortality rates and improvements in mitral regurgitation among both age groups.
- At a 15-month follow-up, while octogenarians had lower rates of rehospitalization and cardiac complications, once adjusting for various baseline characteristics, there were no significant differences in major outcomes between the age groups, indicating the procedure is safe for older patients.
Article Synopsis
- Transcatheter mitral valve repair (TMVR) using MitraClip™ is an effective treatment for mitral regurgitation (MR), with options for implanting one or multiple clips based on the severity of the condition.
- A study analyzed data from the GISE registry, comparing outcomes for patients with one, two, or multiple MitraClips, focusing on 1-year cardiac death or rehospitalization as the primary endpoint.
- The analysis included 1824 patients and revealed significant baseline health differences and procedural variations among those receiving different numbers of MitraClips, impacting clinical outcomes and recovery.
Background: Transcatheter aortic valve implantation (TAVI) is a safe and beneficial treatment for patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. Success rates for TAVI continue to increase due to more refined procedural approaches and devices, and above all, to the improvements in procedural knowledge by TAVI operators. The development of a new delivery system represents an important evolutionary process in the TAVI procedure, both for the type of device and for the operators, as it may substantially expand indications, success rates, and safety.
View Article and Find Full Text PDFObjectives: The management of severe aortic stenosis has been revolutionized by the introduction of transcatheter aortic valve implantation (TAVI), especially in patients at intermediate, high, or prohibitive surgical risk. There is uncertainty, however, regarding the comparative effectiveness and safety of contemporary TAVI devices.
Methods: We queried detailed data from the ongoing national Italian TAVI registry and compared baseline features, procedural details, and 12-month outcomes of Acurate Neo (Boston Scientific), Evolut Pro/R (Medtronic), Lotus (Boston Scientific), Portico (Abbott Vascular), and Sapien/ Sapien S3 Ultra (Edward Lifesciences) transcatheter aortic valves.
Thrombocytopenia after TAVI is common and clinically detrimental. Retrospectively, we observed Portico recipients had a more profound platelet drop than Evolut recipients. We thus investigated periprocedural platelet damage and/orpro-inflammatory state in 64 TAVI recipients at baseline and after implantation.
View Article and Find Full Text PDFBackground: Transcatheter aortic valve implantation (TAVI) has become first-line treatment for severe aortic valve stenosis in patients with moderate, high or prohibitive surgical risk. However, access site complications may occur more frequently in extreme body mass index (BMI) categories. The aim of this study was to describe the features and outcomes of patients undergoing TAVI in a comprehensive Italian prospective clinical registry, focusing on BMI classes.
View Article and Find Full Text PDFThe ACC/TVT score is a specific predictive model of in-hospital mortality for patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to test its predictive accuracy in comparison with standard surgical risk models (Logistic Euroscore, Euroscore II, and STS-PROM) in the population of TAVI patients included in the multicenter RISPEVA (Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea) registry. The study cohort included 3293 patients who underwent TAVI between 2008 and 2019.
View Article and Find Full Text PDFTranscatheter aortic valve implantation (TAVI) is a safe and beneficial treatment for patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The safety of the procedure continues to improve thanks to more refined procedural approaches and devices but, also and above all, to the accrual of the procedural knowledge and expertise by the operators. The diversification of the approaches and the possibility to tailor the treatment on the individual needs and anatomical features of the patients allows a rapid learning curve in the management of even complications.
View Article and Find Full Text PDFThe differential outcomes across the age spectrum of transcatheter aortic valve implantation (TAVI) recipients are still debated. Aim of the study was to evaluate the clinical outcomes of oldest-old patients undergoing TAVI in the large "Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea (RISPEVA)" registry. A total of 3,507 patients were stratified according to age: 1,381 were ≥85 years, 2,126 were <85 years.
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