Publications by authors named "Pilgrim T"
Background: Reports on the durability of transcatheter aortic valve replacement (TAVR) prostheses are scarce and confounded by varying definitions and competing risks of death.
Objectives: The authors sought to determine the incidence, predictors, and clinical outcomes of hemodynamic valve deterioration (HVD) according to the Valve Academic Research Consortium 3 definition after TAVR.
Methods: We analyzed consecutive patients undergoing TAVR in the prospective Bern TAVI (Transcatheter Aortic Valve Implantation) registry between August 2007 and June 2022 for the incidence and predictors of HVD and performed case control-matching to compare outcomes according to HVD.
Background: Lifetime treatment of aortic valve disease is a matter of increasing debate. Although the risks of a second aortic valve intervention are recognized, little attention has been given to the challenges of a third.
Objectives: This study delves into the clinical characteristics, indications, and outcomes of patients undergoing 3 aortic valve interventions.
Background: The human microbiome is crucial in regulating intestinal and systemic functions. While its role in cardiovascular disease is better understood, the link between intestinal microbiota and valvular heart diseases (VHD) remains largely unexplored.
Methods: Peer-reviewed studies on human, animal or cell models analysing gut microbiota profiles published up to April 2024 were included.
Background: Tuberculosis (TB) is the leading cause of death among people with HIV and a major global health challenge. Subclinical cardiovascular manifestations of TB are poorly documented in high TB and HIV burden countries.
Objectives: The purpose of this study was to quantify the prevalence of cardiovascular involvement in TB patients and investigate changes after completion of anti-TB treatment.
Article Synopsis
- Aortic stenosis (AS) and coronary artery disease (CAD) often occur together, presenting challenges in deciding the best treatment approach.
- Recent advances like transcatheter aortic valve replacement (TAVR) have expanded options beyond traditional surgical methods, allowing for combinations of revascularization and valve replacement.
- Treatment strategies should be tailored to each patient based on disease severity and clinical factors, as there's no one-size-fits-all solution for managing AS and CAD.
Timing of Aortic Valve Intervention in the Management of Aortic Stenosis.
JACC Cardiovasc Interv
November 2024
Aortic stenosis (AS) affects about 12% of people aged ≥75 years. Accumulating evidence on the prognostic importance of cardiac damage in patients with asymptomatic and less than severe AS supports the proposition of advancing aortic valve replacement (AVR) to earlier disease stages. Potential benefits of earlier treatment, including prevention of cardiac damage progression and reduced cardiovascular hospitalizations, need to be balanced against the earlier procedural risk and subsequent lifetime management after AVR.
View Article and Find Full Text PDFBackground: The importance of transcatheter heart valve (THV) design on clinical outcome in patients with aortic stenosis (AS) and left ventricular (LV) systolic dysfunction remains unknown.
Objectives: We aimed to compare 5-year outcomes of patients with severe AS and reduced LV ejection fraction (LVEF), undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable vs. self-expanding THVs.
Article Synopsis
- * Surgical options for treating this condition carry a high risk of fatality, leading to interest in less invasive transcatheter therapies, like edge-to-edge repair and valve replacement.
- * Effective use of various imaging techniques is crucial for assessing the severity of the condition, understanding the patient's unique heart issues, and choosing the best treatment options.
Background: Transoesophageal echocardiography (TOE) provides accurate evaluation of mitral valve (MV) function following mitral transcatheter edge-to-edge repair (M-TEER) and may better detect complications in case of suboptimal result.
Aims: We aimed to evaluate midterm anatomical changes and structural complications after M-TEER using TOE and investigate their association with clinical outcomes at 2 years.
Methods: A follow-up TOE at 6 months was systematically recommended to all patients included in our institutional prospective M-TEER registry until December 2021.
Article Synopsis
- Vascular complications are a significant issue for patients undergoing transfemoral transcatheter aortic valve replacement (TAVR), especially those with peripheral artery disease, and the Hostile score has been developed to help assess risk.
- A study validated the Hostile score by analyzing data from 2,023 TAVR patients, finding that those with higher Hostile scores were more likely to experience vascular complications, particularly non-puncture site issues.
- The research found that independent predictors of complications included body mass index, use of specific closure devices, and a higher Hostile score, with the score being particularly effective in predicting non-puncture site complications after the procedure.
Article Synopsis
- This study investigates the use of artificial intelligence to detect transthyretin amyloid cardiomyopathy (ATTR-CM) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
- Researchers analyzed a variety of data including clinical, lab, and imaging results to develop machine learning models for detection and outcome prediction.
- Results showed that while echocardiography and 4D-CT-strain had good to high detection performances, the multi-modality model incorporating various data types did not significantly outperform the 4D-CT-strain model alone.
Article Synopsis
- Percutaneous treatment for structural heart disease is advancing quickly, with the EAPCI's Core Curriculum defining crucial competencies for new interventional cardiologists specializing in this area.
- These specialists, trained in interventional cardiology, manage adult patients and perform various procedures, requiring skills in advanced imaging and planning software, with a focus on the aortic, mitral, and tricuspid valves.
- Comprehensive training in all three areas typically takes at least 18 months, supporting consistent education across Europe, which will eventually influence certifications and patient safety measures.
Background: Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS.
Methods: Patients with a native bicuspid AS and a baseline AAo maximum diameter > 40 mm treated by TAVI and in whom post-TAVI computed tomography (CT) scans beyond 1 year were available were included.
Background: Asymmetrical expansion of transcatheter heart valves (THVs), manifesting as stent frame deformation, is an occasional fluoroscopic finding in transcatheter aortic valve replacement (TAVR).
Objectives: The aim of this study was to investigate the impact of asymmetrical expansion of balloon-expandable THVs on hemodynamic valve performance and clinical outcomes.
Methods: In a prospective registry, TAVR asymmetry index was measured using freeze-frame fluoroscopic images and was defined as the ratio of THV heights: [(longer height/shorter height) - 1] × 100.
Background: Periprocedural myocardial injury impacts clinical outcome after transcatheter aortic valve replacement (TAVR). The optimal medical management strategy for TAVR-related periprocedural myocardial injury has not been established.
Objectives: The authors aimed to investigate the prognostic association of renin-angiotensin system (RAS) inhibitors in patients with periprocedural myocardial injury after TAVR.
Article Synopsis
- The percutaneous treatment of structural heart disease (SHD) is advancing quickly, with the EAPCI's Core Curriculum (CC) defining the necessary competencies for newly trained interventional cardiologists (IC).
- SHD interventional cardiologists manage adult patients throughout the entire treatment process, requiring skills in advanced imaging and planning software, as well as proficiency in procedures related to the aortic, mitral, and tricuspid heart valves.
- Completing specialized SHD training typically takes at least 18 months, though it can be shortened to 1 year for focused training on specific areas, with the goal of promoting standardized, high-quality training across Europe for better patient care and future certifications.
Background: Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR).
Methods: We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR.
Background: The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and might be affected by the extent of extravalvular cardiac damage. We aimed to investigate the prognostic association of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified according to the extent of extravalvular cardiac damage.
Methods: In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into 5 stages of cardiac damage (0-4) according to established criteria.
: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. : REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up.
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