Publications by authors named "VILLABLANCA P"
Introduction: Cardiogenic shock (CS) is marked by substantial morbidity and mortality. The two major CS etiologies include heart failure (HF) and acute myocardial infarction (AMI). The utilization trends of mechanical circulatory support (MCS) and their clinical outcomes are not well described.
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.
The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments.
View Article and Find Full Text PDFBackground: Protruding coronary artery stents can adversely affect transcatheter aortic valve replacement (TAVR) procedure. Current evidence on the topic is limited.
Aims: We aim to study the clinical feasibility and safety of flaring of protruding coronary artery stents before TAVR to reduce interaction with transcatheter heart valves.
Subaortic Membrane and Cardiac Catheterization-Beware of Diagnostic Pitfall.
J Soc Cardiovasc Angiogr Interv
November 2024
Article Synopsis
- Researchers studied 1,729 patients with coronary artery aneurysms (CAAs) to understand their clinical characteristics and predict outcomes, using data from an international registry across 9 countries.
- The majority of patients were male (78.6%) averaging 66 years old, with significant cardiovascular issues such as coronary artery disease (85.8%) and a median of 1 aneurysm per patient, primarily affecting the left anterior descending artery.
- During a median follow-up of about 45 months, 21.9% of patients died, and 37.1% experienced major adverse cardiovascular events; factors like age, diabetes, and kidney disease were linked to worse outcomes.
Article Synopsis
- Tricuspid regurgitation (TR) is a serious condition linked to long-term health issues, including severe right heart failure, but newer less invasive treatments like transcatheter valve interventions (TTVI) are gaining attention.
- A study analyzing over 98,000 tricuspid valve procedures from 2011 to 2020 revealed trends in intervention types, showing a rise in TTVI and a decline in traditional surgical options.
- Findings indicate demographic factors like age and race affect procedure choice and outcomes, with surgical interventions showing higher mortality rates; further research is needed to understand the causes of these evolving trends in treatment results.
Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) in cardiogenic shock (CS) is a novel mechanical cardiocirculatory support strategy that provides robust cardiocirculatory support and simultaneous left and right atrial venting by way of a multifenestrated transeptal catheter. We performed a single-center retrospective analysis of all patients aged ≥18 years with CS who underwent LAVA-ECMO at a quaternary care institution from 2018 to 2023. Clinical outcomes and prehemodynamics and posthemodynamics were evaluated.
View Article and Find Full Text PDFIncidence and risk factors associated with stroke when utilizing peripheral VA-ECMO.
Cardiovasc Revasc Med
October 2024
Article Synopsis
- Mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has improved treatment for cardiogenic shock, but neurological complications, especially strokes, are a major concern and can affect patient outcomes.
- A study at a quaternary center analyzed 244 patients on VA-ECMO from 2018-2022, finding that 14.7% developed a stroke, with ischemic and hemorrhagic strokes occurring almost equally.
- Key risk factors for stroke included the use of P2Y antagonists, limb ischemia, and the need for blood transfusions, while there was no significant link between stroke incidence and overall mortality or the length of VA-EC
Article Synopsis
- Mechanical circulatory support for patients with cardiogenic shock due to valvular heart disease is complicated, but the emerging LAVA-ECMO technique offers a solution by providing circulatory support and ventricular unloading.
- A case study describes a patient with severe heart issues who successfully underwent dual-aortic and mitral valve replacement using LAVA-ECMO.
- Careful planning and operator awareness of the ECMO circuit's management are crucial for avoiding complications during these high-risk procedures.*
Article Synopsis
- - Transcatheter aortic valve replacement (TAVR) is becoming a popular option for low-risk patients, serving as an alternative to traditional surgical valve replacement.
- - The paper reviews scientific evidence, including observational and clinical trial data, focusing on low-risk patients who often have specific conditions like a bicuspid aortic valve.
- - It emphasizes the importance of a multidisciplinary heart team and introduces the concept of 'minimalist TAVR' as a new approach in treating low-risk patients.
Background: There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).
Methods: This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR.
ECG-gated CT improves diagnosis in prosthetic valve degeneration.
Eur Heart J Imaging Methods Pract
January 2024
Article Synopsis
- TAVR (transcatheter aortic valve replacement) offers treatment for severely ill patients, but outcomes for those with cardiogenic shock (CS) are not well understood.
- A meta-analysis of five studies showed that 30-day mortality and major vascular complications were significantly higher in patients with CS compared to those without, but there were no significant differences in longer-term outcomes at one year.
- The study suggests that while short-term risks are elevated for TAVR patients with CS, their long-term prognosis may be similar to those without CS; further research is needed to explore the timing and management strategies of TAVR for this group.
Transjugular Transcatheter Tricuspid Valve Replacement: Early Compassionate Use Outcomes.
JACC Cardiovasc Interv
August 2024
Article Synopsis
- A study assessed the procedural and early outcomes of transjugular transcatheter tricuspid valve replacement (TTVR) for patients with symptomatic tricuspid regurgitation using the LuX-Valve Plus system across 15 centers from January 2022 to February 2024.
- Among 76 patients with a median age of 78, the procedure significantly reduced tricuspid regurgitation, with 95% of patients showing improvement at one month.
- While there were some adverse events including 4 in-hospital deaths and some bleeding, overall survival at one month was high at 94.4%, and patients reported better functional status.
Background: There has been a significant increase in the utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in recent years. Cardiothoracic surgery teams have historically led VA-ECMO care teams, with little data available on alternative care models.
Methods: We performed a retrospective review of a cardiovascular medicine inclusive VA-ECMO service, analyzing patients treated with peripheral VA-ECMO at a large quaternary care center from 2018 to 2022.
Background: Post-transcatheter aortic valve replacement (TAVR), paravalvular leak (PVL) is a quality metric associated with worse clinical outcomes. Transcatheter heart valve (THV) sizing is based primarily on the systolic annular size without regard to the left ventricular outflow tract (LVOT), which also lies within the THV landing zone. We hypothesized that LVOT size relative to the annulus is associated with post-TAVR PVL.
View Article and Find Full Text PDFBackground: 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: Validating the National Institutes of Health NIH Stroke Scale (NIHSS) as a tool to assess deficit severity and prognosis in patients with acute intracerebral hemorrhage would harmonize the assessment of intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) patients, enable clinical use of a readily implementable and non-imaging dependent prognostic tool, and improve monitoring of ICH care quality in administrative datasets.
Methods: Among randomized trial ICH patients, the relation between NIHSS scores early after Emergency Department arrival and 3-month outcomes of dependency or death (modified Rankin Scale, mRS 3-6) and case fatality was examined. NIHSS predictive performance was compared to a current standard prognostic scale, the intracerebral hemorrhage score (ICH score).