bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of haemodynamic performance in patients with aortic stenosis and small annulus undergoing TAVI with self-expandable valves
Authors: Chiarito M , Regazzoli D , Cannata F , Pagnesi M , Pagnotta P.A , Stefanini G.G , Barbanti M , De Marco F , Adamo M , Van Mieghem N.M , Kim W.K , Maisano F , Colombo A , Reimers B , Latib A 
Published: November 2020

Abstract

Background
Small aortic annular size is one of the most important predictor of poor hemodynamic and clinical outcomes in patients treated for aortic stenosis. Post-hoc analyses of pivotal trials showed that transcatheter aortic valve intervention (TAVI) offer better outcomes then surgery in patients with small aortic annulus, especially with self-expandable valves (SEV). However, data about SEVs comparison in this population are limited.

Purpose
Our aim is to assess how valve design and oversizing, with anatomical and echographic features, impact on the hemodynamic performance of SEVs in TAVI patients with small aortic annulus.

Methods
The TAVI SMALL registry enrolled 859 patients with small aortic annulus (CT-scan annular perimeter≤72 mm or area ≤400 mm2) treated for aortic stenosis with currently available SEVs (Evolut R=397; Evolut PRO =84; Acurate Neo=140; Acurate TA= 61; Portico=177) at 9 European centers between 2011 and 2018. We performed multivariable backward logistic regression analyses to identify predictors of high postprocedural mean gradient, moderate-to-severe PPM, and moderate-to-severe para-valvular leak (PVL).

Results
After adjustment for LVEF, we identified annular perimeter and percentage of oversizing as independent predictors of lower post-procedural mean gradient.
Implantation of intra-annular rather than supra-annular bioprosthesis was the only independent predictor of moderate-to-severe PPM.
Predictors of moderate-to-severe PVL are reported in the Table.

Conclusions
Among patients with aortic stenosis and small aortic annulus treated with transcatheter SEVs, use of supra-annular bioproshtesis and oversizing were associated with improved valve performance.

Funding Acknowledgement
Type of funding source: None
Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions registry (TRAMI)
Authors: Iliadis C , Baldus S , Kalbacher D , Boekstegers P , Schillinger W , Ouarrak T , Zahn R , Butter C , Zuern C.S , Von Bardeleben R.S , Senges J , Bekeredjian R , Eggebrecht H , Pfister R 
Published: November 2020

Abstract

Background
Left atrium (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.

Methods
Data from the multicenter German transcatheter mitral valve intervention registry “TRAMI” were used to analyse the association of baseline LA diameter by tertiles and efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with the MitraClip.

Results
In 520 of 843 patients prospectively enrolled in TRAMI baseline LA diameter were reported (median [interquartile range] LA diameter in tertiles: 44 [40–46] mm, 51 [48–53] mm and 60 [55–66] mm). Larger LA diameters were significantly associated with secondary etiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all p&lt;0.05). Technical success was not different across tertiles (96%, 95.4%, 98.4% respectively, p=0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke) (1.8%, 1.2% and 4.4%, p=0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7% respectively, p&lt;0.01), as did hospitalization in survivors (60%, 67.6% and 78.9% respectively, p&lt;0.05). The association between LA diameter and all-cause mortality remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.

Conclusion
LA enlargement is a strong and independent predictor of adverse long-term outcome in mitral regurgitation suggesting that timely transcatheter mitral valve repair may have the potential to modify outcome.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott Vascular.
Transseptal transcatheter mitral valve implantation versus redo surgical mitral valve replacement for degenerated mitral bioprostheses
Authors: Fuchs A , Iung B , Nguyen C , Carrasco J.L , Cimadevilla C , Kerneis C , Eugene M , Ghodhbane W , Ducrocq G , Brochet E , Provenchere S , Vahanian A , Himbert D , Urena-Alcazar M 
Published: November 2020

Abstract

Background
The growing use of surgical bioprostheses raises concerns about a future reoperation for bioprosthesis degeneration. There are few data on outcome after transcatheter mitral valve-in-valve implantation (TMVI) compared with redo surgical mitral valve replacement (SMVR).

Purpose
To compare the feasibility, safety and outcomes of TMVI versus SMVR for degenerated mitral bioprosthesis in high-risk patients.

Methods
In our institution, 52 patients underwent TMVI by transseptal approach and 33 SMVR for degenerated mitral bioprosthesis. The composite endpoint of event-free survival included cardiovascular mortality, stroke, major bleeding, hospitalization for heart failure or mitral valve reintervention.

Results
Mean age and EuroSCORE II were higher in TMVI group vs. SMVR group (age 63±21 years vs. 51±15 years, p=0.002; EuroSCORE II 12.5±12.2% vs. 6.2±3.3%, p=0.001) (Table). In-hospital mortality was 3.8% after TMVI vs. 3.0% after SMVR (p=1.0).
Median follow-up was 2.2 years. At 5 years, survival was 69.7±9.4% after TMVI vs. 86.6±7.6% after SMVR (p=0.10) and event-free survival was lower after TMVI (40.1±9.9% vs 78.7±8.8% respectively, p=0.003) (Figure). In multivariate analysis, older age (p=0.02), neurologic history (p=0.05) and non-elective procedure (p&lt;0.0001) were associated with lower event-free survival, while TMVI vs. SMVR was no longer significant (p=0.17). At last follow-up, 84% patients from TMVI group and 78% from SMVR group were NYHA I-II class. Mean mitral valve gradient and pulmonary artery systolic pressure were respectively 6.8±2.5 mmHg and 45±14 mmHg in TMVI group, and 4.8±2.0 mmHg and 37±11 mmHg in SMVR group.

Conclusion
TMVI is an alternative to SMVR in high-risk patients with degenerated mitral bioprosthesis. Comparison of mid-term results of the two techniques must take into account the differences in patient characteristics.
Event-free survival

Funding Acknowledgement
Type of funding source: None
Echocardiographic and clinical outcomes of MitraClip therapy in patients with severe mitral regurgitation
Authors: Rashi Y , Turyan Medvedovsky A , Tonchev I , Perez A , Elioz R , Lotan C , Gilon D , Planer D , Danenberg H.D , Beeri R , Shuvy M 
Published: November 2020

Abstract

Background
MitraClip implantation improves mitral regurgitation (MR), however its impact on pulmonary hypertension (PHT) is not fully elucidated. Our hypothesis was that changes in pulmonary pressure after MitraClip implantation might predict outcomes.

Methods
We studied a cohort of 149 consecutive patients who underwent MitraClip implantation between August 2015 and September 2019. We compared echocardiographic and clinical variables between a group with not-severe PHT and a group with severe PHT according to Pulmonary artery systolic pressure (PASP) &gt;55 mmHg.

Results
Mean age of the cohort was 73±10 years, 75% were men, and 80% had functional MR. There are no differences in baseline characteristics between the two groups. There was a significant reduction of 13.6 mmHg in PASP at the severe PHT group from 68.2±10.9 mmHg before the procedure to 54.6±14.9 after (P=0.001) compared to the absence of a significant change in the second group. This reduction was maintained in the 6 months follow-up. Although PHT is considered a poor prognostic measure, and the severe PHT group had a baseline PASP higher than the not-severe group (P&lt;0.001), however the Kaplan Meier curve did not show any significant difference in overall survival (p=0.468), and there is also no difference in one-year survival.

Conclusions
MitraClip therapy improves PASP in patients with severe MR and severe PHT. These patients showed the same survival as patients with not-severe PHT. MitraClip is a safety and effective procedure even for patients with severe PHT, that should not be excluded.

Funding Acknowledgement
Type of funding source: None
3-Dimensional assessment of tricuspid annular geometry after percutaneous edge-to-edge repair in patients with severe tricuspid regurgitation
Authors: Da Rocha E Silva J.G , Ruf T.F , Kreidel F , Tamm A.R , Geyer M , Petrescu A , Hell M , Schmidt P , Tang G.H.L , Munzel T , Von Bardeleben R.S 
Published: November 2020

Abstract

Background
Transcatheter tricuspid valve repair (TTVR) using edge-to-edge leaflet therapy (E2E) has evolved as a feasible therapy to treating severe tricuspid regurgitation (TR). The TRILUMINATE trial using the new TriClip NT has shown promising clinical and functional improvements. However, the 3rd generation MitraClip XTr (Abbott Structural Heart, Santa Clara, CA, USA) has a broad off-label experience in the European Union to address tricuspid TR with wider gaps. There is insufficient data on the secondary effects of E2E on tricuspid annular geometry. The aim of this study was to address this lack of knowledge by evaluating the acute effects of E2E using the MitraClip XTr.

Methods
We retrospectively analyzed the imaging data of procedures using the MitraClip XTr to treat severe symptomatic TR at our Institution in 2018. Tricuspid annular geometry was assessed before and immediately after clip implantation by 3D TEE analysis of biplane and manual and automated volume data.

Results
During 2018, 69 patients were treated for severe TR using a transcatheter approach. In 61 patients, E2E was used, in 58 patients the MitraClip XTr was utilized (Pascal: n=3, Edwards Lifesciences, Irvine, CA, USA). Mean age was 79.0 years ± 6.4. Percutaneous TTVR using the MitraClip XTr significantly decreased the diastolic septal-lateral diameter (S/L: 4.1±0.7cm vs. 3.6±0.7cm; p&lt;0.001), annulus area (14.9±6.7 vs. 12.8±6.2 cm2; p&lt;0.001) and annulus perimeter (14.7±25.0 vs. 13.8±24.4 cm; p&lt;0.001) whereas the diastolic anterior-posterior diameter was not significantly affected (A/P: 4.5±1cm vs. 4.4±0.8cm; p=0,45).

Conclusions
Percutaneous TTVR using MitraClip XTr showed significant changes in TV annulus geometry by focal perimeter and area reduction. This highlights a new mechanism of E2E therapy through indirectly adressing the dilated annulus in patients with severe TR.
Annulus geometry by TOE, 3D- and autoMPR

Funding Acknowledgement
Type of funding source: None
Effects of diabetes and obesity in patients undergoing coronary artery bypass graft surgery: ten-year results from the Arterial Revascularisation Trial
Authors: Stefil M , Taggart D , Podesser B , Benedetto U , Gaudino M , Gerry S , Gray A , Lees B , Krzych L , Flather M 
Published: November 2020

Abstract

Background
Coronary artery bypass graft (CABG) surgery is an effective way to manage advanced coronary heart disease. Diabetes is associated with higher risk of mortality in patients undergoing CABG but the effects of obesity, and the interactions between diabetes and obesity in the context of CABG, have not been fully explored.

Methods
The Arterial Revascularisation Trial (ART) compared ten-year mortality in patients undergoing CABG randomised to single or bilateral internal thoracic arterial grafts. Effects of diabetes and obesity on mortality and risk (sternal wound complications) were explored. Diabetes was defined according to clinical history at baseline and combined insulin and non-insulin dependent patients, and obesity was defined as body mass index (BMI) ≥30kg/m2 at baseline.

Results
Information on diabetes, obesity and ten-year mortality were documented for 3094 patients who were included in the analysis. Mean age was 64 years, 86% male, mean weight 82kg and BMI 28. Diabetes was documented in 24% and obesity in 30% and as expected obese patients were more likely to be diabetic. The hazard ratios (95% confidence intervals) for ten-year mortality using the no diabetes, non-obese group as a reference were 1.33 (1.08, 1.64) (diabetes, non-obese), 0.93 (0.75, 1.16) (no diabetes, obese) and 1.18 (0.91, 1.54) (diabetes, obese) groups (Figure 1). Similar patterns of risk were observed whether patients were randomised to receive single or bilateral internal thoracic arteries and diabetes appeared to be the main driver of elevated risk of early sternal wound complications following CABG.

Conclusions
Obesity and diabetes are closely associated but our analysis shows that patterns of risk of death after CABG are not additive for these characteristics, and obesity may actually be associated with lower death rates in patients with and without diabetes. These findings will be explored further to understand mechanisms and interactions with other factors.
Figure 1. Hazard ratios at 10 years

Funding Acknowledgement
Type of funding source: None
Multiple vs single arterial grafting in coronary surgery among diabetic patients: a meta-analysis
Authors: Leite-Moreira J.P , Saraiva F.A , Barros A.S , Leite-Moreira A.F , Lourenco A.P 
Published: November 2020

Abstract

Background and aim
The use of more than one arterial conduit in coronary surgery has been widely associated with better long-term results. We sought to investigate the benefits of Multiple Arterial Grafts (MAG) over Single Arterial Grafts (SAG), among diabetic patients, in short and long-term results throughout a meta-analysis of propensity score matching (PSM) studies.

Methods
MEDLINE and ISI Web of Science were used to find relevant literature (1960–2018). We included cohort studies with at least 200 patients and that reported one of these outcomes: long-term survival, early mortality or sternal wound infection (SWI). Survival was collected through hazard ratio (HR) along with their variance and the other endpoints using frequencies or odds ratio (OR) from the matched sample. Fixed effect models were used to compute statistical combined measures and 95% confidence intervals (CI).

Results
Eleven studies were included performing a total of 9670 diabetic patients: 4833 MAG and 4837 SAG (1:1 PSM in all studies). MAG group consisted in bilateral internal mammary artery (BIMA) in 8 studies; single IMA (SIMA)+radial artery (RA) in 5 studies; and one study reported several MAG approaches: BIMA+RA+Gastroepiploic artery (GEA), SIMA+RA+GEA, SIMA+GEA or BIMA+GEA. SAG group consisted in SIMA with or without saphenous vein graft in all studies, except for one that included also patients with GEA instead of SIMA. Ten studies reported long-term survival and mean follow-up time ranged from 5 to 12 years (max. follow-up 30y). Overall, MAG had significantly improved long-term survival compared with SAG (pooled HR=0.79, 95% CI: 0.74–0.85, p&lt;0.01). In-hospital mortality was reported by 6 studies (4202 patients: 2099 MAG and 2103 SAG) and occurred in 3.0% vs. 3.3% in MAG vs. SAG patients, respectively (pooled OR: 0.91, 95% CI: 0.65–1.29, p=0.60). SWI was reported by 6 studies (4432 patients: 2216 MAG and 2216 SAG) and occurred in 2.8% vs. 2.2% in MAG vs. SAG patients, respectively (pooled OR: 1.31, 95% CI: 0.90–1.92, p=0.15). Excluding one article in which MAG group consisted in IMA+RA, the remaining 5 BIMA vs. SIMA studies reported an higher risk of SWI in MAG group (pooled OR: 1.63, 95% CI: 1.07–2.49, p=0.02)

Conclusion
Considering PSM studies, MAG provides superior long-term survival compared to SAG in diabetic patients. This surgical technique does not implement additional risk regarding in-hospital mortality, but MAG with BIMA was associated with a higher risk of SWI in this specific subgroup of patients.
Forest plot survival

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Universidade do Porto/FMUP e FSE-Fundo Social Europeu, NORTE 2020-Programa Operacional Regional do Norte,-Programas Doutorais
Echocardiography-guided transcatheter closure of perimembranous ventricular septal defects without arterial access:a fluoroscopy-free technique for alternative use in children
Authors: Bu H , Yang Y , Wu Q , Zhang W , Hu S , Zhao T 
Published: November 2020

Abstract

Background
Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and potential arterial complications. The feasibility of another alternative surgical repair technique for closure of VSDs by percardiac device has been proven. However, the disadvantages of surgical trauma and incision in the inferior sternum cannot avoid.

Purpose
In an effort to avoid radiation exposure, arterial access, surgical incision and complications, we established a novel technique for transcatheter VSD closure via the femoral vein approach under the guidance of transesophageal echocardiography (TEE) without fluoroscopy. And the feasibility and safety of this new strategy have been assessed.

Methods
From January 2015 to June 2019, a total of 48 PmVSD patients (mean age, 7.5±2.4 years [range, 4.3– 12.0 years]; mean body weight 24.6±6.8 kg [range, 16.5–38.5 kg]; VSD diameter, 4.3±0.6 mm [range, 3.2–5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy.

Results
The transcatheter occlusion procedure under TEE guidance was successful in 46 (95.8%) patients. Surgery was necessary in 2 (4.2%) patients. The mean procedural duration, post-operative mechanical ventilation duration, intensive care unit (ICU) residence, and in-hospital durations were 27.2±7.4 min (range, 12.0–42.0 min), 63.2±5.3 min (range, 56.0–78.0 min), 2.1±0.1 h (mean, 2.0–2.4 h), and 2.7±0.3 d (range, 2.5–3.0 d), respectively. One patient had immediate post-operative trivial residual shunt and four patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 2 cases were noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1–36 months follow-up.

Conclusion
Echocardiography-guided percutaneous device closure of PmVSDs solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision.
Procedure of percutaneous closure PmVSD

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry.
Standardization of bicuspid valve repair with aortic annuloplasty provides similar results to tricuspid aortic valve repair
Authors: Le Breton C , Lansac E , Amabile N , Khelil N , Berrebi A , Mankoubi L , Noghin M , Debauchez M , Monin J.L 
Published: November 2020

Abstract

Background
Bicuspid aortic valves (BAV) represent the main cause of severe dystrophic aortic insufficiency in young patients and are mostly replaced with high rates of valve-related events and altered quality of life in case of mechanical prosthesis. Valve repair is now recommended for root aneurysm and tricuspid aortic valves (TAV) when feasible. However, concerns remain regarding the long-term durability of BAV repair, compared to TAV.

Purpose
Our objective is to compare the long-term results of repair between TAV and BAV, in consecutive patients operated on with a standardized approach according to each phenotype of the dystrophic ascending aorta.

Methods
Data were prospectively collected into the multicenter international AVIATOR registry (AorticValve repair InternATiOnal Registry). Between 2003 and 2019, according to ascending aorta phenotypes, 226 patients with BAV and 309 patients with TAV underwent either isolated valve repair with external ring annuloplasty (26,2%), or root remodeling with external ring (59,4%), or a supra-coronary graft with external ring (14,4%).

Results
Cusp repair was performed in 95,1% patients in the BAV group and in 63,8% in the TAV group. The 30-day operative mortality was 0,93% (n=5). Mean follow-up was 5,5±4,4 years. The actuarial survival rate at 12 years was 93,2% in the BAV group and 87,8% in the TAV group (p=0,14). Freedom from reoperation at 12 years was similar between groups being 94,9% for bicuspid and 93,2% for tricuspid (p=0,75). Freedom from major adverse valve-related events at 12 years was 82,8% and 82,9% in BAV and TAV groups respectively (p=0,17). At 12 years, freedom from AI ≥Grade 2 or ≥Grade 3 was 68,7% and 94,3% for BAV and 76,5% and 94,7% for TAV group, with no significant difference (respectively p=0,16 and p=0,92).

Conclusion
Aortic valve repair with a standardized approach adapted to the aorta phenotype provides excellent long-term results with a low rate of valve-related events. Similar results were achieved between BAV and TAV patients.
freedom from reoperation for BAV and TAV

Funding Acknowledgement
Type of funding source: None