bluuebunny/crossref_metadata_2025_split huggingface dataset:
426 Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation: a propensity matched analysis of a multicentre registry
Authors: Bruno Francesco , Crimi Gabriele , Ascenzo Fabrizio D’ , Marzo Vincenzo De , Scudeler Luca , Marco Federico De , Oreglia Jacopo , Testa Luca , Gorla Riccardo , Esposito Giuseppe , Spaccarotella Carmen , Soriano Francesco , Vercellino Matteo , Balbi Manrico , Morici Nuccia , Indolfi Ciro , Conrotto Federico , Bedogni Francesco , Porto Italo , Ferrari Gaetano Maria De 
Published: December 2021

Abstract

Aims
The transfemoral (TF) approach appeared to be the safest and the broadest used approach in TAVI, characterized by a lower rate of periprocedural bleedings and vascular complications and is currently recommended by the guidelines as a first line approach when feasible. If in the early experience TF access was achieved using a surgical cutdown approach, through the last years, there has been increasing evidence of the safety and efficacy of a fully percutaneous approach over a surgical access, albeit available evidences are controverting and mostly including first generation prostheses and high risk patients. The aim of the study is to compare percutaneous and surgical access in a large, real-word, multicentre of TF TAVI.

Methods and results
Consecutive patients undergoing successful TF TAVI were prospectively enrolled in local clinical registries of five high volume centres in Italy: IRCCS Ospedale Policlinico San Martino (Genoa), IRCCS Policlinico San Donato (Milan), Città Della Salute e della Scienza, (Turin), Ospedale Niguarda Ca’ Granda (Milan), Magna Graecia University, (Catanzaro), between January 2014 to December 2019. Univariate and multivariate analysis using IPTW were performed. A total of 1946 TF TAVI patients (female 42.8%) were prospectively included. Patients underwent surgical access had a significantly higher surgical risk (STS score of 8.9 vs. 6.4, P &lt; 0.001, and EuroSCORE of 15.1 vs. 8.7, P &lt; 0.001, respectively). Overall survival was comparable between the two groups (HR: 1.14, 95% CI: 0.76–1.71). Patients who underwent surgical access experienced more VARC-2 major and VARC-2 minor vascular complications (13% vs. 7%, P = 0.003 and 11% vs. 6.1%, P = 0.007, respectively) and more VARC-2 major/life threatening and minor bleeding (27.4% vs. 17.8, P = 0.001, and 9.6% vs. 2.1%, P &lt; 0.001, respectively). After IPTW adjustment, surgical access was associated with an increased risk of major vascular complications (HR: 3.32, 95% CI: 1.84–5.97), minor bleeding (HR: 4.24, 95% CI: 1.16–15.54) and stage 2–3 AKI (HR: 2.60, 95% CI: 1.07–6.33).

Conclusions
The performance of the percutaneous transfemoral TAVI approach was safe and feasible and resulted in fewer major vascular complications, bleedings and AKI than the surgical femoral isolation. Procedural time and hospital length were also lower in the percutaneous group. Routine application of the percutaneous approach might reduce acute complications in patients undergoing transfemoral TAVI and reduce procedural time and hospital length.
700 The role of Impella CP in the management of malignant arrhythmias: a case of asymptomatic ventricular fibrillation
Authors: Caminiti Rodolfo , Colarusso Luigi , Parlavecchio Antonio , Vetta Giampaolo , Mancini Nastasia , Luzza Francesco , Micari Antonio , Bella Gianluca Di , Vizzari Giampiero , Crea Pasquale 
Published: December 2021

Abstract

Introduction
The Impella Heart Pump device (Abiomed, Danvers, MA, USA) is commonly used to provide mechanical circulatory support during high-risk percutaneous coronary intervention (PCI) and has demonstrated both efficacy and safety in patients with cardiogenic shock. Left ventricular assist devices (LVADs) alter the pathophysiological impact of ventricular arrhythmias in advanced heart failure; for example, life-threatening arrhythmias such as ventricular fibrillation (VF). We present a case of sustained VF tolerance in a patient with IMPELLA CP® support.

Methods and results
A 64-year-old man was admitted with typical chest pain that began 3 days earlier and an anterior myocardial infarction with ST-segment elevation. Urgent coronary angiogram showed a left anterior descending artery treated with angioplasty and stent implantation (TIMI 3). An initial echocardiogram, performed after PCI, showed a reduced left ventricular ejection fraction (LVEF) of approximately 35% with good right ventricular function. Two days later, the ECG tracing showed persistence of the ST elevation, and the patient developed recurrent ventricular tachycardia and an episode of acute pulmonary oedema; the echocardiogram showed a significant worsening of LVEF (15%). A percutaneous mechanical circulatory support device (Impella CP; Abiomed) was inserted through the right common femoral artery in order to preserve adequate systemic perfusion (Figure 1A). Twelve hours later, the patient developed rapid VT degenerating into VF without loss of consciousness (Figure 1C). During the arrhythmia, the patient was alert and his mental status was normal, Impella flow was 2.4–3.0 l/min, and invasive blood pressure (IBP) was 80/65 mmHg (Figure 1D). Intravenous lidocaine was administered without effect. After approximately 10 min of incessant VF, the patient received sedation with propofol from the anesthesiologist. A single unsynchronized DC shock of 200 J converted the patient to sinus rhythm. A bedside transthoracic echocardiogram was performed to check the optimal position of the Impella device (Figure 1B). In the following days, the patient had two new episodes of asymptomatic VF treated with DC-shock after sedation and was transferred to the cardiac surgery department to undergo urgent LVAD implantation.

Conclusions
Impella CP was helpful in the management of this patient with severe heart failure and malignant ventricular tachyarrhythmias, reducing the hemodynamic and neurological impact of this latter catastrophic arrhythmic event.
120 Safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with CKD: the Verona real-world experience
Authors: Fezzi Simone , Castaldi Gianluca , Widmann Maddalena , Marin Federico , Ruzzarin Alessandro , Tavella Domenico , Ribichini Flavio 
Published: December 2021

Abstract

Aims
To evaluate the safety and the efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension on top of medical therapy.

Methods and results
Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) monitoring were collected at baseline and 3, 6, and 12 months after RSD. Efficacy was assessed also in patients with an estimated glomerular filtration rate below 45 ml/min/1.73 m2. Patients were defined responders to RSD if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at the last follow-up available. Fifty-four patients with multiple comorbidities underwent RSD for uncontrolled-resistant hypertension from 2012 to 2021. Baseline office and ambulatory BP was 161.0/87.2 ± 24.1/15.6 mmHg and 155.4/87.5 ± 19.3/14.6 mmHg, respectively. At 12-month follow-up a significant reduction of office and ambulatory systolic BP, respectively by − 15.66 ± 29.73 mmHg (P &lt; 0.01) and by − 11.3 ± 23.1 mmHg (P &lt; 0.05), was noticed. BP reduction at 12-month follow-up among patients with eGFR &lt;45 ml/min was similar to that obtained in patients with higher eGFR. Among patients treated before July 2020 with available follow-up (45/54) 36 patients (80%) were classified as responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of success of RSD at univariate analysis. Among responders and non-responders, the average medication number showed no significant difference at baseline and during follow-up. No major complications were observed and renal function was stable up to 12 months, even in patients with lowest eGFR at baseline.

Conclusions
RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction of systolic BP and a trend of reduction of the diastolic BP up to 12 months. 775 Figure
256 Impact of physiologically diffuse vs. focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy
Authors: Scarsini Roberto , Fezzi Simone , Pesarini Gabriele , Sole Paolo Alberto Del , Mammone Concetta , Marcoli Michele , Venturi Gabriele , Tavella Domenico , Pighi Michele , Ribichini Flavio 
Published: December 2021

Abstract

Aims
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree in ∼20% of intermediate coronary lesions. The physiological pattern of disease has a significant influence on FFR-iFR discordance. However, if the pattern of disease (diffuse vs. focal) impacts on QFR accuracy and on its agreement with FFR and iFR remains unknown.

Methods and results
194 unselected patients with 224 intermediate coronary lesions were investigated with iFR, FFR and QFR. The physiological pattern of disease was independently assessed with iFR Scout pullback in all the cases by two expert interventional cardiologists who were blinded to the clinical presentation, patient characteristics, coronary angiography and QFR results. A predominantly physiologically focal pattern was observed in 81 (36.2%) lesions, whereas a predominantly physiologically diffuse was observed in 143 (63.8%) cases. QFR demonstrated a significant correlation (r = 0.581, P &lt; 0.001) and a substantial agreement with iFR, both in diffuse (AUC = 0.798) and in focal (AUC = 0.812) pattern of disease. Disagreement between QFR and iFR was observed in 51 (22.8%) lesions, consisting of iFR+/QFR − (64.7%) and iFR−/QFR + (35.3%). Notably, the physiological pattern of disease was the only variable significantly associated with iFR/QFR disagreement. In particular, coronary lesions with iFR+/QFR− demonstrated a significantly higher prevalence of predominantly physiologically diffuse pattern of disease compared with the subgroup with iFR−/QFR + [81.3% (26 of 32) vs. 55.6% (10 of 18); P = 0.012]. QFR virtual pullback demonstrated an excellent agreement (83.9%) with iFR Scout pullback in classifying the physiological pattern of disease.

Conclusions
QFR has a good diagnostic accuracy in assessing myocardial ischemia independently of the pattern of coronary disease. However, the physiological pattern of disease has an influence on the QFR/IFR disagreement, which occurs in ∼20% of the cases. The QFR virtual pullback correctly defined the physiological pattern of disease in the majority of the cases using the iFR pullback as reference.
214 Covered stent in a chest trauma: congenital coronary arterial fistula or traumatic coronary perforation?
Authors: Marsico Fabio , Carpinella Gerardo , Scalise Martina , Esposito Mafalda , Furbatto Fulvio , D’Andrea Davide , Serino Federica , Ziviello Francesca , Rumolo Salvatore , Bitello Carlo , Crispo Salvatore , Mauro Ciro 
Published: December 2021

Abstract

Aims
Coronary arterial fistula consists in a communication between a coronary artery and a cardiac cavity. It is tipically a congenital condition, but it can also be a result of invasive cardiac procedure. Although chest truama generally evolve to massive pericardial effusion, in some cases it can determine also a coronary perforation, with a consequent coronary arterial fistula.

Methods and results
A 22-year-old male patient, with no cardiovascular history, was admitted after a road accident, reporting pelvis break, 17 costal break, and sternal break, with consequent chest pain. On admission the patient had a heart rate of 100 b.p.m. and a blood pressure of 130/80 mmHg. Elettrocardiogram (ECG) reported ST elevation in antero-septal derivations (V1–V4). Echocardiogram showed a global left ventricular (LV) ejection fraction of 55%, with an apical-septal akinesia, with a minimal anterior pericardial effusion, not emodinamically significant. So, an emergency coronary angiography was performed, showing a fistula of the distal segment of the left anterior discendent coronary (LAD). In this case there were two possible options, a previously unknown congenital coronary arterial fistula, or a traumatic coronary perforation, determining a coronary arterial fistula. Considering the possibility of a traumatic coronary perforation, with the consequent risk of rapid pericardial effusion worsening, the decision was to perform percutaneous coronary intervention (PCI) with a covered stent (Biotronik Papyrus 2.5 × 20 mm, 8 atm), with a good final result, with total occlusion of fistula.

Conclusions
At 1 month follow-up, the patient was asymptomatic for dyspnoea or chest pain, with a heart rate of 70 b.p.m. and a blood pressure of 130/80 mmHg. ECG showed no anomalies in ST-T tract.
262 An attractive endovascular strategy for combined—aneurysmal and stenotic—coronary artery disease
Authors: Vendrametto Fauzia , Pierri Alessandro , Barbisan Davide , Piazza Rita , Pavan Daniela , Sinagra Gianfranco 
Published: December 2021

Abstract
In patients undergoing coronary angiography the coexistence of aneurysmal and stenotic lesions in adjacent segments of the same epicardial vessel is uncommon. We describe a rare case of single-vessel coronary artery disease (CAD) in a 70-year-old male, presenting with progressive effort-induced angina of 3-months’ evolution. The coronary angiogram revealed a critical calcified stenosis in the context of diffuse ectasia affecting the right coronary artery (RCA). Our report focuses on a complex revascularization procedure using the self-expandable Carotid Wallstent. Highlighting the importance of a multidisciplinary approach, we provide an original and effective endovascular solution for an unusual pathological angiographic finding, which could be of potential interest for interventional cardiologists.
651 Prevention of contrast induced nephropathy with urine alkalinization: the final results of the TEATE study
Authors: Molisana Michela , Lombardi Marco , Genovesi Eugenio , Innocentiis Carlo De , Limbruno Ugo , Misuraca Leonardo , Moretti Luciano , Vito Luca Di , Renda Giulia , Zimarino Marco , Nicola Marta Di , Caterina Raffaele De 
Published: December 2021

Abstract

Aims
Contrast-induced acute kidney injury (CI-AKI) after coronary angiography and percutaneous interventions (PCI) impacts on hospitalization duration and mortality. Pre-procedural hydration is the sole strategy currently recommended for preventing CI-AKI. The role of sodium bicarbonate (SB) although attractive, since urine alkalinization suppresses the production of reactive oxygen species, is still controversial, and the optimal dosing to attain adequate urine alkalinization is still undefined. The PrevenTion of contrast-inducEd nephropathy with urine alkalinization (TEATE) study was a prospective 3-centre 3-arm single-blind randomized controlled trial testing the hypothesis that adequate urine alkalinization is associated with CI-AKI prevention. Secondary endpoints were the efficacy of SB vs. saline in achieving adequate urine alkalinization and reducing the incidence of CI-AKI compared with saline.

Methods and results
Patients candidate to coronary angiography and/or PCI with moderate-to-severe chronic kidney disease [eGFR of 15–60 ml/min/1.73 m2, by the Modification of Diet in Renal Disease Study equation (MDRD)] were randomly assigned to saline hydration (control), oral SB or i.v. SB. The study protocol was registered (ClinicalTrials.gov NCT02980003). We evaluated urinary pH at the time of hospitalization, immediately before coronary angiography and 24–48 h after angiography. According to urine pH immediately before the procedure, patients were divided in two groups above or below a pH cut-off of 6. We enrolled a total of 241 patients: 81 were randomly assigned to the control group, 82 to i.v. SB and 78 to oral SB. Patients achieving a urinary pH &gt; 6 before angiography had a lower incidence of CI-AKI (46%) than patients with urinary pH ≤ 6 (54%) [OR = 0.48 (95% CI: 0.25–0.9), P = 0.023]. The number of patients with urine pH &gt; 6 was higher in both the i.v. (71%) and the oral SB (65%) groups compared to the hydration-only group (44%, P = 0.004). We found however no difference in the incidence of CI-AKI in the three treatment arms (20% in hydration alone, 21% in oral SB group and 22% in i.v. SB group) (P = 0.94). Subgroup analyses according to basal urine pH and eGFR ranges failed to identify statistically significant differences in the development of CI-AKI according to treatment allocation.

Conclusions
Urinary pH before the administration of contrast medium is an inverse correlate of CI-AKI incidence, and SB is superior to hydration alone in achieving urinary alkalinization. Since, however, SB did not reduce the incidence of CI-AKI, we conclude that urinary pH is a marker and not a mediator of CI-AKI.
712 In-stent restenosis: how optical coherence tomography can make the difference
Authors: Ricci Sara , De Candia Gianfranco , Cadeddu Mauro , Lai Giorgio , Secchi Sara , Aste Francesca , Meloni Luigi , Montisci Roberta 
Published: December 2021

Abstract

Aims
Patient male, 38 years old, affected by hypercholesterolaemia, carotid atherosclerosis, in 2014 NSTEMI (bivascular coronary artery disease treated by angioplasty and implantation of a medicated stent in the ostial and proximal tract of the right coronary artery). In September 2021 the patient went to the emergency room of our hospital for chest pain, that comes during physical exertion, with a spontaneous regression. We performed blood tests that showed phase rise of the Hs-TNI (&gt;25 000 ng/dl). The ECG showed lateral sub-endocardial ischemia and the transthoracic echocardiogram a slight reduction in ejection fraction with hypochinesia of the inferior and inferior-lateral wall. After collegial discussion, it was decided to perform a coronary angiography.

Methods and results
The coronary angiography showed the left coronary artery free from stenosis, with a collateral circle towards the right coronary; the right coronary showed an ostial and proximal critical in-stent restenosis with patency of the stent in the middle segment, total occlusion of the distal segment. It was decided to treat the right coronary. A guide wire was pushed into to the right coronary with difficulty and, after recanalization of the vessel, an optical coherence tomography (OCT) was performed. The OCT pointed out a homogeneous widespread neointima into the stent and an extraluminal fibrous-calcified plaque in the ostial proximal segment, which caused likely the stent under-expansion and then the stent fracture. We proceeded with angioplasty and stent implantation of the distal lesion. Due to the mechanism underlying critical in-stent restenosis (fracture of the stent) of the ostial proximal segment, we first proceed with a pre-dilatation of the lesion and then with a stent in stent implantation. Post-dilatation with a non-compliant balloon at high atm. Eventually, we found out a detail not visible before due to the ostial stenosis: the protrusion of some millimeters of the previously implanted stent in the ascending aorta; this was the cause of the difficulty in advancing the angioplasty material throughout the procedure. As a result, we had no complications.

Conclusions
Intracoronary imaging has stronger evidences to guide the percutaneous revascularization, especially for in-stent restenosis. Evaluation by OCT can highlight the mechanism of in-stent restenosis (biological causes/mechanical causes) and consequently it can guide the most appropriate method to perform percutaneous revascularization.
612 Comparison of two self-expandable supra-annular bioprosthesis: a propensity score-matched analysis
Authors: Sticchi Alessandro , Gallo Francesco , Marzo Vincenzo De , Won-keun Kim , Zeus Tobias , Toggweiler Stefan , Marco Federico De , Reimers Bernhard , Nombela-franco Luis , Barbanti Marco , Brugaletta Salvatore , Piva Tommaso , Rodes-cabau Josep , Porto Italo , Colombo Antonio , Giannini Francesco 
Published: December 2021

Abstract

Aims
Limited data reported the comparison of bioprostheses for transcatheter aortic valve implantation (TAVI) among devices of supra-annular design. The aim of this study is to compare the clinical outcomes of the ACURATE neo and Evolut R/PRO valves for TAVI in a propensity score-matched analysis (PSM).

Methods and results
We performed a propensity score-matched analysis equalizing almost all the patient’s risk factors, anatomical and procedural characteristics, and assessing the predictive value of the remaining features. Our data were derived from a large, real-world, contemporary, multicentre, international, retrospective registry of 3862 consecutive patients undergoing TAVI using two different self-expandable supra-annular valves (Medtronic Evolut R/PRO and Boston ACURATE neo). We reached a matched population of 713 couples for each device group with a medium follow-up of 456.5 days. In the comparison of the clinical outcomes between the Evolut and the ACURATE patients, no difference occurred in mortality (9.8% vs. 9.0%, P = 0.650), heart failure hospitalization (9.6% vs. 6.0%, P = 0.076), myocardial infarction (0.7% vs. 0.4%, P = 0.718), stroke (2.4% vs. 1.4%, P = 0.239), major bleeding (3.3% vs. 3.4%, P = 1.000), vascular complications (13.7% vs. 10.9%, P = 0.126), endocarditis (1.1% vs. 0.6%, P = 0.568), sepsis (0.9% vs. 0.5%, P = 0.605), acute kidney injury (0.9% vs. 0.5%, P = 0.605), and new left bundle branch block (17% vs. 13.5%, P = 0.187). The only outcome with a significant difference between the groups was the need of pacemaker implantation in favour of the ACURATE valve (5.3% vs. 12.9% for the Evolut, P &lt; 0.001).

Conclusions
In our PSM cohort, the comparison between the Evolut and the ACURATE valve showed no significant differences in the multiple outcomes evaluated, except for the rate of new pacemaker implantation. This data confirmed the recent literature, but it needs further dedicated investigation using the following devices generations.
374 Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI
Authors: Venturi Gabriele , Scarsini Roberto , Pighi Michele , Sole Paolo Alberto Del , Mainardi Andrea , Ribichini Flavio 
Published: December 2021

Abstract

Aims
The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established.

Methods and results
A large retrospective multicentre cohort of 1381 patients treated with TAVI was analysed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and one year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (HR: 1.16, 95% CI: 1.09–1.22, P &lt; 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (OR: 1.18, 95% CI: 1.08–1.28, P &lt; 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, P = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, P = 0.006) but not CV/CrCl was associated with the risk of 1-year mortality after TAVI.

Conclusions
CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.