cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.7951700
title: Long-arm Clip for Transcatheter Edge-to-Edge Treatment of Mitral and Tricuspid Regurgitation – Ex-Vivo Beating Heart Study

description: <b>Background:</b> A longer-arm clip design for transcatheter edge-to-edge repair of mitral and tricuspid valves could be beneficial in treating complex valve pathologies. Its hemodynamic effects and usability are unknown. This study aims to assess its new design in an ex-vivo beating heart model. <b>Methods:</b> The long-arm clip was implanted in porcine left (n = 14) and right (n = 6) hearts with induced degenerative mitral regurgitation and functional tricuspid regurgitation, respectively. Hemodynamic conditions were assessed at baseline, pathology and post-treatment. Usability and grasping quality were evaluated during simulated treatment. <b>Results:</b> Mitral valve treatment significantly increased cardiac output (<i>p</i> p = 0.001) with respect to pathological conditions. Tricuspid treatment with grasping involving septal leaflet significantly increased cardiac output (posterior-septal grasping: <i>p</i> = 0.006; anterior-septal grasping: <i>p</i> = 0.04). There was no significant increase of transvalvular gradient pressure nor tissue damage. <b>Conclusion:</b> Long-arm clip treatment was feasible in porcine hearts, it effectively reduced regurgitation and did not significantly increase the transvalvular pressure gradient. <b>Abbreviations:</b> MV, mitral valve; DMR, degenerative mitral regurgitation; FTR, functional tricuspid regurgitation; TV, tricuspid valve; XTR Clip, long-arm clip; P2, posterior middle scallop of mitral valve; MRF, mitral regurgitation fraction; A-P, medial grasping of anterior and posterior leaflets; A-S, medial grasping of anterior and septal leaflets; P-S, medial grasping of posterior and septal leaflets; CO<sub>s</sub>, systemic cardiac output; CO<sub>p</sub>, pulmonary cardiac output; AoP, mean aortic pressure; PAP, mean pulmonary artery pressure; LAP, mean left atrial pressure; LAP<sub>syst</sub>, mean left atrial pressure during ventricular systole; Δp<sub>m</sub>, mean diastolic pressure gradient across mitral valve; Δp<sub>t</sub>, mean diastolic pressure gradient across tricuspid valve; APd, mid-systole mitral antero-posterior distance; CI, confidence interval
DOI: 10.6084/m9.figshare.7951700.v1
title: Long-arm clip for Transcatheter Edge-to-Edge Treatment of Mitral and Tricuspid Regurgitation – Ex-Vivo Beating Heart Study

description: <b>Background:</b> A longer-arm clip design for transcatheter edge-to-edge repair of mitral and tricuspid valves could be beneficial in treating complex valve pathologies. Its hemodynamic effects and usability are unknown. This study aims to assess its new design in an ex-vivo beating heart model. <b>Methods:</b> The long-arm clip was implanted in porcine left (n = 14) and right (n = 6) hearts with induced degenerative mitral regurgitation and functional tricuspid regurgitation, respectively. Hemodynamic conditions were assessed at baseline, pathology and post-treatment. Usability and grasping quality were evaluated during simulated treatment. <b>Results:</b> Mitral valve treatment significantly increased cardiac output (<i>p</i> p = 0.001) with respect to pathological conditions. Tricuspid treatment with grasping involving septal leaflet significantly increased cardiac output (posterior-septal grasping: <i>p</i> = 0.006; anterior-septal grasping: <i>p</i> = 0.04). There was no significant increase of transvalvular gradient pressure nor tissue damage. <b>Conclusion:</b> Long-arm clip treatment was feasible in porcine hearts, it effectively reduced regurgitation and did not significantly increase the transvalvular pressure gradient. <b>Abbreviations:</b> MV, mitral valve; DMR, degenerative mitral regurgitation; FTR, functional tricuspid regurgitation; TV, tricuspid valve; XTR Clip, long-arm clip; P2, posterior middle scallop of mitral valve; MRF, mitral regurgitation fraction; A-P, medial grasping of anterior and posterior leaflets; A-S, medial grasping of anterior and septal leaflets; P-S, medial grasping of posterior and septal leaflets; CO<sub>s</sub>, systemic cardiac output; CO<sub>p</sub>, pulmonary cardiac output; AoP, mean aortic pressure; PAP, mean pulmonary artery pressure; LAP, mean left atrial pressure; LAP<sub>syst</sub>, mean left atrial pressure during ventricular systole; Δp<sub>m</sub>, mean diastolic pressure gradient across mitral valve; Δp<sub>t</sub>, mean diastolic pressure gradient across tricuspid valve; APd, mid-systole mitral antero-posterior distance; CI, confidence interval
DOI: 10.6084/m9.figshare.9897107
title: Lying down on the Job? Repeat MitraClip after Previous Clip Migrates to an Unusual Position

description: Lying down on the Job? Repeat MitraClip after Previous Clip Migrates to an Unusual Position
DOI: 10.6084/m9.figshare.9897107.v2
title: Lying down on the Job? Repeat MitraClip after Previous Clip Migrates to an Unusual Position

description: Lying down on the Job? Repeat MitraClip after Previous Clip Migrates to an Unusual Position
DOI: 10.6084/m9.figshare.9963728
title: Incidence, Characteristics and Management of Persistent Peri-Device Flow after Percutaneous Left Atrial Appendage Occlusion

description: <b>Background</b><b>:</b> Severe peri-device leaks after left atrial appendage (LAA) occlusion requires continuation of life-long oral anticoagulation. However, the majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics, and management of peri-device leak after LAA occlusion are scarce. <b>Methods</b><b>:</b> We assessed the incidence of peri-device leak, its characteristics, and their management outcomes in 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018. <b>Results</b><b>:</b> Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5 ± 4.3 vs. 19.8 ± 3.7 mm, <i>p</i> &lt; 0.001), and more sub-optimal deployments (100% vs. 26.7%, <i>p</i> &lt; 0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications. <b>Conclusions</b><b>:</b> Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.
DOI: 10.6084/m9.figshare.9897107.v1
title: Lying Down on the Job? Repeat Mitraclip after Previous Clip Migrates to an Unusual Position

description: Lying Down on the Job? Repeat Mitraclip after Previous Clip Migrates to an Unusual Position
DOI: 10.6084/m9.figshare.9963728.v2
title: Incidence, Characteristics and Management of Persistent Peri-Device Flow after Percutaneous Left Atrial Appendage Occlusion

description: <b>Background</b><b>:</b> Severe peri-device leaks after left atrial appendage (LAA) occlusion requires continuation of life-long oral anticoagulation. However, the majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics, and management of peri-device leak after LAA occlusion are scarce. <b>Methods</b><b>:</b> We assessed the incidence of peri-device leak, its characteristics, and their management outcomes in 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018. <b>Results</b><b>:</b> Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5 ± 4.3 vs. 19.8 ± 3.7 mm, <i>p</i> &lt; 0.001), and more sub-optimal deployments (100% vs. 26.7%, <i>p</i> &lt; 0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications. <b>Conclusions</b><b>:</b> Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.
DOI: 10.6084/m9.figshare.9159497.v1
title: 3D Cardiac Printing to Plan Transcatheter Closure of an Iatrogenic Primum Atrial Septal Defect

description: 3D Cardiac Printing to Plan Transcatheter Closure of an Iatrogenic Primum Atrial Septal Defect
DOI: 10.6084/m9.figshare.9159497
title: 3D Cardiac Printing to Plan Transcatheter Closure of an Iatrogenic Primum Atrial Septal Defect

description: 3D Cardiac Printing to Plan Transcatheter Closure of an Iatrogenic Primum Atrial Septal Defect
DOI: 10.6084/m9.figshare.9963728.v1
title: Incidence, Characteristics and Management of Persistent Peri-Device Flow After Percutaneous Left Atrial Appendage Occlusion

description: <b>Background</b>: Severe peri-device leaks after left atrial appendage (LAA) occlusion require continuation of life-long oral anticoagulation. However, majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics and management of peri-device leak after LAA occlusion are scarce. <b>Methods</b>: We assessed the incidence of peri-device leak, its characteristics, and their management outcomes 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018. <b>Results</b>: Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5±4.3 vs. 19.8±3.7 mm, p&lt;0.001), and more sub-optimal deployments (100% vs. 26.7%, p&lt;0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 2 (22%) remained on oral anticoagulation and 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications. <b>Conclusions</b>: Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.
DOI: 10.6084/m9.figshare.7553852.v3
title: Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

description: <b>Background:</b> To examine contemporary clinical and economic outcomes with the implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety, and satisfaction. <b>Methods:</b> A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). <b>Results:</b> There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there were no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; <i>p</i> <b>Conclusions:</b> The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.
DOI: 10.6084/m9.figshare.7553852
title: Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

description: <b>Background:</b> To examine contemporary clinical and economic outcomes with the implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety, and satisfaction. <b>Methods:</b> A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). <b>Results:</b> There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there were no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; <i>p</i> <b>Conclusions:</b> The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.
DOI: 10.6084/m9.figshare.7543010
title: Prevalence, Burden and Echocardiographic Features of Moderate to Severe Tricuspid Regurgitation: Insights from a Tertiary Referral Center

description: <b>Background</b><b>:</b> Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center. <b>Methods</b><b>:</b> A retrospective analysis was performed on 6309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE). <b>Results</b><b>:</b> A total of 2336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III–IV (<i>p</i> = 0.022) and on higher doses of loop diuretic (<i>p</i> = 0.022) than those with only moderate TR. Multivariable analysis revealed that blood urea nitrogen (BUN, <i>p</i> = 0.031) and abnormal liver function blood tests (<i>p</i> = 0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and tricuspid annular plane systolic excursion were found to be independent predictors of mid-term NACE. <b>Conclusions</b><b>:</b> The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.
DOI: 10.6084/m9.figshare.7543010.v2
title: Prevalence, Burden and Echocardiographic Features of Moderate to Severe Tricuspid Regurgitation: Insights from a Tertiary Referral Center

description: <b>Background</b><b>:</b> Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center. <b>Methods</b><b>:</b> A retrospective analysis was performed on 6309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE). <b>Results</b><b>:</b> A total of 2336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III–IV (<i>p</i> = 0.022) and on higher doses of loop diuretic (<i>p</i> = 0.022) than those with only moderate TR. Multivariable analysis revealed that blood urea nitrogen (BUN, <i>p</i> = 0.031) and abnormal liver function blood tests (<i>p</i> = 0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and tricuspid annular plane systolic excursion were found to be independent predictors of mid-term NACE. <b>Conclusions</b><b>:</b> The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.
DOI: 10.6084/m9.figshare.7543010.v1
title: Prevalence, burden and echocardiographic features of moderate to severe tricuspid regurgitation: insights from a tertiary referral center

description: <b>Background</b>. Although systematically underestimated in the past, the importance of tricuspid regurgitation (TR) is being progressively recognized. We aimed to evaluate the clinical significance of severe TR from a cohort of patients at a tertiary center. <b>Methods</b>. A retrospective analysis was performed on 6,309 consecutive patients undergoing echocardiography between October 2014 and September 2015 in a single center in Milan, Italy. The study endpoints included cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE). <b>Results</b>. A total of 2,336 (37%) patients were found to have TR of any severity, 272 (4.3%) had severe TR, 415 (6.6%) moderate TR, and 1,649 (26.1%) mild TR. In the severe TR group, 40 (14.7%) patients suffered cardiovascular death, while 53 (19.5%) and 141 (51.8%) developed MACCE and NACE, respectively. In addition, there were 88 (32.4%) patients with severe TR who were re-hospitalized for cardiovascular-related events. Patients with severe TR were more likely to be in New York Heart Association functional class III-IV (<i>p</i>=0.022) and on higher doses of loop diuretic (<i>p</i>=0.022) than those with only moderate TR. Multivariable analysis revealed that Blood Urea Nitrogen (BUN, <i>p</i>=0.031) and abnormal liver function blood tests (<i>p</i>=0.010) were independent predictors of mid-term cardiovascular mortality, while BUN and Tricuspid Annular Plane Systolic Excursion were found to be independent predictors of mid-term NACE. <b>Conclusions</b>. The prevalence of any TR was high in patients undergoing echocardiography at a tertiary referral center, and severe TR was not uncommon and associated with high mid-term morbidity and mortality.
DOI: 10.6084/m9.figshare.7605653
title: Annular Rupture Successfully Salvaged by Valve-in-Valve Implantation

description: Annular Rupture Successfully Salvaged by Valve-in-Valve Implantation
DOI: 10.6084/m9.figshare.7553852.v2
title: Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

description: <b>Background</b>. To examine contemporary clinical and economic outcomes with implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety and satisfaction. <b>Methods</b>. A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). <b>Results</b>. There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there was no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; p&lt;0.001). Implementation of MP was associated with a significant decrease in total variable costs of 17.9%, an increase in patients with a positive contribution margin (from 30% in 2015 to 65% in 2017), and cumulative cost savings of $3.6 million over two years. <b>Conclusions</b>. The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.
DOI: 10.6084/m9.figshare.7605653.v1
title: Annular Rupture Successfully Salvaged by Valve-In-Valve Implantation

description: Annular Rupture Successfully Salvaged by Valve-In-Valve Implantation
DOI: 10.6084/m9.figshare.12018243
title: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty

description: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty
DOI: 10.6084/m9.figshare.12018243.v3
title: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty

description: Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty