Subject(s)
Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Female , Humans , Male , Recovery of Function , Severity of Illness Index , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imagingABSTRACT
INTRODUCTION: Are the current data on the Cardioband in the clinical area enough to consider it a tool for mitral regurgitation treatment? Severe secondary mitral valve insufficiency frequently affects high-risk surgical patients. The Cardioband system is a novel percutaneous surgical-like device for direct annuloplasty. It is implanted into the beating heart by transvenous femoral access, with minimal impact on hemodynamic and cardiac function during implantation. So far, it has demonstrated safety and feasibility in high-risk patients with functional mitral regurgitation; it has imparted significant annular reduction and regurgitation improvements. In well-selected patients, it could be an option for mitral valve repair. AREAS COVERED: This is a bibliographic review based on scientific publications and medical congress reports. It includes the most current information related to Cardioband in mitral regurgitation. EXPERT COMMENTARY: This novel, less-invasive and effective tool is an option for the open repair or replacement of the mitral valve in high-risk surgical patients. Although the current results of Cardioband are promising, more data and longer follow-up times are necessary to confirm its safety and efficacy and to evaluate the durability of the results.
Subject(s)
Heart Valve Prosthesis , Mitral Valve Insufficiency/therapy , Clinical Trials as Topic , Heart Valve Prosthesis Implantation , Humans , Mitral Valve/surgery , Statistics as TopicSubject(s)
Cardiac Catheterization/instrumentation , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve Annuloplasty , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Cardiac Catheterization/adverse effects , Clinical Decision-Making , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Patient Selection , Prosthesis Design , Recovery of Function , Risk Factors , Treatment OutcomeABSTRACT
Over the last few years, treatment of severe symptomatic aortic stenosis in high-risk patients has drastically changed to adopt a less-invasive approach. Transcatheter aortic valve implantation (TAVI) has been developed as a very reproducible and safe procedure, as shown in many trials. When compared to surgery, TAVI has produced superior, or at least comparable, results, and thus a trend to broaden treatment indications to lower-risk patients has erupted as a natural consequence, even though there is a lack of long-term evidence. In this review, we summarize and underline aspects that still remain unanswered that are compulsory if we want to enhance our understanding of this disease.
ABSTRACT
We reported an unusual case of left ventricular pouch, in a 72-year-old man who had an acute coronary syndrome treated with percutaneous revascularization. The echocardiogram showed a sort of pouch, delimited by epicardium and endocardium, confirmed by 3D echo. This finding appeared as an echo free area, with a really slight color flow inside. We consequently supposed it would be a dissecting hematoma, a rare complication of the ischemic disease, due to the rupture of the intramyocardial vessels among the spiral myocardial fibers. This would produce a hemorrhagic pouch contained by epicardial and endocardial layers, which could evolve into mural thrombi.
Subject(s)
Echocardiography/methods , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Myocardial Infarction/physiopathology , Ventricular Remodeling/physiology , Acute Disease , Aged , Diagnosis, Differential , Echocardiography, Three-Dimensional/methods , Humans , Magnetic Resonance Imaging/methods , Male , Tomography, X-Ray Computed/methodsABSTRACT
Although menopause is a universal phenomenon among women, the timing of the onset and the duration of the menopausal transition and the timing of the final menstrual period are not so codified. Compelling evidence supports the idea that the different impact of cardiovascular disease and the differences in vascular biology in men and women may be, at least in part, related to the cardiovascular and metabolic effects of sex steroid hormones. Indeed, androgens and estrogens influence a multitude of vascular biological processes and their cardiovascular effects are multifaceted. Gender pharmacology has proven that men and women have tiny but not paltry different effects to the same drug. Estrogens exert potential beneficial effects on the cardiovascular system in both sexes. It is evident that there is a need for the physician who approaches the female patient, to stress the main anamnestic data concerning her hormonal life starting from menarche, through pregnancy, until menopause. Thus it will be not only a formality becoming a cornerstone of the first doctor-patient relationship, both for in- and outpatient, we will have a clear and complete representation of the etiology and evolution of cardiovascular diseases that increasingly afflict the female gender.
Subject(s)
Cardiovascular Diseases/epidemiology , Gonadal Steroid Hormones/metabolism , Menopause/physiology , Cardiovascular Diseases/metabolism , Female , Humans , Menopause/metabolism , Physician-Patient Relations , Postmenopause , Quality of Life , Risk AssessmentABSTRACT
Intraluminal aortic clamping has been achieved until now by means of a sophisticated device consisting of a three-lumen catheter named Endoclamp, which allows at the same time occlusion of the aorta, antegrade delivering of cardioplegia, and venting through the aortic root. This tool has shown important advantages allowing aortic occlusion and perfusate delivering without a direct contact with ascending aorta reducing meanwhile the risk of traumatic and/or iatrogenic injuries. Recently, a new device (Intraclude catheter) with the same characteristics and properties has been proposed and introduced in clinical practice. The aim of this paper is to investigate the differences between Endoclamp and Intraclude catheters and to analyze the advantages advocated by this new device for intraluminal aortic occlusion since it is noticeable as these new technological tools are gaining more and more attractiveness due to their appraised clinical efficacy.
Subject(s)
Cardiac Catheters , Cardiac Surgical Procedures/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Vascular Access Devices , Cardiac Surgical Procedures/adverse effects , Equipment Design , Equipment Failure Analysis , Humans , Minimally Invasive Surgical Procedures/adverse effects , Technology Assessment, BiomedicalABSTRACT
OBJECTIVES: The aim of this study is to assess the efficacy of the high-dose rosuvastatin preadministration in reducing periprocedural myocardial necrosis and major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing elective percutaneous coronary intervention (PCI). BACKGROUND: Elective PCI may be complicated with an elevation of cardiac biomarkers. Several studies suggested that pretreatment with statins may be associated with a reduction in periprocedural myocardial necrosis. METHODS: One hundred and sixty patients with stable angina who underwent elective PCI were randomly assigned to receive either a preprocedural loading dose (40 mg) of rosuvastatin group (RG, n = 80) or a standard treatment [control group (CG), n = 80].The primary endpoint was the incidence of periprocedural myocardial necrosis. The secondary endpoint was the assessment of MACCE [cardiac death, all-myocardial infarction (MI), stroke, and target vessel revascularization (TVR)] at a 30-day and 12-month follow-up, as well as the rate of periprocedural rise of Troponin T-serum levels >3× upper limit of normal. RESULTS: Twelve and 24-hr post-PCI creatinine kinase MB isoform elevation >3× occurred more frequently in the CG than in the RG (22.7 vs. 7.1; P = 0.034 and 26.4 vs. 8.7; P = 0.003). At the 30-day and 12-month follow-up, the incidence of cumulative MACCE was higher in CG than in the RG (30.0% vs. 8.7%; P = 0.001 and 35.0% vs. 12.5%; P = 0.001).The difference between the groups was mainly due to the periprocedural MI incidence (26.4% vs. 8.7%; P = 0.003).The rate of cardiac death, spontaneous MI, TVR, and stroke were similar in the two groups. CONCLUSIONS: High loading dose of rosuvastatin within 24 hr before elective PCI seems to decrease the incidence of periprocedural myocardial necrosis during a period of 12-months compared to the standard treatment.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Coronary Stenosis/therapy , Fluorobenzenes/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Myocardial Infarction/prevention & control , Premedication , Pyrimidines/administration & dosage , Sulfonamides/administration & dosage , Aged , Angioplasty, Balloon, Coronary/methods , Cardiac Catheterization/methods , Cardiotonic Agents/administration & dosage , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/mortality , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Italy , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Myocardial Infarction/pathology , Necrosis/etiology , Necrosis/prevention & control , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Prospective Studies , Pulse Therapy, Drug , Risk Assessment , Rosuvastatin Calcium , Survival Rate , Treatment OutcomeSubject(s)
Adenosine/administration & dosage , Angina, Stable/surgery , Angioplasty, Balloon, Coronary/adverse effects , Myocardial Infarction/prevention & control , Vasodilator Agents/administration & dosage , Aged , Angina, Stable/blood , Angina, Stable/drug therapy , Coronary Vessels , Creatine Kinase, MB Form/blood , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Incidence , Injections, Intra-Arterial , Intraoperative Period , Italy/epidemiology , Male , Middle Aged , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Retrospective Studies , Treatment Outcome , Troponin T/bloodABSTRACT
BACKGROUND: Twelve-month dual antiplatelet therapy (DAT) with aspirin and clopidogrel after drug-eluting stent (DES) implantation is routinely recommended. It is unclear if prolonged (>12-month) DAT is also favorable. We compared the outcome of patients discontinuing DAT 12 months after off-label DES implantation versus those with DAT for >12 months. METHODS: Baseline, treatment, and outcome data of patients undergoing off-label DES implantation and free from events 11.5 months after index procedure were retrospectively retrieved. Those discontinuing DAT between 11.5 and 12.5 months (12-month DAT group) were compared to those discontinuing DAT after 12.5 months (>12-month DAT group). The primary end-point was the long-term (>24-month) rate of major adverse cerebro-cardiovascular events (MACCE). RESULTS: Two hundred seventy-two patients met study inclusion criteria: 133 (48.9%) in the 12-month DAT group and 139 (51.1%) in the >12-month DAT group (who were on DAT for an average of 24 months). After an average of 36 months after DES implantation, 14 patients (5.1%) developed MACCE, with 6 (3.5%) cardiac deaths, 7 (2.2%) myocardial infarctions, no stroke, and 5 (1.8%) repeat revascularizations. The >12-month DAT group had a significantly lower risk of MACCE (1 [0.7%] vs. 13 [9.8%] in the 12-month DAT group, P < 0.001) and myocardial infarction (0 vs. 7 [5.3%], P = 0.006), with such differences confirmed at multivariable propensity-adjusted analyses. No significant differences in terms of minor or major bleedings occurred. CONCLUSIONS: In this retrospective registry, patients with off-label DES implantation receiving prolonged (>12 months) DAT presented with lower rates of MACCE and myocardial infarction.
Subject(s)
Drug-Eluting Stents , Platelet Aggregation Inhibitors/therapeutic use , Aspirin/therapeutic use , Clopidogrel , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/epidemiology , Myocardial Revascularization , Off-Label Use , Registries , Retreatment/statistics & numerical data , Retrospective Studies , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
OBJECTIVES: The aim of our study is to evaluate the safety and efficacy of DES implantation in an unselected, "real world," high-risk population. BACKGROUND: Several clinical trials showed that drug-eluting stents (DESs) implantation is safe and effective in selected population. In spite of these encouraging results, there are some concerns about "real world" utilization of these stents. METHODS: One thousand four hundred and fifty-five off-label patients have been included in our registry. Primary end-points were: long-term clinical incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombosis (ST). We detected the difference between uniDES vs. multiDES implantation in terms of MACCE, death, nonfatal-MI, the composite of death/nonfatal-MI and target lesion revascularization (TLR) and the difference between DES type in term of MACCE. RESULTS: At 36 months follow-up we found: cardiac death occurred in 20 patients (1.6%); 33 patients (2.6%) had a nonfatal MI and 81 patients (6.3%) had a TLR. We observed one (0.1%) acute, 9 subacute (0.6%), 6 late (0.6%), and 1 (0.5%) very late definite ST. No difference were found in terms of overall MACCE, MI, death and composite of death/nonfatal-MI between uni- and multiDES implantation but multiDES group had a higher incidence of TLR. No difference between DES type in term of MACCE was detected. CONCLUSIONS: DES utilization shows their safety and efficacy in off-label patients with complex clinical and angiographic profile in terms of long-term incidence of MACCE. MultiDES implantation is associated with a higher risk of long-term TLR. No difference between DES type was found.