ABSTRACT Introduction and objectives: After the positive pre-clinical and clinical results with Angiolite, a cobalt-chromium sirolimus-eluting stent, we decided to analyze its performance in a ...non-selected, real-world population: the RANGO registry. Methods: We conducted an observational, prospective, multicenter registry of patients with different clinical indications. All consecutive patients treated with percutaneous coronary intervention with, at least, 1 Angiolite stent and who gave their informed consent were included. The registry primary endpoint was the occurrence of target lesion failure (TLF) at 6, 12, and 24 months defined as cardiovascular death, myocardial infarction (MI) related to target vessel, and clinically driven target lesion revascularization. The secondary endpoints were the individual components of the primary endpoint, major adverse cardiovascular events (MACE: all-cause mortality, any MI, or any revascularization), and stent thrombosis. We describe the 2-year clinical results of the RANGO study in the entire population, in those who only received Angiolite stents, and in 2 predefined subgroups: diabetics and patients with small-vessels (≤ 2.5mm). Results: 646 patients (426 of them only received Angiolite stents) with a high-risk profile were recruited: prevalence of previous MI (18.4%), previous coronary revascularization (23.4%), clinical presentation as ST-segment elevation MI (23.1%), and multivessel disease (47.8%). At the 2-year follow-up, the rates of TLF, MACE, and stent thrombosis were 3.4%, 9.6%, and 0.9%, respectively. Similar results were observed among patients treated with Angiolite stents only: TLF, 3.1%; MACE, 8.0%; thrombosis, 0.7%. The rates were not significantly different for the diabetic (TLF, 3.0%; MACE, 14.1%; thrombosis, 1.0%), and small-vessel subgroups (TLF, 4.3%; MACE, 12.1%; thrombosis, 0%). Conclusions: In conclusion, the results of this observational registry on the use of Angiolite in a real-world population, including a high-risk population, corroborate the excellent results observed in previous studies, up to a 2-year follow-up. An extended 5-year follow-up is planned to discard the occurrence of late events.
Coronary artery disease (CAD) is a common co-morbidity in transcatheter aortic valve implantation (TAVI) patients, but the prognostic value of coronary revascularization before TAVI is currently ...unknown. The aim of the present study was to assess the impact of coronary revascularization in patients who underwent TAVI. Patients underwent TAVI from 2008 to 2016 were included in the study. Baseline SYNTAX score and residual SYNTAX score (rSS) after percutaneous coronary intervention were calculated. Based on rSS, patients were classified as complete revascularization (rSS = 0), reasonably incomplete revascularization (rSS >0 and <8), and incomplete revascularization (rSS ≥8). The primary objective was to evaluate the impact of CAD and rSS on major cardiovascular adverse events (MACEs). The secondary objective was to assess the impact of rSS on hospitalization for heart failure. A total of 349 patients (mean age 82.4 ± 5.7 years, 53% women) were included in the study. A total of 187 patients (53.6%) had CAD (mean baseline SYNTAX score 9.2 ± 8.1). Percutaneous coronary intervention was performed in 29.9% of patients, achieving reasonably incomplete revascularization in 45.4%, and incomplete revascularization in 24.5%. The mean follow-up was 35.2 ± 25.3 months. No differences were observed in MACE rate between the CAD and non-CAD groups, or between the different degrees of revascularization. Differences were also not seen in the different levels of revascularization and hospitalization due to heart failure. In patients who underwent TAVI in this study, no association was found between the presence of CAD or the degree of revascularization in a long-term follow-up.
Background To determine the prevalence of malnutrition, as assessed through the nutritional risk index (NRI), in patients undergoing transcatheter aortic valve implantation (TAVI) and the prognostic ...impact of this status. In the multivariate analysis (age, logistic EuroScore and renal function, estimated by MDRD4, were included), NRI was independently associated with mortality after TAVI implantation, with HR = 2.4, 95% CI 1.2- 5.1; p = 0.014.
Case Resolution With an 8.5% score in the Society of Thoracic Surgeons risk score for mortality rate, we decided to implant one Evolut PRO transfemoral bioprostheis on an underexpanded bioprosthesis. ...The computed tomography confirmed the lack of coverage of the bioprosthetic stent over the aortic annulus at the level of the Valsava, non-coronary and right coronary sinuses (figure 1), indicative of stent recoil of the stent harboring the bioprosthetic leaflets as the possible mechanism of periprosthetic failure and causing malapposition with the aortic annulus. The perimeter of the aortic annulus was 79.3 mm (minimum diameter: 22 mm; maximum diameter: 25 mm). Figure 1. Lack of coverage of the bioprosthetic stent over the aortic annulus at the level of the Valsava, non-coronary and right coronary sinuses (asterisk). The colored dots are indicative of the location of coronary sinuses. One self-expandable prosthesis was selected with leaflets at the supra-annular level, since it has already been confirmed that in valve-in-valve procedures, the hemodynamic outcome is better compared to the annular implantation that leaves a more significant trans-prosthetic gradient. Also, the position of the prosthesis inside the prosthesis needs to be optimal, which makes the Evolut R the perfect device for this kind of procedure for its...
Presentation of the case We hereby present the case of an 83 year old hypertense, diabetic male patient with asymptomatic severe aortic stenosis, preserved ventricular function, mild mitral ...regurgitation and no coronary artery disease. He had low-intermediate surgical risk (3.1% in the Society of Thoracic Surgeons scoring system) and, in medical-surgical session, it was decided to proceed with the surgical replacement of his aortic valve. Perceval Sutureless Aortic Heart Valve, Sorin size L was implanted. The follow-up echocardiogram prior to hospital discharge showed an aortic transvalvular gradient of 22/11 mmHg and 2 periprosthetic regurgitation jets indicative of mild-to-moderate aortic failure with pulmonary artery systolic pressure of 40 mmHg. Five months after valvular replacement, the patient was hospitalized due to acute heart failure with acute pulmonary edema. During the physical examination, the auscultation showed murmurs indicative of grade III/IV aortic regurgitation and bilateral pulmonary rales. The echorcardiogram showed severe aortic failure due to the lack of stent coverage of the aortic bioprosthesis at the level of the aortic annulus and in the area corresponding to the non-coronary sinus and most of the right coronary sinus which conditioned 2 regurgitation jets towards the left ventricle that appeared slightly dilated. The left ventricular ejection fraction was somehow...
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