Patrizia Presbitero's research while affiliated with Istituto Clinico Humanitas IRCCS and other places
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Publications (316)
Early menopause is associated with an increased risk of cardiovascular diseases, including aortic stenosis (AS). We sought to investigate the prevalence and impact of early menopause on clinical outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) for severe symptomatic AS. Women's International TAVI is a multinational,...
Background: Frailty has been shown to significantly affect outcomes after transcatheter aortic valve replacement (TAVR). The impact of pre-frailty on TAVR outcomes in women is still unclear.
Aim: To assess the impact of pre-frailty and frailty on outcomes in women enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN-TA...
Background
Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with severe aortic stenosis (AS). Predicting which patients are at risk for adverse clinical outcomes after TAVI remains difficult, especially in women.
Aim
To identify predictors of adverse events in the WIN-TAVI cohort.
Methods
The WIN-TAVI s...
Although most patients with small aortic annulus are women, there is paucity of data on the prognostic impact of small aortic prosthesis in women who underwent transcatheter aortic valve implantation (TAVI). Therefore, we aimed to evaluate the impact of small valve size on 1-year clinical outcomes after TAVI in women. The Women's INternational Tran...
Background
It is unknown whether contemporary drug‐eluting stents have a similar safety profile in high bleeding risk patients treated with 1‐month dual antiplatelet therapy following percutaneous coronary interventions.
Methods and Results
We performed an interventional, prospective, multicenter, single‐arm trial, powered for noninferiority with...
Background
Thrombotic events are reduced with cangrelor, an intravenous P2Y 12 inhibitor. We sought to characterize the timing, number, and type of early events (within 2 hours of randomization) in CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Interventio...
Objectives
To describe the incidence, predictors, and clinical impact of permanent pacemaker insertion (PPI) following transcatheter aortic valve replacement (TAVR) in women.
Background
Data on pacemaker insertion complicating TAVR in women are scarce.
Methods
The Women's International Transcatheter Aortic Valve implantation (WIN-TAVI) is a prosp...
Background: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining mid-term outcomes after mitral ViV and ViR.
Methods: Patients undergoing mitral ViV and...
Objective
To evaluate the incidence, predictors and outcomes of female patients with patient‐prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS).
Background
Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which co...
Background
Female subjects constitute half of all transcatheter aortic valve implantation (TAVI) candidates, but the association between important comorbidities such as diabetes mellitus (DM) and clinical outcomes after TAVI remains unclear in this group.
Method
WIN-TAVI is a real-world international registry of exclusively female subjects undergo...
Background:
Large data comparing the performance of new-generation self-expandable versus balloon-expandable transcatheter heart valves in bicuspid aortic stenosis are lacking. We aim to compare the safety and performance of balloon-expandable and self-expandable transcatheter heart valves in the treatment of bicuspid aortic stenosis.
Methods:
T...
Aims:
Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.
Methods and results:
A total of 1006 aortic ViV procedures performed...
Background:
The prevalence of both chronic kidney disease (CKD) and aortic stenosis (AS) increase with age. Although baseline CKD is frequent in patients undergoing transcatheter aortic valve replacement (TAVR), its significance among women is largely unknown.
Methods:
Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) is a...
There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset a...
We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compar...
Objectives:
The purpose of the study was to investigate the impact of oral anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter aortic valve replacement (TAVR).
Background:
Non-vitamin K oral anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (AF), while their comparative...
Background:
Several clinical and procedural factors determine outcomes after transcatheter aortic valve replacement (TAVR), but data are scarce on the impact of post-TAVR discharge disposition on long-term outcomes. We sought to analyse whether discharge location after TAVR is associated with 1-year outcomes in women undergoing contemporary TAVR....
Pre-existing atrial fibrillation (AF) is common among patients who underwent transcatheter aortic valve implantation (TAVI) and has been associated with adverse outcomes. The specific impact of AF at baseline in women who underwent TAVI, however, remains unknown. The Women's International Transcatheter Aortic Valve Implantation is a prospective, mu...
Background:
The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) programme was designed to assess the comparative safety and effectiveness of radial versus femoral access and of bivalirudin versus unfractionated heparin with optional glycoprotein IIb/IIIa inhibitors in patients with t...
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's d...
Background:
The potential protective effects of remote ischemic preconditioning (RIPC) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) remain to be defined.
Methods and results:
A double blind, randomized, placebo controlled multicenter study was performed. Patients younger than 85years old, with a renal clea...
Background:
Aortic valve calcification patterns were associated with short- and long-term outcomes in previous small observational datasets of patients undergoing transcatheter aortic valve implantation (TAVI). The specific impact of multi detector-row computed tomography (MDCT) findings on outcomes in women has not been reported. We sought to des...
Background:
It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in...
Objectives:
This study sought to examine the safety and performance of contemporary transcatheter aortic valve replacement (TAVR) in an exclusive all-women TAVR population, and to further investigate the potential impact of female sex-specific characteristics on composite 1-year clinical outcomes.
Background:
Women comprise ≥50% patients undergo...
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gende...
Objectives
This study sought to compare clinical outcome of polymer-free amphilimus-eluting stent (PF-AES) versus biodegradable-polymer biolimus-eluting stent (BD-BES) in “all-comer” diabetes mellitus (DM) and non-DM patients who underwent percutaneous coronary intervention.
Background
The PF-AES has shown promising preliminary results in patients...
Aims:
There are limited data on coronary obstruction following transcatheter valve-in-valve (ViV) implantation inside failed aortic bioprostheses. The objectives of this study were to determine the incidence, predictors, and clinical outcomes of coronary obstruction in transcatheter ViV procedures.
Methods and results:
A total of 1612 aortic pro...
Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared to patients with preserved LVEF. To evaluate the impact of early LVEF recovery in patients with baseline dysfunction on clinical outcomes after TAVI, we included all consecutive patients undergoing TAVI from the Italian Clinical...
Background
Despite promising results following transcatheter aortic valve implantation (TAVI), several relevant challenges still remain. To overcome these issues, new generation devices have been developed. The purpose of the present study was to determine whether TAVI with the new self-expanding repositionable Evolut R offers potential benefits co...
Aims:
Given the different pathogenesis, use of drug eluting stent (DES) in patients with Spontaneous Coronary Artery Dissection SCAD may delay the healing of the dissected vessel. Aim of our study was to compare the safety and the efficacy of DES vs. bare metal stent (BMS) in a cohort of patients who underwent stenting for SCAD.
Methods and resul...
Heavily calcified unprotected left main (ULM) disease continues to be a challenging situation and represent a high-risk subset for interventional cardiologist. To date, there are limited data investigating the results after rotational atherectomy (RA) in this setting. The aim of this study was to investigate the in-hospital and 1-year outcomes afte...
Objectives:
To compare the long-term clinical outcomes of paclitaxel drug-coated-balloons (DCB) and everolimus-eluting-stents (EES) following the treatment of de novo small vessel coronary artery disease.
Background:
It is currently unclear whether treatment of de novo small vessel coronary disease with DCB is comparable to second generation dru...
Cardiac conditions that need percutaneous intervention during pregnancy are very rare because usually they are diagnosed and treated before pregnancy. However, as a result of the hemodynamic changes (Fig. 19.1) and hypercoagulability state of pregnancy, some previously undiagnosed conditions can be unmasked or can rapidly deteriorate even in previo...
Aims:
To evaluate the safety and efficacy profile of new-generation, Synergy-Everolimus Eluting stents (S-EES) as compared to Xience-EES (X-EES) with durable polymer-coating in "complex patients".
Methods and results:
We included 2,001 consecutive patients treated with S-EES (n=400) or X- EES (n=1601) at two Italian centers between May 2013 and...
Objectives:
To evaluate the impact of diabetes on the efficacy of drug-eluting balloon (DEB) as compared to paclitaxel-eluting stent (PES) for the reduction of restenosis in small vessels according to the presence of diabetes in patients enrolled in the BELLO (Balloon Elution and Late Loss Optimization) trial.
Background:
Small vessel disease is...
Aims:
The aim of this multicentre study was to investigate the in-hospital and midterm outcomes of rotational atherectomy (RA) followed by metallic stent implantation.
Methods and results:
Between 2002 and 2013, 1,176 de novo lesions with calcified coronary lesions treated by RA and metallic stent implantation at nine institutions were assessed....
In-stent restenosis (ISR) represents the key limitation of bare metal stent (BMS) implantation as a result of excessive neointimal hyperplasia within the implanted stent. Drug-eluting stents (DES) were developed to address this limitation. ISR was observed in around 20-30% of patients treated in BMS pivotal trials. The last technical evolution of D...
Objectives:
We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions.
Background:
Limited data are available addressing the benefits of planned RA compared to provisional RA.
Methods:
Between 2002 and 2013, all patients with calcified lesions treated...
Aims:
Clinical trials have shown that transcatheter aortic valve implantation for aortic stenosis compares favorably to surgical replacement in high-risk patients and is superior to medical therapy in those at prohibitive risk. There is uncertainty however on patterns and trends in transcatheter aortic valve implantation, especially focusing on It...
Objectives:
The study sought to examine the safety and performance of transcatheter aortic valve replacement (TAVR) using an all-female registry and to further explore the potential impact of female sex-specific characteristics on clinical outcomes after TAVR.
Background:
Although women comprise 50% of patients with symptomatic severe aortic ste...
Scarce data are available on the impact of age on transcatheter aortic valve implantation (TAVI) outcomes. We, therefore, analyzed 1845 consecutive patients from 9 Italian centers who underwent TAVI with the CoreValve Revalving System (CRS) from September 2007 to March 2014; patients were dichotomized according to their age in the date of the proce...
Background:
Several factors have been identified as predictors of events after transcatheter aortic valve implantation (TAVI) but the impact of left ventricular ejection fraction (LVEF) and mean transaortic gradient (MTG) is controversial. This multicenter study aimed to clarify the prognostic role of low LVEF and low MTG after TAVI.
Methods:
Fr...
Background:
Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI.
Methods:
Six-hundred-forty-nine patient...
This book describes a wide range of interventional procedures currently employed in the treatment of cardiac diseases in women with the aim of enabling not only interventional cardiologists but also cardiologists and cardiac surgeons to refine their approach to female patients and thus improve outcomes. The book reflects the increasing awareness of...
CONCLUSIONS In high risk patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, elevated neutrophil to lymphocyte ratio was associated with increased mortality at 30 days. This effect was independent of previously established risk predictors in these patients. More large scale randomized studies are needed to furthe...
Background:
Conflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome.
Methods:
We randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated he...
Very few women become interventional cardiologists, although a substantial proportion of cardiologists and the majority of medical students are women. In accordance with the EAPCI Women Committee mission of attaining gender equality at the professional level, a worldwide survey was recently conducted aiming to understand better the motivations and...
The optimal treatment of de novo small-vessel coronary artery disease remains unclear. The use of drug-eluting stents in this patient group are limited by high rates of restenosis [(1)][1] and the requirement of prolonged treatment with dual antiplatelet therapy. The use of drug-coated balloons (
The aim of this study is to describe the cerebral ischemia recurrence rate after percutaneous patent foramen ovale (PFO) closure in patients older than 55 years and their outcomes, compared with younger patients.
The registries data and the recent randomized trials about PFO closure are focused on patients younger than 55 years. Little is known abo...
Background. It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management.
Methods. We did a randomised, multicentre, superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segmen...
We present a case of hybrid mitral valve-in valve implantation. The planned transapical approach failed due to the inability to cross the degenerated stenotic mitral bioprosthesis. An alternative strategy was performed: first, an anterograde crossing of mitral stenosis, and then, a guidewire externalization through the apex by using a snare. To our...
Regurgitation due to a paravalvular leak (PVL) is a complication that may affect patients undergoing surgical mechanical or bioprosthetic heart valve replacement. PVL can also occur after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and is associated with significantly worse outcomes. We report a case in wh...
Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are at elevated risk for bleeding and thromboembolic ischemic events. Currently, guidelines on antithrombotic treatment for these patients are based on weak consensus. We describe patterns and determinants of antithrombotic prescriptions in this population...
Pregnancy is associated with significant hemodynamic, tissue and hematic changes in the maternal cardiovascular system, which could result in worsening some previously asymptomatic cardiac conditions. Since the last 30 years, new techniques and devices have been introduced in the field of structural and coronary heart disease. In this review, we de...
Background
The aim of this study was to assess the impact of bivalirudin, as compared to unfractionated heparin, on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).MethodsA meta-analysis of randomized trials comparing bivalirudin versus heparin in patients with STEMI undergoing primary percutaneous coronary int...
Two different devices, 1 self-expanding and 1 balloon-expandable, have been developed for patients who underwent transcatheter aortic valve implantation with contrasting data about efficacy and safety. Pubmed, Medline, and Google Scholar were systematically searched for studies of these different devices, with data derived from randomized controlle...
Chronic total occlusions (CTO) still remain one of the most technically challenging scenarios in which inter- ventions are performed. Although the antegrade approach is the most common method of CTO recanaliza- tion, management of CTOs has recently been refined through the development of a retrograde approach that offers an additional possibility o...
Chronic total occlusions (CTO) still remain one of the most technically challenging scenarios in which interventions are performed. Although the antegrade approach is the most common method of CTO recanalization, management of CTOs has recently been refined through the development of a retrograde approach that offers an additional possibility of su...
Elevated values of systolic pulmonary artery pressure (sPAP) represent a common finding in patients with aortic stenosis and severe left ventricular hypertrophy. Prognostic impact of sPAP and its potential improvement after transcatheter aortic valve implantation (TAVI) remains to be determined.
This is a multicenter retrospective registry in five...
A prospective, multi-center, randomized trial, BELLO (Balloon Elution and Late Loss Optimization), showed that the primary endpoint of in-stent (in-balloon) late loss was significantly less with drug-eluting balloons (DEB) as compared with paclitaxel-eluting stents (PES). At 6months, DEB and PES were associated with similar rates of angiographic re...
Until now, there is no medium- to long-term clinical evidence of the best treatment after rotational atherectomy.
From the databases of seven high-volume centres, years 2005-2010, we retrospectively analysed the long-term outcome of patients who had undergone rotational atherectomy followed by plain-balloon angioplasty or implantation of drug-eluti...
Objectives
INSPIRE-1 (Italian Nobori Stent ProspectIve REgistry-1) was designed and conducted to assess clinical performance of Nobori biolimus A9-eluting stent (BES) implantation in an unrestricted “real-world” cohort of patients.
Methods
Unrestricted consecutive high-risk patients treated with BES with biodegradable polymer (Nobori, Terumo, Toky...
Aims: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS). From October 2008 to January 2013, 1,557 consecutive patients undergo...
In view of the high number of bioprosthetic valves implanted during the past 30 years, an increasing number of patients are coming to medical attention because of degenerated bioprostheses. Transcatheter aortic valve-in-valve implantation has been described as a less invasive alternative to re-operation to treat severe structural valve deterioratio...
Citations
... Similar to aortic ViV procedures, THV is anchored at the level of the SHV sewing ring. Deformation following mitral ViV i.e. underexpansion, hourglass shape, and vertical deformation, is more frequent than seen with TAVR in native AS and aortic ViV [6,28,29]. This is because of the greater degree of oversizing required to secure the THV, due to higher risk of valve migration. ...
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... 26 29 In addition, using vitamin K antagonists in patients with atrial fibrillation may contribute to valve calcification and faster progression and has also been associated with worse outcomes after transcatheter aortic valve implantation. [30][31][32] To our knowledge, this is the first study that applies a subject-specific approach to predict the progression rate of aortic stenosis. Using a mixed-effects Patient 1 has rapid progression and is an elderly individual of 80 years old with a history of atrial fibrillation and chronic kidney disease, and has left ventricular hypertrophy (elevated LVMI). ...
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... Additionally, the size of the aortic annulus was significantly smaller in the small LVIO group, resulting in the use of smaller valves, but a small aortic annulus was not a significant factor of HF readmission post-TAVI in this study. These results were consistent with those of a previous study that compared 1-year clinical outcomes between small and non-small valves [27]. ...
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... These findings were subsequently validated in the international multicenter prospective EVOLVE Short DAPT registry. [45]. Several trials evaluating the SYNERGY TM are currently ongoing. ...
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... This early occurrence of ST is consistent with results from a larger study, CHAMPION PHOENIX, which included patients with stable coronary artery disease or ACS without OHCA. In that study, most ischemic events were observed within the initial two hours following PCI [35]. The use of cangrelor in this study significantly reduced the number of ischemic events without an increase in bleeding complications [35]. ...
... EVO-LUTE LOW-RISK and PARTNER-3 studies have shown that TAVI is not inferior to SAVR, even in low-risk patients [71][72][73]. However, TAVI is associated with risks such as death, bleeding complications, atrioventricular blocks requiring a pacemaker, and stroke [74][75][76]. ...
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... The study design has been previously described. 11,12 The study was approved at all sites by local ethical committees and was conducted according to the Declaration of Helsinki, International Organization for Standardization Guidelines, and Good Clinical Practice Guidelines. All patients provided written informed consent. ...
... The data regarding the long-term outcomes of this procedure are limited, and further analysis, including RCTs, should be carried out. However, the limited data gathered so far suggest that the procedure is safe and is not associated with high rates of complication and mortality in short-term follow-up in patients who are not candidates for repeat surgery [98][99][100]. ViV could be a potential alternative solution to the need for reoperation in bioprosthetic SVD. ...
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... However, PPM seemed not to have an impact on 1-year clinical outcomes. (19) In the TAVI-SMALL registry, where the majority of the patients were females, severe, but not a moderate PPM was associated with poor outcome, and BE device was found to be the strongest predictor of PPM. (20) In the OPERA-TAVI registry, the rate of PPM did not differ significantly in females versus males in both ULTRA and PRO groups, although, in line with available literature, smaller annuli and smaller valve sizing were observed in females. ...
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... Somewhat counterintuitively, obesity may be an advantageous factor for TAVI outcome [25]. Goel et al. [26] previously reported both younger age and higher BMI in patients with DM before TAVI, thereby linking two factors that favorably affect procedural outcomes to a diagnosis of DM. However, DM is also associated with accelerated atherosclerosis [27], and both, patients with IDDM and with NIDDM have higher comorbidity rates compared to non-diabetics, including a diagnosis of hypertension, a history of previous MI, or pre-Life 2023, 13, 54 7 of 10 vious CABG. ...
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