Minerva cardioangiologica
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Minerva cardioangiologica · Jun 2018
Review Comparative StudyTranscatheter aortic valve implantation (TAVI) in 2018: recent advances and future development.
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis (AS) who are at high or prohibitive surgical risk. In the past years, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement (SAVR) in the treatment of intermediate risk patients. ⋯ Currently, several trials are investigating the role of TAVI in low surgical risk patients, novel indications and peri-operative management. In this review we give an overview on 1) current generation TAVI devices; on 2) recent clinical trial results and guidelines; and on 3) future trends and novel developments in the field of interventional treatment of AS.
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Minerva cardioangiologica · Jun 2018
ReviewDirect oral anticoagulants use in elderly patients with non valvular atrial fibrillation: state of evidence.
Non-valvular atrial fibrillation (NVAF) increases the risk of stroke by three- to five-fold, especially in elderly patients, creating a huge burden on medical system as well as a negative impact on patients' lives. Balancing efficacy and bleeding risk is a challenge when considering anticoagulation therapy in elderly patients, because of their frequent high risk of both stroke and bleeding. Real world data reveal the underuse of anticoagulation in the elderly, especially due to physicians' fear of bleeding, often neglecting the thromboembolic risk. ⋯ However, there are conflicting opinions on the absolute benefit of DOACs use in elderly patients. A key factor to consider is that elderly patients frequently suffer from renal impairment and therefore dose adjustments according to creatinine clearance are mandatory for DOACs. As each DOAC comes with its own unique advantages and safety profile, a personalized case by case approach should be adopted to decide on the appropriate anticoagulation regimen for elderly patients after weighing the overall risks and benefits of therapy.
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Minerva cardioangiologica · Apr 2018
Multicenter Study Comparative StudyStentless sutureless and transcatheter valves: a comparison of the hemodynamic performance of different prostheses concept.
Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. A new concept of surgical sutureless (SU) bioprosthesis has been developed in the last decade. In this multi-institutional study we sought to compare hemodynamics of different bioprosthesis concept as transcatheter (TAVR), Livanova Perceval S sutureless valve and Freedom Solo Stentless (FS) valve in patients undergoing aortic valve replacement (sAVR). ⋯ SU patients demonstrated post-operative excellent hemodynamic performance with smaller EROA and higher gradients compared to FS and TAVR. TAVR demonstrated higher mortality and pacemaker rates. Further studies are warrented to validate TAVR indications in this subset of patients.
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Minerva cardioangiologica · Dec 2017
ReviewClinical cardiac imaging in cardiac arrest and periarrest.
Echocardiography during preresuscitation care, cardiopulmonary resuscitation and postresuscitation is suggested to be an important tool in critical care medicine. At present a structured process integrating advanced life support and transtoracic echocardiography is not included in guidelines of cardiac resuscitation. However identification and treatment of reversible causes or complicating factors during cardiopulmonary resuscitation is rational and aimed to improve the outcomes. Furthermore, echocardiography has the potential to define the efficiency of the chest compressions and the optimal duration of the resuscitation maneuvers and/or the right time to switch to extracorporeal resuscitation.
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Minerva cardioangiologica · Oct 2017
Safety and efficacy of non-continuous echocardiography-guided pericardiocentesis: a single-center study of 478 patients.
There are limited contemporary data on the safety and efficacy of echocardiography-guided pericardiocentesis in Italy. The aim of the study was to evaluate safety and efficacy of pericardiocentesis, performed with non-continuous echocardiography monitoring. All the procedures performed at Department of Cardiovascular Disease, Ospedali Riuniti Ancona, from January 2001 to June 2013, were retrospectively analyzed to determine risks connected to the procedure and its success rate. Epidemiological data, procedure indications and etiology of the effusions were also recorded. ⋯ Echocardiography-guided pericardiocentesis is an effective and safe procedure, with a low rate of complications.