Minerva cardioangiologica
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Minerva cardioangiologica · Aug 2013
ReviewLong-term results after transcatheter aortic valve implantation: positive and side effects.
The scientific and technological progress in the field of medicine has allowed to treat patients with severe aortic valve stenosis and with a high perioperative risk. Before the introduction of transcatheter aortic valve implantation (TAVI), patients considered at high risk for surgical treatment were managed with medical therapy or with balloon aortic valvuloplasty. With more than 50000 transcatheter aortic valves implanted in patients around the world, TAVI has demonstrated to be a valid alternative to surgical aortic valve replacement in inoperable and high-risk patients. ⋯ In this review, we will present the immediate results and distinct TAVI-related drawbacks and relative impact on the long-term outcome. New technology advances promise to simplify TAVI and to improve the results by reducing the rate of TAVI-specific issues such as paravalvular aortic regurgitation, annular rupture, and conduction disturbances which may impact on the clinical outcome. Therefore, we believe that when some of these weaknesses will be overcome, even patients at lower risk might benefit from TAVI in the near future.
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Minerva cardioangiologica · Aug 2013
Neurological recovery after out-of-hospital cardiac arrest: hospital admission predictors and one-year survival in an urban cardiac network experience.
The aim of the study was to detect early predictors of neurological recovery and evaluate one year survival related to neurological status at discharge in patients (pts) admitted after out of hospital cardiac arrest (OHCA). ⋯ Forty-one percent of pts admitted to our tertiary centre after OHCA were discharged with CPC 1-2 and at one year follow-up 96% of these were alive, while all pts classified as CPC 3-4 died. Easily documented information such as the time from OHCA to ROSC and the time of first shock to ROSC are early independent predictors of neurological recovery.
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Minerva cardioangiologica · Feb 2013
Incidence and very long- term outcomes of stent thrombosis after bare-metal or drug-eluting stent implantation: a retrospective analysis.
Stent thrombosis is a major safety issue after percutaneous coronary intervention (PCI) with stent implantation and it is associated with major early and mid-term complications. However, its long-term impact has been incompletely described. We thus aimed to appraise incidence, predictors and very long-term outlook of stent thrombosis after bare metal stent (BMS) or drug-eluting stent (DES) implantation. ⋯ This long-term registry shows that stent thrombosis remains a major safety issue after PCI with stent implantation, with a significant prognostic impact. However, in the present work the risk of stent thrombosis was similar with either DES or BMS, suggesting thus that DES are not associated with any increase in long-term thrombotic risk in comparison to BMS.
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Cardiorenal syndromes (CRS) are disorders of the heart and kidneys in which an acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. Primary disorders of one of these two organs often result in secondary dysfunction or injury of the other. The lack of specific trials in this field highlights the need for further studies aimed to assess titration and appropriate dosages of drugs, according to both the etiology of chronic heart failure (CHF) and also the severity of underlying renal dysfunction. ⋯ Therefore, Current American and European Guidelines for AHFS does not provide specific recommendation for patients with renal impairment. In this scenario several questions regarding the drugs, their recommended dosage and potential adverse effects on cardiac and renal outcome need to be addressed. Subsequently, therapy inducing an improvement in the renal function, a reduction of neurohormonal activation and an improvement of renal blood flow, could lead to a reduction in mortality and hospitalization in patients with CRS.
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Minerva cardioangiologica · Jun 2012
Review Randomized Controlled Trial Multicenter StudyRenalguard system in high-risk patients for contrast-induced acute kidney injury.
Contrast-induced acute kidney injury (CI-AKI) predicts unfavorable outcomes. The use of the RenalGuard™® system, to create high urine output and fluid balancing, may be beneficial in preventing CI-AKI. The REMEDIAL II trial is a randomized, multicenter, investigator-driven trial addressing the prevention of CI-AKI in high risk patients. ⋯ CI-AKI (defined as an increase of ≥0.3 mg/dL in the serum creatinine concentration at 48 hours after the procedure) occurred in 16/146 patients in the RenalGuard group (11%) and in 30/146 patients in the Control group (20.5%) (P=0.025; OR=0.47; 95% CI=0.24-0.92). Absolute changes in CyC at 24 hours (0.02±0.32 versus -0.08±0.26; P=0.002) and at 48 hours (0.12±0.42 versus -0.03±0.31; P=0.001), as well as the rate of in-hospital dialysis (4.1% versus 0.7%; P=0.056) were higher in the Control group. In conclusion, the RenalGuard therapy seems to be a promising new approach in preventing CI-AKI in high risk patients.