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Early mortality and safety after transcatheter aortic valve replacement using the SAPIEN 3 in nonagenarians

Journal of Geriatric Cardiology 2018年第6期15卷 387-393页

作者： Eiji Ichimoto Adam Arnofsky Michael Wilderman Richard Goldweit joseph de gregorio department of Invasive Cardiology Englewood Hospital and Medical Center Englewood N J United States department of Cardiothoracic Surgery Englewood Hospital and Medical Center Englewood N J United States department of Vascular Surgery Englewood Hospital and Medical Center Englewood N J United States department of Interventional Cardiology Englewood Hospital and Medical Center Englewood NJ United States

Background Transcatheter aortic valve replacement （TAVR） has been performed for many elderly patients with severe aortic stenosis （AS）. The SAPIEN 3 is one of the latest balloon-expandable prosthesis. This study aimed to investigate the early clinical outcomes after TAVR using the SAPIEN 3 in nonagenarians. Methods A total of 97 consecutive patients underwent TAVR for severe AS between de- cember 2015 and december 2016. Of these, 85 consecutive patients who underwent TAVR using the SAPIEN 3 were included. According to the age, patients were classified into age 〉 90 years group （17 patients） or age 〈 90 years group （68 patients）. The clinical outcomes in- cluding all-cause mortality and composite endpoint of early safety at 30 days were evaluated. Results The Society of Thoracic Surgeons score in age 〉 90 years group was higher than age 〈 90 years group （12.3 ±6.1% vs. 8.5 ± 5.1%, P 〈 0.01）. There was no significant difference in 30-day mortality between the two groups. However, the life-threatening bleeding and major vascular complications in age 〉 90 years group were greater than age 〈 90 years group （11.8% vs. 1.5%, P = 0.04 and 11.8% vs. 1.5%, P = 0.04, respectively）. The composite endpoint of early safety at 30 days was similar between the two groups. Multivariate logistic regression analysis showed that prior myocardial infarction was an independent predictor of the composite endpoint of early safety （odds ratio： 4.76, 95% confidence interval： 1.02-22.21, P = 0.047）. Conclusions The early mortality and safety after TAVR using the SAPIEN 3 in nonagenarians were similar and acceptable despite of higher operative risk.

关键词： Nonagenarians SAPIEN 3 Transcatheter aortic valve replacement

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Prognostic significance of post percutaneous coronary intervention thrombocytopenia

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World Journal of Meta-Analysis 2014年第2期2卷 24-28页

作者： Michele Schiariti Loredana Iannetta Concetta Torromeo Michele de gregorio Paolo Emilio Puddu Laboratory of Biotechnologies Applied to Cardiovascular Medicine Department of Cardiovascular Respiratory NephrologicalAnesthesiological and Geriatrical Sciences Sapienza University of Rome department of Medicine St. Joseph Mercy Oakland Hospital

Several definitions of post percutaneous coronary intervention(PCI)thrombocytopenia(TC)were *** studies demonstrated that a relative drop in platelet count≥25%is the most appropriate *** this definition a population is detected that is exposed not only to increased risk of hemorrhagic complications but also to increased risk of ischemic events,which may appear a *** patients with acute coronary syndromes undergoing PCI,several conditions might be associated with TC:cardiopulmonary bypass and the presence of extra corporeal membrane oxygenators,intra aortic balloon pump(IABP),cardiogenic shock,thrombolytic drugs and anticoagulant or antiplatelet *** studies demonstrated that TC and ischemic outcomes are related although it is unclear whether this is a direct relationship or TC is just a secondary effect of another cryptic *** is suggested that further investigations determine whether there is a real link between TC,a probably welldefined covariate,and ischemic outcomes or whether IABP is the joining link between these two variables and whose presence needs in any case be considered in multivariable ***-PCI TC could be only a secondary effect of IABP *** turn,the prolonged use of heparin necessarily accompanying the use of IABP,and producing a paradoxical pro-thrombotic TC,might also be implicated.

关键词： Thrombocytopenia Outcome Percutaneous coronary intervention Intra aortic balloon pump

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