Balloon Aortic Valvuloplasty as Bridge-to-Decision in High Risk Patients with Severe Aortic Valve Stenosis

Background. A sizable group of patients with symptomatic aortic stenosis (AS) can undergo neither surgical aortic valve replacement (AVR) nor transcatheter aortic valve implantation (TAVI) because of clinical contraindications. The aim of this study was to assess the potential role of balloon aortic valvuloplasty (BAV) as a “bridge-to-decision” in selected patients with severe AS and potentially reversible contraindications to definitive treatment. Methods. We retrospectively enrolled 645 patients who underwent first BAV at our Institution between July 2007 and December 2012. Of these, the 202 patients (31.2%) who underwent BAV as bridge-to-decision (BTD) requiring clinical re-evaluation represented our study population. BTD patients were further subdivided in 5 groups: low left ventricular ejection fraction; mitral regurgitation grade ≥3; frailty; hemodynamic instability; comorbidity. The main objective of the study was to evaluate how BAV influenced the final treatment strategy in the whole BTD group and in its single specific subgroups. Results. Mean logistic EuroSCORE was 23.5±15.3%, mean age was 81±7 years. Mean transaortic gradient decreased from 47±17 mmHg to 33±14 mmHg. Of the 193 patients with BTD-BAV who received a second heart team evaluation, 72.5% were finally deemed eligible for definitive treatment (25.4%for AVR; 47.2% for TAVI): respectively, 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented relevant comorbidities. 27.5% of the study population was deemed ineligible for definitive treatment and treated with standard therapy/repeated BAV. In-hospital mortality was 4.5%, cerebrovascular accident occurred in 1% and overall vascular complications were 4% (0.5% major; 3.5% minor). Conclusions. Balloon aortic valvuloplasty should be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive percutaneous or surgical treatment.

Seismotectonic study on two strategic infrastructures in Southern Italy

With the entry into force of the latest Italian Building Code (NTC 2008, 2018), innovative criteria were provided, especially for what concerns the seismic verifications of large infrastructures. In particular, for buildings considered as strategic, such as large dams, a seismotectonic study of the site was declared necessary, which involves a re-assessment of the basic seismic hazard. This PhD project fits into this context, being part of the seismic re-evaluation process of large dams launched on a national scale following the O.P.C.M. 3274/2003, D.L. 79/2004. A full seismotectonic study in the region of two large earth dams in Southern Italy was carried out. We identified and characterized the structures that could generate earthquakes in our study area, together with the definition of the local seismic history. This information was used for the reassessment of the basic seismic hazard, using probabilistic seismic hazard assessment approaches. In recent years, fault-based models for the seismic hazard assessment have been proposed all over the world as a new emerging methodology. For this reason, we decided to test the innovative SHERIFS approach on our study area. The occasion of the seismotectonic study gave also the opportunity to focus on the characteristics of the seismic stations that provided the data for the study itself. In the context of the work presented here, we focused on the 10 stations that had been active for the longest time and we carried out a geophysical characterization, the data of which merged into a more general study on the soil-structure interaction at seismic stations and on the ways in which it could affect the SHA. Lastly, an additional experimental study on the two dams and their associated minor structures is also presented, aimed at defining their main dynamic parameters, useful for subsequent dynamic structural and geotechnical studies.