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Transcatheter Valve Replacement in Adults With Congenital Heart Disease-The Mayo Clinic Experience. 经导管瓣膜置换术治疗成人先天性心脏病——梅奥诊所的经验。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-10-27 DOI: 10.1161/CIRCINTERVENTIONS.125.015667
Alexander C Egbe, Allison K Cabalka, Nathaniel W Taggart, Donald J Hagler, Mackram F Eleid, Charanjit S Rihal, Jason H Anderson

Background: The current study aims to describe outcomes after transcatheter valve replacement in adults with congenital heart disease.

Methods: Retrospective study of adults with congenital heart disease who underwent transcatheter valve replacement and had a 1-year follow-up postintervention at Mayo Clinic (2010-2024). The study period was divided into early (2010-2014), mid (2015-2019), and late (2020-2024) eras. The primary outcome was valve reintervention. The secondary outcomes were all-cause mortality and temporal change in prosthetic valve gradient and clinical indices of disease severity.

Results: Overall, 341 patients (age 38±17 years; 175 [51%] men) received 346 prostheses (pulmonary [N=236, 68%], tricuspid [N=75, 22%], aortic [N=22, 8%], and mitral [N=7, 2%]). The prostheses were Sapien (N=181, 52%), Melody (N=142, 41%), and Harmony prostheses (N=23, 7%). The number of transcatheter valve implantations increased from the early era (N=75), mid era (N=109), to the late era (N=162). The 10-year incidence of valve reintervention was 35%, and was similar between Sapien versus Melody prosthesis (41% versus 33%; P=0.11). The 10-year incidence of all-cause mortality was 13%. There was a temporal increase in prosthetic valve Doppler mean gradient (baseline versus 10 years) for pulmonary (12±5 versus 28±11 mmHg; P<0.001), tricuspid (3±1 versus 8±3 mmHg; P<0.001), and aortic prosthesis (13±5 versus 26±12 mmHg; P<0.001). There was a temporal increase in predicted peak oxygen consumption (absolute ∆, 9% [95% CI, 4-13]; P=0.006) and a decrease in NT-proBNP (N-terminal pro-B-type natriuretic peptide) level (absolute ∆, -138 pg/mL [95% CI, -209 to -64]; P<0.001) at 1-year postintervention.

Conclusions: There has been a temporal increase in the number of transcatheter valve implantations over time. Transcatheter valve replacement was associated with clinical improvement across multiple domains. However, there was a significant increase in prosthetic valve gradient within 10 years of follow-up, suggesting limited prosthesis longevity. There is a need for strategies to improve prosthetic valve longevity, which in turn may improve outcomes in this population.

背景:目前的研究旨在描述成人先天性心脏病经导管瓣膜置换术后的结果。方法:回顾性研究在梅奥诊所接受经导管瓣膜置换术的成人先天性心脏病患者,干预后随访1年(2010-2024)。研究阶段分为早期(2010-2014)、中期(2015-2019)和后期(2020-2024)三个阶段。主要结局是瓣膜再干预。次要结局是全因死亡率、人工瓣膜梯度的时间变化和疾病严重程度的临床指标。结果:341例患者(年龄38±17岁,男性175例(51%))接受了346个假体(肺[N=236, 68%],三尖瓣[N=75, 22%],主动脉[N=22, 8%],二尖瓣[N=7, 2%])。分别为Sapien (N=181, 52%)、Melody (N=142, 41%)和Harmony (N=23, 7%)。经导管瓣膜置入术的数量从早期(75例)、中期(109例)到晚期(162例)依次增加。10年瓣膜再介入发生率为35%,Sapien和Melody假体的发生率相似(41%对33%;P=0.11)。10年全因死亡率发生率为13%。肺动脉假瓣膜的多普勒平均梯度(基线与10年相比)在时间上增加(12±5对28±11 mmHg; PPPP=0.006), NT-proBNP (n -末端前b型利钠肽)水平下降(绝对值∆,-138 pg/mL [95% CI, -209至-64];结论:随着时间的推移,经导管瓣膜植入的数量在时间上增加。经导管瓣膜置换术与多个领域的临床改善相关。然而,在随访10年内,假体瓣膜梯度显著增加,表明假体寿命有限。有必要制定策略来提高人工瓣膜的使用寿命,这反过来可能会改善这一人群的预后。
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引用次数: 0
Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions. 后拉压力梯度对经皮冠状动脉介入治疗后临床结果的影响。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-10-25 DOI: 10.1161/CIRCINTERVENTIONS.125.016022
Kazumasa Ikeda, Takuya Mizukami, Koshiro Sakai, Frederic Bouisset, Jeroen Sonck, Adriaan Wilgenhof, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Masahiro Hada, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Antonio Maria Leone, Lokien X van Nunen, William F Fearon, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien Adjedj, Javier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Danielle Keulards, Frederik M Zimmermann, Tatyana Storozhenko, Bruno R da Costa, Gianluca Campo, Colin Berry, Damien Collison, Thomas W Johnson, Daniel Munhoz, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A Ali, Takashi Kubo, Kazuhiro Satomi, Nobuhiro Tanaka, Bernard De Bruyne, Nils P Johnson, Carlos Collet

Background: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI.

Methods: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization.

Results: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR (r=0.92 [95% CI, 0.91-0.93]; P<0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of target vessel failure (adjusted hazard ratio, 1.97 [95% CI, 1.24-3.15]; P=0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes.

Conclusions: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

背景:经皮冠状动脉介入治疗(PCI)后血流受损是已知的不良结局预测因素。回拉压力梯度(PPG)是一种新的生理指标,可区分局灶性疾病和弥漫性疾病,并可预测pci后血流储备分数(FFR)。这项对PPG Global (NCT04789317)研究的事后分析旨在评估PPG模型预测PCI后FFR的预后性能,并确定预测的生理结果是否与PCI后不良事件相关。方法:前瞻性、多中心研究,纳入血流动力学显著的冠状动脉疾病(CAD)行PCI的患者。采用基于FFR和PPG的预测模型估计pci后FFR。根据预测值,将血管分为pci术后最佳或次优生理状态。主要终点是1年时靶血管衰竭(TVF)。TVF被定义为心源性死亡、靶血管心肌梗死(MI)和缺血驱动的靶血管重建术的复合。结果:共分析855例患者(890条血管)。预测和测量的pci后FFR之间的平均差异为0.001(一致性限制为-0.10至0.10)。预测和测量的δ FFR之间有很强的相关性(r = 0.92; 95% CI: 0.91-0.93; p < 0.001)。预测pci后生理机能不佳的血管TVF发生率明显较高(校正风险比[HR]: 1.97; 95% CI: 1.24-3.15; p = 0.004)。预测的次优生理与不良临床结果独立相关。结论:ppg预测的pci后生理学与1年时TVF相关。这些发现将冠状动脉生理学的作用从诊断评估扩展到PCI后的风险分层和预后预测。
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引用次数: 0
Pulmonary Artery Systolic Pressure Trajectories After Transcatheter Edge-to-Edge Repair in Atrial and Ventricular Secondary Mitral Regurgitation. 经导管边缘对边缘修复心房和心室继发性二尖瓣反流后肺动脉收缩压轨迹。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-11-16 DOI: 10.1161/CIRCINTERVENTIONS.125.016067
Philipp von Stein, Jörg Hausleiter, Patrick Horn, Mirjam Kessler, Volker Rudolph, Bernhard Unsöld, Philipp Lurz, Marcel Weber, Niklas Schofer, Mathias H Konstandin, Juan F Granada, Helge Möllmann, Amir Abbas Mahabadi, Tobias Kister, Victor Mauri
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引用次数: 0
Pursuit of Perfection: Expanding Our Understanding of Balloon Postdilation During TAVR. 追求完美:扩大我们对TAVR中球囊后扩张的理解。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-11-21 DOI: 10.1161/CIRCINTERVENTIONS.125.016177
Neal S Kleiman
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引用次数: 0
Single TriClip Steerable Guide for Combined MitraClip and TriClip Transcatheter Edge-to-Edge Repair (STriC-TEER): A Multicenter Experience. 结合MitraClip和TriClip经导管边缘到边缘修复(stricteer)的单TriClip导向指南:一个多中心的经验。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-11-16 DOI: 10.1161/CIRCINTERVENTIONS.125.015864
Kent Chak-Yu So, Darren Walters, Krissada Meemook, Jianqiang Xu, Angel Lai, Chun-Chin Chang, Tawai Ngernsritrakul, Surakiat Leelasithorn, Khin May Thaw, Dale Murdoch, Ching-Wei Lee, Kevin Ka-Ho Kam, Gregory Scalia, Bryan P Yan, Alex Pui-Wai Lee, Gilbert H L Tang, Yat-Yin Lam, Adam S H Sung
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引用次数: 0
Drug-Eluting Stent, Drug-Coated Balloon, or Plain Old Balloon Angioplasty for In-Stent Coronary Restenosis: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials. 药物洗脱支架、药物包被球囊或普通旧球囊血管成形术治疗支架内冠状动脉再狭窄:来自随机试验混合治疗比较荟萃分析的见解
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-11-12 DOI: 10.1161/CIRCINTERVENTIONS.125.015161
M Haisum Maqsood, Robert S Zhang, Nil Rawal, Gal Sella, Neal S Kleiman, Sripal Bangalore

Background: Drug-coated balloons (DCBs) are now a Food and Drug Administration-approved treatment option for the management of in-stent restenosis (ISR) based on superior outcomes compared with plain old balloon angioplasty (POBA) alone. However, the efficacy of DCB compared with drug-eluting stent (DES; repeat stenting) for ISR is uncertain, with prior studies showing inferiority of DCB. We aimed to compare the outcomes of DES, DCB, or POBA in patients with coronary ISR.

Methods: We searched PubMed, EMBASE, and clinicaltrials.gov databases (until August 1, 2025) for randomized clinical trials that compared DCB, DES, or POBA alone for ISR. Outcomes included major adverse cardiovascular events, target lesion revascularization, all-cause mortality, cardiovascular mortality, stent thrombosis, late lumen loss, and postprocedure minimum lumen diameter.

Results: From 18 randomized clinical trials that randomized 3820 patients with ISR, at mean follow-up of 18 months, compared with POBA, both DCB and DES were associated with reduction in major adverse cardiovascular events (odds ratio, 0.34 [95% CI, 0.24-0.50]; odds ratio, 0.37 [95% CI, 0.25-0.54]) driven by reduction in target lesion revascularization (odds ratio, 0.28 [95% CI, 0.15-0.50]; odds ratio, 0.21 [95% CI, 0.10-0.42]). DCB had a lower postprocedure minimum lumen diameter but lower late lumen loss (mean difference, -0.16 [95% CI, -0.29 to -0.04] mm) compared with DES with no difference in other clinical outcomes.

Conclusions: In patients with ISR, DCB reduced major adverse cardiovascular events/target lesion revascularization compared with POBA. There was no significant difference in clinical outcomes between DCB and DES.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42024598433.

背景:药物包被球囊(DCBs)治疗支架内再狭窄(ISR)的疗效优于单纯球囊血管成形术(POBA),现已获得美国食品和药物管理局(fda)批准。然而,与药物洗脱支架(DES;重复支架)相比,DCB治疗ISR的疗效尚不确定,已有研究表明DCB的疗效较差。我们的目的是比较DES、DCB或POBA在冠状动脉ISR患者中的疗效。方法:我们检索PubMed、EMBASE和clinicaltrials.gov数据库(截止到2025年8月1日),查找比较DCB、DES或POBA单独治疗ISR的随机临床试验。结果包括主要不良心血管事件、靶病变血运重建术、全因死亡率、心血管死亡率、支架血栓形成、晚期管腔丧失和术后最小管腔直径。结果:在18项随机临床试验中,随机分配3820例ISR患者,平均随访18个月,与POBA相比,DCB和DES都与主要不良心血管事件的减少相关(优势比0.34 [95% CI, 0.24-0.50];优势比0.37 [95% CI, 0.25-0.54]),这是由于目标病变血循环重建的减少(优势比0.28 [95% CI, 0.15-0.50];优势比0.21 [95% CI, 0.10-0.42])。与DES相比,DCB具有更低的术后最小管腔直径,但更低的晚期管腔损失(平均差异,-0.16 [95% CI, -0.29至-0.04]mm),其他临床结果无差异。结论:与POBA相比,在ISR患者中,DCB减少了主要不良心血管事件/靶病变血运重建。DCB组与des组的临床结局无显著差异。唯一标识符:CRD42024598433。
{"title":"Drug-Eluting Stent, Drug-Coated Balloon, or Plain Old Balloon Angioplasty for In-Stent Coronary Restenosis: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.","authors":"M Haisum Maqsood, Robert S Zhang, Nil Rawal, Gal Sella, Neal S Kleiman, Sripal Bangalore","doi":"10.1161/CIRCINTERVENTIONS.125.015161","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015161","url":null,"abstract":"<p><strong>Background: </strong>Drug-coated balloons (DCBs) are now a Food and Drug Administration-approved treatment option for the management of in-stent restenosis (ISR) based on superior outcomes compared with plain old balloon angioplasty (POBA) alone. However, the efficacy of DCB compared with drug-eluting stent (DES; repeat stenting) for ISR is uncertain, with prior studies showing inferiority of DCB. We aimed to compare the outcomes of DES, DCB, or POBA in patients with coronary ISR.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, and clinicaltrials.gov databases (until August 1, 2025) for randomized clinical trials that compared DCB, DES, or POBA alone for ISR. Outcomes included major adverse cardiovascular events, target lesion revascularization, all-cause mortality, cardiovascular mortality, stent thrombosis, late lumen loss, and postprocedure minimum lumen diameter.</p><p><strong>Results: </strong>From 18 randomized clinical trials that randomized 3820 patients with ISR, at mean follow-up of 18 months, compared with POBA, both DCB and DES were associated with reduction in major adverse cardiovascular events (odds ratio, 0.34 [95% CI, 0.24-0.50]; odds ratio, 0.37 [95% CI, 0.25-0.54]) driven by reduction in target lesion revascularization (odds ratio, 0.28 [95% CI, 0.15-0.50]; odds ratio, 0.21 [95% CI, 0.10-0.42]). DCB had a lower postprocedure minimum lumen diameter but lower late lumen loss (mean difference, -0.16 [95% CI, -0.29 to -0.04] mm) compared with DES with no difference in other clinical outcomes.</p><p><strong>Conclusions: </strong>In patients with ISR, DCB reduced major adverse cardiovascular events/target lesion revascularization compared with POBA. There was no significant difference in clinical outcomes between DCB and DES.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42024598433.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015161"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why Disease Distribution Matters for PCI Outcomes: Lessons From PPG-Based Prediction. 为什么疾病分布影响PCI结果:基于ppg预测的经验教训。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-11-21 DOI: 10.1161/CIRCINTERVENTIONS.125.016158
Bon-Kwon Koo, Doyeon Hwang
{"title":"Why Disease Distribution Matters for PCI Outcomes: Lessons From PPG-Based Prediction.","authors":"Bon-Kwon Koo, Doyeon Hwang","doi":"10.1161/CIRCINTERVENTIONS.125.016158","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.016158","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016158"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multicenter Pivotal Trial of the Minima Stent for Vascular Stenosis in Infants and Young Children. 最小支架治疗婴幼儿血管狭窄的多中心关键试验。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 Epub Date: 2025-10-10 DOI: 10.1161/CIRCINTERVENTIONS.125.015618
Patrick M Sullivan, Evan M Zahn, Shyam Sathanandam, Brian Morray, Shabana Shahanavaz, Arash Salavitabar, Aimee K Armstrong, Diego Porras, Darren P Berman

Background: The Minima Stent System is the first stent designed, tested, and Food and Drug Administration-approved for use in neonates, infants, and children. Our objective was to evaluate the safety and efficacy of Minima implantation for pulmonary artery stenosis (PAS) and coarctation of the aorta (CoA).

Methods: Multicenter, single-arm, prospective, nonrandomized trial. Primary end points included stenosis relief, freedom from device-related serious adverse events or surgical intervention through 6 months, and maintenance of vessel lumen diameter on computed tomography or catheter angiography at 6 months.

Results: Forty-two patients (21 PAS, 15 recurrent CoA, and 6 native CoA) underwent Minima implantation at a median age and weight of 9 (range, 0.4-112) months and 7.8 (3.4-28.3) kg. Implantation was successful in 41 (97.6%) and resulted in a median increase in minimal vessel diameter of 131% (46%-483%) and reduction in median pressure gradients from 25 (0-63) to 0 (0-6; P<0.001) mm Hg in patients with CoA. Two acute PAS stent embolizations occurred; both stents were secured in the contralateral PA, and one was treated with an additional Minima stent. Seven patients with CoA, all under 6 kg, experienced transient femoral artery thrombosis. At 6 months, there were no explants or device-related serious adverse events. Luminal diameter was maintained at 89% (59%-137%) of the implant diameter. During a median follow-up of 596 (412-979) days, 13 (31%; 7 CoA and 6 PAS) patients underwent planned stent expansion without complications.

Conclusions: The Minima system is safe and effective for treating PAS and CoA in infants and small pediatric patients. Luminal patency was preserved, and planned reinterventions for somatic growth seem well-tolerated in early follow-up.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05086016.

背景:Minima支架系统是第一个设计、测试并获得美国食品和药物管理局批准用于新生儿、婴儿和儿童的支架。我们的目的是评估Minima植入治疗肺动脉狭窄(PAS)和主动脉缩窄(CoA)的安全性和有效性。方法:多中心、单臂、前瞻性、非随机试验。主要终点包括狭窄缓解,6个月内没有器械相关的严重不良事件或手术干预,6个月时计算机断层扫描或导管血管造影显示血管管腔直径维持。结果:42例患者(21例PAS, 15例复发性CoA, 6例先天性CoA)在中位年龄9(0.4-112)月龄和7.8 (3.4-28.3)kg时接受了Minima植入,41例(97.6%)患者植入成功,最小血管直径中位数增加131%(46%-483%),中位压力梯度从25(0-63)降至0(0-6);结论:Minima系统治疗婴幼儿和小儿科患者PAS和CoA安全有效。保留腔内通畅,在早期随访中,对躯体生长的计划再干预似乎耐受良好。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT05086016。
{"title":"Multicenter Pivotal Trial of the Minima Stent for Vascular Stenosis in Infants and Young Children.","authors":"Patrick M Sullivan, Evan M Zahn, Shyam Sathanandam, Brian Morray, Shabana Shahanavaz, Arash Salavitabar, Aimee K Armstrong, Diego Porras, Darren P Berman","doi":"10.1161/CIRCINTERVENTIONS.125.015618","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015618","url":null,"abstract":"<p><strong>Background: </strong>The Minima Stent System is the first stent designed, tested, and Food and Drug Administration-approved for use in neonates, infants, and children. Our objective was to evaluate the safety and efficacy of Minima implantation for pulmonary artery stenosis (PAS) and coarctation of the aorta (CoA).</p><p><strong>Methods: </strong>Multicenter, single-arm, prospective, nonrandomized trial. Primary end points included stenosis relief, freedom from device-related serious adverse events or surgical intervention through 6 months, and maintenance of vessel lumen diameter on computed tomography or catheter angiography at 6 months.</p><p><strong>Results: </strong>Forty-two patients (21 PAS, 15 recurrent CoA, and 6 native CoA) underwent Minima implantation at a median age and weight of 9 (range, 0.4-112) months and 7.8 (3.4-28.3) kg. Implantation was successful in 41 (97.6%) and resulted in a median increase in minimal vessel diameter of 131% (46%-483%) and reduction in median pressure gradients from 25 (0-63) to 0 (0-6; <i>P</i><0.001) mm Hg in patients with CoA. Two acute PAS stent embolizations occurred; both stents were secured in the contralateral PA, and one was treated with an additional Minima stent. Seven patients with CoA, all under 6 kg, experienced transient femoral artery thrombosis. At 6 months, there were no explants or device-related serious adverse events. Luminal diameter was maintained at 89% (59%-137%) of the implant diameter. During a median follow-up of 596 (412-979) days, 13 (31%; 7 CoA and 6 PAS) patients underwent planned stent expansion without complications.</p><p><strong>Conclusions: </strong>The Minima system is safe and effective for treating PAS and CoA in infants and small pediatric patients. Luminal patency was preserved, and planned reinterventions for somatic growth seem well-tolerated in early follow-up.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05086016.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015618"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of Milestones to Guide Discharge After Elective PCI is Safe and Significantly Reduces Length of Stay. 使用里程碑来指导选择性PCI术后出院是安全的,并显著缩短住院时间。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-10-24 DOI: 10.1161/CIRCINTERVENTIONS.125.015403
Johanna Ben-Ami Lerner, B Patrick Crane, Dara Colasurdo, Loretta Gioiella, Louai Razzouk, Kristin A Tuozzo, Irina Inoyatova, Margaret Accardo, Michael Querijero, Jasmine Bar, Morgan Murtha, Kevin Kirchen, Michael Attubato, Sunil V Rao
{"title":"Use of Milestones to Guide Discharge After Elective PCI is Safe and Significantly Reduces Length of Stay.","authors":"Johanna Ben-Ami Lerner, B Patrick Crane, Dara Colasurdo, Loretta Gioiella, Louai Razzouk, Kristin A Tuozzo, Irina Inoyatova, Margaret Accardo, Michael Querijero, Jasmine Bar, Morgan Murtha, Kevin Kirchen, Michael Attubato, Sunil V Rao","doi":"10.1161/CIRCINTERVENTIONS.125.015403","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015403","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015403"},"PeriodicalIF":7.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patterns of Restenosis After Left Main Bifurcation Single- or Dual-Stenting: An EBC MAIN Trial Subanalysis. 左主干分叉单支架术或双支架术后再狭窄的模式:一项EBC主要试验亚分析。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-01 Epub Date: 2025-09-17 DOI: 10.1161/CIRCINTERVENTIONS.125.015546
Annette Maznyczka, Sandeep Arunothayaraj, Adrian P Banning, Thomas Schmitz, Adrian Wlodarczak, Marc Silvestri, Mohaned Egred, René Koning, Mark S Spence, Marie-Claude Morice, Thierry Lefevre, Miroslaw Ferenc, James Cockburn, Andrejs Erglis, Philippe Brunel, Francesco Burzotta, Evgeny Kretov, Thomas Hovasse, Manuel Pan, Gerald Clesham, Alaide Chieffo, Darren Mylotte, Mitchell Lindsay, Evald H Christiansen, Frédéric Bouisset, Beatriz Vaquerizo, Jens Flensted Lassen, Olivier Darremont, Yves Louvard, Goran Stankovic, David Hildick-Smith

Background: In the randomized EBC MAIN trial (European Bifurcation Club Left Main Coronary Stent), target lesion revascularization at 3 years poststenting of left main (LM) bifurcations was more frequent with upfront dual-stenting compared with the stepwise provisional approach. Restenosis location and its relation to stent technique are poorly characterized. The aim of this study was to investigate restenosis location after LM bifurcation stenting, and the impact of stent implantation technique.

Methods: Patients from the EBC MAIN trial who underwent target lesion revascularization during the 3-year follow-up had restenosis location assessed by the core laboratory. Restenosis was defined as ≥50% lesion diameter stenosis.

Results: Among 48 patients with target lesion revascularization (mean age 70.3±10.6 years, 72.9% men), 31 were randomized to and treated with upfront dual-stenting, while 17 were randomized to the stepwise provisional technique, of whom 4 had dual-stent implantation. The treatment groups therefore comprised 35 dual-stented and 13 single-stented patients. The commonest pattern of subsequent restenosis was isolated ostial circumflex restenosis (58% of patients), regardless of dual- or single-stent implantation. The ostial circumflex was the culprit lesion for target lesion revascularization in 34 (71%) patients overall (dual- versus single-stented patients: 77% versus 54%; P=0.115). During the 3-year follow-up, the mean % diameter stenosis at the circumflex ostium was similar after dual- versus single-stent implantation (64.6% versus 60.5%, coefficient, -0.12 [95% CI, -0.46 to 0.22]; P=0.473). Single stenting from LM to the circumflex artery was associated with worse subsequent mean % diameter stenosis in the ostium of the left anterior descending artery versus single stenting from LM- left anterior descending (49.8% versus 19.8%, coefficient, 0.57 [95% CI, 0.003-1.13]; P=0.049).

Conclusions: The circumflex ostium is the commonest site requiring revascularization after LM bifurcation stenting, irrespective of whether 1 or 2 stents were deployed. Strategies are needed to improve the long-term success of percutaneous coronary intervention to the circumflex artery ostium.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02497014.

背景:在随机的EBC MAIN试验(欧洲分支俱乐部左主干冠状动脉支架)中,与分步临时入路相比,前置双支架植入术在左主干(LM)分支植入术后3年的靶病变重建术更为频繁。再狭窄的位置及其与支架技术的关系尚不清楚。本研究的目的是探讨LM分叉支架植入术后再狭窄的位置,以及支架植入术的影响。方法:来自EBC MAIN试验的患者在3年随访期间接受了靶病变血运重建术,并由核心实验室评估再狭窄位置。再狭窄定义为病变直径≥50%的狭窄。结果:48例靶病变血运重建术患者(平均年龄70.3±10.6岁,男性72.9%)中,31例随机接受前期双支架治疗,17例随机接受逐步暂置技术治疗,其中4例行双支架植入术。因此,治疗组包括35例双支架患者和13例单支架患者。随后最常见的再狭窄模式是孤立性口旋再狭窄(58%的患者),无论双支架植入还是单支架植入。在34例(71%)患者中(双支架vs单支架患者:77% vs 54%; P=0.115),口旋是靶病变血运重建的罪魁祸首。在3年随访期间,双支架与单支架植入后,旋口狭窄的平均直径百分比相似(64.6% vs 60.5%,系数为-0.12 [95% CI, -0.46 ~ 0.22]; P=0.473)。与LM-左前降支单支架术相比,LM-左前降支单支架术术后左前降支口平均%直径狭窄更严重(49.8%对19.8%,系数0.57 [95% CI, 0.003-1.13]; P=0.049)。结论:无论放置1个或2个支架,旋口是LM分叉支架置入后最常见的需要血运重建的部位。需要一些策略来提高经皮冠状动脉绕道口介入治疗的长期成功率。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT02497014。
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引用次数: 0
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Circulation: Cardiovascular Interventions
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