Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.09.003
Ignacio J. Amat-Santos MD, PhD , Mario García-Gómez MD , Pablo Avanzas MD, PhD , Víctor Jiménez-Diaz MD , Juan H. Alonso-Briales MD , José M. de la Torre Hernández MD , Jorge Sanz-Sánchez MD , José Antonio Diarte-de Miguel MD , Ángel Sánchez-Recalde MD , Luis Nombela-Franco MD, PhD , Jesús Jiménez-Mazuecos MD , Vicenç Serra MD , Juan Manuel Nogales-Asensio MD , Sergio García-Blas MD , Antonio Gómez-Menchero MD , Raquel del Valle MD, PhD , Carolina Mayor Déniz MD , Walid Al Houssaini MD , Gabriela Veiga-Fernández MD, PhD , José Luis Diez-Gil MD , J. Alberto San Román MD, PhD
Background
Severe aortic stenosis (AS) coexists with coronary artery disease (CAD) in approximately 50% of patients. The preferred treatment is combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). However, transcatheter aortic valve replacement (TAVR) along with percutaneous coronary intervention (PCI) has emerged as a viable alternative.
Objectives
This study sought to compare the outcomes of PCI + TAVR vs CABG + SAVR.
Methods
This national multicenter retrospective study in Spain involved patients with severe AS and CAD treated between 2018 and 2021. Patients underwent either PCI + TAVR or CABG + SAVR and were compared. The primary endpoint was all-cause mortality and stroke at 1 year. Propensity score analysis was performed to mitigate baseline differences.
Results
Of the 1,342 included patients, 625 (46.6%) underwent PCI + TAVR, and 713 (53.1%) underwent CABG + SAVR. Patients in the percutaneous arm were older (age 81.6 ± 5.8 years vs 72.1 ± 7 years; P < 0.001), had a higher prevalence of chronic kidney disease (40.6% vs 14.9%; P < 0.001), and had higher Society of Thoracic Surgeons risk scores (4.3% [interquartile range (Q1-Q3): 2.8-6.4] vs 2.2% [Q1-Q3: 1.4-3.3]; P < 0.001). Technical success rates were 96% for PCI + TAVR and 98.4% for CABG + SAVR (P = 0.008), with similar periprocedural mortality (0.8% vs 0.7%; P = 0.999). However, the mortality + stroke rate at 30 days was higher in the CABG + SAVR group compared with PCI + TAVR, both in the unmatched (12.2% vs 4.7%; P = 0.005) and matched cohorts (8.8% vs 4.5%; P = 0.002), persisting at the 1-year follow-up.
Conclusions
Despite a lower baseline risk, CABG + SAVR in patients with severe AS and CAD was associated with a higher rate of death and stroke compared with PCI + TAVR, highlighting the necessity for a large, randomized analysis.
{"title":"Surgical vs Transcatheter Treatment in Patients With Coronary Artery Disease and Severe Aortic Stenosis","authors":"Ignacio J. Amat-Santos MD, PhD , Mario García-Gómez MD , Pablo Avanzas MD, PhD , Víctor Jiménez-Diaz MD , Juan H. Alonso-Briales MD , José M. de la Torre Hernández MD , Jorge Sanz-Sánchez MD , José Antonio Diarte-de Miguel MD , Ángel Sánchez-Recalde MD , Luis Nombela-Franco MD, PhD , Jesús Jiménez-Mazuecos MD , Vicenç Serra MD , Juan Manuel Nogales-Asensio MD , Sergio García-Blas MD , Antonio Gómez-Menchero MD , Raquel del Valle MD, PhD , Carolina Mayor Déniz MD , Walid Al Houssaini MD , Gabriela Veiga-Fernández MD, PhD , José Luis Diez-Gil MD , J. Alberto San Román MD, PhD","doi":"10.1016/j.jcin.2024.09.003","DOIUrl":"10.1016/j.jcin.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Severe aortic stenosis (AS) coexists with coronary artery disease (CAD) in approximately 50% of patients. The preferred treatment is combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). However, transcatheter aortic valve replacement (TAVR) along with percutaneous coronary intervention (PCI) has emerged as a viable alternative.</div></div><div><h3>Objectives</h3><div>This study sought to compare the outcomes of PCI + TAVR vs CABG + SAVR.</div></div><div><h3>Methods</h3><div>This national multicenter retrospective study in Spain involved patients with severe AS and CAD treated between 2018 and 2021. Patients underwent either PCI + TAVR or CABG + SAVR and were compared. The primary endpoint was all-cause mortality and stroke at 1 year. Propensity score analysis was performed to mitigate baseline differences.</div></div><div><h3>Results</h3><div>Of the 1,342 included patients, 625 (46.6%) underwent PCI + TAVR, and 713 (53.1%) underwent CABG + SAVR. Patients in the percutaneous arm were older (age 81.6 ± 5.8 years vs 72.1 ± 7 years; <em>P</em> < 0.001), had a higher prevalence of chronic kidney disease (40.6% vs 14.9%; <em>P</em> < 0.001), and had higher Society of Thoracic Surgeons risk scores (4.3% [interquartile range (Q1-Q3): 2.8-6.4] vs 2.2% [Q1-Q3: 1.4-3.3]; <em>P</em> < 0.001). Technical success rates were 96% for PCI + TAVR and 98.4% for CABG + SAVR (<em>P =</em> 0.008), with similar periprocedural mortality (0.8% vs 0.7%; <em>P</em> = 0.999). However, the mortality + stroke rate at 30 days was higher in the CABG + SAVR group compared with PCI + TAVR, both in the unmatched (12.2% vs 4.7%; <em>P</em> = 0.005) and matched cohorts (8.8% vs 4.5%; <em>P</em> = 0.002), persisting at the 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>Despite a lower baseline risk, CABG + SAVR in patients with severe AS and CAD was associated with a higher rate of death and stroke compared with PCI + TAVR, highlighting the necessity for a large, randomized analysis.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2472-2485"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620884","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}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.08.004
Gagan D. Singh MD , Matthew J. Price MD , Mony Shuvy MD , Jason H. Rogers MD , Carmelo Grasso MD , Francesco Bedogni MD , Federico Asch MD , José L. Zamorano MD , Melody Dong PhD , Kelli Peterman MPH , Evelio Rodriguez MD , Saibal Kar MD , Ralph Stephan von Bardeleben MD , Francesco Maisano MD
Background
Reducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown.
Objectives
This study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER.
Methods
EXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg.
Results
A total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG.
Conclusions
Reduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG.
{"title":"Combined Impact of Residual Mitral Regurgitation and Gradient After Mitral Valve Transcatheter Edge-to-Edge Repair","authors":"Gagan D. Singh MD , Matthew J. Price MD , Mony Shuvy MD , Jason H. Rogers MD , Carmelo Grasso MD , Francesco Bedogni MD , Federico Asch MD , José L. Zamorano MD , Melody Dong PhD , Kelli Peterman MPH , Evelio Rodriguez MD , Saibal Kar MD , Ralph Stephan von Bardeleben MD , Francesco Maisano MD","doi":"10.1016/j.jcin.2024.08.004","DOIUrl":"10.1016/j.jcin.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Reducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER.</div></div><div><h3>Methods</h3><div>EXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg.</div></div><div><h3>Results</h3><div>A total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG.</div></div><div><h3>Conclusions</h3><div>Reduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2530-2540"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.08.039
Steven J. Yakubov MD, Carlos Sanchez MD
{"title":"It Is Time to Tighten the Screws!","authors":"Steven J. Yakubov MD, Carlos Sanchez MD","doi":"10.1016/j.jcin.2024.08.039","DOIUrl":"10.1016/j.jcin.2024.08.039","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2541-2542"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500661","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}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.08.032
Tanush Gupta MD , S. Chris Malaisrie MD , Wayne Batchelor MD , Konstantinos Dean Boudoulas MD , Laura Davidson MD , Uzoma N. Ibebuogu MD , Jacques Kpodonu MD , Ramesh Singh MD , Ibrahim Sultan MD , Misty Theriot BSN , Michael J. Reardon MD , Martin B. Leon MD , Kendra J. Grubb MD, MHA , A Perspective From the American College of Cardiology Cardiac Surgery Team and Interventional Cardiology Councils
Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice. The American College of Cardiology’s Cardiac Surgery Team Section Leadership and Interventional Cardiology Councils, a multidisciplinary collaboration of cardiologists and cardiac surgeons, sought to summarize the relevant data into a decision-making tool for heart valve teams. A literature review was completed, and guidelines, randomized controlled trials, and large observational studies were summarized into a pragmatic decision-making approach to treating young and low-risk patients with AS.
{"title":"Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis","authors":"Tanush Gupta MD , S. Chris Malaisrie MD , Wayne Batchelor MD , Konstantinos Dean Boudoulas MD , Laura Davidson MD , Uzoma N. Ibebuogu MD , Jacques Kpodonu MD , Ramesh Singh MD , Ibrahim Sultan MD , Misty Theriot BSN , Michael J. Reardon MD , Martin B. Leon MD , Kendra J. Grubb MD, MHA , A Perspective From the American College of Cardiology Cardiac Surgery Team and Interventional Cardiology Councils","doi":"10.1016/j.jcin.2024.08.032","DOIUrl":"10.1016/j.jcin.2024.08.032","url":null,"abstract":"<div><div>Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice. The American College of Cardiology’s Cardiac Surgery Team Section Leadership and Interventional Cardiology Councils, a multidisciplinary collaboration of cardiologists and cardiac surgeons, sought to summarize the relevant data into a decision-making tool for heart valve teams. A literature review was completed, and guidelines, randomized controlled trials, and large observational studies were summarized into a pragmatic decision-making approach to treating young and low-risk patients with AS.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2455-2471"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620862","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}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.08.046
Annette Maznyczka MD, PhD, MSc , Bernard Prendergast MD , Marc Dweck MD, PhD , Stephan Windecker MD , Philippe Généreux MD , David Hildick-Smith MD , Jeroen Bax MD, PhD , Thomas Pilgrim MD, MSc
Aortic stenosis (AS) affects about 12% of people aged ≥75 years. Accumulating evidence on the prognostic importance of cardiac damage in patients with asymptomatic and less than severe AS supports the proposition of advancing aortic valve replacement (AVR) to earlier disease stages. Potential benefits of earlier treatment, including prevention of cardiac damage progression and reduced cardiovascular hospitalizations, need to be balanced against the earlier procedural risk and subsequent lifetime management after AVR. Two small, randomized trials indicate that early surgical AVR may improve survival in patients with asymptomatic severe AS, and observational data suggest that AVR may reduce mortality even in patients with moderate AS. A clear understanding of the pathophysiology of cardiac damage secondary to AS is needed to develop strategies to select patients for earlier AVR. Noninvasive imaging can detect early cardiac damage, and indices such as fibrosis, global longitudinal strain, and myocardial work index have potential use to guide stratification of patients for earlier AVR. Ongoing randomized trials are investigating the safety and efficacy of AVR for patients with asymptomatic severe AS and those with moderate AS who have symptoms/evidence of cardiac damage. Pathophysiological considerations and accumulating evidence from clinical studies that support earlier timing of AVR for AS will need to be corroborated by the results of these trials. This review aims to evaluate the evidence for earlier AVR, discuss strategies to guide stratification of patients who may benefit from this approach, highlight the relevant ongoing randomized trials, and consider the consequences of earlier intervention.
在年龄≥75 岁的人群中，约有 12% 的人患有主动脉瓣狭窄（AS）。越来越多的证据表明，无症状和不太严重的主动脉瓣狭窄患者的心脏损伤对预后非常重要，这支持了将主动脉瓣置换术（AVR）提前到疾病早期阶段的主张。早期治疗的潜在益处（包括预防心脏损伤进展和减少心血管疾病住院治疗）需要与早期手术风险和主动脉瓣置换术后的终生管理相平衡。两项小型随机试验表明，早期手术自动脉翻转术可提高无症状重度 AS 患者的生存率，而观察数据表明，即使是中度 AS 患者，自动脉翻转术也可降低死亡率。需要清楚了解继发于 AS 的心脏损伤的病理生理学，以制定选择患者进行早期 AVR 的策略。无创成像可检测早期心脏损伤，纤维化、整体纵向应变和心肌功指数等指标可用于指导对患者进行分层，以便尽早进行房室重建。目前正在进行的随机试验正在研究对无症状的重度 AS 患者和有心脏损伤症状/证据的中度 AS 患者进行 AVR 的安全性和有效性。病理生理学方面的考虑因素和临床研究积累的证据支持尽早对强直性脊柱炎患者进行体外反搏术，但还需要这些试验结果的证实。本综述旨在评估早期房室重建的证据，讨论指导对可能从这种方法中获益的患者进行分层的策略，强调正在进行的相关随机试验，并考虑早期干预的后果。
{"title":"Timing of Aortic Valve Intervention in the Management of Aortic Stenosis","authors":"Annette Maznyczka MD, PhD, MSc , Bernard Prendergast MD , Marc Dweck MD, PhD , Stephan Windecker MD , Philippe Généreux MD , David Hildick-Smith MD , Jeroen Bax MD, PhD , Thomas Pilgrim MD, MSc","doi":"10.1016/j.jcin.2024.08.046","DOIUrl":"10.1016/j.jcin.2024.08.046","url":null,"abstract":"<div><div>Aortic stenosis (AS) affects about 12% of people aged ≥75 years. Accumulating evidence on the prognostic importance of cardiac damage in patients with asymptomatic and less than severe AS supports the proposition of advancing aortic valve replacement (AVR) to earlier disease stages. Potential benefits of earlier treatment, including prevention of cardiac damage progression and reduced cardiovascular hospitalizations, need to be balanced against the earlier procedural risk and subsequent lifetime management after AVR. Two small, randomized trials indicate that early surgical AVR may improve survival in patients with asymptomatic severe AS, and observational data suggest that AVR may reduce mortality even in patients with moderate AS. A clear understanding of the pathophysiology of cardiac damage secondary to AS is needed to develop strategies to select patients for earlier AVR. Noninvasive imaging can detect early cardiac damage, and indices such as fibrosis, global longitudinal strain, and myocardial work index have potential use to guide stratification of patients for earlier AVR. Ongoing randomized trials are investigating the safety and efficacy of AVR for patients with asymptomatic severe AS and those with moderate AS who have symptoms/evidence of cardiac damage. Pathophysiological considerations and accumulating evidence from clinical studies that support earlier timing of AVR for AS will need to be corroborated by the results of these trials. This review aims to evaluate the evidence for earlier AVR, discuss strategies to guide stratification of patients who may benefit from this approach, highlight the relevant ongoing randomized trials, and consider the consequences of earlier intervention.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2502-2514"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.08.048
David A. McNamara MD, MPH , Jeremy Albright PhD , Devraj Sukul MD , Stanley Chetcuti MD , Annemarie Forrest MS, MPH , Paul Grossman MD , Raed M. Alnajjar MD , Himanshu Patel MD , Hitinder S. Gurm MBBS , Ryan D. Madder MD
Background
Little is known about institutional radiation doses during transcatheter valve interventions.
Objectives
The authors sought to evaluate institutional variability in radiation doses during transcatheter valve interventions.
Methods
Using a large statewide registry, transcatheter edge-to-edge mitral valve repair, transcatheter mitral valve replacement, and transcatheter aortic valve replacement procedures between January 1, 2020, and December 31, 2022, with an air kerma (AK) recorded were analyzed. Patient and procedural characteristics were compared between cases with AK ≥2 and <2 Gy. Associations of variables with AK ≥2 Gy were investigated using Bayesian random effects modeling and median ORs for the performing hospital.
Results
Among 9,446 procedures across 30 hospitals, median (Q1-Q3) procedural AK was 0.592 Gy (0.348-0.989 Gy) with AK ≥2 Gy in 533 cases (5.6%). Wide variation in procedural AK was observed, with an institutional frequency of AK ≥2 Gy ranging from 0.0% to 29.5%. Bayesian modeling identified the performing hospital as more strongly associated with the odds of a procedural AK ≥2 Gy than any patient or procedural factors (hospital median OR: 3.54 [95% credible interval: 2.52-16.66]).
Conclusions
In a large, multicenter state-wide registry, there is wide institutional variability in patient-level radiation doses during transcatheter valve interventions, with the performing hospital having a higher odds of an AK ≥2 Gy than any patient or procedural factors. Future interventions are warranted to reduce procedural-related variation in radiation exposure.
{"title":"Institutional Variation in Patient Radiation Doses During Transcatheter Valve Interventions","authors":"David A. McNamara MD, MPH , Jeremy Albright PhD , Devraj Sukul MD , Stanley Chetcuti MD , Annemarie Forrest MS, MPH , Paul Grossman MD , Raed M. Alnajjar MD , Himanshu Patel MD , Hitinder S. Gurm MBBS , Ryan D. Madder MD","doi":"10.1016/j.jcin.2024.08.048","DOIUrl":"10.1016/j.jcin.2024.08.048","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about institutional radiation doses during transcatheter valve interventions.</div></div><div><h3>Objectives</h3><div>The authors sought to evaluate institutional variability in radiation doses during transcatheter valve interventions.</div></div><div><h3>Methods</h3><div>Using a large statewide registry, transcatheter edge-to-edge mitral valve repair, transcatheter mitral valve replacement, and transcatheter aortic valve replacement procedures between January 1, 2020, and December 31, 2022, with an air kerma (AK) recorded were analyzed. Patient and procedural characteristics were compared between cases with AK ≥2 and <2 Gy. Associations of variables with AK ≥2 Gy were investigated using Bayesian random effects modeling and median ORs for the performing hospital.</div></div><div><h3>Results</h3><div>Among 9,446 procedures across 30 hospitals, median (Q1-Q3) procedural AK was 0.592 Gy (0.348-0.989 Gy) with AK ≥2 Gy in 533 cases (5.6%). Wide variation in procedural AK was observed, with an institutional frequency of AK ≥2 Gy ranging from 0.0% to 29.5%. Bayesian modeling identified the performing hospital as more strongly associated with the odds of a procedural AK ≥2 Gy than any patient or procedural factors (hospital median OR: 3.54 [95% credible interval: 2.52-16.66]).</div></div><div><h3>Conclusions</h3><div>In a large, multicenter state-wide registry, there is wide institutional variability in patient-level radiation doses during transcatheter valve interventions, with the performing hospital having a higher odds of an AK ≥2 Gy than any patient or procedural factors. Future interventions are warranted to reduce procedural-related variation in radiation exposure.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 21","pages":"Pages 2488-2498"},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500659","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号