JACC. Cardiovascular interventions最新文献

英文中文

Characteristics, Trends, and Outcomes of Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Replacement in United States 美国血管内碎石辅助经股动脉经导管主动脉瓣置换术的特点、趋势和结果

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.08.033

Background

Transfemoral (TF) access is the preferred approach for transcatheter aortic valve replacement (TAVR). Limited data exist regarding the outcomes of intravascular lithotripsy (IVL)-assisted TF TAVR in patients with peripheral artery disease.

Objectives

This study sought to examine contemporary characteristics, trends, and outcomes of IVL TAVR in the United States.

Methods

The Vizient Clinical Database was queried for patients who underwent percutaneous TAVR between October 1, 2020, and November 30, 2023. Outcomes with IVL TAVR vs non–IVL TAVR were examined after propensity score matching. The primary outcome was a composite of in-hospital death, stroke, vascular complications, surgical vascular intervention, and major bleeding.

Results

Over the study period, 129,655 patients (mean age of 78.4 years, 42.2% women, 87.1% White) underwent percutaneous TAVR at 361 hospitals, 1,242 (0.96%) of whom underwent IVL TAVR. There was an uptrend in IVL TAVR, but the frequency remained low. IVL TAVR patients had a higher median Elixhauser comorbidity score (5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 3-6]) compared to non–IVL TAVR. TAVR was completed via the TF approach in 1,238 (99.7%) IVL TAVR patients. In a 3:1 propensity score matching analysis, IVL TAVR was associated with a higher rate of the primary composite outcome (21.9% vs 13.7%; P < 0.001) driven by higher rates of vascular complications, surgical vascular intervention, and major bleeding. In-hospital death and stroke were similar in both groups.

Conclusions

In the United States, IVL is increasingly adopted to facilitate TF TAVR. IVL TAVR patients exhibited a higher burden of comorbidities and experienced more complications compared to non–IVL TAVR patients. Further studies are needed to identify appropriate anatomical and clinical use criteria for IVL TAVR and to compare its outcomes vs alternative non–TF TAVR.

背景经股动脉（TF）入路是经导管主动脉瓣置换术（TAVR）的首选入路。有关外周动脉疾病患者在血管内碎石术（IVL）辅助下进行经皮主动脉瓣置换术（TAVR）的结果数据有限。本研究旨在研究美国 IVL TAVR 的当代特征、趋势和结果。经过倾向得分匹配后，对 IVL TAVR 与非 IVL TAVR 的结果进行了研究。主要结果是院内死亡、中风、血管并发症、外科血管介入治疗和大出血的综合结果。结果在研究期间，361家医院的129655名患者（平均年龄78.4岁，42.2%为女性，87.1%为白人）接受了经皮TAVR，其中1242人（0.96%）接受了IVL TAVR。IVL TAVR呈上升趋势，但频率仍然很低。与非 IVL TAVR 相比，IVL TAVR 患者的中位 Elixhauser 合并症评分更高（5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 3-6]）。1238例（99.7%）IVL TAVR患者通过TF方法完成了TAVR。在3:1倾向得分匹配分析中，IVL TAVR与较高的主要复合结局发生率相关（21.9% vs 13.7%; P <0.001），原因是血管并发症、外科血管干预和大出血发生率较高。结论在美国，IVL越来越多地被用于TF TAVR。与非IVL TAVR患者相比，IVL TAVR患者的合并症负担更高，并发症也更多。还需要进一步研究，以确定 IVL TAVR 的适当解剖和临床使用标准，并将其结果与其他非 TTF TAVR 进行比较。

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Chronic Spontaneous Coronary Artery Dissection 慢性自发性冠状动脉夹层

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.008

引用次数: 0

Full Issue PDF 全期 PDF

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/S1936-8798(24)01402-X

引用次数: 0

Stay Calm and Carry On With Intravascular Lithotripsy–Assisted Transfemoral-TAVR in Patients With Calcific-Iliofemoral Artery Disease? 钙化性股动脉疾病患者在血管内碎石辅助经股动脉-TAVR术中保持冷静并继续治疗？

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.049

引用次数: 0

Salvage Pulmonary Artery Thrombectomy for High-Risk Pulmonary Embolism Patients Requiring Venoarterial Extracorporeal Membrane Oxygenation Support 为需要静脉体外膜氧合支持的高风险肺栓塞患者实施肺动脉血栓抢救性切除术

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.08.017

引用次数: 0

The Promise and Challenges of Pressure-Guided Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension 压力引导下球囊肺血管成形术治疗慢性血栓栓塞性肺动脉高压的前景与挑战

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.013

引用次数: 0

Impact of Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR 髂股动脉粥样硬化的严重程度和范围对接受 TAVR 患者临床结果的影响

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.07.009

Background

Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease.

Objectives

The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR.

Methods

In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non–puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis.

Results

Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non–puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non–puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non–puncture site vascular complications were 0.554 and 0.829, respectively.

Conclusions

The Hostile score proved useful in predicting non–puncture site vascular complications after TAVR. (SwissTAVI Registry; NCT01368250).

背景：血管并发症仍是经口经导管主动脉瓣置换术（TAVR）的主要问题。Hostile评分已被提出用于对患有外周动脉疾病的TAVR患者进行风险分层：作者旨在评估 Hostile 评分在预测 TAVR 术后髂股血管并发症方面的有效性：在一项前瞻性 TAVR 登记中，我们验证了 Hostile 评分预测穿刺和非穿刺部位血管并发症的有效性。该评分系统综合了髂股动脉粥样硬化的程度（病变数量、病变长度和最小管腔直径）和复杂性（迂曲、钙化和是否存在阻塞）：2014年3月至2022年6月期间，2023名患者使用当代设备接受了经股动脉TAVR，其中106名（5.2%）患者出现了穿刺部位血管并发症，28名（1.4%）患者出现了非穿刺部位血管并发症。血管并发症患者的 "敌对 "评分高于无并发症患者（1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001）。与 ProGlide 相比，体重指数越高（OR：1.23；95% CI：1.04-1.50），使用 Prostar（OR：6.03；95% CI：2.23-16.30）或 MANTA（OR：6.18；95% CI：2.67-14.与 ProGlide 相比，Prostar（OR：6.03；95% CI：2.23-16.30）或 MANTA（OR：6.18；95% CI：2.67-14.27）是穿刺部位血管并发症的独立预测因素，而较高的 Hostile 评分（OR：1.91；95% CI：1.55-2.35）和女性性别（OR：2.69；95% CI：1.12-6.42）是非穿刺部位血管并发症的独立预测因素。预测穿刺部位和非穿刺部位血管并发症的接受者操作特征曲线下面积分别为 0.554 和 0.829：结论：Hostile评分有助于预测TAVR术后非穿刺部位血管并发症。(瑞士TAVI注册；NCT01368250）。

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引用次数: 0

Trends, Predictors, and Outcomes of Bleeding Complications After Mitral Transcatheter Edge-to-Edge Repair 二尖瓣经导管边缘到边缘修复术后出血并发症的趋势、预测因素和结果

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.035

Background

Bleeding events after arterial transcatheter procedures are associated with increased morbidity and mortality. The frequency and clinical implications of bleeding after mitral transcatheter edge-to-edge repair (M-TEER) have not been well-studied.

Objectives

The authors sought to explore the association of in-hospital bleeding events after M-TEER with patient outcomes.

Methods

Patients undergoing M-TEER who were included in the TVT (Transcatheter Valve Therapy) Registry between 2013 and 2022 were included. Rates of the primary endpoint, the composite of death or hospital readmission at 30 days, were compared between patients who experienced in-hospital major or life-threatening bleeding vs those without bleeding. Secondary analyses examined the association between in-hospital bleeding and death or readmission at 1 year, as well as independent predictors of major in-hospital bleeding.

Results

Over the study period, in-hospital major bleeding occurred in 1,205 (2.3%) of 51,533 patients. Rates of bleeding decreased over time (from 7.1% in 2013 to 2.0% in 2021; P < 0.001). In-hospital bleeding was associated with increased rates of death or readmission at both 30 days (adjusted OR: 2.15 [95% CI: 1.81-2.54]; P < 0.0001) and 1 year (adjusted HR: 1.43 [95% CI: 1.27-1.60]; P < 0.0001). The strongest correlates of in-hospital bleeding included female sex, prior percutaneous coronary intervention, baseline hemoglobin, greater procedure acuity, and longer procedure duration.

Conclusions

Bleeding after M-TEER is associated with increased risk of subsequent death and hospital readmission. Although reductions in bleeding complications over time are encouraging, continued efforts are needed to further mitigate hemorrhagic complications of M-TEER.

背景动脉经导管手术后出血事件与发病率和死亡率增加有关。作者试图探讨二尖瓣经导管边缘到边缘修补术（M-TEER）后院内出血事件与患者预后的关系。方法纳入2013年至2022年期间TVT（经导管瓣膜治疗）注册中接受M-TEER的患者。比较了发生院内大出血或危及生命出血的患者与未发生出血的患者的主要终点（30 天内死亡或再次入院的复合终点）发生率。次要分析研究了院内出血与死亡或 1 年后再入院之间的关系，以及院内大出血的独立预测因素。结果在研究期间，51,533 名患者中有 1,205 人（2.3%）发生了院内大出血。随着时间的推移，出血率有所下降（从2013年的7.1%降至2021年的2.0%；P< 0.001）。院内出血与30天（调整后OR：2.15 [95% CI：1.81-2.54]；P <；0.0001）和1年（调整后HR：1.43 [95% CI：1.27-1.60]；P <；0.0001）的死亡或再入院率增加有关。结论 M-TEER术后出血与后续死亡和再入院风险增加有关。尽管随着时间的推移出血并发症的减少令人鼓舞，但仍需继续努力进一步减轻 M-TEER 的出血并发症。

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引用次数: 0

Bleeding After Transcatheter Structural Valve Interventions 经导管结构瓣膜介入术后出血

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.036

引用次数: 0

Toward Effective EVT for ALI 实现 ALI 的有效 EVT

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-10-28 DOI: 10.1016/j.jcin.2024.09.037

引用次数: 0

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