JACC. Cardiovascular interventions最新文献

Background: Evidence regarding the incidence of prosthesis-patient mismatch (PPM) and long-term mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is scarce.

Objectives: This study sought to assess the incidence and prognostic impact of PPM after TAVR for bicuspid AS compared with that for tricuspid AS.

Methods: In total, 7,393 patients who underwent TAVR were prospectively enrolled in the OCEAN-TAVI (Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation) registry, an ongoing Japanese, multicenter registry. We analyzed 7,051 patients (median age = 85 years, 68.4% women) and identified 503 (7.1%) with bicuspid AS. We compared the incidence of PPM and long-term mortality in 497 patients with and 497 without bicuspid AS after one-to-one propensity score matching analysis.

Results: Among the 7,051 patients, moderate and severe PPM were observed in 756 (10.7%) and 92 (1.3%) patients, respectively. Upon Kaplan-Meier curve analysis of the overall cohort, severe PPM appeared to be associated with long-term mortality (log-rank test, P = 0.065). After propensity score matching analysis, moderate and severe PPM were more frequently observed among patients with tricuspid AS than patients with bicuspid AS (moderate PPM, 11.7% vs 4.4%; severe PPM, 1.4% vs 1.0%; P = 0.0001).

Conclusions: Severe PPM appeared to be associated with all-cause mortality. Moderate and severe PPM were more frequently observed in patients with tricuspid AS than patients with bicuspid AS.

Background: Several randomized clinical trials have shown that the composite endpoint of death, stroke, and myocardial infarction (MI) is equivalent between carotid artery stenting and carotid endarterectomy. However, the risk of minor stroke has been consistently higher with carotid artery stenting.

Objectives: The authors sought to evaluate the safety and effectiveness of a novel carotid stent system comprised of a stent, an adjustable integrated embolic filter and a postdilation balloon, in patients at elevated risk for adverse events from carotid endarterectomy.

Methods: PERFORMANCE II (Protection against Emboli during caRotid artery stenting using a 3-in-1 delivery system comprised oF a pOst-dilation balloon, integRated eMbolic filter, and A Novel Carotid stEnt II) was a prospective, multicenter, single-arm study. The primary endpoint was the composite of major adverse events defined as death, all stroke, and MI within 30 days of the procedure, plus ipsilateral stroke through 12 months.

Results: 305 patients were enrolled at 32 centers in the United States and Europe. The mean age was 69.6 ± 7.5 years; 65.9% were male, and 20% were symptomatic. The mean lesion length was 19.1 ± 6.7 mm, and 34.5% of lesions were severely calcified. At 30 days, there were 4 minor strokes (1.3%), with no major strokes. There was 1 cardiac death on day 30, resulting in a stroke/death rate of 1.6% and a stroke/death/MI rate of 2.3%. The 12-month primary endpoint occurred in 2.8%; there were no major strokes, clinically driven target lesion revascularizations, stent thromboses, or neurological deaths. The 30-day all stroke plus ipsilateral stroke through 12 months rate was 1.8%.

Conclusions: The rate of major adverse events was extremely low, demonstrating the study system is a safe, effective, and durable treatment option for high-risk patients. (Protection against Emboli during caRotid artery stenting using a 3-in-1 delivery system comprised oF a pOst-dilation balloon, integRated eMbolic filter, and A Novel Carotid stEnt II [PERFORMANCE II]; NCT04201132).

Background: Recent data support both surgical-first and endovascular-first revascularization approaches for chronic limb-threatening ischemia (CLTI), but hospital-based practices are poorly described.

Objectives: This aim of this study was to characterize contemporary variations and outcomes associated with each strategy among U.S. hospitals providing both approaches.

Methods: Medicare beneficiaries ≥66 years of age with CLTI treated at institutions offering both strategies between October 1, 2015 to December 31, 2021 were analyzed. A marginal Cox regression approach was used, and models were adjusted for patient-level covariates.

Results: Among 196,070 patients at 1,832 institutions, 82.5% underwent endovascular treatment. Patients undergoing endovascular revascularization were older and had a higher comorbidity burden. The adjusted median OR for receiving an endovascular procedure was 2.32 among hospitals (Q1-Q3: 2.24-2.40; P < 0.01), demonstrating high variability in intervention use. Patients undergoing endovascular revascularization at the highest quintile hospitals had a lower rate of major amputation (adjusted HR [aHR]: 0.82; 95% CI: 0.77-0.88; P < 0.01) and a higher rate of repeat procedures (aHR: 1.37; 95% CI: 1.32-1.43; P < 0.01). Patients undergoing surgical bypass at the highest quintile hospitals had a higher rate of major amputation (aHR: 1.21; 95% CI: 1.13-1.29; P < 0.01) and a lower rate of repeat procedures (aHR: 0.73; 95% CI: 0.70-0.76; P < 0.01).

Conclusions: This study showed large interhospital variability in revascularization strategies, as well as improved outcomes for patients receiving endovascular treatment at higher volume sites. Further work is needed to standardize treatments with the goal of improving limb salvage rates.