JACC. Cardiovascular interventions最新文献

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Pursuit of State-of-the-Art PCI With Imaging and Physiology 追求最先进的PCI成像和生理学

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-12 DOI: 10.1016/j.jcin.2025.11.006

Edward T. Ha MD , Tatsunori Takahashi MD , Yuhei Kobayashi MD

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Atherectomy Atherectomy

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-12 DOI: 10.1016/j.jcin.2025.11.018

Joshua A. Beckman MD, MS , Alexander E. Sullivan MD

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Heart Failure Guideline-Directed Medical Therapy After TAVR TAVR后心脏衰竭的药物治疗指南

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-12 DOI: 10.1016/j.jcin.2025.11.022

Marco De Carlo MD, PhD, Giulia Costa MD, PhD

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Retrograde Access via Direct Puncture of the Occluded Segment in Complex Femoropopliteal Chronic Total Occlusions 复杂股腘慢性全闭塞闭塞段逆行穿刺治疗

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-12 DOI: 10.1016/j.jcin.2025.11.005

Birte Winther MD , Andrej Schmidt MD , Sophia Wilz MD , Dierk Scheinert MD , Axel Fischer MD , Sandra Düsing MD , Sabine Steiner MD , Tim Wittig MD

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Long-Term Impact of Mild Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后轻度瓣旁反流的长期影响：OCEAN-TAVI注册。

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-12 DOI: 10.1016/j.jcin.2025.09.004

Yusuke Watanabe MD , Masanori Yamamoto MD , Hirofumi Hioki MD , Masafumi Saito MD , Jo Omiya MD , Kento Kito MD , Yosei Iseki MD , Masataka Arakawa MD , Mizuki Miura MD , Shinichi Shirai MD , Kenichi Ishizu MD , Toru Naganuma MD , Futoshi Yamanaka MD , Masahiko Noguchi MD , Yohei Ohno MD , Tetsuro Shimura MD , Fumiaki Yashima MD , Kensuke Takagi MD , Gaku Nakazawa MD , Masahiko Asami MD , Kentaro Hayashida MD

Background

The clinical significance of mild paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR) remains uncertain.

Objectives

The aim of this study was to evaluate the impact of mild PVR on long-term clinical outcomes and bioprosthetic valve failure (BVF) following TAVR.

Methods

A total of 5,068 patients from the OCEAN-TAVI (Optimized Catheter Valvular Intervention–Transcatheter Aortic Valve Implantation; UMIN000020423) registry who underwent TAVR and had no or trace or mild PVR at discharge were analyzed. Patients were stratified according to PVR severity and followed for up to 9 years. The primary outcomes were all-cause mortality and BVF, defined according to Valve Academic Research Consortium 3 criteria.

Results

Median follow-up duration was 4.7 years (Q1-Q3: 2.9-6.0 years). Mild PVR was observed in 1,601 patients (31.6%). At 9-year follow-up, Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of all-cause mortality (75.9% [95% CI: 71.3%-80.2%] vs 72.2% [95% CI: 68.1%-76.3%]; log-rank P = 0.014) and BVF (20.7% [95% CI: 12.8%-32.5%] vs 17.3% [95% CI: 11.0%-26.6%]; P = 0.029) in patients with mild PVR than in those with no or trace PVR. Fine-Gray analysis confirmed mild PVR as an independent predictor of BVF (subdistribution HR [sHR]: 1.48; 95% CI: 1.07-2.04; P = 0.018), and Cox regression showed a significant association with all-cause mortality (HR: 1.11; 95% CI: 1.02-1.21; P = 0.014). The risk for BVF was especially elevated in patients receiving balloon-expandable valves (sHR: 1.46; 95% CI: 1.02-2.08; P = 0.038), those undergoing nontransfemoral TAVR (sHR: 5.58; 95% CI: 1.57-19.9; P = 0.0086), and those with impaired renal function (estimated glomerular filtration rate < 30 mL/min/1.73 m²; sHR: 3.86; 95% CI: 1.30-11.5; P = 0.015). Baseline mild PVR was independently associated with an increased risk for progression to moderate or greater PVR (HR: 3.74; 95% CI: 2.84-4.92; P < 0.001).

Conclusions

Mild PVR after TAVR is associated with a significantly increased risk for BVF and all-cause mortality, highlighting the importance of optimizing valve deployment and monitoring patients with even mild PVR.

背景：经导管主动脉瓣置换术（TAVR）后轻度瓣旁反流（PVR）的临床意义尚不明确。目的：本研究的目的是评估轻度PVR对TAVR后长期临床结果和生物假体瓣膜衰竭（BVF）的影响。方法：对OCEAN-TAVI（优化导管瓣膜介入-经导管主动脉瓣植入术）登记（UMIN000020423）中5,068例接受TAVR且出院时无PVR或轻度PVR的患者进行分析。根据PVR严重程度对患者进行分层，随访时间长达9年。主要结局是全因死亡率和BVF，根据Valve学术研究联盟3标准定义。结果：中位随访时间为4.7年（Q1-Q3: 2.9-6.0年）。1601例（31.6%）患者出现轻度PVR。在9年的随访中，Kaplan-Meier分析显示，轻度PVR患者的累积全因死亡率（75.9% [95% CI: 71.3%-80.2%] vs . 72.2% [95% CI: 68.1%-76.3%]; log-rank P = 0.014）和BVF （20.7% [95% CI: 12.8%-32.5%] vs . 17.3% [95% CI: 11.0%-26.6%]; P = 0.029）显著高于无PVR或轻度PVR患者。细灰色分析证实轻度PVR是BVF的独立预测因子（亚分布HR [sHR]: 1.48; 95% CI: 1.07-2.04; P = 0.018）， Cox回归显示与全因死亡率显著相关（HR: 1.11; 95% CI: 1.02-1.21; P = 0.014）。接受球囊扩张瓣膜的患者（sHR: 1.46; 95% CI: 1.02-2.08; P = 0.038）、非经股TAVR患者（sHR: 5.58; 95% CI: 1.57-19.9; P = 0.0086）和肾功能受损患者（估计肾小球滤过率< 30 mL/min/1.73 m2; sHR: 3.86; 95% CI: 1.30-11.5; P = 0.015）发生BVF的风险特别高。基线轻度PVR与进展为中度或更严重PVR的风险增加独立相关（HR: 3.74; 95% CI: 2.84-4.92; P < 0.001）。结论：TAVR后轻度PVR与BVF和全因死亡率的风险显著增加相关，突出了优化瓣膜部署和监测轻度PVR患者的重要性。

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Bailout PASCAL Implantation for Salvation of Iatrogenic Leaflet Perforation During Transcatheter Edge-to-Edge Repair 经导管边缘对边缘修复术中拯救医源性小叶穿孔的PASCAL植入术

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

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Alexander Hof MD, Marcel Halbach MD, Stephan Baldus MD, Roman Pfister MD, Christos Iliadis MD

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JACC. Cardiovascular interventions

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JACC. Cardiovascular interventions

Pub Date : 2025-12-22 DOI: 10.1016/j.jcin.2025.10.037

Andreas Seitz MD, Peter Ong MD

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Good People, Good Memories, Good Life! 好人，美好回忆，美好生活！

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

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