Pub Date : 2024-11-24DOI: 10.1016/j.jcin.2024.10.045
Alejandro Travieso, Syed Zaid, Bjarne Linde Nørgaard, Matjaz Bunc, Hasan Jilaihawi, Vinayak N Bapat, Gilbert H L Tang, Ole De Backer
{"title":"Impact of Valve Sizing and Positioning on Expansion and Hemodynamics in Redo TAVR With SAPIEN 3.","authors":"Alejandro Travieso, Syed Zaid, Bjarne Linde Nørgaard, Matjaz Bunc, Hasan Jilaihawi, Vinayak N Bapat, Gilbert H L Tang, Ole De Backer","doi":"10.1016/j.jcin.2024.10.045","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.10.045","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872117","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 : 2024-11-23DOI: 10.1016/j.jcin.2024.10.015
Kalyan R Chitturi, Beni R Verma, Andrew P Hill, Dan Haberman, Lior Lupu, Brian C Case, Toby Rogers, Lowell F Satler, Hayder D Hashim, Ron Waksman, Itsik Ben-Dor
{"title":"Percutaneous Bailout of an Entrapped Coronary Intravascular Lithotripsy Balloon.","authors":"Kalyan R Chitturi, Beni R Verma, Andrew P Hill, Dan Haberman, Lior Lupu, Brian C Case, Toby Rogers, Lowell F Satler, Hayder D Hashim, Ron Waksman, Itsik Ben-Dor","doi":"10.1016/j.jcin.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.10.015","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785495","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 : 2024-11-22DOI: 10.1016/j.jcin.2024.09.074
Damien Collison
{"title":"The Best of Both Worlds: Intracoronary Imaging and Physiology, Together in Perfect Harmony?","authors":"Damien Collison","doi":"10.1016/j.jcin.2024.09.074","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.09.074","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872121","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 : 2024-11-20DOI: 10.1016/j.jcin.2024.10.016
Claudiu Ungureanu, Mihai Cocoi, Lucien Finianos, Tim Noterdaeme, Pieter-Jan Palmers, Giuseppe Colletti, Olivier Gach
{"title":"Drug-Eluting Stent Delivery Via Nonexternalized Retrograde Wire in Chronic Total Occlusion Intervention: First Report.","authors":"Claudiu Ungureanu, Mihai Cocoi, Lucien Finianos, Tim Noterdaeme, Pieter-Jan Palmers, Giuseppe Colletti, Olivier Gach","doi":"10.1016/j.jcin.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.10.016","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785477","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.2024.09.003
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}
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