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.2024.10.013
Thomas Attumalil, Sami Alnasser, Geraldine Ong, Paolo Denti, Mohammed Alkasab, Yazeed Almalki, David Latter, Gianluigi Bisleri, Neil P Fam
{"title":"Transseptal Valve-in-Valve Implantation for Degenerated Low-Profile Tendyne.","authors":"Thomas Attumalil, Sami Alnasser, Geraldine Ong, Paolo Denti, Mohammed Alkasab, Yazeed Almalki, David Latter, Gianluigi Bisleri, Neil P Fam","doi":"10.1016/j.jcin.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.10.013","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710089","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.2024.08.048
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}
Pub Date : 2024-11-11DOI: 10.1016/j.jcin.2024.09.030
Kuniaki Takahashi, Hisao Otsuki, Frederik M Zimmermann, Victoria Y Ding, Keith G Oldroyd, Olaf Wendler, Michael J Reardon, Y Joseph Woo, Alan C Yeung, Nico H J Pijls, Bernard De Bruyne, William F Fearon
Background: Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.
Objectives: This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG.
Methods: The FAME 3 trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease. This prespecified subgroup analysis compared the incidence of major adverse cardiac and cerebrovascular events (MACCE) according to sex, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years.
Results: Of 1,500 patients included in the FAME 3 trial, 265 (17.7%) were women. Women had a significantly higher risk of MACCE at 3 years compared with men after CABG (18.1% vs 11.7%; adjusted HR: 2.07; 95% CI: 1.19-3.60), whereas women had a similar risk of MACCE at 3 years compared with men after PCI (18.2% vs 19.1%; adjusted HR: 1.27; 95% CI: 0.79-2.03). Regarding treatment effects by sex, women undergoing PCI had a similar risk of MACCE at 3 years compared with CABG (adjusted HR: 1.15; 95% CI: 0.62-2.11). By contrast, men undergoing PCI had a higher risk of MACCE at 3 years compared with CABG (adjusted HR: 1.68; 95% CI: 1.25-2.25; Pinteraction = 0.142), which was mainly driven by a higher risk of myocardial infarction (adjusted HR: 2.11; 95% CI: 1.26-3.56; Pinteraction = 0.102) and repeat revascularization (adjusted HR: 2.26; 95% CI: 1.47-3.47; Pinteraction = 0.071).
Conclusions: In the FAME 3 trial, at 3 years, women had similar outcomes with FFR-guided PCI compared with CABG, whereas men had improved outcomes with CABG. (A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease [FAME 3]; NCT02100722).
{"title":"Sex Differences in Patients Undergoing FFR-Guided PCI or CABG in the FAME 3 Trial.","authors":"Kuniaki Takahashi, Hisao Otsuki, Frederik M Zimmermann, Victoria Y Ding, Keith G Oldroyd, Olaf Wendler, Michael J Reardon, Y Joseph Woo, Alan C Yeung, Nico H J Pijls, Bernard De Bruyne, William F Fearon","doi":"10.1016/j.jcin.2024.09.030","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.09.030","url":null,"abstract":"<p><strong>Background: </strong>Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.</p><p><strong>Objectives: </strong>This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG.</p><p><strong>Methods: </strong>The FAME 3 trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease. This prespecified subgroup analysis compared the incidence of major adverse cardiac and cerebrovascular events (MACCE) according to sex, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years.</p><p><strong>Results: </strong>Of 1,500 patients included in the FAME 3 trial, 265 (17.7%) were women. Women had a significantly higher risk of MACCE at 3 years compared with men after CABG (18.1% vs 11.7%; adjusted HR: 2.07; 95% CI: 1.19-3.60), whereas women had a similar risk of MACCE at 3 years compared with men after PCI (18.2% vs 19.1%; adjusted HR: 1.27; 95% CI: 0.79-2.03). Regarding treatment effects by sex, women undergoing PCI had a similar risk of MACCE at 3 years compared with CABG (adjusted HR: 1.15; 95% CI: 0.62-2.11). By contrast, men undergoing PCI had a higher risk of MACCE at 3 years compared with CABG (adjusted HR: 1.68; 95% CI: 1.25-2.25; P<sub>interaction</sub> = 0.142), which was mainly driven by a higher risk of myocardial infarction (adjusted HR: 2.11; 95% CI: 1.26-3.56; P<sub>interaction</sub> = 0.102) and repeat revascularization (adjusted HR: 2.26; 95% CI: 1.47-3.47; P<sub>interaction</sub> = 0.071).</p><p><strong>Conclusions: </strong>In the FAME 3 trial, at 3 years, women had similar outcomes with FFR-guided PCI compared with CABG, whereas men had improved outcomes with CABG. (A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease [FAME 3]; NCT02100722).</p>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785543","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}
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