Journal of interventional cardiology最新文献

Background

Ventricular septal defects (VSDs) are the most common congenital heart defects, with outcomes influenced by size and location. Transcatheter closure (TCC) has become a widely used option for repair. This study presents a decade-long institutional experience with TCC of VSDs, evaluating its safety and efficacy.

Methods

This retrospective study analyzed patients who underwent attempted TCC of VSDs between 2015 and 2024. Patients were selected based on clinical and hemodynamic significance, and indications for closure were heart-failure symptoms and a Qp:Qs ratio exceeding 1.5. Procedural success, complications, and ventricular remodeling were analyzed as primary outcomes.

Results

A total of 149 patients (51% male) were included; of these, 23 (15.4%) patients were local (Israeli) and 126 (84.6%) were foreign nationals. The mean age was 86.67 ± 57.13 months. Successful closure was achieved in 139 patients (93.3%). The mean defect diameter was 4.72 ± 1.82 mm. The majority had perimembranous defects (111 patients, 74.5%). ADO II devices (96 cases, 65%) and MFO devices (49 cases, 33%) were predominantly used. The retrograde approach was employed in 136 (92%) of cases. The most notable complication was a residual shunt adjacent to the device, detected in 21 patients (15.1%) at a 1-week follow-up; 19 patients (13.7%) had mild residual shunts and 2 patients (1.4%) had moderate residual shunts. In the long-term follow-up cohort, residual shunt persisted in 3 of 52 patients (5.8%), all of which were mild. No mortality or instances of complete heart block were reported. Overall, 10 procedures (6.7%) failed. Device embolization occurred in six cases (4%), five of which required surgical intervention. Univariable analysis showed significantly higher LVEDD Z-score, Qp:Qs ratio, defect diameter, and systolic pulmonary artery pressure in failed cases. In further analysis for pmVSD patients, device choice and subaortic rim were also significantly associated with failure.

Conclusions

This decade-long experience demonstrates TCC as a safe and effective treatment for VSDs, with high success rates and minimal complications.

Background

Hemodynamically significant patent ductus arteriosus (hsPDA) leads to left-sided chamber dilatation and mitral valve (MV) annular stretching, potentially resulting in mitral regurgitation (MR). While transcatheter PDA closure often improves MR, persistent MR may be associated with adverse outcomes. This study aimed to identify echocardiographic predictors of persistent MR following transcatheter PDA closure in pediatric patients.

Methods

We conducted a retrospective study of 183 pediatric patients (aged 1–18 years) who underwent transcatheter PDA closure at Seoul National University Hospital between 2004 and 2021. Echocardiographic parameters, including left ventricular internal diameter in diastole (LVIDd), MV annulus diameter, and MR severity were analyzed before and after the procedure. Cardiac catheterization data were also reviewed.

Results

The mean age at the time of the procedure was 1.92 years, and the average pulmonic end diameter of PDA was 2.91 mm. After transcatheter PDA closure, LVIDd (Z-score), LVIDd/BSA, and MV annulus (Z-score) significantly decreased. The prevalence of MR decreased from 22.4% (preclosure) to 8.2% (postclosure). Multivariate analysis identified preclosure LVIDd (Z-score), postclosure MV annulus diameter (mm), MV annulus (Z-score), and the presence of MV prolapse as independent predictors of persistent MR. ROC analysis demonstrated that a preclosure LVIDd (Z-score) ≥ 2.95 predicted persistent MR with a sensitivity of 66.7% and a specificity of 83.9%.

Conclusions

Persistent MR after transcatheter PDA closure is predicted by preclosure LVIDd (Z-score), postclosure MV annulus diameter, and the presence of MV prolapse. Recognizing these factors may help guide clinical management and improve outcomes for patients at the risk of persistent MR.

Background

The Impella CP is a widely used mechanical circulatory support device for patients with cardiogenic shock undergoing high-risk percutaneous coronary intervention. Hemostasis following Impella removal remains a clinical challenge. Although the preclosure technique using the Perclose ProGlide device is standard in elective procedures, its feasibility in emergency settings for cardiogenic shock has not been well established.

Methods

This single-center, retrospective study included 14 consecutive patients with myocardial infarction complicated by cardiogenic shock who underwent Impella CP insertion between January 2020 and December 2024. Patients requiring coronary artery bypass grafting or venoarterial extracorporeal membrane oxygenation were excluded. A single Perclose ProGlide device was deployed using the preclosure technique at the time of Impella insertion. For hemodynamically stable patients, the Impella was removed within 48 h at the bedside. Procedural endpoints comprised door-to-preclose, door-to-unloading (DTU), and door-to-balloon (DTB) times. Safety endpoints were also evaluated.

Results

10 patients underwent Impella removal using the preclosure technique, and 4 patients underwent surgical cutdown. Comparing the preclose and surgical groups, the DTU time was not significantly different (median [interquartile range]: 89.5 [86.25–98.75] min vs. 92.0 [74.5–112.5] min, respectively; p = 0.811), nor was the DTB time (107.0 [104.25–119.75] min vs. 109.0 [88.5–131.0] min, respectively; p = 1.000). However, the time to Impella removal was significantly shorter in the preclose versus surgical groups (25.0 [22.0–27.75] h vs. 73.0 [59.0–91.5] h, respectively; p = 0.014). Technical success was achieved in all cases without major bleeding, surgical conversion, or infection.

Conclusions

This study demonstrated the feasibility and safety of total percutaneous bedside Impella CP removal using a single Perclose ProGlide device in patients with cardiogenic shock. The preclosure technique did not prolong DTB or DTU times and may be a practical alternative to surgical Impella device removal in stable patients.

Background and Objectives

The double-ProGlide technique is commonly used to achieve hemostasis in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). However, it has been associated with the rise of access-site stenosis. Therefore, in this study, we compared the safety and effectiveness of the single-ProGlide technique, with the option to deploy additional ProGlides if needed, to the double-ProGlide method in patients undergoing transfemoral TAVR.

Methods

In this single-center retrospective study, we included 551 patients who underwent transfemoral TAVR from May 2016 to July 2022. Propensity score matching was performed to control for confounding factors, resulting in two matched groups of 175 patients each. Primary outcomes included the technical success of vascular closure, immediate procedural results, 30-day clinical outcomes, and access-related vascular complications.

Results

Baseline characteristics were similar between the two groups after matching. No significant differences were observed in the immediate procedural results and 30-day clinical outcomes in the two groups. The single-ProGlide group showed a higher technical success rate for vascular closure (90.3% for single vs. 86.3% for double; p = 0.24) and a lower rate of any vascular complication (9.7% vs. 16.0%, p = 0.079) compared to the double-ProGlide group, although these differences did not reach statistical significance. Female sex (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.48–5.93, p = 0.003), smaller access vessel diameter (OR 0.65, 95% CI 0.50–0.82, p < 0.001), and increased number of ProGlides used (OR 4.94, 95% CI 2.46–10.6, p < 0.001) were associated with vascular closure device failure.

Conclusions

The single-ProGlide technique, with the option to use additional devices as required, appears to be a viable alternative to the double-ProGlide technique. It demonstrated high technical success for main-access closure and a trend toward lower vascular complication rates in transfemoral TAVR, although these differences did not reach statistical significance.

Introduction

Transcatheter closure for secundum-type atrial septal defect (ASD II) with a bioresorbable septal occluder (as the “reSept ASD Occluder” by atHeart Medical) is a promising new technology, especially for their usage in children.

Material

The reSept ASD Occluder by atHeart Medical AG, Baar, Switzerland, is a self-centering double disk, repositionable, and retractable device with a bioresorbable framework (polylactic-co-glycolic acid), which is almost completely resorbed by 18–24 months postimplantation.

Results

This manuscript reports the clinical follow-up of now more than 3 years for the four first-in-child ASD device closures using a reSept ASD Occluder. This device exhibited a flat configuration without any obstruction or erosion of adjacent cardiac structures in all cases during follow-up. Importantly, there was no evidence or clinical indications of systemic or local inflammation attributable to the ingrowth, reabsorption, and endothelialization processes of the device within our study population. The assessment of interatrial septum thickness, serving as a marker for local tissue reaction and inflammation and endothelialization, through serial echocardiograms did show only a mild increase from the time of implantation to 12-month follow-up, but no relevant further increase of interatrial septal thickness thereafter until 3-year follow-up.

Conclusions

The CBSO/“reSept ASD Occluder” device system emerges as a promising alternative for transcatheter atrial septal defect (ASD) closure in pediatric patients. Our initial experience with its first-in-child implantation not only demonstrated effective and safe usage but also showed excellent results throughout the initial 3-year clinical follow-up period.

Background

The left atrial appendage (LAA) plays an important role as a reservoir and has endocrine functions. This study aimed to assess the acute hemodynamic effects associated with LAA closure (LAAC) and ensuing structural changes 3 months after closure.

Methods

Two centers enrolled patients for LAAC from January 2022 to July 2024. Invasive hemodynamic measurements of left atrial pressure (LAP) were taken after the transseptal puncture and postdevice deployment (both before and after isometric exercise). The heart failure (HF) biomarkers (NT-proBNP, NT-proANP, and GDF-15) were assessed before and 3 months after LAAC. The echocardiographic parameters were assessed before and 6 months after LAAC.

Results

Sixty-two patients participated (age 75.7 ± 8.2 years, 45 (72.6%) males, CHA₂DS₂VASc 4.1 ± 1.3). Both rest and postexercise LAP values increased after device implantation (rest: 14.9 ± 7.1 before vs. 17.6 ± 7.9 mm Hg after, p < 0.001; postexercise: 18.7 ± 8.6 before vs. 21.8 ± 9.5 mm Hg after, p < 0.001). The administration of larger volumes of fluid during the procedure was significantly correlated with a higher increase in resting LAP following device implantation. On the other hand, exercise-induced changes in postprocedural LAP (i.e., the difference between postexercise vs. rest) were negatively associated with the amount of fluid administered during the procedure. Three months postprocedure, we observed no changes in HF biomarkers. Six months postprocedure, we observed no changes in LA and LV echocardiographic parameters.

Conclusions

LAAC caused an acute increase in both rest and exercise LAP. The amount of procedural fluid is one of the most important parameters associated with LAP changes.

Aim/Background

Periprocedural myocardial infarction (PMI) remains a significant complication of elective percutaneous coronary intervention (PCI) procedures and is linked to increased morbidity and mortality. Heart rate recovery (HRR), reflecting autonomic function and parasympathetic reactivation, has been established to predict adverse cardiovascular outcomes. This study investigates the association between HRR, assessed through cardiopulmonary exercise testing (CPET), and the occurrence of PMI in patients undergoing elective PCI.

Materials and Methods

This retrospective observational study included 401 patients who underwent elective PCI between January 2022 and September 2024. HRR was measured at 1- and 3-min intervals following CPET. Baseline demographic, clinical, and laboratory data were analyzed alongside procedural variables. PMI was defined based on the Fourth Universal Definition of Myocardial Infarction. Statistical analyses, including multivariate logistic regression and receiver operating characteristics (ROC) curve analysis, were performed to assess the predictive value of HRR.

Results

Patients with PMI exhibited significantly lower HRR at both 1 min (11.12 ± 3.25 vs. 14.21 ± 4.22, p  <  0.001) and 3 min (42.99 ± 13.17 vs. 48.36 ± 9.72, p  <  0.001) after peak exercise compared to those without PMI. ROC analysis revealed HRR as a reliable predictor of PMI, with AUCs of 0.723 (1 min) and 0.616 (3 min). Multivariate analysis confirmed HRR at 1 min (OR: 0.744, 95% CI: 0.617–0.897, p = 0.002) and 3 min (OR: 0.950, 95% CI: 0.905–0.999, p = 0.044) as independent predictors of PMI.

Conclusion

HRR measured by CPET independently predicts PMI in patients undergoing elective PCI. Incorporating HRR into preoperative risk assessments could enhance clinical decision-making and improve procedural outcomes. Future studies are needed to explore its integration into standard PCI protocols for better risk stratification.

Background

Cutting balloon (CB) can reduce vascular inflammation and elastic recoil, and these findings have been verified in combination with stent implantation in patients with coronary artery disease (CAD). This study aims to compare the immediate effect of CB with conventional balloon pre-dilatation before drug-eluting balloon (DEB) angioplasty for the treatment of CAD.

Methods

Patients with CAD, diagnosed by elective coronary angiography and having either de novo lesions or in-stent restenosis (ISR) were included. All patients were randomly assigned to undergo predilatation with either a CB or a conventional balloon prior to DEB treatment. We assessed the immediate effect and the level of inflammatory factors after the operation between two groups.

Results

Eighty-five patients were enrolled. In the CB group (n = 42), all patients achieved residual stenosis  < 30% (100% procedural success), with no acute complications observed. In the conventional balloon group (n = 43), 6 patients had residual stenosis  ≥ 30% (resulting in an 86.0% procedural success rate), and two acute complications occurred (one type B dissection and one acute branch occlusion), neither requiring bail-out stenting. Moreover, serum levels of IL-6, IL-8, TNF-α, and CRP at 24 h were significantly higher than those before and immediately after the operation in the two groups. The degrees of increase in concentration of IL-6, IL-8, and TNF-α 24-h postoperatively were lower in the CB group than those in the conventional balloon group (P < 0.05).

Conclusions

In the treatment of CAD with DEB angioplasty, predilatation with CB was associated with improved immediate procedural success and a reduced inflammatory response compared with conventional balloon predilatation.

Background

Coronary artery disease (CAD) and atrial fibrillation (AF) frequently co-occur. They influence each other in terms of occurrence and aggravation, which has an impact on the prognosis. Meanwhile, there is a lack of reports on whether AF rhythm at the time of coronary revascularizations is related to long-term prognosis. We aimed to determine whether AF upon electrocardiography at the time of revascularization for CAD affects the patient’s long-term outcome.

Methods

We observed the clinical outcomes (up to 10 years) in 7733 patients who underwent coronary intervention at two centers. Patients were divided into AF and non-AF groups on the day of the procedure, and analyses were performed after validation through propensity score matching. The primary outcome was major adverse cardiac events (MACEs) defined as a composite of all-cause mortality, spontaneous myocardial infarction, stroke, and hospitalization. Subgroup analysis was performed for different causes of hospitalization.

Results

During follow-up (mean: 3.8 years), the incidence and risk of MACEs did not differ between the AF and non-AF groups (23.3% vs. 36.2%, adjusted hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.74–1.98, p = 0.443) following coronary intervention, after propensity score matching. However, the incidence of hospitalization events was higher in the AF group than that in the non-AF group (2.2% vs. 8.6%, adjusted HR: 3.28, 95% CI: 1.02–10.53, p = 0.046). Among the causes of hospitalization, the incidence of major bleeding was significantly higher in the AF group.

Conclusions

The effect of AF during coronary revascularization on the incidence of the MACEs over a mean follow-up of 3.8 years was not statistically significant. However, AF was associated with a higher incidence of hospitalization during the follow-up period.

Trial Registration: ClinicalTrials.gov identifier: NCT04650529