Kardiologia polska最新文献

Background: Left main coronary trifurcations pose specific challenges for percutaneous coronary intervention due to complex anatomy and lack of standardized approaches.

Aims: We assess to evaluate the stent conformations achieved by different adaptations to trifurcations of stepwise provisional stenting in a bench test.

Methods: Percutaneous coronary intervention procedures were performed in silicon trifurcation models using standard equipment. After main vessel stenting and proximal optimization technique, side branch (SB) rewiring was conducted via same-cell (SAC) or neighbouring-cell (NEC) under optical coherence tomography guidance. SBs dilation was then performed using either simultaneous trissing or serial kissing balloon techniques. Following repeat proximal optimization technique, stent expansion and apposition were assessed with optical coherence tomography and micro-computed tomography.

Results: All 4 technique combinations were feasible and resulted in satisfactory stent expansion and apposition. Micro-computed tomography analysis showed that trissing improved expansion at the polygon of confluence compared to serial kissing (23.7 vs. 21.1 mm²; P = 0.043), while SAC rewiring yielded better expansion at the distal main vessel ostium than NEC (10.3 vs. 9.6 mm²; P = 0.003). Rewiring technique determined the conformation of the stent at the level of SBs take-off: NEC produced 2 stent fenestrations and SAC a single stent fenestration (with a minimal area significantly smaller than the sum of the 2 achieved by NEC: 16.4 mm² vs. 13.4 + 14.5 mm²; P = 0.019).

Conclusions: All provisional stenting strategies tested were technically feasible for left main trifurcations. SB rewiring and ballooning technique influenced stent configuration, particularly the number and size of fenestrations, but had limited impact on overall stent expansion and apposition.

Background: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) have expanded treatment options for severe aortic stenosis, yet comparative real-world data remain limited.

Aims: We aimed to compare early and up to 6-month clinical and hemodynamic outcomes of SU-AVR versus transfemoral TAVI.

Methods: All consecutive patients undergoing SU-AVR (n = 53) or TAVI (n = 245) between 2014-2023 were retrospectively analyzed. Propensity score matching (1:1 nearest neighbor, no replacement) generated 53 balanced pairs.

Results: Paravalvular leak was more frequent after TAVI and was driven by mild leaks (40.0% vs. 13.3%; P = 0.019), while moderate-to-severe paravalvular leak was low and comparable (6.7% vs. 3.3%; P = 0.646). TAVI demonstrated lower transvalvular gradients compared to SU-AVR (P = 0.004); other 6-month echocardiographic parameters, including left ventricular ejection fraction and pulmonary artery pressure, were comparable. Permanent pacemaker implantation rates were comparable. Early mortality did not differ between the SU-AVR and TAVI groups (13.5% vs. 5.7%; P = 0.173). TAVI was associated with shorter hospitalization (median 5.2, interquartile range 3.7-7.3 vs. 8.7, interquartile range 6.3-11.9 days; P <0.001).

Conclusions: In selected high-risk patients, SU-AVR and TAVI showed complementary early profiles. Individualized Heart Team-based decision-making remains essential.

Background: Conduction system pacing (CSP) is becoming standard of care in cardiac electrotherapy. To achieve the most physiological effect, the pacing lead should penetrate deeply into the myocardium of the interventricular septum (IVS). While CSP's beneficial effect on left ventricular function has been proven, the safety profile and late complications, including IVS perforation, local myocardial damage, and ST-segment changes, continue to be assessed.

Aims: The aim of this study was to assess the prevalence, clinical significance, and potential mechanisms of ST-segment elevation (STE) following CSP implantation.

Methods: We retrospectively analyzed 412 patients who underwent CSP between 2020 and 2024 in two cardiology departments.

Results: Significant STE, consistent with STE myocardial infarction criteria, was recorded in five cases. In most patients, STE occurred several hours after procedure, manifested in anterior leads (V1-V4), and was associated with anginal pain and significant troponin levels. Coronary angiography, performed in 4 cases, showed the possible mechanisms. These included damage to septal branches resulting in septal hematoma (2 cases), occlusion of the left anterior descending artery requiring percutaneous transluminal coronary angioplasty (1 case), and procedure-related stress inducing takotsubo syndrome (1 case).

Conclusions: The prolonged STE may occur several hours after the procedure, emphasising the necessity of patient monitoring. The STE is a critical marker that may signify iatrogenic acute coronary syndrome from direct damage to the left anterior descending artery or its septal branches, or the formation of IVS hematoma and fistulas. Multimodality diagnostic tools, such as urgent selective coronary angiography or computed tomography angiography, are mandatory to detect serious complications early and facilitate appropriate treatment.

The management of direct oral anticoagulants (DOAC) during percutaneous coronary interventions is a common challenge in clinical practice. The periprocedural management remains highly variable and insufficiently evidence-based. This review summarizes the pharmacokinetic properties of DOACs, evaluates contemporary guideline recommendations and examines observational and prospective evidence for interruption versus continuation strategies in coronary and structural interventions. For percutaneous coronary interventions, predominantly via radial-access, observational evidence suggests that uninterrupted DOAC therapy is associated with low rates of bleeding and thromboembolism. Questioning the routine practice of pre-procedural interruption in low-risk cases. In contrast, patients undergoing transcatheter structural interventions are older, requiring femoral access and at a higher baseline bleeding risk. In this setting, recent data do not support routine continuation of anticoagulation. We propose a patient and procedure-specific approach to DOAC management that prioritizes access site, procedural complexity and renal function over uniform interruption protocols. There is a need for targeted prospective randomized studies on periprocedural and immediate postprocedural management in these populations.