Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.06.015
Luca Scorpiglione , Jacopo Pizzicannella , Elena Bacigalupi , Vincenzo Cicchitti , Francesco Pelliccia , Melissa Foglietta , Sabina Gallina , Marco Zimarino
De-escalation of dual antiplatelet therapy (DAPT) is gaining traction as a strategy to reduce bleeding risks while ensuring ischemic outcomes. Undiscriminating de-escalation, notably in patients with high ischemic risk, might expose them to major adverse cardiac events.
Platelet function and genetic tests are emerging tools to guide de-escalation, but both present specific drawbacks. Recent meta-analyses have aimed to consolidate the findings of individual trials to provide clearer insights. Yet, limitations remain for patients with concomitant high bleeding and ischemic risks. These high-risk patients are frequently underrepresented in clinical trials, and, therefore, currently available guidelines lack evidence-based recommendations for this subset. While DAPT de-escalation strategies hold promise, the choice of approach, whether clinically or assay-guided, remains complex and should be individualized.
{"title":"Therapeutic strategies aiming at the reduction of the antiplatelet intensity should not overlook the ischemic risk in patients with coronary syndromes","authors":"Luca Scorpiglione , Jacopo Pizzicannella , Elena Bacigalupi , Vincenzo Cicchitti , Francesco Pelliccia , Melissa Foglietta , Sabina Gallina , Marco Zimarino","doi":"10.1016/j.carrev.2024.06.015","DOIUrl":"10.1016/j.carrev.2024.06.015","url":null,"abstract":"<div><div>De-escalation of dual antiplatelet<span><span> therapy (DAPT) is gaining traction as a strategy to reduce bleeding risks while ensuring ischemic outcomes. Undiscriminating de-escalation, notably in patients with high ischemic risk, might expose them to </span>major adverse cardiac events.</span></div><div>Platelet function<span> and genetic tests are emerging tools to guide de-escalation, but both present specific drawbacks. Recent meta-analyses have aimed to consolidate the findings of individual trials to provide clearer insights. Yet, limitations remain for patients with concomitant high bleeding and ischemic risks. These high-risk patients are frequently underrepresented in clinical trials, and, therefore, currently available guidelines lack evidence-based recommendations for this subset. While DAPT de-escalation strategies hold promise, the choice of approach, whether clinically or assay-guided, remains complex and should be individualized.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 78-84"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.07.018
Sunil V. Rao , Eric Bailey
{"title":"Editorial: The need for standardized feedback systems for interventional cardiologists","authors":"Sunil V. Rao , Eric Bailey","doi":"10.1016/j.carrev.2024.07.018","DOIUrl":"10.1016/j.carrev.2024.07.018","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 39-40"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.05.022
Pruthvi C. Revaiah , Tsung-Ying Tsai , Bo Wang , Mick Renkens , Shigetaka Kageyama , Adrian Wlodarczak , Julien Lemoine , Helge Mollmann , Manel Sabate , Faisal Sharif , Azfar Zaman , Joanna Wykrzykowska , Edouard Benit , He Xing Qiang , Kotaro Miyashita , Akihiro Tobe , Takashi Muramatsu , Kengo Tanabe , Yukio Ozaki , Scot Garg , Patrick W. Serruys
Background
There are different definitions of periprocedural myocardial infarction (PPMI) both in terms of thresholds for cardiac biomarkers and the ancillary criteria for myocardial ischemia. Cardiac Troponin I (cTnI) and cardiac Troponin T (cTnT) are used interchangeably to diagnose PPMI.
Objectives
This study evaluated the frequency of periprocedural myocardial injury and infarction as defined by the Society of Cardiovascular Angiography & Interventions (SCAI), the Academic Research Consortium-2 (ARC-2), and the 4th Universal definition of MI (4UDMI) stratified using cTnT versus cTnI, among patients with chronic coronary syndrome (CCS) and unstable angina.
Results
Among 830 patients, PPMI rates according to the SCAI, ARC2 and 4UDMI criteria were 4.34 %, 2.05 %, and 4.94 % respectively, with higher rates seen for all definitions when using cTnI versus cTnT (SCAI: 9.84 % vs. 1.91 %, p < 0.001; ARC 2: 3.15 % vs. 1.56 %, p = 0.136; and 4UDMI 5.91 % vs. 4.51 %, p = 0.391). Minor and major periprocedural myocardial injury was respectively observed in 58.31 % and 27.10 % of patients, with rates of both significantly higher when using cTnI versus cTnT (Minor: 69.29 % vs. 53.47 %, p < 0.001, Major: 49.21 % vs. 17.36 %, p < 0.001).
Conclusions
Among patients with CCS and unstable angina, PPMIs defined by SCAI occurred more frequently when using cTnI as opposed to cTnT, whereas the type of troponin had no impact on the incidence of PPMIs according to the ARC-2 and 4UDMI.
{"title":"Frequency of periprocedural myocardial injury and infarction stratified by cardiac troponin I and cardiac troponin T","authors":"Pruthvi C. Revaiah , Tsung-Ying Tsai , Bo Wang , Mick Renkens , Shigetaka Kageyama , Adrian Wlodarczak , Julien Lemoine , Helge Mollmann , Manel Sabate , Faisal Sharif , Azfar Zaman , Joanna Wykrzykowska , Edouard Benit , He Xing Qiang , Kotaro Miyashita , Akihiro Tobe , Takashi Muramatsu , Kengo Tanabe , Yukio Ozaki , Scot Garg , Patrick W. Serruys","doi":"10.1016/j.carrev.2024.05.022","DOIUrl":"10.1016/j.carrev.2024.05.022","url":null,"abstract":"<div><h3>Background</h3><div><span>There are different definitions of periprocedural myocardial infarction (PPMI) both in terms of thresholds for cardiac biomarkers and the ancillary criteria for myocardial ischemia. Cardiac </span>Troponin I<span> (cTnI) and cardiac Troponin T (cTnT) are used interchangeably to diagnose PPMI.</span></div></div><div><h3>Objectives</h3><div>This study evaluated the frequency of periprocedural myocardial injury<span><span> and infarction as defined by the Society of Cardiovascular Angiography & Interventions (SCAI), the Academic Research Consortium-2 (ARC-2), and the 4th Universal definition of MI (4UDMI) stratified using cTnT versus cTnI, among patients with chronic coronary syndrome (CCS) and </span>unstable angina.</span></div></div><div><h3>Results</h3><div>Among 830 patients, PPMI rates according to the SCAI, ARC2 and 4UDMI criteria were 4.34 %, 2.05 %, and 4.94 % respectively, with higher rates seen for all definitions when using cTnI versus cTnT (SCAI: 9.84 % vs. 1.91 %, <em>p</em> < 0.001; ARC 2: 3.15 % vs. 1.56 %, <em>p</em> = 0.136; and 4UDMI 5.91 % vs. 4.51 %, <em>p</em><span> = 0.391). Minor and major periprocedural myocardial injury was respectively observed in 58.31 % and 27.10 % of patients, with rates of both significantly higher when using cTnI versus cTnT (Minor: 69.29 % vs. 53.47 %, p < 0.001, Major: 49.21 % vs. 17.36 %, p < 0.001).</span></div></div><div><h3>Conclusions</h3><div>Among patients with CCS and unstable angina<span>, PPMIs defined by SCAI occurred more frequently when using cTnI as opposed to cTnT, whereas the type of troponin had no impact on the incidence of PPMIs according to the ARC-2 and 4UDMI.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 12-19"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.06.012
Francesco Bianchini , Enrico Romagnoli , Cristina Aurigemma , Marco Lombardi , Francesca Graziani , Giulia Iannaccone , Gabriella Locorotondo , Marco Busco , Silvia Malara , Marialisa Nesta , Piergiorgio Bruno , Nunzio Girlando , Michele Corrado , Luigi Natale , Antonella Lombardo , Francesco Burzotta , Carlo Trani
Aims
The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures.
Methods
Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm2/m2 (if BMI < 30 kg/m2) or < 0.55 cm2/m2 (if BMI ≥ 30 kg/m2). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up.
Results
A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765–0.994],p = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001–0.964],p = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919–0.999],p = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028–4.086],p = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %;p = 0.023).
Conclusion
In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence.
{"title":"A multimodal approach to predict prosthesis-patient mismatch in patients undergoing valve-in-valve trans-catheter aortic valve implantation","authors":"Francesco Bianchini , Enrico Romagnoli , Cristina Aurigemma , Marco Lombardi , Francesca Graziani , Giulia Iannaccone , Gabriella Locorotondo , Marco Busco , Silvia Malara , Marialisa Nesta , Piergiorgio Bruno , Nunzio Girlando , Michele Corrado , Luigi Natale , Antonella Lombardo , Francesco Burzotta , Carlo Trani","doi":"10.1016/j.carrev.2024.06.012","DOIUrl":"10.1016/j.carrev.2024.06.012","url":null,"abstract":"<div><h3>Aims</h3><div>The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures.</div></div><div><h3>Methods</h3><div><span>Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm</span><sup>2</sup>/m<sup>2</sup><span> (if BMI < 30 kg/m</span><sup>2</sup>) or < 0.55 cm<sup>2</sup>/m<sup>2</sup> (if BMI ≥ 30 kg/m<sup>2</sup>). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up.</div></div><div><h3>Results</h3><div><span>A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765–0.994],</span><em>p</em> = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001–0.964],<em>p</em> = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919–0.999],<em>p</em> = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028–4.086],<em>p</em> = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %;<em>p</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 41-47"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.06.020
Daniel Tébar , Alfonso Jurado-Román , Santiago Jiménez-Valero , Guillermo Galeote , Ariana Gonzálvez , Borja Rivero , Andoni García , Jose Manuel Añón Elizalde , Alicia Lorenzo , Carmen Fernández Capitán , Rosario Torres , Clara Soto , Sergio Alcolea , Sandra Rosillo , Juan Caro Codón , Emilio Arbas , Fernando Tejera , Ignacio Plaza , Lisardo Boscá , Raúl Moreno
Background
High-risk Pulmonary Embolism (PE) mortality remains very high. Systemic thrombolysis is effective but carries significant complications and contraindications related to the hemorrhagic risk. Percutaneous thrombectomy using aspiration catheters may be an alternative in patients with a high bleeding risk.
Objective
This study aimed to evaluate the results of catheter-directed thrombectomy using aspiration dedicated catheters in patients with high-risk PE and absolute contraindication to systemic thrombolysis, with specific focus on procedural success, safety, and in-hospital outcomes.
Methods
A prospective study enrolled all consecutive patients diagnosed with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis, who underwent percutaneous pulmonary thrombectomy using dedicated aspiration catheters. The study documented the effectiveness and complications of the procedure, as well as patient outcomes at discharge and during the follow-up period.
Results
Thirteen patients underwent percutaneous pulmonary thrombectomy using aspiration dedicated catheters. The procedure was successful for all patients, resulting in hemodynamic and respiratory improvement within the first 24 h. No deaths attributable to cardiovascular or respiratory causes occurred during admission or follow-up. Furthermore, no serious adverse events or complications were reported during the procedure or hospitalization.
Conclusions
Percutaneous pulmonary thrombectomy with dedicated aspiration catheters in patients with high-risk pulmonary embolism and contraindications to systemic thrombolysis was associated with excellent clinical results and low rate of complications.
背景：高危肺栓塞（PE）的死亡率仍然很高。全身溶栓治疗虽然有效，但却存在严重的并发症和与出血风险相关的禁忌症。对于出血风险较高的患者来说，使用抽吸导管进行经皮血栓切除术不失为一种选择：本研究旨在评估使用抽吸专用导管对高风险 PE 和全身溶栓绝对禁忌症患者进行导管引导下血栓切除术的结果，特别关注手术成功率、安全性和院内预后：这项前瞻性研究纳入了所有被诊断为高危肺栓塞且全身溶栓绝对禁忌症的连续患者，他们都接受了使用专用抽吸导管的经皮肺血栓切除术。研究记录了手术的有效性和并发症，以及患者出院时和随访期间的治疗效果：13名患者使用专用抽吸导管接受了经皮肺血栓切除术。所有患者的手术都很成功，在最初的24小时内血液动力学和呼吸系统都有所改善。此外，在手术或住院期间也没有发生严重的不良事件或并发症：结论：对于有全身溶栓禁忌症的高危肺栓塞患者，使用专用抽吸导管进行经皮肺血栓切除术临床效果极佳，并发症发生率低。
{"title":"Percutaneous pulmonary thrombectomy with aspiration catheters in patients with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis","authors":"Daniel Tébar , Alfonso Jurado-Román , Santiago Jiménez-Valero , Guillermo Galeote , Ariana Gonzálvez , Borja Rivero , Andoni García , Jose Manuel Añón Elizalde , Alicia Lorenzo , Carmen Fernández Capitán , Rosario Torres , Clara Soto , Sergio Alcolea , Sandra Rosillo , Juan Caro Codón , Emilio Arbas , Fernando Tejera , Ignacio Plaza , Lisardo Boscá , Raúl Moreno","doi":"10.1016/j.carrev.2024.06.020","DOIUrl":"10.1016/j.carrev.2024.06.020","url":null,"abstract":"<div><h3>Background</h3><div><span>High-risk Pulmonary Embolism (PE) mortality remains very high. Systemic </span>thrombolysis<span> is effective but carries significant complications and contraindications related to the hemorrhagic risk. Percutaneous thrombectomy using aspiration catheters may be an alternative in patients with a high bleeding risk.</span></div></div><div><h3>Objective</h3><div>This study aimed to evaluate the results of catheter-directed thrombectomy using aspiration dedicated catheters in patients with high-risk PE and absolute contraindication to systemic thrombolysis, with specific focus on procedural success, safety, and in-hospital outcomes.</div></div><div><h3>Methods</h3><div>A prospective study enrolled all consecutive patients diagnosed with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis, who underwent percutaneous pulmonary thrombectomy using dedicated aspiration catheters. The study documented the effectiveness and complications of the procedure, as well as patient outcomes at discharge and during the follow-up period.</div></div><div><h3>Results</h3><div>Thirteen patients underwent percutaneous pulmonary thrombectomy using aspiration dedicated catheters. The procedure was successful for all patients, resulting in hemodynamic and respiratory improvement within the first 24 h. No deaths attributable to cardiovascular or respiratory causes occurred during admission or follow-up. Furthermore, no serious adverse events or complications were reported during the procedure or hospitalization.</div></div><div><h3>Conclusions</h3><div>Percutaneous pulmonary thrombectomy with dedicated aspiration catheters in patients with high-risk pulmonary embolism and contraindications to systemic thrombolysis was associated with excellent clinical results and low rate of complications.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 56-61"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.07.002
Stephanie Brunner, Federico Moccetti, Lucca Loretz, Nina Conrad, Matthias Bossard, Adrian Attinger-Toller, Reto Kurmann, Florim Cuculi, Mathias Wolfrum, Stefan Toggweiler
Background
In patients undergoing transcatheter aortic valve replacement (TAVR), elevated pre-procedural C-reactive protein (CRP) levels are frequently observed. Its impact on long-term results of TAVR is unclear. The aim of the study was to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR.
Methods
Consecutive patients undergoing TAVR between August 2012 and January 2023 at a tertiary cardiology facility were included. Patients were divided into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). The cohorts were followed clinically for up to six years after TAVR.
Results
From a total of 1000 TAVR patients (mean age 81 ± 6 years), 268 patients (27 %) were found to have elevated baseline CRP (>5 mg/l). Such patients had significantly more co-morbidities (e.g. chronic obstructive pulmonary disease, atrial fibrillation, heart failure, concomitant valvopathies). They also developed periprocedural infections more frequently (3 % vs. 1 %, p = 0.007) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97, CI 1.47–2.64, p < 0.001). All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels.
Conclusion
Albeit long-term results of TAVR patients with elevated pre-procedural CRP levels seem favorable in terms of survival and development of valve dysfunction, they have an increased risk for periprocedural infections and re-admissions due to infections of any type during the follow-up period.
{"title":"The impact of elevated C-reactive protein levels on long-term outcomes of patients undergoing transcatheter aortic valve replacement","authors":"Stephanie Brunner, Federico Moccetti, Lucca Loretz, Nina Conrad, Matthias Bossard, Adrian Attinger-Toller, Reto Kurmann, Florim Cuculi, Mathias Wolfrum, Stefan Toggweiler","doi":"10.1016/j.carrev.2024.07.002","DOIUrl":"10.1016/j.carrev.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>In patients undergoing transcatheter aortic valve replacement (TAVR), elevated pre-procedural C-reactive protein (CRP) levels are frequently observed. Its impact on long-term results of TAVR is unclear. The aim of the study was to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing TAVR between August 2012 and January 2023 at a tertiary cardiology facility were included. Patients were divided into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). The cohorts were followed clinically for up to six years after TAVR.</div></div><div><h3>Results</h3><div><span>From a total of 1000 TAVR patients (mean age 81 ± 6 years), 268 patients (27 %) were found to have elevated baseline CRP (>5 mg/l). Such patients had significantly more co-morbidities (e.g. chronic obstructive pulmonary disease<span>, atrial fibrillation, heart failure, concomitant valvopathies). They also developed periprocedural infections more frequently (3 % vs. 1 %, </span></span><em>p</em> = 0.007) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97, CI 1.47–2.64, <em>p</em> < 0.001). All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels.</div></div><div><h3>Conclusion</h3><div>Albeit long-term results of TAVR patients with elevated pre-procedural CRP levels seem favorable in terms of survival and development of valve dysfunction, they have an increased risk for periprocedural infections and re-admissions due to infections of any type during the follow-up period.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 71-75"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.07.008
Alejandro Lemor, Gabriel A. Hernandez
{"title":"Editorial: Mechanical circulatory support in acute myocardial infarction with cardiogenic shock: A friend or a foe?","authors":"Alejandro Lemor, Gabriel A. Hernandez","doi":"10.1016/j.carrev.2024.07.008","DOIUrl":"10.1016/j.carrev.2024.07.008","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 34-35"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.08.005
Herbert G. Kroon, Thijmen Hokken, Maarten van Wiechen, Joris F.W. Ooms, Lennart van Gils, Isabella Kardys, Joost Daemen, Peter P.T. De Jaegere, Rutger-Jan Nuis, Nicolas M. Van Mieghem
New conduction disorders remain a frequent complication in current transcatheter aortic valve replacement (TAVR) era. Left bundle branch block (LBBB) occurs early in about 20–30 % of TAVR-patients, persists at 1 month in about 35–45 % of cases and will likely remain thereafter. Third-degree atrioventricular block (AV3B) affects approximately 15 % of patients. Pacemaker dependency gradually decreases throughout follow-up and approximately 25–35 % of patients remain pacemaker dependent at one year. We aimed to review what is currently known about the dynamics of acquired conduction disorders, including extraction of predictors, and how to interpret these dynamics in light of an early discharge policy.
{"title":"Conduction dynamics over time after transcatheter aortic valve replacement: An expert review","authors":"Herbert G. Kroon, Thijmen Hokken, Maarten van Wiechen, Joris F.W. Ooms, Lennart van Gils, Isabella Kardys, Joost Daemen, Peter P.T. De Jaegere, Rutger-Jan Nuis, Nicolas M. Van Mieghem","doi":"10.1016/j.carrev.2024.08.005","DOIUrl":"10.1016/j.carrev.2024.08.005","url":null,"abstract":"<div><div>New conduction disorders remain a frequent complication in current transcatheter aortic valve replacement (TAVR) era. Left bundle branch block (LBBB) occurs early in about 20–30 % of TAVR-patients, persists at 1 month in about 35–45 % of cases and will likely remain thereafter. Third-degree atrioventricular block (AV3B) affects approximately 15 % of patients. Pacemaker dependency gradually decreases throughout follow-up and approximately 25–35 % of patients remain pacemaker dependent at one year. We aimed to review what is currently known about the dynamics of acquired conduction disorders, including extraction of predictors, and how to interpret these dynamics in light of an early discharge policy.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 92-102"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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