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Safety and efficacy of covered stent grafts in the treatment of emergent access related complications. 有盖支架移植物治疗紧急入路相关并发症的安全性和有效性。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-16 DOI: 10.1016/j.carrev.2024.08.011
Michael Wilderman, Kazuya Tateishi, David O'Connor, Sophia Simonian, Anjali Ratnathicam, Kristen Cook, Lucius De Gregorio, Hosam Hmoud, Joseph De Gregorio

Background: Large bore percutaneous access is becoming increasingly common. Parallel to this, we observe an increase in vascular access site complications such as bleeding, dissection, thrombosis or pseudo-aneurysms. This study was aimed to evaluate safety and efficacy of covered stent grafts for fixing large bore vascular access injuries.

Methods: A total of 147 Viabahn or Viabahn VBX (WL Gore) stent grafts which were placed across the inguinal ligament in emergent settings in 136 patients, were retrospectively analyzed. The two endpoints were the technical success rate, defined by complete arterial repair, and long-term stent graft patency. We also looked at the need for open conversion, wound infections, and in hospital and 30-day mortality. We followed the patients using duplex ultrasound and computed tomography angiogram to assess for arterial patency, freedom from intervention, stent kinking and clinical symptoms.

Results: 30 Viabahn and 117 Viabahn VBX (WL Gore) stent grafts were placed in the distal external iliac artery and into the proximal common femoral artery of 136 patients. Indications for intervention were bleeding in 92 patients (68 %), flow limiting dissection in 41 patients (30 %) and symptomatic AVF in 3 patients (2 %). Primary technical success rate was 100 %. Limited 3-year follow up (101/136 patients) showed 99 % patency with no evidence of stent fracture, stenosis or kinking except in one patient who needed target lesion revascularization due to neointimal hyperplasia.

Conclusions: Covered stent grafts can be placed safely, efficiently, and effectively in the distal external iliac and common femoral arteries across the inguinal ligament. These stent grafts can be used as an alternative therapeutic option to open surgery in patients with large bore vascular access injuries.

背景:大口径经皮入路越来越普遍。与此同时,我们发现血管通路部位的并发症也在增加,如出血、夹层、血栓或假性动脉瘤。本研究旨在评估覆盖支架移植物固定大口径血管通路损伤的安全性和有效性:回顾性分析了 136 名患者的 147 个 Viabahn 或 Viabahn VBX(WL 戈尔公司)支架移植物,这些移植物都是在紧急情况下穿过腹股沟韧带植入的。两个终点分别是技术成功率(以动脉完全修复为标准)和支架移植物的长期通畅率。我们还考察了患者是否需要进行开放性转流、伤口感染以及住院和 30 天死亡率。我们使用双相超声波和计算机断层扫描血管造影术对患者进行随访,以评估动脉通畅度、无介入治疗、支架扭结和临床症状:在136名患者的髂外动脉远端和股总动脉近端分别植入了30枚Viabahn和117枚Viabahn VBX(WL戈尔)支架移植物。92 名患者(68%)的介入指征为出血,41 名患者(30%)为血流受限夹层,3 名患者(2%)为症状性动静脉瘘。初次技术成功率为 100%。为期3年的有限随访(101/136例患者)显示,支架通畅率为99%,无支架断裂、狭窄或扭结迹象,只有一名患者因新血管内膜增生而需要进行靶病变血管再通手术:结论:覆盖支架移植物可以安全、高效、有效地穿过腹股沟韧带植入髂外动脉和股总动脉远端。这些支架移植物可作为大口径血管通路损伤患者开放手术的替代治疗方案。
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引用次数: 0
Conduction dynamics over time after transcatheter aortic valve replacement: An expert review. 经导管主动脉瓣置换术后随时间变化的传导动力学:专家点评。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-16 DOI: 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.

在目前的经导管主动脉瓣置换术(TAVR)时代,新的传导障碍仍然是一种常见的并发症。左束支传导阻滞(LBBB)在大约20%-30%的TAVR患者中早期出现,大约35%-45%的病例在1个月后持续存在,并且可能会一直存在。约15%的患者会出现三度房室传导阻滞(AV3B)。起搏器依赖性在随访过程中逐渐降低,大约 25%-35% 的患者在一年后仍然依赖起搏器。我们旨在回顾目前对获得性传导障碍动态变化的了解,包括提取预测因素,以及如何根据早期出院政策解释这些动态变化。
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引用次数: 0
Aortic balloon valvuloplasty outcome according to calcium distribution and valve geometry - The ABCD study. 根据钙分布和瓣膜几何形状得出的主动脉球囊瓣膜成形术结果--ABCD 研究。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-16 DOI: 10.1016/j.carrev.2024.08.004
Gianni Dall'Ara, Sara Piciucchi, Carolina Moretti, Caterina Cavazza, Miriam Compagnone, Giuseppe Guerrieri, Simone Grotti, Daniela Spartà, Roberto Carletti, Elisabetta Fabbri, Emanuela Giampalma, Andrea Santarelli, Filippo Ottani, Marco Balducelli, Francesco Saia, Fabio Felice Tarantino, Marcello Galvani

Background: There is little data on the outcome of balloon aortic valvuloplasty (BAV) in relation to valve dimensions and calcification patterns. The procedure is not standardized, particularly the choice of balloon size.

Methods: This retrospective multicenter study focused on BAV efficacy and safety by analyzing the relationship between balloon size, annulus geometry (i.e., diameters, perimeter, and area), and calcification patterns (total burden and calcium distribution over each individual leaflet). From March 2018 to March 2023, all consecutive patients who underwent clinically indicated BAV and ECG-gated multidetector computed tomography of the aorta were included, except those with a bicuspid valve. Calcium score was calculated on contrast-enhanced images based on a luminal attenuation threshold of +100 HU.

Results: One hundred and fifteen patients were included. Procedural success was 82.6 %. The balloon-to-annulus ratio (BAR) relative to diameter, perimeter, and area was higher in patients with successful BAV. Patients with unsuccessful BAV had a significantly higher aortic valve calcium burden. The complication rate was 4.3 % and there was no association with valve geometry or calcium burden. A trend towards a reduced complication rate was found as calcium asymmetry increased. BAR minimum annulus diameter was the best parameter in predicting procedural success, with a cut-off at 0.85.

Conclusions: BAV efficacy is correlated directly with balloon size in relation to annulus dimension and inversely with total calcium burden. The minimum diameter of the valve may be adopted as a reference for balloon sizing.

背景:关于球囊主动脉瓣成形术(BAV)的结果与瓣膜尺寸和钙化模式的关系的数据很少。该手术没有标准化,尤其是球囊大小的选择:这项回顾性多中心研究通过分析球囊大小、瓣环几何形状(即直径、周长和面积)和钙化模式(总负荷和钙在每个瓣叶的分布)之间的关系,重点研究主动脉瓣成形术的疗效和安全性。从 2018 年 3 月至 2023 年 3 月,所有接受有临床指征的 BAV 和心电图门控主动脉多矢量计算机断层扫描的连续患者均被纳入研究,但双尖瓣患者除外。根据+100 HU的管腔衰减阈值计算造影剂增强图像的钙化评分:结果:共纳入 115 名患者。手术成功率为 82.6%。相对于直径、周长和面积,成功 BAV 患者的球囊与窦腔比率(BAR)更高。BAV手术不成功的患者主动脉瓣钙负荷明显较高。并发症发生率为 4.3%,与瓣膜几何形状或钙质负荷无关。随着钙质不对称程度的增加,并发症发生率呈下降趋势。BAR最小瓣环直径是预测手术成功的最佳参数,临界值为0.85:BAV疗效与球囊大小和瓣环尺寸直接相关,而与总钙负荷成反比。瓣膜的最小直径可作为球囊大小的参考。
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引用次数: 0
Microcirculatory status after intravascular lithotripsy: The MARVEL study. 血管内碎石术后的微循环状态:MARVEL 研究。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-16 DOI: 10.1016/j.carrev.2024.08.009
Frederic Bouisset, Javier Escaned, Daniel Munhoz, Takuya Mizukami, Ruiko Seki, Carlos H Salazar, Jeroen Sonck, Nieves Gonzalo, Bernard De Bruyne, Carlos Collet
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引用次数: 0
Risk factors for early mortality following transcatheter edge-to-edge repair of mitral regurgitation. 经导管边缘到边缘二尖瓣反流修复术后早期死亡率的风险因素。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-15 DOI: 10.1016/j.carrev.2024.08.001
Yong-Hao Yeo, Jia-Yean Thong, Min-Choon Tan, Qi-Xuan Ang, Boon-Jian San, Bryan E-Xin Tan, Arka Chatterjee, Kwan Lee

Background: While transcatheter edge-to-edge repair (TEER) with MitraClip is increasingly used, data on the risk stratification for assessing early mortality after this procedure are scarce.

Objective: This study aimed to assess early mortality and analyze the risk factors of early mortality among patients who underwent TEER.

Methods: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the risk factors associated with early mortality.

Results: A total of 15,931 patients who had TEER were included; 292 (1.8 %) with early mortality and 15,639 (98.2 %) without. There was a decreasing trend in early mortality from 2.8 % in the first quarter of 2017 to 1.2 % in the fourth quarter of 2020, but it was not statistically significant (p = 0.18). In multivariable analysis, the independent risk factors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95 % confidence interval [CI]: 1.11-2.22, p = 0.01), end-stage renal disease (aOR: 2.34; CI: 1.44-3.79, p < 0.01), chronic liver disease (aOR: 4.90; CI: 3.29-7.29, p < 0.01), coagulation disorder (aOR: 3.42; CI: 2.35-5.03, p < 0.01), systolic heart failure (aOR: 2.81; CI: 1.34-5.90, p < 0.01), diastolic heart failure (aOR: 2.69; CI: 1.24-5.84, p = 0.01) and unspecified heart failure (aOR: 3.23; CI: 1.49-7.01, p < 0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2 %) and infection (26.6 %), respectively.

Conclusion: The early mortality following TEER was low at 1.8 %. The independent risk factors associated with early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure (both systolic and diastolic).

背景:虽然使用MitraClip进行经导管边缘到边缘修补术(TEER)的患者越来越多,但评估该手术后早期死亡率的风险分层数据却很少:本研究旨在评估接受 TEER 患者的早期死亡率,并分析早期死亡率的风险因素:我们的研究使用了具有全国代表性的全国再入院数据库(Nationwide Readmissions Database),纳入了在 2017 年 1 月至 2020 年 11 月期间接受 TEER 的 18 岁或以上患者。我们根据早期死亡(术后 30 天内死亡)的发生率将队列分为两组。根据ICD-10,我们确定了TEER术后早期死亡的趋势,并进一步分析了与早期死亡相关的风险因素:共纳入 15,931 例 TEER 患者,其中 292 例(1.8%)有早期死亡,15,639 例(98.2%)无早期死亡。早期死亡率呈下降趋势,从2017年第一季度的2.8%降至2020年第四季度的1.2%,但无统计学意义(P = 0.18)。在多变量分析中,早期死亡的独立风险因素是不需要透析的慢性肾病(调整后的几率比 [aOR]:1.57; 95 % 置信区间 [CI]:1.11-2.22,P = 0.01)、终末期肾病(aOR:2.34;CI:1.44-3.79,P = 0.01)、急性肾衰竭(aOR:2.34;CI:1.44-3.79,P = 0.01TEER 的早期死亡率较低,仅为 1.8%。与早期死亡率相关的独立风险因素是慢性肾病(包括终末期肾病)、慢性肝病、凝血功能障碍和心力衰竭(收缩期和舒张期)。
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引用次数: 0
The impact of stress testing to guide PCI in patients with chronic coronary disease. 压力测试对慢性冠心病患者PCI的指导作用。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-15 DOI: 10.1016/j.carrev.2024.08.010
Garry W Hamilton, Anoop N Koshy, Diem Dinh, Angela Brennan, Julian Yeoh, Matias B Yudi, Mark Horrigan, Christopher M Reid, Dion Stub, William Chan, Ernesto Oqueli, Melanie Freeman, Chin Hiew, Andrew Ajani, Omar Farouque, David J Clark

Background: Guidelines and international appropriate use criteria increasingly endorse non-invasive stress testing to evaluate patients with suspected chronic coronary disease (CCD). We sought to review the real-world utilisation of non-invasive stress testing and investigate whether their use prior to PCI associates with outcomes in patients with CCD.

Methods: Consecutive patients from a multicentre registry who underwent PCI for CCD between 2006 and 2018 were included. Clinical characteristics and outcomes were stratified according to whether stress testing was performed prior to PCI (stress vs no-stress groups). The primary outcome was 3-year all-cause mortality.

Results: Among the 8251 patients included, 4970 (60.2 %) underwent pre-PCI stress testing and this proportion increased over time (p-for-trend<0.001). The stress group had a lower prevalence of prior revascularization, myocardial infarction, or heart failure, and a lower incidence of triple vessel disease, in stent re-stenosis, and ACC/AHA class B2/C lesions (all p < 0.001). When comparing post-procedural outcomes, the stress group had lower rates of arrhythmia (1.5 % vs 2.6 %, p = 0.001), new heart failure (0.2 % vs 0.8 %, p = 0.001), renal impairment, and a shorter length of stay (1.6 vs 2.1 days, p < 0.001). Mortality at 3-years was lower in those undergoing PCI following stress testing (5.8 % vs 8.8 %, p < 0.001). After adjusting for key clinical variables, stress guided revascularization was associated with a significantly lower risk of 3-year mortality (adjusted Hazard Ratio 0.77, 95 % CI 0.64-0.92).

Conclusions: In patients with CCD, PCI guided by non-invasive stress testing is increasingly utilized and associated with improved survival. Further studies are necessary to investigate whether this results from differences in patient characteristics, optimized patient selection, or refined choice of target vessel.

背景:越来越多的指南和国际适当使用标准认可用无创压力测试来评估疑似慢性冠状动脉疾病(CCD)患者。我们试图回顾无创压力测试在现实世界中的使用情况,并研究PCI术前使用无创压力测试是否与CCD患者的预后有关:方法:纳入2006年至2018年期间因CCD接受PCI治疗的多中心登记的连续患者。根据 PCI 前是否进行压力测试对临床特征和预后进行分层(压力组与无压力组)。主要结果是3年全因死亡率:结果:在纳入的 8251 例患者中,4970 例(60.2%)接受了 PCI 前压力测试,且这一比例随着时间的推移而增加(p-for-trend):在CCD患者中,越来越多的患者在无创压力测试的指导下进行PCI,这与生存率的提高有关。有必要开展进一步的研究,以探讨患者特征的差异、患者选择的优化或靶血管选择的改进是否会导致这一结果。
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引用次数: 0
Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock 静脉体外膜氧合治疗急性心肌梗死并发心源性休克的疗效
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.carrev.2024.04.081
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引用次数: 0
In-Hospital Safety and Effectiveness of Non-Emergent, MCS-Supported High-Risk PCI Procedures: A Comprehensive Propensity-Score Matched Analysis of Contemporary, Large-Scale Claims Dataset 非紧急、MCS 支持的高风险 PCI 程序的院内安全性和有效性:对当代大规模索赔数据集的倾向分数匹配综合分析
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.carrev.2024.04.065
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引用次数: 0
Transcatheter Interventions for Acute Pulmonary Embolism in Patients With Underlying Malignancy: A Propensity-Matched Nationwide Study 经导管介入治疗恶性肿瘤患者的急性肺栓塞:倾向匹配全国性研究
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.carrev.2024.04.113
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引用次数: 0
Impact of the Use of Plaque Modification Techniques on Coronary Microcirculation Using an Angiography-Derived Index of Microcirculatory Resistance. 使用血管造影得出的微循环阻力指数,分析斑块修饰技术的使用对冠状动脉微循环的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.carrev.2024.04.119
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引用次数: 0
期刊
Cardiovascular Revascularization Medicine
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