Journal of Invasive Cardiology最新文献

Objectives: Aortic stenosis (AS) is the most common valvular heart disease, with transcatheter aortic valve implantation (TAVI) now preferred for select severe cases. This study evaluated the early safety and performance of the new Myval Octacor Transcatheter Heart Valve (THV) (Meril Life Sciences), for which limited clinical data exist.

Methods: The authors retrospectively analyzed 43 consecutive patients with severe AS who underwent TAVI using the Myval Octacor THV at a tertiary cardiac center. Primary outcomes included all-cause mortality, stroke, major vascular complications, conduction abnormalities, new pacemaker implantation, paravalvular leak, and valve failure at 30 days follow-up.

Results: The median age was 81 years (IQR: 7), and 22 patients (51.2%) were female. Coronary artery disease was present in 24 (55.8%). Technical success rate was 100%. Mean pressure gradient decreased significantly post-procedure (55 mm Hg [IQR: 24] vs 5 mm Hg [IQR: 2]; P ≤ .001). No in-hospital deaths occurred. Two patients (4.7%) received permanent pacemakers during hospitalization, and 3 (7.0%) required pacemakers within a week because of conduction issues. Two patients (4.7%) experienced Bleeding Academic Research Consortium Type 3a bleeding. At 30 days, 42 patients remained in follow-up (98%), with 55% improved to New York Heart Association Class I. No vascular complications, stroke, acute kidney injury, valve thrombosis, or endocarditis occurred. One patient had valve failure from a significant paravalvular leak and 1 noncardiac death occurred 2 weeks post-discharge.

Conclusions: Early outcomes suggest that the Myval Octacor THV is a safe and effective option for TAVI in severe AS; however, larger studies with longer follow-up are required.

Objectives: Despite the preference for transradial access (TRA) in percutaneous coronary interventions (PCI), many operators still use large-bore guiding catheters through the transfemoral approach (TFA), especially in complex cases. This study evaluated the feasibility, safety, and efficacy of the Distal RailTracking (DRT) technique, a sheathless approach via distal radial access (DRA), and investigated its impact on clinical practice.

Methods: The multicenter SWITCH D-RIL study enrolled patients who required treatment of severely calcified coronary disease by rotational atherectomy, and compared those who underwent PCI before (pre-DRT, n = 97) and after (post-DRT, n = 99) DRT was adopted as the primary approach.

Results: Procedural success rates without access site crossover were similar between groups. No significant differences were found in periprocedural complications, in-hospital and 30-day major adverse cardiovascular events, and access- and non-access-related major bleedings. The post-DRT group exhibited a significantly higher use of large-bore guiding catheters (97.1% vs 31.7%). Overall, DRA was used in 90.5% of cases in the post-DRT group, with TFA accounting for 9.5%; the pre-DRT group primarily employed conventional TRA (82.2%), with the remaining cases involving TFA and 1 transbrachial access. The post-DRT group demonstrated increased usage of burrs larger than 1.5 mm (51.4% vs 13.9%) and additional calcium modifying tools (42.9% vs 24.8%).

Conclusions: The DRT technique demonstrated feasibility, safety, and efficacy in treating severely calcified coronary disease. This study highlights the reliability of DRA, even when large bore guiding catheters are necessary, emphasizing its potential to provide a safer approach while ensuring radial artery preservation.

Objectives: Endovascular repair of coarctation of the aorta (CoA) can be challenging in the presence of arch angulation, post-stenotic dilation, or prior surgical repair, which may limit the performance of balloon-expandable covered stents. To address these anatomic constraints, the authors evaluated the use of a self-expanding thoracic aortic endoprosthesis for CoA repair.

Methods: The authors performed a multicenter retrospective review of patients who underwent endovascular repair of native or recurrent CoA using the GORE TAG Thoracic Branch Endoprosthesis Extender or GORE TAG Conformable Thoracic Stent Graft (W.L. Gore & Associates) between January 1, 2023, and December 31, 2025.

Results: Thirteen patients (median age 32 years; range, 21-49 years; 77% male) underwent endovascular treatment. All patients exhibited significant baseline peak-to-peak gradients (median = 23 mm Hg; IQR: 10, 27). Hemodynamic resolution was achieved in all cases (median = 0 mm Hg; IQR: 0, 2; P < .001). Median waist diameter increased from 11 mm (IQR: 9, 12) to 20 mm (IQR: 18, 22) (P < .001). Aortic isthmus ratio increased from 0.46 (IQR: 0.39, 0.54) to 0.87 (IQR: 0.77, 0.92) (P < .001). No intraprocedural complications were observed.

Conclusions: Self-expanding thoracic endografts demonstrated excellent conformability, effective gradient elimination, and early procedural success in the treatment of CoA. Continued follow-up, including protocolized imaging, will be essential to assess mid- and long-term durability and to define the role of this approach in patients with complex aortic anatomy.