Journal of Invasive Cardiology最新文献

Objectives: The ValveClamp system (Hanyu Medical Technology) is a novel transcatheter edge-to-edge repair (TEER) system designed for ease of operation; however, there is a lack of data on its application in secondary mitral regurgitation (SMR). The authors report the mid-term outcomes of TEER using the ValveClamp system in SMR.

Methods: The study prospectively analyzed consecutive severe SMR patients who underwent transapical ValveClamp implantation at 10 Chinese centers. The enrolled patients were categorized into atrial SMR (aSMR) and ventricular SMR (vSMR) groups. Clinical and echocardiographic outcomes were evaluated at baseline and at follow-up.

Results: A total of 19 aSMR and 24 vSMR patients were enrolled. Technical success was achieved in 100% of the patients and the overall 30-day device success rate was 88.37%. At 1 year, sustained MR reduction to less than or equal to 1+ was achieved in 76.47% of aSMR cases and 77.27% of vSMR cases, and positive reverse left cardiac remodeling was observed. The estimated overall 1-year survival and HF rehospitalization rates for aSMR and vSMR were 83.33% and 83.59%, respectively (log rank P = .98), and improvement of New York Heart Association functional class and Kansas City Cardiomyopathy Questionnaire score were observed in both groups. In multivariable logistic analysis, a lower leaflet-to-annulus index (LAI) (odds ratio [OR], 0.021; 95% CI, 0.001-0.042; P = .02) and a narrow MR jet type (OR, 12.029; 95% CI, 1.530-94.592-0.990; P = .02) were independently associated with a higher incidence of a residual MR of at least 2+ at 3 months after TEER.

Conclusions: TEER using the ValveClamp system is a safe and feasible therapeutic option for patients with SMR regardless of MR etiology. A lower LAI and a narrow MR jet type were independent predictors of residual MR at follow-up.

The authors propose a modified transcatheter aortic valve replacement technique wherein the removal of the guidewire and delivery catheter immediately after the valve implantation helps to not only shorten the procedure but also decrease complications induced by the guidewire and delivery catheter.

Background: The use of the Ostial Flash balloon (Ostial Corporation) has received limited study in aorto-ostial chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).

Methods: The authors evaluated the outcomes of Ostial Flash balloon use in a large CTO-PCI registry (PROGRESS-CTO, NCT02061436).

Results: The Ostial Flash balloon was used in 54 of 907 aorto-ostial CTO PCIs in 905 patients (6.0%). The mean patient age was 65.1 ± 10.7 and 80.6% were men, with a high prevalence of diabetes mellitus, hypertension, prior PCI, and prior myocardial infarction. The mean occlusion length was 40.5 ± 25.1 mm, 52.2% had moderate to severe calcification, and the mean Japanese-CTO score was 2.8 ± 1.1. Lesions treated with the Ostial Flash balloon were more frequently located in the right aorto-ostium (79.6% vs 66.0%, P = .002). In the Ostial Flash group, the most common successful CTO crossing technique was antegrade wiring (46.3%), followed by the retrograde approach (40.7%); intravascular imaging was used in 61.1% of cases. Technical success (92.6% vs 87.9%, P = .300) and the incidence of major adverse cardiac events (MACE) (5.6% vs 3.6%, P = .450) was similar in the Ostial Flash vs non-Ostial Flash patients, respectively. In multivariable analysis, PCI of proximal right coronary artery CTOs was independently associated with use of the Ostial Flash balloon (odds ratio 2.2; 95% CI, 1.1-4.8; P = .036).

Conclusions: The Ostial Flash balloon is infrequently used in aorto-ostial CTO PCI. Although there were no differences in MACE with use of the balloon, randomized controlled trials are needed to determine its effectiveness.

Background: Upfront 2-stent techniques are often used in bifurcation percutaneous coronary interventions (PCI), but there is controversy about optimal strategy selection.

Methods: The authors examined the clinical and angiographic characteristics and long-term outcomes of 232 bifurcation PCIs that were performed using the double kissing (DK) crush or culotte technique in 216 patients between 2014 and 2023 using data from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (NCT05100992). The inverse probability of treatment weighted (IPTW) Cox proportional hazards model was used to assess long-term outcomes.

Results: DK crush was more commonly used (69.0%). Patients in the DK-crush group had similar baseline characteristics to those in the culotte group. Lesions treated with DK crush were more likely to be in the left main coronary artery (42.9% vs 15.5%, P less than .001), had larger proximal (3.50 [3.50-4.00] vs 3.50 [3.21-3.79] mm, P = .027) and distal (3.00 [3.00-3.50] vs 3.00 [2.75-3.25] mm, P = .047) main vessel diameter, and were more likely to have severe calcification (29.8% vs 5.6%, P less than .001). Technical (98.8% vs 97.2%, P = .588), procedural success (96.5% vs 95.1%, P = .698), and in-hospital major adverse cardiovascular events (MACE) (6.1% vs 3.0%, P = .509) were similar in both groups. During a median follow-up of 43 months, 60 (33.9%) patients experienced MACE. On IPTW adjusted Cox analysis, DK crush was associated with lower follow-up MACE (hazard ratio 0.28; 95% CI, 0.13-0.60; P = .001) compared with culotte driven by lower target vessel revascularization (TVR) (14.3% vs 29.3%, P = .029).

Conclusions: Compared with culotte, DK crush is associated with similar periprocedural outcomes but lower TVR and MACE during follow-up.