Journal of Invasive Cardiology最新文献

Objectives: Systematic reviews and meta-analyses have highlighted the benefits of distal over proximal transradial access, including lower rates of radial artery occlusion and faster hemostasis. Despite the increasing adoption of distal transradial access by interventionalists, there is a lack of data addressing gender-specific differences. This study aimed to assess those differences in routine coronary procedures via distal transradial access.

Methods: The authors conducted a retrospective analysis of a large, real-world sample of 6871 consecutive all-comers who underwent coronary procedures via distal transradial access using data from the DISTRACTION registry.

Results: The mean patient ages were 63.8 ± 15.7 years, 63.5 ± 17.7, and 64.4 ± 11.1 years for total, male, and female groups, respectively; 65% of the patients were male. In the female group, there was statistically significant predominance of hypertension (82.2% vs 74%), diabetes (46.8% vs 37%), obesity (29.3% vs 22.2%), severe mitral valve disease (3.1% vs 1.1%), coronary angiography-only (48.7% vs 36%), and access-site crossovers (3.1% vs 1.5%). In the male group, there were more rates of former or current smoking (54.2% vs 40.8%), previous percutaneous coronary intervention (PCI) (29.8% vs 19.7%), previous coronary artery bypass grafting (4.5% vs 1.9%), ST-segment elevation myocardial infarction (24.2% vs 18.5%), PCI (66.1% vs 52.5%), left main PCI (2.6% vs 1.7%), redo right distal transradial access (15.3% vs 9.9%), and 7F sheath size (2.6% vs 0.9%). No major adverse cerebrovascular and cardiac events directly related to distal transradial access, no hand/thumb dysfunction or ischemia after any procedure, and no relevant access-site-related bleeding were recorded.

Conclusions: The adoption of distal transradial access by proficient operators as the default approach for routine coronary procedures appears to be safe and feasible in both male and female patients, with very low rates of access site crossovers and complications.

Objectives: Increasing atrial fibrillation (AF) disease-related healthcare burden, coupled with positive evidence on catheter ablation for AF, has led to pressure on hospital procedure efficiency. Medtronic's Sphere-9 system (a novel lattice-tip dual-energy pulsed field and radiofrequency [RF] ablation catheter) demonstrated non-inferiority in effectiveness and superiority in procedural times compared with a contact-force sensing RF catheter (ThermoCool SmartTouch SF [STSF]). This analysis evaluated the impact of procedural efficiencies on electrophysiology (EP) lab utilization.

Methods: A discrete event simulation model evaluated EP lab efficiency using procedure times from the SPHERE Per-AF trial for pulmonary vein isolation-only cases and those with additional ablation lesion sets. Lab day ran from 7 am to 7 pm with 1 hour needed to perform an additional non-ablation EP case, and same-day discharge was allowed for cases ending by 5 pm.

Results: Analysis included 211 patients in the Sphere-9 arm and 207 in the STSF arm. Procedure times were 100.8 ± 31 minutes for Sphere-9 and 125.9 ± 49 for STSF. Sphere-9 resulted in more than a 10-fold reduction in cumulative overtime hours (41 hours for Sphere-9 vs 424 for STSF). Overtime occurred on 7% of lab days with Sphere-9 and 36% with STSF. Additionally, 73% of Sphere-9 lab days allowed for 1 additional non-ablation EP case compared with 40% of STSF lab days. Finally, 38% of Sphere-9 lab days allowed for same-day discharge for the third case compared with 17% of STSF lab days.

Conclusions: In patients with persistent AF, the Sphere-9 system was more efficient and predictable compared with STSF, leading to significant improvements in EP lab efficiency.

Objectives: Transcatheter tricuspid valve-in-valve (ViV) replacement has emerged as a less invasive alternative to redo surgery in patients with failing bioprosthetic tricuspid valves. While short- and mid-term outcomes have been reported, data on long-term follow-up remain limited.

Methods: The authors conducted a single-center observational study including 12 consecutive patients who underwent transcatheter tricuspid ViV replacement. Clinical, echocardiographic, and procedural data were prospectively collected. Patients were followed at 1 and 12 months, and yearly thereafter; follow-up included annual clinical visits and echocardiography.

Results: The mean age of the patients was 45 years (range, 23-69 years); 92% were women, and the indication for ViV was prosthetic valve regurgitation in most (58%) cases. A balloon-expandable SAPIEN valve (Edwards Lifesciences) was implanted in all cases, with 100% procedural success. After a mean follow-up of 6 years (range, 1-11 years), 3 (25%) patients died, and 1 was readmitted because of heart failure. Functional status improved significantly, with all surviving patients in New York Heart Association class I or II at last follow-up. Transvalvular gradients remained stable over time in 83% of the patients. Two (17%) patients developed bioprosthetic valve dysfunction during follow-up: one due to significant tricuspid stenosis and the other due to severe tricuspid regurgitation.

Conclusions: Tricuspid ViV replacement offers durable symptomatic improvement and stable prosthesis function during long-term follow-up in most cases. This study is the first to report outcomes greater than or equal to 5 years in this population and supports the continued use of ViV as a viable option for these patients. Larger studies are warranted to validate these findings.

Objectives: Current guidelines recommend patent foramen ovale (PFO) closure in patients with cryptogenic stroke, while atrial septal defect (ASD) closure is indicated for a shunt with right atrial/right ventricular (RV) enlargement. Major procedural complication rates from PFO/ASD closure are low. However, there is a theoretical risk of thrombus formation early after implantation, prior to endothelialization of the device, that may be prevented by dual antiplatelet therapy (DAPT). There is little data on the optimal timing and duration of DAPT post-device placement; thus, this study aimed to evaluate the safety of shortened DAPT after PFO/ASD closure with respect to device thrombosis and clinical stroke.

Methods: One hundred ninety-four patients 18 years or older who underwent transcatheter PFO/ASD closure from 2010 to 2021 were included in the study. The primary outcome was the rate of device thrombosis at 1 year. The secondary outcome was stroke and peripheral embolization at 1 year.

Results: Closures were primarily performed for cryptogenic stroke (41.9%) and ASD closure for RV enlargement (26.9%). The average length of DAPT was 2.91 ± 2.6 months. At 1 year, there were no cases of device thrombosis or embolization.

Conclusions: This study suggests that 3 months or less of DAPT may be safe in patients after percutaneous PFO/ASD closure.

Background: Operator radiation exposure (ORE) is one of the most adverse occupational hazards faced by interventional cardiologists. The presence of subclavian tortuosity can influence ORE.

Methods: This single-center retrospective study compared the cumulative radiation (CR) exposure in μSv and normalized radiation exposure (CR/DAP) of the primary operator during cardiac catheterization of all patients with subclavian tortuosity from left (LRA) and right radial artery approaches (RRA). ORE was measured at 4 anatomical locations: thorax, abdomen, left eye, and right eye.

Results: CR dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .004), right eye (P = .01), thorax (P = .01) and abdomen (P = .01). CR/DAP dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .04) and right eye (P = .03).

Conclusions: In cases with subclavian tortuosity, the LRA was associated with less CR to the operator than the RRA. The LRA was also associated with less CR/DAP that persisted at the anatomical location of the left eye. The authors recommend operators have time thresholds to exchange for appropriate catheters in patients with subclavian tortuosity. Furthermore, operators should consider time thresholds to change access sites to avoid potential procedural complications and excessive fluoroscopic times.