Journal of Invasive Cardiology最新文献

Objectives: The benefits of distal (dTRA) over proximal transradial access (pTRA), mainly faster hemostasis and fewer radial artery occlusion, have been highlighted. Nevertheless, data addressing chronic vs acute coronary syndromes peculiarities are lacking; thus this study aimed to assess those differences.

Methods: The authors conducted a retrospective analysis of 6871 consecutive and all-comers patients from a real-world, large-scale registry of routine coronary angiography and/or percutaneous coronary intervention (PCI) via dTRA.

Results: Mean patient ages were 63.8 ± 15.7, 64.8 ± 15.7, and 62.9 ± 16 years for total, chronic, and acute coronary syndromes groups, respectively. In the chronic coronary syndromes group (n = 2,767, 40.3%) there was predominance of hypertension (83.5% vs 72.9%; P less than .001), diabetes (46.2% vs 37.4%; P less than .001), previous PCI (37.2% vs 20.2%; P less than .001) or coronary bypass surgery (4.9% vs 2.7%; P less than .001), previous ipsilateral pTRA (13.9% vs 8.5%; P less than .001) or dTRA (21.7% vs 8.9%; P less than 0.001) sheath insertion, and ultra-low contrast procedures (66.5% vs 61.2%; P less than .001). In the acute coronary syndromes group, there was predominance of male patients (66.9% vs 63.3%; P = .002), smokers (53.9% vs 45.6%; P less than .001), total amount of PCI (72.3% vs 48.5%; P less than .001), and right dTRA (85.3% vs 70.3%; P less than .001). No major adverse events directly related to dTRA were recorded.

Conclusions: When performed by proficient operators, routine coronary procedures via dTRA appear to be safe and feasible in both chronic and acute coronary syndromes, with similar low rates of access-site crossovers and complications.

Objectives: The authors hypothesized that the origin of the right coronary artery (RCA) is a direct continuation of the major aortic arch branches (MAAB) takeoff plane, which may have implications for brachiocephalic interventions and next generation transcatheter aortic valve intervention (TAVI) embolic protection devices (EPDs).

Methods: In this single-center, retrospective, cross-sectional study, the authors analyzed computed tomographic angiography (CTA) images from 92 patients undergoing TAVI evaluation to determine the spatial relationship between the origin of the RCA and the MAAB takeoff plane. Patients with prior cardiothoracic or aortic interventions and those with anomalous RCA origin were excluded. Using double oblique imaging planes, the authors assessed whether the RCA and MAAB takeoffs were visualized within the same sagittal plane.

Results: The mean age of the patients was 76.4 years; 52% were female. Most patients had hypertension (90%), coronary artery disease (65%), or a history of smoking (47%). The RCA origin aligned with the forward and downward continuation of the MAAB plane in 77.1% of the patients.

Conclusions: This novel anatomical relationship, not previously described in literature, may be clinically useful during cardiac catheterization when cannulating brachiocephalic vessels to visualize right and left internal mammary arteries and during brachiocephalic interventions such as subclavian and carotid stenting. Additionally, the findings suggest that some third generation TAVI EPDs with anchoring probes resting in the aortic root may lie in close proximity to the RCA ostium. This proximity could hinder urgent RCA cannulation during TAVI procedures. As new EPD designs gain traction globally, it is essential for TAVI operators to understand this anatomical nuance.

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.