Journal of Invasive Cardiology最新文献

Objectives: The smoke-like effect (SE), the spontaneous echocardiographic contrast in the left atrium at transesophageal echocardiography, has been anecdotally reported after transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR), but uncertainty persists on its impact. Thus, the authors aimed at appraising the incidence, correlates, and outcomes of SE after TEER Methods. The authors conducted a retrospective multicenter observational study that included all patients in whom successful TEER with MitraClip (Abbott) had been completed. Smoke-like effect was defined as the presence of swirling spontaneous echocardiographic contrast in the left atrium. Baseline clinical characteristics, echocardiographic features, and procedural details were collected. Outcomes included death, reintervention, and rehospitalization for heart failure (HF).

Results: A total of 2228 patients were included, with 143 (6.4%) exhibiting SE. Several baseline differences disfavored these individuals, including age, functional class, surgical risk, and significant tricuspid regurgitation (all P less than .05). Procedurally, SE was associated with implantation of multiple MitraClips and longer procedures, but lower rates of significant residual MR (all P less than .05). Hospital outcomes were similarly favorable and the same held true for subsequent follow-up (average 19 months, all P greater than .05). The only exception was the risk of rehospitalization for HF, which appeared marginally significant disfavoring the SE group at unadjusted analysis (hazard ratio [HR] = 1.68 [95% CI, 1.04-2.70], P = .033). This association was, however, no longer significant when baseline differences were taken into account (HR = 1.52 [95% CI, 0.94-2.48], P = .091).

Conclusions: SE after TEER is not uncommon, and is typically associated with a significantly worse clinical profile, particularly prior atrial fibrillation. Irrespectively, SE is not associated with adverse outcomes in the short- or long-term. Accordingly, it should not be considered per se as an indication for more aggressive medical management, with antithrombotic regimens being instead informed by other more established indications.

Objectives: Paravalvular leak (PVL) is a complication of valve replacement that may result in hemolytic anemia. This study evaluated the long-term impact of transcatheter PVL closure (TPVLC) on hemolysis markers in affected patients.

Methods: This multicenter study included 39 patients who underwent TPVLC for hemolysis from February 2013 to March 2024. Lactate dehydrogenase (LDH), hemoglobin (Hb) and indirect bilirubin were assessed at baseline and at 1, 6, 12, and 24 months. A subgroup of patients who had received preprocedural blood transfusions was also analyzed. Secondary endpoints included procedure-related hemolysis and preprocedural predictors of hemolysis compared with a cohort treated for heart failure.

Results: In the overall cohort (n = 39), TPVLC resulted in a significant improvement in hemolysis markers. Indirect bilirubin levels significantly decreased from the first month (P = .001), while LDH levels showed a significant reduction from 6 months onwards (P = .02). Hb levels significantly increased from the first month (P = .009). In transfused patients, both LDH and indirect bilirubin levels significantly decreased from the first month (P = .006 and P = .005, respectively), whereas Hb levels demonstrated a significant increase from 6 months onwards (P = .011). Procedure-related hemolysis occurred in 3 (7.7%) patients. Predictors of hemolysis included mechanical prostheses (P = .008), mitral PVL (P = .002), and chronic kidney disease (P = .001).

Conclusions: TPVLC significantly improves hemolysis markers over long-term follow-up.

This study evaluates the procedural outcomes and short-term follow-up of the WATCHMAN FLX Pro left atrial appendage occlusion (LAAO) device (Boston Scientific) using the EXPRESS-LAAO protocol at a high-volume center. The new device offers enhanced features, including a 40-mm size for large anatomies, additional radiopaque markers for improved positioning, and a hemocompatible coating for faster endothelization. The EXPRESS-LAAO protocol streamlines patient management with pre-procedure computed tomography or cardiac magnetic resonance imaging, intracardiac echocardiography guidance, conscious sedation, and same-day discharge for stable patients. Between June and September 2024, 109 patients (median age 78 years, 48.6% female) underwent LAAO with the WATCHMAN FLX Pro device. Key indications included recurrent falls (33%), gastrointestinal bleeding (29.4%), and very high bleeding risk (21.1%). Procedural success was high (99.1%), with 1 case of cardiac tamponade requiring pericardiocentesis and no in-hospital complications. The 40-mm device was used in 7.3% of cases, proving essential for larger anatomies. At an average follow-up of 49.7 days, there was 1 lacunar stroke without device-related complications and 1 minor bleeding event. The study demonstrates the safety and effectiveness of the WATCHMAN FLX Pro device using the EXPRESS-LAAO protocol. The TruSteer catheter (Boston Scientific) facilitated implantations in complex anatomies, reducing the number of maneuvers. While post-LAAO imaging surveillance was a limitation, this is the first study assessing peri-procedural outcomes with the new device. Findings support its clinical utility in high-risk patients requiring LAAO.

Objectives: Transcatheter closure of paravalvular leaks (PVL) is an established treatment method. However, because of the frequent anatomical complexity of the PVL channel and lack of dedicated equipment, PVL crossing remains challenging. This study aims to provide an initial assessment of the safety and efficacy of using an angioplasty balloon to facilitate PVL passage.

Methods: The authors describe 12 cases of predilatation of the PVL tract using a coronary balloon after an attempt to pass the sheath was unsuccessful.

Results: In each case, the procedure was successful with final implantation of the occluder. No adverse events directly related to the technique were observed.

Conclusions: The technique of traversing the PVL channel using small coronary balloons may be an effective alternative method. Results of this registry are a preview of further research into the development and improvement of the described technique.

Objectives: An early invasive strategy is recommended for patients with acute myocardial infarction-related cardiogenic shock (AMICS). However, data on outcomes of patients undergoing early coronary angiography (CA) without subsequent percutaneous coronary intervention (PCI) are limited. The authors examined the characteristics and outcomes of patients with AMICS who underwent early CA and were treated with or without acute PCI.

Methods: The authors analyzed data from the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) CA registry. Patient characteristics, indications for CA, treatments, and in-hospital outcomes were collected and analyzed. All patients who underwent CA for AMICS were included.

Results: Between January 2009 and December 2020, 4290 patients with AMICS underwent CA within 24 hours after symptom onset. Patients referred to urgent coronary artery bypass grafting (CABG) were excluded. Among the remaining 4075 patients, 3249 (79.7%) underwent acute PCI, 428 (10.5%) had significant coronary artery disease (CAD) but were not treated with PCI, and 398 (9.8%) had no significant CAD. Patients who did not undergo PCI were older and more likely to have a history of prior PCI or CABG. The in-hospital mortality rate was 47.2% among patients without PCI, 41.9% among those treated with PCI, and 36.5% among those without significant CAD.

Conclusions: In this large, contemporary CA registry, approximately 10% of AMICS patients had significant CAD but did not undergo acute PCI; this subgroup exhibited high in-hospital mortality. Another 10% of patients had no significant CAD, with one-third dying during hospitalization. Further studies are needed to identify strategies to improve outcomes in these populations.