Eurointervention最新文献

Calcified nodules (CNs) represent significant challenges in percutaneous coronary intervention (PCI) due to their complex morphology, variable treatment responses, and association with stent failure due to reprotrusion or stent underexpansion. CNs are classified into eruptive and non-eruptive subtypes, each with distinct histological features and prognostic implications. Eruptive CNs are biologically active, being associated with a disrupted fibrous cap, overlying thrombus, and intraplaque haemorrhage, and they are thus more readily deformable by balloon dilation during PCI. Non-eruptive CNs, or nodular calcifications, tend to be stable, with an intact fibrous cap, and their deformability varies depending on the composition and base of the nodules. Enhanced angiography and intravascular imaging have greatly improved our understanding of CNs and may help to accurately identify nodule subtypes and guide treatment. Furthermore, understanding the deformability of CNs is crucial for optimising treatment outcomes. In this review, we discuss the identification and management of CNs in the context of PCI.

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represents a unique clinical syndrome, comprising non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. NSTEMI, as the more common and serious form of NSTE-ACS, is particularly noteworthy because of its diverse clinical presentation, electrocardiogram changes, and angiography findings, which may pose challenges in diagnosis and treatment and may subsequently influence prognosis. This review offers a comprehensive overview of current evidence-based approaches to NSTE-ACS management, focusing on diagnosis, risk stratification, and treatment strategies while highlighting emerging trends and ongoing challenges in optimising patient outcomes.

Up to one-third of patients referred for transcatheter tricuspid valve intervention (TTVI) have a transvalvular pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead in place. Both the electrophysiology and interventional cardiology communities have been alerted to the complexity of decision-making in this situation due to potential interactions between the leads and the TTVI material, including the risk of jailing or damage to the leads. This document, commissioned by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, reviews the scientific evidence to inform Heart Team discussions on the management of patients with a PPM or ICD who are scheduled for or have undergone TTVI. Graphical abstract.

Background: Given the poor prognosis of tricuspid regurgitation (TR) patients, there is growing interest in addressing TR, particularly since the emergence of novel transcatheter tricuspid valve interventions for patients at high risk for surgery.

Aims: The TRICURE first-in-human (FIH) study evaluates the initial feasibility and clinical safety of the Topaz transcatheter tricuspid valve replacement (TTVR) system in treating TR. Featuring a novel dual-stent design, the system is specifically engineered for the unique anatomy of the tricuspid valve. It has a flexible outer stent with low radial force designed to accommodate annular dynamics and conform to the non-circular, variable shapes of the tricuspid valve, coupled to a rigid inner stent aiming to maintain valve function integrity.

Methods: TRICURE FIH is a prospective, multicentre, first-in-human study with follow-up extending to 5 years. The primary safety endpoint is a composite measure including all-cause mortality, heart failure rehospitalisation, and reintervention for failed tricuspid therapy at 30 days. The primary performance endpoint is device success, defined as a TR reduction ≥1 grade with no more than moderate TR post-procedure.

Results: A total of 20 patients were enrolled. The procedure time (from delivery system insertion to removal) was 35±16 minutes. At 30 days, the primary safety endpoint, a composite of major adverse events, was observed in 35%, and the primary performance endpoint was successfully achieved in all patients (100%), with all patients having a TR reduction of at least 3 grades, and none of the patients having more than mild TR post-procedure. No device-related pacemaker implant was reported. An exemplary case report demonstrates complete elimination of TR and a reverse remodelling of the right ventricle of 19% at 6 months.

Conclusions: The TRICURE FIH study provides evidence of the feasibility and safety of a novel TTVR system. Outcomes need to be confirmed in a larger series. (ClinicalTrials.gov: NCT05126030).

Background: The latest-generation SAPIEN 3 Ultra RESILIA (S3UR) transcatheter heart valve (THV) incorporates several changes in leaflet design, including an improved anticalcification coating and modified commissural attachment. There are no established data on hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) using the S3UR.

Aims: Our study aimed to elucidate the clinical features of HALT following S3UR implantation.

Methods: As a subset of the OCEAN (Optimized CathEter vAlvular INtervention)-TAVI registry, we prospectively assessed patients who underwent cardiac computed tomography (CT) 30 days after S3UR implantation. HALT and potentially relevant THV geometry were analysed using four-dimensional CT data by an independent core laboratory.

Results: Of the 445 patients studied, HALT was detected in 95 patients (21.3%) 30 days after TAVI. The modification of the commissural attachment specific to the 20 mm and 23 mm S3UR THVs did not affect the incidence of HALT (22.1% for ≤23 mm; 20.2% for ≥26 mm; p=0.636). The hourglass-shaped THV frame (p<0.001) and asymmetricity of THV leaflets (p=0.002) were independently associated with HALT development. A trend toward higher mean aortic gradients at 30 days with greater degrees of HALT (HALT >25% vs HALT ≤25%: 10.3 [interquartile range [IQR] 7.0-13.0] mmHg vs 8.6 [IQR 6.3-11.6] mmHg; p=0.007; HALT >50% vs HALT ≤50%: 11.5 [IQR 7.0-14.3] mmHg vs 8.9 [IQR 6.3-11.9] mmHg; p=0.002) was noted.

Conclusions: The incidence of HALT for the S3UR was comparable with the already reported incidences for the previous-generation SAPIEN 3 THV. Given the haemodynamic impact of HALT severity and multiplicity, strategic planning to avoid deformation of the implanted THV might be required. (Clinical trial registration: UMIN000020423).