Journal of the Society for Cardiovascular Angiography & Interventions最新文献

{"title":"Management of Balloon Pulmonary Angioplasty Complications: An Ounce of Prevention is a Pound of Cure","authors":"Vladimir Lakhter DO","doi":"10.1016/j.jscai.2025.104157","DOIUrl":"10.1016/j.jscai.2025.104157","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104157"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline ECG Outperforms the Angiogram for Predicting Mortality in COVID-19–Associated STEMI: Insights From the NACMI Registry","authors":"Kevin R. Bainey MD, MSc ,&nbsp;Payam Dehghani MD ,&nbsp;Jyotpal Singh PhD ,&nbsp;G.B. John Mancini MD ,&nbsp;Ross Garberich MS, MBA ,&nbsp;Seth Bergstedt MS ,&nbsp;Shaun G. Goodman MD ,&nbsp;Wah Wah Htun MD ,&nbsp;Catherine P. Benziger MD, MPH ,&nbsp;Nima Ghasemzadeh MD ,&nbsp;Anna E. Bortnick MD, PhD, MSc ,&nbsp;Rohan Kankaria MD ,&nbsp;Cindy L. Grines MD ,&nbsp;Keshav Nayak MD ,&nbsp;M. Chadi Alraies MD, MPH ,&nbsp;Rajan A.G. Patel MD ,&nbsp;Rosa M. Marticorena DClinEpi, PhD ,&nbsp;Shy Amlani MD ,&nbsp;Santiago Garcia MD ,&nbsp;Timothy D. Henry MD","doi":"10.1016/j.jscai.2025.103994","DOIUrl":"10.1016/j.jscai.2025.103994","url":null,"abstract":"<div><h3>Background</h3><div>Patients with COVID-19 continue to present with ST-elevation myocardial infarction (STEMI). To date, there have been no core laboratory electrocardiogram (ECG) description of these patients. Accordingly, we aimed to evaluate the ECG characteristics and coronary angiograms of patients hospitalized with COVID-19–associated STEMI.</div></div><div><h3>Methods</h3><div>In a prespecified analysis from the North American COVID-19 Myocardial Infarction (NACMI) registry, we collected baseline STEMI ECGs in COVID-19–positive patients for core laboratory interpretation (Canadian VIGOUR Centre, Edmonton, Canada), including ST-segment analysis, worst lead ST-elevation (ST-E), sum ST-elevation (ΣST-E), and sum ST deviation (ΣST-D). Available core laboratory angiograms (Cardiovascular Imaging Research Core Laboratory, Vancouver, Canada) were also collected. ECG and angiographic variables associated with in-hospital death were analyzed.</div></div><div><h3>Results</h3><div>Of the 392 patients, 28.1% died in-hospital. Greater median ST-E (deviation) was observed in those who died (ST-E: 2.20 vs 1.65 mm; <em>P</em> = .006; ΣST-E: 7 vs 5 mm; <em>P</em> = .005; ΣST-D: 11 vs 9 mm; <em>P</em> = .013, respectively). Following adjustment for clinical characteristics, ΣST-D was a positive predictor of in-hospital death (relative risk [RR], 1.03; 95% CI, 1.01-1.05; <em>P</em> = .003). In 173 patients with available coronary angiograms, 32% of the baseline ECGs could not define infarct location (19% with angiography). Following adjustment, only ECG characteristics were independent predictors of in-hospital mortality (ST-E: RR, 1.14; 95% CI, 1.04-1.22; ΣST-E: RR, 1.03; 95% CI. 1.01-1.05: ΣST-D: RR, 1.03; 95% CI, 1.01-1.05).</div></div><div><h3>Conclusions</h3><div>In COVID-19–positive patients with STEMI, ST-E (deviation) is a predictor of in-hospital mortality and likely reflects microthrombi in multiple territories compromising myocardial perfusion. Our data support ECG as a simple tool to help risk stratify patients with COVID-19–associated STEMI.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 103994"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Coronary Artery Calcium Score Threshold Predictive of Obstructive Coronary Artery Disease","authors":"Denizhan Ozdemir MD, PhD ,&nbsp;Devarshi Vasa BA ,&nbsp;Serdar Farhan MD,&nbsp;Manish Vinayak MBBS,&nbsp;James Johnson MD,&nbsp;Vishal Dhulipala MBBS,&nbsp;Amir Hamdan BS,&nbsp;Gina LaRocca MD, MHSc,&nbsp;Annapoorna S. Kini MD,&nbsp;Deepak L. Bhatt MD, MPH, MBA,&nbsp;Samin K. Sharma MD","doi":"10.1016/j.jscai.2025.104048","DOIUrl":"10.1016/j.jscai.2025.104048","url":null,"abstract":"<div><h3>Background</h3><div>Coronary computed tomography angiography and coronary artery calcium score (CACS) are rapidly being adopted for the noninvasive assessment of coronary artery disease (CAD). One of the primary limitations of calcium imaging is the inability to assess obstructive lesions in the presence of a high calcium burden. Currently, there is no guidance on what level of coronary artery calcium indicates a high risk of obstructive CAD. We aimed to determine sex-specific CACS thresholds suggestive of obstructive CAD by comparing coronary angiography with adjunctive tools to available CACS information.</div></div><div><h3>Methods</h3><div>From August 2018 to August 2023, we retrospectively analyzed 1799 consecutive patients' clinical characteristics, angiographic information, and available intracoronary physiological/anatomical testing at a single institution. We evaluated the sex-specific distribution of CACS and its specificity for identifying obstructive CAD at a threshold of 90%.</div></div><div><h3>Results</h3><div>Baseline characteristics were similar between the obstructive (n = 1223) and nonobstructive (n = 576) CAD groups. A CACS of ≥1000 in women (HR, 2.81; 95% CI, 1.77-4.47; <em>P</em> &lt; .001) and ≥1400 in men (HR, 3.34; 95% CI, 2.23-5.02; <em>P</em> &lt; .001) predicted obstructive CAD at 90% specificity.</div></div><div><h3>Conclusions</h3><div>A CACS of ≥1000 in women and ≥1400 in men identifies obstructive CAD at 90% specificity. These thresholds should be prospectively validated and may potentially be used to guide the selection of patients who would benefit from intensification of medical therapy or invasive evaluation in the appropriate clinical context.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104048"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utility of Cerebral Protection Devices in Transcatheter Aortic Valve Replacement: A Systematic Review and Bayesian Meta-analysis","authors":"Tomonari M. Shimoda MD ,&nbsp;Yosuke Sakurai MD ,&nbsp;Minami Watanabe MD ,&nbsp;Shinichi Fukuhara MD ,&nbsp;Yujiro Yokoyama MD ,&nbsp;Hiroki A. Ueyama MD ,&nbsp;Roger J. Laham MD ,&nbsp;Michel Pompeu Sá MD, MSc, PhD ,&nbsp;Kaveh Hosseini MD ,&nbsp;Tsuyoshi Kaneko MD ,&nbsp;Toshiki Kuno MD, PhD","doi":"10.1016/j.jscai.2025.104047","DOIUrl":"10.1016/j.jscai.2025.104047","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral embolic protection (CEP) devices are designed to reduce procedure-related stroke during transcatheter aortic valve replacement (TAVR). In light of recent randomized controlled trials (RCTs), we performed an updated meta-analysis to evaluate their impact on stroke and mortality.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, EMBASE, and Cochrane Central through June 2025 for RCTs comparing TAVR with or without the CEP devices. Outcomes of interest included all stroke, disabling stroke, and all-cause mortality. Data were extracted and pooled using a random-effects frequentist meta-analysis. In addition, a Bayesian meta-analysis was performed with both vague and informative priors to evaluate the probability of a clinically meaningful reduction in stroke.</div></div><div><h3>Results</h3><div>Eight RCTs with 11,632 patients (CEP group = 5969; control group = 5663) were included. We found no difference in all strokes between the groups (risk ratio, 0.92; 95% CI, 0.74-1.15), nor in disabling stroke or all-cause mortality. In the Bayesian meta-analysis for all strokes using a vague prior, posterior probabilities that the risk ratio was &lt;1, &lt;0.9, and &lt;0.67 were 71.9%, 35.6%, and 0.1%, respectively. For disabling stroke, the probabilities were 89.6%, 73.3%, and 12.1%, respectively. With an informative prior, posterior probabilities for all strokes were 95.9%, 39.0%, and 0% and the probabilities for disabling strokes were 98.3%, 73.8%, and 0%, respectively.</div></div><div><h3>Conclusions</h3><div>CEP devices did not significantly reduce stroke or mortality during TAVR, and the probability of a clinically meaningful benefit was low. Larger studies with extended follow-up are warranted to clarify their role in contemporary practice.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104047"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Investigation of the Safety and Effectiveness of the Occlutech Flex II PFO Occluder: Design and Rationale of the Multicenter, Randomized OCCLUFLEX Trial","authors":"Andrew M. Goldsweig MD, MS ,&nbsp;David E. Thaler MD, PhD ,&nbsp;Steven J. Yakubov MD","doi":"10.1016/j.jscai.2025.104046","DOIUrl":"10.1016/j.jscai.2025.104046","url":null,"abstract":"<div><h3>Background</h3><div>The Prospective Randomized Multi-center Controlled Clinical Investigation Comparing Patent Foramen Ovale (PFO) Outcomes of the Occlutech Flex II PFO Occluder to Standard of Care PFO Occlusion (OCCLUFLEX) trial (NCT05069558) is designed to evaluate whether percutaneous PFO closure with the Occlutech Flex II PFO Occluder is noninferior to closure with the AMPLATZER Talisman PFO Occluder and Gore CARDIOFORM Septal Occluder.</div></div><div><h3>Methods</h3><div>Enrollment will include 450 subjects across 48 centers in the United States, Canada, and Europe. Enrolled subjects will be older than 18 years of age with no upper age limit, have a cryptogenic stroke likely attributable to paradoxical embolism, as determined by a neurologist and cardiologist following evaluation to exclude other causes of ischemic stroke, and with an echocardiographically confirmed PFO. Eligible subjects will be randomized 1:1 to receive a Occlutech Flex II PFO Occluder or standard of care PFO occluder (either the AMPLATZER or Gore device). Randomization should occur within 5 working days before the procedure. Subjects will be followed with scheduled assessments conducted at discharge, 1 month, 6 months, and 12 months postprocedure and annually to 5 years, transitioning into a postapproval study, contingent upon premarket approval. The primary end point is effective PFO closure at 12 months by echocardiographic bubble study, the secondary end point is nonfatal recurrent stroke through 12 months, and the safety end point is all device- and procedure-related serious adverse events within 12 months including postprocedural atrial fibrillation.</div></div><div><h3>Conclusions</h3><div>OCCLUFLEX is the first multicenter randomized trial directly comparing PFO closure devices. This trial will offer valuable evidence for physicians, including procedural characteristics, device success, postimplant atrial fibrillation rates, and outcomes in patients aged &gt;60 years.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104046"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Identifying and Managing Complications for the Operator","authors":"Jason B. Katz MD ,&nbsp;Kelley Chen MD ,&nbsp;Michael J. Cuttica MD ,&nbsp;Ruben Mylvaganam MD ,&nbsp;Yasmin Raza MD ,&nbsp;Maanasi Samant MD ,&nbsp;Jordan Durkin PA-C ,&nbsp;Kevin Jin BS ,&nbsp;Benjamin L. Magod MD ,&nbsp;Charles Logan MD ,&nbsp;Benjamin H. Freed MD ,&nbsp;S. Christopher Malaisrie MD ,&nbsp;Stephen F. Chiu MD ,&nbsp;Daniel R. Schimmel MD","doi":"10.1016/j.jscai.2025.104049","DOIUrl":"10.1016/j.jscai.2025.104049","url":null,"abstract":"<div><div>Balloon pulmonary angioplasty (BPA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension who cannot receive pulmonary thromboendarterectomy or who have residual pulmonary hypertension after pulmonary thromboendarterectomy. As BPA volume and expertise have increased, significant strides in refining this technique have improved success and minimized complications; yet, minimal literature exists on appropriate complication management. This review summarizes how interventionalists can prevent, recognize, and manage BPA complications effectively. Operators must first focus on appropriate patient and vessel selection. Lower lung zones coupled with ring-like stenoses and web lesions are more favorable. Increased patient age, tortuous or subtotal lesions, and elevated pulmonary vascular resistance (&gt;6 Wood units) portend a higher risk for complications. Vascular perforation can be treated with balloon tamponade, embolization (gelfoam and/or coils), and covered stents. Massive hemoptysis is managed with intubation and single lung ventilation if needed. As shock is predominantly hemorrhagic and/or cardiogenic, first-line therapies include vasopressors, inodilators, pulmonary vasodilators, and volume resuscitation, whereas mechanical support devices are second-line. Although reperfusion lung injury (RLI) is uncommon, it is generally well tolerated and managed with positive pressure ventilation, high-flow oxygen therapy, and diuresis. Acute kidney injury can be reduced by dilution of contrast dye, use of extension catheters, and procedural planning. Utilization of standard, angle-minimizing techniques, avoidance of high-dose cinefluoroscopy, and digital subtraction angiography minimizes radiation dose. In conclusion, most complications can be avoided or managed effectively without major morbidity or mortality by optimal preparation, patient selection, and commitment to a comprehensive BPA program.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104049"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative Contribution of High-Dose Outliers to Cumulative Occupational Radiation Dose in the Catheterization Laboratory","authors":"Ryan D. Madder MD ,&nbsp;Michael Abiragi MD ,&nbsp;Luai Madanat MD ,&nbsp;Stacie VanOosterhout MEd ,&nbsp;Jessica L. Parker MS ,&nbsp;Devraj Sukul MD ,&nbsp;David A. McNamara MD, MPH","doi":"10.1016/j.jscai.2025.104054","DOIUrl":"10.1016/j.jscai.2025.104054","url":null,"abstract":"<div><h3>Background</h3><div>The contribution of high radiation dose outliers to cumulative occupational radiation dose is understudied.</div></div><div><h3>Methods</h3><div>Physician radiation data were collected during consecutive coronary cases, and per case doses were ranked by magnitude. The relationship between the per case rank and relative contribution to cumulative dose was summed for cases ≤50th percentile and for cases &gt;90th percentile. A similar methodology was applied for radiation doses among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators. Multivariable logistic regression was fit to identify independent predictors of physician radiation dose &gt;90th percentile during coronary cases.</div></div><div><h3>Results</h3><div>Across 363 coronary cases, the median physician radiation dose per case was 10.2 (3.2, 35.5) μSv, and the cumulative radiation dose was 13,230 μSv. Coronary cases ≤50th percentile accounted for only 5.0% of the cumulative radiation dose. Cases &gt;90th percentile accounted for 60.3% of the cumulative dose. Cases &gt;90th percentile accounted for 51.3%, 39.9%, 45.8%, and 64.8% of the cumulative dose among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators, respectively. ST-segment elevation myocardial infarction (OR, 6.2; 95% CI, 1.5-26.3; <em>P</em> = .01), percutaneous coronary intervention (OR, 5.6; 95% CI, 2.2-14.2; <em>P</em> &lt; .001), right heart catheterization (OR, 4.4; 95% CI, 1.7-11.7; <em>P</em> = .003), and male sex (OR, 3.2; 95% CI, 1.3-8.0; <em>P</em> = .01) were independently associated with physician radiation dose &gt;90th percentile.</div></div><div><h3>Conclusions</h3><div>Physician radiation dose outliers contribute disproportionately to the cumulative radiation dose, with cases above the 90th percentile accounting for 60% of the cumulative dose. High radiation dose outliers are an important target for future radiation mitigation efforts.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104054"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Based Differences in Long-Term Outcomes Following Intravascular Brachytherapy for In-Stent Restenosis","authors":"Mangesh Kritya MD ,&nbsp;Chloe Kharsa MD, MSc ,&nbsp;Gal Sella MD ,&nbsp;Devin Olek MS ,&nbsp;Bin S. Teh MD ,&nbsp;Muhammad Faraz Anwaar MD ,&nbsp;Joseph Elias MD ,&nbsp;Elia El Hajj MD ,&nbsp;Albert E. Raizner MD ,&nbsp;Andrew Farach MD ,&nbsp;Neal S. Kleiman MD ,&nbsp;Alpesh R. Shah MD","doi":"10.1016/j.jscai.2025.104041","DOIUrl":"10.1016/j.jscai.2025.104041","url":null,"abstract":"<div><h3>Background</h3><div>In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention, and intravascular brachytherapy (IVBT) has proved to be an important treatment strategy. However, limited data exist on sex-specific outcomes following IVBT.</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study included 223 patients (61 women, 162 men) treated with IVBT for ISR between 2014 and 2023. The primary end points were all-cause mortality, target lesion revascularization, and major adverse cardiovascular events. Secondary outcomes included technical success, myocardial infarction, cardiac death, and heart failure hospitalization. Multivariable Cox regression was used to adjust for clinical and procedural covariates.</div></div><div><h3>Results</h3><div>Baseline characteristics were largely similar between sexes, except for higher body surface area and diabetes prevalence in men. Procedural success rates did not differ between groups. However, female sex was independently associated with a higher risk of target lesion revascularization (adjusted HR, 1.80; 95% CI, 1.07-3.01; <em>P</em> = .026) and major adverse cardiovascular events (adjusted HR, 1.63; 95% CI, 1.09-2.45; <em>P</em> = .017). Women also had a higher risk of myocardial infarction (adjusted HR, 2.58; 95% CI, 1.29-5.19; <em>P</em> = .008), whereas no significant sex-based differences were observed for all-cause mortality or heart failure hospitalization.</div></div><div><h3>Conclusions</h3><div>Despite comparable procedural outcomes, women undergoing IVBT for ISR experienced higher rates of adverse cardiovascular events. These findings underscore the need for sex-stratified risk assessment and further prospective research to understand and address sex-based differences in outcomes after IVBT.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104041"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transseptal Device Comparison for Improved Puncture and Streamlined Mitral Edge-To-Edge Repair","authors":"Anastasia E.I. Malek DO ,&nbsp;Meghali Singhal DO ,&nbsp;Wes Soliman MD ,&nbsp;Saja Al-Dujaili PhD ,&nbsp;Mohammad Al-Khalaf PhD ,&nbsp;Brynn Okeson MSc ,&nbsp;Carmen Carbajal BSc ,&nbsp;Samantha Yim RN, BSN ,&nbsp;Jason Boyatt MD ,&nbsp;David Lerner DO ,&nbsp;Michael Shenoda MD ,&nbsp;Joseph Aragon MD","doi":"10.1016/j.jscai.2025.103935","DOIUrl":"10.1016/j.jscai.2025.103935","url":null,"abstract":"<div><h3>Background</h3><div>Septal anatomy dictates the complexity of transseptal puncture (TSP) and strongly influences left atrial access for large mitral transcatheter edge-to-edge mitral valve repair. This study aimed to compare 2 TSP needle-based techniques—mechanical needle (MN; BRK Transseptal Needle, Abbott) and radiofrequency-powered needle (RFN; NRG Transseptal Needle, Boston Scientific)—with the VersaCross Large Access system (VLA, Boston Scientific), comprising a radiofrequency wire and 12.5F transseptal introducer.</div></div><div><h3>Methods</h3><div>This is a retrospective single-center review of consecutive MitraClip (Abbott) cases using MN (n = 28), RFN (n = 55)—both with an 8.5F sheath and pigtail exchange wire, and VLA (n = 109). Procedures were evaluated for TSP success, time to TSP, MitraClip steerable guide catheter (SGC) delivery, clip deployment, and overall procedure time. Acute adverse events were assessed.</div></div><div><h3>Results</h3><div>The TSP was successful in 100% of cases with no adverse events. The TSP time from groin access was the shortest with VLA (MN, 26.6 ± 18.5 minutes; RFN, 21.3 ± 11.9 minutes; VLA, 15.8 ± 10.0 minutes). VLA required less time to SGC delivery from TSP (MN, 18.4 ± 12.8 minutes; RFN, 9.7 ± 5.1 minutes; VLA, 5.4 ± 4.6 minutes). There were no differences in time to clip deployment between groups. Total procedure time was the lowest with VLA (MN, 138 ± 64 minutes; RFN, 123 ± 63 minutes; VLA, 96 ± 51 minutes). TSP and SGC delivery times were more consistent using VLA than those with MN (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Use of VLA allowed for shorter TSP times and more efficient SGC delivery into the left atrium. The choice of transseptal technique can improve overall procedure time, leading to catheterization laboratory predictability and efficiency.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 103935"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Left Atrial Appendage Occlusion During Cardiac Surgery in Atrial Fibrillation: A Contemporary Systematic Review and Meta-Analysis","authors":"Abdul Rasheed Bahar MD ,&nbsp;Ishaq Khoury MD ,&nbsp;Mohamad Hamza MD ,&nbsp;Sultana Jahan MD ,&nbsp;Mohamad Hasan Jawadi MD ,&nbsp;Manisha Guntha MD ,&nbsp;Yasemin Bahar MD ,&nbsp;Saman Razzaq MD ,&nbsp;M. Chadi Alraies MD, MPH","doi":"10.1016/j.jscai.2025.104002","DOIUrl":"10.1016/j.jscai.2025.104002","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage occlusion (LAAO) has emerged as a promising adjunctive strategy for stroke prevention in patients with atrial fibrillation (AF) undergoing cardiac surgery. While previous studies have assessed its efficacy, a comprehensive evaluation integrating both randomized controlled trials and observational data remains limited.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis to evaluate the safety and effectiveness of LAAO compared with no LAAO in patients with AF undergoing cardiac surgery. A total of 20 studies (12 observational and 8 randomized controlled trials) encompassing 215,181 patients treated between 2005 and 2024 were included. Pooled odds ratios with 95% CIs were calculated using fixed- and random-effects models for primary and secondary outcomes, with heterogeneity, publication bias, and sensitivity analyses performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</div></div><div><h3>Results</h3><div>Left atrial appendage occlusion was associated with a significant reduction in ischemic stroke (odds ratio, 0.72; 95% CI, 0.66-0.79), systemic embolism, hemorrhagic stroke, silent cerebral infarcts, and cardiac death. A significant reduction in all-cause mortality was observed using a fixed-effects model, but not with the random-effects model due to substantial heterogeneity. No significant differences were observed in myocardial infarction, peripheral ischemia, or major bleeding events. Sensitivity and cumulative analyses supported the robustness of the ischemic stroke findings. Subgroup analyses revealed no significant variation in outcomes based on study design or publication year.</div></div><div><h3>Conclusions</h3><div>Left atrial appendage occlusion during cardiac surgery is associated with a significant reduction in thromboembolic events, without increasing the risk of major complications. These findings support the role of LAAO as a safe and effective adjunctive intervention in appropriately selected patients with AF. Further high-quality, prospective studies are warranted to confirm these benefits and inform guideline-directed practice.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 1","pages":"Article 104002"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}