Cardiovascular Intervention and Therapeutics最新文献

Performance evaluation of the latest fifth-generation SAPIEN 3 Ultra RESILIA (S3UR) valve in patients who underwent transcatheter aortic valve replacement (TAVR) is limited. The aim of this study was to compare the 1-year clinical outcomes, including valve performance, in patients undergoing TAVR with the S3UR compared to the SAPIEN 3 or SAPIEN 3 Ultra (S3/S3U). Patients with severe native aortic stenosis who underwent TAVR with either the S3UR or the S3/S3U valve were matched using propensity scores. Predictors of 1-year outcomes were identified. A subgroup analysis of patients who underwent post-TAVR CT was conducted. Among 4,908 patients, 312 matched pairs were assessed. At 1-year, compared to the S3/S3U group, the S3UR group exhibited lower all-cause mortality (HR: 0.42; 95% CI: 0.18-0.96; p = 0.041). The S3UR group demonstrated superior hemodynamic performance, including lower transvalvular gradients, larger effective orifice areas, and decreased incidence of severe prosthesis-patient mismatch and paravalvular leak. In patients who underwent post-TAVR CT (n = 280), prevalence of hypoattenuated leaflet thickening (HALT) at 30-day was lower in the S3UR group compared to S3/S3U (5.7% vs 16.2%; p = 0.006). In multivariate analysis, the S3UR group was independently associated with lower 1-year mortality and reduced HALT. In this propensity score-matched cohort, compared with the S3/S3U group, the S3UR group demonstrated favorable clinical outcomes and superior hemodynamic performance. In subgroup analysis, S3UR was also associated with a lower HALT incidence.

Left atrial appendage closure (LAAC) is an established therapy for stroke prevention in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate long-term oral anticoagulation (OAC). In Japan, LAAC was introduced in 2019 and has been performed in more than 10,000 cases a0s of 2025. Although indications remain limited to high-risk patients with OAC contraindications, procedural volume continues to rise. This review outlines the current status, remaining challenges, and future perspectives of LAAC, with emphasis on the WATCHMAN device. The WATCHMAN FLX and FLX Pro have enhanced procedural safety, sealing efficacy, and anatomical adaptability. Large clinical trials and registries have confirmed stroke prevention efficacy comparable to OAC with fewer hemorrhagic complications. However, device-related thrombus (DRT) and peri-device leak (PDL) remain major concerns, underscoring the need to optimize postprocedural antithrombotic therapy. The Amulet device provides superior ostial sealing through its dual-disk design but is technically more complex and associated with higher procedural complication rates. Intracardiac echocardiography (ICE) has emerged as a less invasive alternative to transesophageal echocardiography, reducing anesthesia requirements and enabling same-session LAAC with AF ablation. The development of pulsed field ablation (PFA) further improves the feasibility of such integrated approaches. Future priorities include risk stratification for DRT, individualized antithrombotic strategies, and broader indications encompassing OAC-resistant embolic stroke and other high-risk populations. With advancing technology, ICE-guided, minimally invasive workflows and integrated ablation-occlusion procedures are expected to establish LAAC as a key component of comprehensive AF management.

Postprocedural aortic regurgitation (AR) is a challenging complication following transcatheter device closure of perimembranous ventricular septal defects (pmVSD) in pediatric patients. This study aimed to identify risk factors for AR and evaluate its long-term outcomes. A total of 1,427 children who underwent successful pmVSD closure between June 2002 and August 2023 were retrospectively analyzed, with a median follow-up of 80 months (range, 12 to 248). Patients were further divided into early (2002-2016) and late (2017-2023) eras to assess temporal effects. Postprocedural AR occurred in 157 patients (11.0%), including 151 new-onset and 6 aggravated cases. AR was mostly trivial or mild, with 3 moderate cases (one requiring early valve repair). AR developed in 105 patients early after closure and in 52 during follow-up. Multivariate analysis identified repeated track creations (odds ratio [OR]: 2.000; 95% confidence interval [CI]: 1.286 to 3.112; P = 0.002) and opening the left disk above the aortic valve (OR: 5.071; 95% CI: 2.476 to 10.389; P < 0.001) as independent risk factors. Subgroup analysis showed consistent findings in the early era, whereas a smaller subaortic rim emerged as an additional risk factor in the late era. At the last follow-up, 2 patients had moderate AR, 10 mild, and 62 trivial. In conclusion, most AR cases after pmVSD closure are mild or trivial with favorable long-term outcomes. Minimizing repeated track creations and avoiding opening the left disk above the aortic valve may help reduce AR risk, whereas a smaller subaortic rim may increase its likelihood.