Cardiovascular Intervention and Therapeutics最新文献

This systematic review and meta-analysis evaluate Acute Kidney Injury (AKI) differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and how surgical risk stratification and diagnostic criteria influence outcomes. Following the PRISMA guidelines, we included both non-randomized studies and randomized clinical trials that reported AKI criteria and patients' surgical risk in patients with aortic stenosis by searching PubMed, Scopus, and Web of Science until late September. We executed a random-effects model in Review Manager to pool effect estimates of AKI incidence or the need for dialysis as an odds ratio (OR) and I² heterogeneity, and we utilized R for meta-regression to address any heterogeneity with subgroup analysis for surgical risk, AKI criteria, and study design. We used the Newcastle Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of bias assessment and GRADE for certainty assessment. Involving 17 studies and a total of 13,777 patients, we found that the AKI incidence was significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30, 0.44], I² = 55%, P = 0.003), along with the need for dialysis (OR = 0.35; 95% CI: [0.19, 0.63], I² = 0%, P = 0.92). The study also found that intermediate and low-risk patients had more favorable outcomes. However, the retrospective study design and VARC-2 criteria were associated with unfavorable outcomes. TAVR effectively reduced the risk of AKI in all surgical risk categories and the need for dialysis compared to SAVR in patients with AS.

Percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) is technically challenging because of the presence of the transcatheter heart valve (THV), which complicates coronary artery engagement. Owing to their flexibility, diagnostic catheters (DCs) facilitate coronary access, but require subsequent exchange to guiding catheters (GCs) for PCI. The feasibility of using an extension wire (EW) to facilitate DC-to-GC exchange in this context remains unexplored. A retrospective analysis was conducted at our institution, examining 11 PCI cases performed after TAVR between January 6, 2020, and June 1, 2024, in which an EW was employed to transition from a DC to a GC. Clinical, angiographic, and procedural data were reviewed. Procedural success was defined as a successful DC-to-GC exchange and completion of PCI. DC-to-GC exchange using an EW was successfully achieved in all 11 cases (100%). Revascularization was achieved in 10/11 cases (91%). The lesions were uniformly classified as American College of Cardiology/American Heart Association Type B2/C. The GCs included Judkins-type in 7/11 cases (64%) and backup-type in 4/11 cases (36%). The THV types included SAPIEN in 6/11 cases (55%), Evolut in 3/11 cases (27%), and Navitor in 2/11 cases (18%). A 6Fr GC was utilized in 10/11 cases (91%), and rotational atherectomy was performed in 1/11 cases (9%). The use of an EW to facilitate the transition from DC to GC in PCI after TAVR resulted in high procedural success, providing a feasible approach for addressing complex lesions and optimizing procedural outcomes.

Coronary microvascular dysfunction (CMD) is well-characterized in the context of coronary artery disease, but its relationship to obstructive hypertrophic cardiomyopathy (oHCM) is poorly understood. In addition, the impact of percutaneous transluminal septal myocardial ablation (PTSMA) on CMD has not been fully evaluated. Between October 2023 and May 2024, PTSMA was performed on 10 patients with oHCM. A pressure guidewire in the left anterior descending artery (LAD) was used to invasively assess CMD before and after the procedure. Measurements were recorded for resting full-cycle ratio (RFR), fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). The 10 patients had a median age of 66 [57-75] years, with a resting left ventricular pressure gradient of 44 [17-84] mmHg, measured via catheterization. Prior to PTSMA, the RFR measured in the LAD was 0.93 [0.91-0.96], and the FFR was 0.95 [0.92-0.95], which were both within normal limits. However, the CFR was reduced to 1.8 [1.6-2.1], and the IMR was elevated to 31 [25-39], which indicated CMD. Post-procedure, the left ventricular pressure gradient decreased to 5 [2-8] mmHg, CFR improved to 2.5 [2.2-3.6], and IMR decreased to 22 [17-26], indicating improvement in CMD. In patients with oHCM, myocardial hypertrophy contributes to left ventricular outflow tract obstruction and CMD. This study demonstrated that PTSMA as a septal reduction therapy improved the left ventricular pressure gradient and CMD.

High aortic angulation (AA) can pose significant challenges during TAVR. This meta-analysis determines the impact of a horizontal aorta on TAVR outcomes with balloon-expandable (BEV) and self-expanding valves (SEVs). A comprehensive search was conducted from inception to June 2024. Thirteen observational studies assessing the impact of aortic angulation in patients undergoing TAVR replacement were included. The pooled results indicated that short-term mortality was significantly lower in patients with a non-horizontal aorta (RR = 0.76; 95% CI 0.62-0.95, P = 0.01). Subgroup analysis displayed that BEVs had a lower short-term mortality with a horizontal aorta than SEVs. The incidence of stroke was not significantly affected by aortic angulation with either valve type. However, the overall risk of permanent pacemaker implantation was lower in patients with a non-horizontal aorta for both valve types. Paravalvular regurgitation was also reduced in the non-horizontal aorta group, with no difference between aortic angulations in patients with BEVs. In contrast, SEVs favored a non-horizontal aorta in reducing paravalvular leak (RR = 0.66; 95% CI 0.46-0.94, P = 0.02). Both BEVs and SEVs show better results in patients with lower aortic root angulation. The increased incidence of conduction abnormalities and PPI rates with both valve types in patients with horizontal aorta is a concern. BEVs could be potentially used preferentially to SEVs in patients with a horizontal aorta as there was no difference between horizontal and non-horizontal aorta groups regarding short-term mortality, moderate-to-severe paravalvular leak, and need for a second valve.

Large-scale data on the current status, outcomes, and complications of transcatheter patent ductus arteriosus (PDA) closure in adults remain limited. This study aimed to elucidate the current status of transcatheter PDA closure in adults. Patient data (age ≥ 16 years) between January 2015 and December 2023 were extracted from the Japanese Structural Heart Disease (J-SHD) registry. We assessed the current practice of transcatheter PDA closure in Japan, focusing on the clinical characteristics, in-hospital mortality, intraoperative deaths, and adverse events. Procedural success was defined as appropriate device implantation without any adverse events. A total of 377 adult patients (median age, 65 years [interquartile range, 50-74 years]; 18.3% male) who underwent transcatheter PDA closure were included. Overall, 9.8% (n = 24) of the patients were New York Heart Association class III/IV. The most common comorbidities were hypertension (43.0%, n = 162), hyperlipidemia (16.7%, n = 63), and renal dysfunction (10.9%, n = 41). The median Qp/Qs ratio was 1.5 [1.3-1.8], and the median procedural time was 100 [65-120] minutes. The procedural success rate was 99.2% (n = 374). The rate of failed deployment was 0.3% (n = 1). No intraoperative deaths occurred, and complications were rare; 0.5% (n = 2) of the patients required emergency surgery. No hemorrhage requiring transfusion, vascular rupture, vessel obstruction, or contrast-induced nephropathy was observed after the procedures. Real-world data demonstrated that transcatheter PDA closure is safe and effective in adults. However, the high prevalence of comorbidities and the rare occurrence of emergency surgery underscore the need for careful postprocedural management.

Since patients with cardiac arrest associated with acute myocardial infarction (MI) may not be successfully resuscitated, the underlying mechanisms of acute MI leading to out-of-hospital cardiac arrest (OHCA) have not been elucidated. This study evaluated whether there are differences in the plaque characteristics of infarct-related lesions between acute MI patients with OHCA and those without OHCA. This study analyzed 604 consecutive patients with a diagnosis of acute MI who underwent intravascular ultrasound (IVUS) evaluation of the infarct-related lesion before coronary intervention. All study patients were divided into two groups based on whether they presented with OHCA. The underlying mechanisms of acute MI were classified into four categories according to pre-interventional angiographic and IVUS images: plaque rupture, plaque erosion, calcified nodule, and embolization. Of the 604 patients diagnosed with acute MI, 69 (11%) suffered from OHCA. The OHCA group had a higher frequency of plaque rupture and calcified nodules than the non-OHCA group. Multivariate logistic regression analysis showed that an infarct-related lesion in the left main artery, the underlying plaque morphology of a calcified nodule, and plaque rupture were significantly associated with OHCA. In patients with acute MI, plaque morphology of infarct-related lesions with plaque rupture or a calcified nodule has a higher risk of leading to OHCA than other morphological types.

Reducing total ischemic time in ST-elevation myocardial infarction (STEMI) is crucial for improving outcomes. While procedural time during primary percutaneous coronary intervention (PCI) is critical, strategies to shorten it need to be explored. To examine whether the single-catheter PCI (SC-PCI) method using a universal guiding catheter, Ikari-Left curve, without catheter exchange reduces PCI time compared to conventional PCI (C-PCI). The Speedy PCI study is a prospective, multicenter, randomized trial comparing SC-PCI versus C-PCI. The primary endpoint was the time from sheath insertion to first device activation (S2B) time. Secondary endpoints included door-to-balloon time, total ischemia time, fluoroscopy time, contrast volume, hospital expenses, and 30-day mortality. A total of 380 patients (SC-PCI: 194; C-PCI: 186) were analyzed. Both groups had high primary PCI success rates (92.3 vs. 91.9%, p = 0.74) and similar radial access usage (higher than 97%). SC-PCI method showed a significantly shorter S2B time (15.8 ± 10.9 min) compared to the C-PCI method (18.7 ± 10.6 min, p = 0.007) with reduced number of total catheters used (1.2 ± 0.6 vs. 2.7 ± 0.7, p < 0.0001, respectively). No cases of coronary dissection caused by the guiding catheter were observed in the SC-PCI method. Clinical outcomes at 30 days and 1-year follow-up, including all-cause mortality and stroke rates, were similar between the groups. The SC-PCI method using the Ikari curve demonstrated a significant reduction in PCI procedure time while maintaining safety and primary PCI success in primary PCI for STEMI.

Transcatheter aortic valve implantation (TAVI) TAVI outcomes for patients with bicuspid aortic valve (BAV) and severe aortic stenosis are uncertain due to their exclusion from major clinical trials. We analyzed TAVI patients in the United States using data from the Nationwide Readmissions Database (2016-2019) identified using ICD-10 codes. We established matched cohorts of BAV and trileaflet aortic valve (TAV) patients using propensity-score matching (PSM). Primary outcomes were in-hospital mortality, 30-day mortality, and 30-day readmission rates. Out of 233,683 TAVI patients identified, 3169 (1.4%) had BAV. BAV patients were younger with fewer comorbidities. After PSM, 2,840 pairs were analyzed. Compared to TAV patients, TAVI in BAV patients showed comparable in-hospital mortality (1.2% vs. 2.0%; OR 0.62; 95% CI 0.36-1.04; p = 0.07) and 30-day readmission rates (10.0% vs. 12.3%; OR 0.79; 95% CI 0.60-1.03; p = 0.08), with lower 30-day mortality rates (0.88% vs. 1.96%; OR 0.44; 95% CI 0.23-0.84; p = 0.01). Post-TAVI in-hospital complications rates, including stroke, acute kidney injury, pacemaker need, and others, were similar between BAV and TAV patients. TAVI in BAV shows acceptable safety compared to TAV, but further randomized trials are needed to establish long-term outcomes and durability.