Catheterization and Cardiovascular Interventions最新文献

Background

Percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) has gained interest as concomitant coronary artery disease (CAD) is now often treated conservatively before TAVR, and TAVR is increasingly used in younger patients with longer life expectancies. Therefore, more contemporary data on PCI after TAVR are warranted to optimize CAD treatment and guide lifetime management. The primary objective was to evaluate the incidence of PCI in patients with prior TAVR, including insights on trends and procedural and clinical outcomes from a large, nationwide cohort.

Methods

Data from the Netherlands Heart Registration were used to identify patients with prior TAVR who underwent PCI between January 2015 and September 2021.

Results

Among 216,813 PCI patients, 419 (0.19%) had previously undergone TAVR, representing an incidence of 2.81% among all TAVR patients (n = 14,933) in the Netherlands. The annual proportion of PCI procedures after TAVR increased from 0.05% in 2015 to 0.39% in 2021 (p < 0.001). Procedural adverse events were low. Patients treated with self-expanding transcatheter heart valves (THVs) more frequently underwent PCI without stenting (17.8% vs. 10.1%, p = 0.049), though target vessel revascularization rates and all-cause mortality were comparable. Matched patients with and without prior TAVR had similar clinical outcomes.

Conclusions

The incidence of PCI after TAVR is low but increasing. Clinical outcomes are comparable between THV platforms, but self-expanding THVs were associated with higher rates of PCI without stent implantation. The growing need for PCI after TAVR underscores the importance of coronary access in lifetime management strategies by multidisciplinary heart teams.

Background

Transcatheter pulmonary valve replacement (tPVR) has emerged as a promising management strategy for dysfunctional right ventricular outflow tract (RVOT). However, the management of chronic pulmonary regurgitation (PR) in native or patched RVOT remains challenging with the vast variation in morphology, leading to the demand for novel self-expandable valves.

Objective

To report procedural performance and medium-term follow-up data of the Med Zenith PT-Valve for tPVR in native or patched RVOT from a single-center feasibility trial.

Methods

Fifteen patients with PR were recruited for candidacy assessment, with 12 tPVR procedures performed with per-protocol follow-up.

Results

Amongst patients recruited, one with concomitant aortic pathology was diverted to surgery; there was one screen failure (7.1%) and one patient withdrew consent. Twelve patients underwent tPVR with the study valve with 100% success rate. Complications included one wire-related pulmonary hemorrhage, one transient brachial neuropraxia, one femoral pseudoaneurysm, and two patients with non-sustained ventricular tachycardia Day 1 post-tPVR. Both patients received a short course of a beta-blocker without recurrence of arrhythmia. There were no deaths or valve-related reinterventions with a median follow-up of 28.5 months (range 17.9–40.0 months). One episode of infective endocarditis was managed conservatively with antibiotics with no sequelae. There were otherwise no late complications. Significant improvement in biventricular volume and PR fraction was observed.

Conclusion

The Med Zenith PT-Valve has performed well over short to mid-term follow-up in patients with significant PR in native or patched RVOT. Future studies are required to elucidate the longevity of the valve.

Background

Studies on outcomes of primary PCI have shown that among patients with STEMI, complete revascularization had better outcomes than culprit vessel PCI alone.

Aims

Data on individual coronary artery PCI is rare. We wanted to see if individual coronary artery PCI had effect on outcomes.

Results

Patients who did not undergo PCI had worst outcomes in terms of mortality and cardiogenic shock. LAD interventions had best outcomes with lesser complication rates. OM interventions had the best safety profile. LCX interventions had more incidence of complications and mortality as compared to LAD and RCA interventions. LCX lesions also had a high SYNTAX score. Branch vessel interventions had an intermediate to high-risk profile.

Conclusions

We found that the clinical outcomes were significantly related to the coronary artery revascularized.

In current practice, stenting a myocardial bridging segment is known to be associated with dire consequences such as stent fracture and in-stent restenosis, thus it should best be avoided. However, sometimes stenting a bridging segment may be deemed necessary due to various reasons. We present a case in which an unintended dissection extended into a bridging segment, warranting stenting. We studied the effect of the bioadaptor stent, with its unique uncaging element, in such a segment using optical coherence tomography (OCT). Reangiogram 8 months after the index procedure showed a satisfactory result with no stent-related complications, while OCT showed preservation of bridging vasomotion as well as a positive remodeling effect in the stented bridging segment. Bioadaptor stenting in the myocardial bridging segment can provide scaffold support, preserve the bridging vasomotion, and bring about a positive remodeling effect. This finding may impact future practice on stenting strategies in myocardial bridging, should it be necessary; however, further studies are required to validate this concept and its applicability to other bridging cases.

Stroke remains one of the most devastating complications following transcatheter aortic valve implantation (TAVI). Although cerebral embolic protection devices (CEPDs) have emerged to mitigate patients' risks, their impact on stroke risk, as well as other clinical and neurocognitive outcomes after TAVI, remains uncertain. We aimed to assess whether CEPDs alleviate stroke risks and neurocognitive outcomes after TAVI. We systematically searched MEDLINE, Scopus, Web of Science (WOS), and the Cochrane CENTRAL from inception until May 2025. We included randomized controlled trials (RCTs) that assessed the effectiveness of CEPD compared to the control group (no CEPD) in adult patients (> 18 years) undergoing TAVI. The primary endpoint was the incidence of all-cause stroke. In contrast, the secondary endpoints included disabling stroke, systemic bleeding, transient ischemic attack (TIA), and major adverse cardiovascular and cerebrovascular events (MACCE). Additionally, we assessed neurological outcomes, including changes in the Montreal Cognitive Assessment (MoCA) score, the National Institutes of Health Stroke Scale (NIHSS) score, and the presence of new ischemic lesions. Nine RCTs comprising 11,696 patients were included in the final analysis. The use of CEPDs showed no statistical difference in reducing all-cause stroke compared to the control group (OR = 0.91, 95% CI [0.73–1.15], p = 0.44). Additionally, there was no significant difference in other studies' secondary outcomes, including disabling stroke, MACCE, systemic bleeding, or neurological outcomes, such as worsening NISSS, decline in MoCA score, and the presence of new ischemic lesions. The use of CEPD during TAVI showed no benefit in reducing the risks of all-cause stroke and other neurological outcomes studied.

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of sudden death. It occurs when a thrombus develops in the venous system and then dislodges to embolize into the pulmonary arteries, causing obstruction. The current mainstay of treatment is anticoagulation. Adjunct mechanical thrombectomy (MT) or pharmacological thrombolysis may be added, following a risk assessment, for intermediate to massive PE. However, physicians remain reluctant to adopt them as first-line treatment when comparing the benefits and risks to anticoagulation alone. This study aims to compare the safety and efficacy of MT with anticoagulation therapy alone in the treatment of intermediate to large-sized PE patients, focusing on hospital stay, ICU admission, morbidity, and mortality. Following PRISMA guidelines, a search was conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from inception up to July 5, 2025. Studies were then screened based on predefined inclusion and exclusion criteria. The Newcastle−Ottawa Scale was used to assess the quality of evidence. Studies were required to report at least one of the following outcomes: mortality rate, hospital stay, overall complications, and ICU stay. Screening & data were extracted independently by eight co-authors, and a senior co-author resolved all conflicts. From a pool of 5661 studies, a total of six studies (1509 patients) were included. MT was associated with a trend toward lower all-cause mortality (OR = 0.5, 95% CI, 0.27 to 1.01; p = 0.05; I² = 46%) and a significantly lower rate of ICU length of stay by 3.0 days than those in the anticoagulant therapy group (MD: − 3.01, 95% CI, −5.57 to −0.44, p = 0.02; I² = 83%). No significant difference was found in overall complications and length of hospital stay between the MT and anticoagulant groups. However, MT was associated with lower rates of overall complications by 49% (OR = 0.51, 95% CI, 0.10 to 2.67, p = 0.43; I² = 83%) and shorter hospital stays (MD: −0.76; 95% CI, −4.64 to 3.13, p = 0.70; I² = 93%). MT showed greater efficacy in reducing mortality rates and ICU stay compared to intermediate to high-risk PE patients treated with conventional anticoagulant therapy.