To conduct a meta-analysis to investigate the X-ray radiation exposure between left and right radial approach (LRA/RRA) during percutaneous coronary procedures. A systematic literature search from the inception of Scopus, Embase, Pubmed, and Web of science databases were systematic searched until July 2025 was performed for studies that compared the radiation exposure between LRA and RRA. 19 randomized controlled trials (RCTs) with 9443 individuals were included in our meta-analysis. The overall effect showed a significantly reduction in fluoroscopy time (FT) and dose area product (DAP) for the LRA group compared to the RRA group (standardized mean difference [SMD] 0.105, 95% confidence interval [CI]: 0.037–0.174, I2 = 54.9%, p = 0.003; SMD 0.09, 95% CI: 0.016–0.163, I2 = 51.3%, p = 0.017). The pooled results did not show any significant different of cumulative air kerma (CAK) between RRA group and LRA group during percutaneous coronary procedure (SMD 0.067, 95% CI: −0.001 TO 0.135, I2 = 22.5%, p = 0.055). Both the operator's radiation dose and the DAP-normalized thorax dose were significantly lower with LRA compared to RRA during percutaneous coronary procedure (SMD 0.297, 95% CI: 0.023–0.71, I2 = 84.4%, p = 0.034; SMD 0.392, 95% CI: 0.251–0.533, I2 = 0%, p = 0.000). The LRA was associated with a significant reduction in FT, DAP and the operator's radiation exposure compared to the RRA during percutaneous coronary procedures.
对经皮冠状动脉手术中左桡骨入路和右桡骨入路（LRA/RRA）之间的x射线暴露进行荟萃分析。从Scopus、Embase、Pubmed和Web of science数据库开始系统检索到2025年7月，对LRA和RRA之间辐射暴露的研究进行了系统的文献检索。我们的meta分析纳入了19项随机对照试验（RCTs），共9443人。总体效果显示，与RRA组相比，LRA组的透视时间（FT）和剂量面积积（DAP）显著减少（标准化平均差[SMD] 0.105, 95%可信区间[CI]: 0.037-0.174, I2 = 54.9%, p = 0.003; SMD = 0.09, 95% CI: 0.016-0.163, I2 = 51.3%, p = 0.017）。合并结果显示，RRA组和LRA组在经皮冠状动脉手术过程中累积空气kerma （CAK）无显著差异（SMD = 0.067, 95% CI: -0.001 TO 0.135, I2 = 22.5%, p = 0.055）。经皮冠状动脉手术中，LRA患者的放疗剂量和ap标准化胸腔剂量均明显低于RRA （SMD 0.297, 95% CI: 0.023 ~ 0.71, I2 = 84.4%, p = 0.034; SMD 0.392, 95% CI: 0.251 ~ 0.533, I2 = 0%, p = 0.000）。与RRA相比，LRA与经皮冠状动脉手术中FT、DAP和操作者辐射暴露的显著降低有关。
{"title":"Comparison of Radiation Exposure to X-Ray Between Left and Right Radial Approach During Coronary Procedures: A Meta-Analysis Based on Randomized Controlled Trials","authors":"Youjin Zhu, Shixin Li, Hao Wang, Yan Xu","doi":"10.1002/ccd.70360","DOIUrl":"10.1002/ccd.70360","url":null,"abstract":"<div>\u0000 \u0000 <p>To conduct a meta-analysis to investigate the X-ray radiation exposure between left and right radial approach (LRA/RRA) during percutaneous coronary procedures. A systematic literature search from the inception of Scopus, Embase, Pubmed, and Web of science databases were systematic searched until July 2025 was performed for studies that compared the radiation exposure between LRA and RRA. 19 randomized controlled trials (RCTs) with 9443 individuals were included in our meta-analysis. The overall effect showed a significantly reduction in fluoroscopy time (FT) and dose area product (DAP) for the LRA group compared to the RRA group (standardized mean difference [SMD] 0.105, 95% confidence interval [CI]: 0.037–0.174, I<sup>2</sup> = 54.9%, <i>p</i> = 0.003; SMD 0.09, 95% CI: 0.016–0.163, I<sup>2</sup> = 51.3%, <i>p</i> = 0.017). The pooled results did not show any significant different of cumulative air kerma (CAK) between RRA group and LRA group during percutaneous coronary procedure (SMD 0.067, 95% CI: −0.001 TO 0.135, I<sup>2</sup> = 22.5%, <i>p</i> = 0.055). Both the operator's radiation dose and the DAP-normalized thorax dose were significantly lower with LRA compared to RRA during percutaneous coronary procedure (SMD 0.297, 95% CI: 0.023–0.71, I<sup>2</sup> = 84.4%, <i>p</i> = 0.034; SMD 0.392, 95% CI: 0.251–0.533, I<sup>2</sup> = 0%, <i>p</i> = 0.000). The LRA was associated with a significant reduction in FT, DAP and the operator's radiation exposure compared to the RRA during percutaneous coronary procedures.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"407-416"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Timely coronary angiography (CAG) is pivotal for the management of acute coronary syndrome (ACS). However, in patients with severe peripheral arterial disease (PAD), conventional vascular access through the radial or femoral arteries may be impossible, resulting in critical treatment delays. In this case study, we report a 42-year-old woman who presented with ACS and acute pulmonary edema. Electrocardiography revealed ST-segment elevation in aVR with reciprocal changes, and echocardiography showed inferoposterior wall hypokinesia with reduced ejection fraction (40%). The patient was urgently transferred for CAG. Catheterization revealed complete occlusion of both axillary arteries and the distal abdominal aorta, precluding radial and femoral access. Carotid and superficial temporal artery access were briefly considered but deferred owing to the absence of prior vascular imaging and lack of surgical standby. Computed tomography angiography was planned to evaluate potential alternative routes; however, the patient developed rapid hemodynamic deterioration and died before imaging could be performed. This case highlights the catastrophic implications of unrecognized diffuse PAD in ACS, in which conventional vascular access may be entirely unavailable. In summary, these findings suggest that awareness and early assessment of PAD, particularly in high-risk patients, are essential for anticipating procedural challenges. In extreme cases, unconventional access routes, such as the carotid or superficial temporal arteries, may offer viable, life-saving alternatives if planned in advance with appropriate imaging and surgical support.
{"title":"Challenges of Coronary Access in Acute Coronary Syndrome With Severe Peripheral Arterial Disease: A Fatal Case","authors":"Saroj Kumar Sahoo, Ramachandra Barik, Siddhartha Sathia, Chitta Ranjan Mohanty","doi":"10.1002/ccd.70368","DOIUrl":"10.1002/ccd.70368","url":null,"abstract":"<div>\u0000 \u0000 <p>Timely coronary angiography (CAG) is pivotal for the management of acute coronary syndrome (ACS). However, in patients with severe peripheral arterial disease (PAD), conventional vascular access through the radial or femoral arteries may be impossible, resulting in critical treatment delays. In this case study, we report a 42-year-old woman who presented with ACS and acute pulmonary edema. Electrocardiography revealed ST-segment elevation in aVR with reciprocal changes, and echocardiography showed inferoposterior wall hypokinesia with reduced ejection fraction (40%). The patient was urgently transferred for CAG. Catheterization revealed complete occlusion of both axillary arteries and the distal abdominal aorta, precluding radial and femoral access. Carotid and superficial temporal artery access were briefly considered but deferred owing to the absence of prior vascular imaging and lack of surgical standby. Computed tomography angiography was planned to evaluate potential alternative routes; however, the patient developed rapid hemodynamic deterioration and died before imaging could be performed. This case highlights the catastrophic implications of unrecognized diffuse PAD in ACS, in which conventional vascular access may be entirely unavailable. In summary, these findings suggest that awareness and early assessment of PAD, particularly in high-risk patients, are essential for anticipating procedural challenges. In extreme cases, unconventional access routes, such as the carotid or superficial temporal arteries, may offer viable, life-saving alternatives if planned in advance with appropriate imaging and surgical support.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"387-390"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High-degree atrioventricular block (AVB) and permanent pacemaker (PPM) implantation remain common complications following transcatheter aortic valve replacement (TAVR). Limited evidence exists on whether early postprocedural administration of atrioventricular (AV) nodal blocking medications impacts these outcomes.
Objectives
This study aimed to evaluate the safety of AV nodal blocker use within the first 48 h after TAVR.
Methods
A retrospective cohort study was conducted in adults who underwent TAVR from January 1, 2016 to April 2, 2024. The population was divided into two cohorts based on administration of an AV nodal blocker within the first 48 h. The primary endpoint was the rate of second-degree or higher AVB at 30 days.
Results
A total of 756 patients met the study criteria, with 381 (50.4%) receiving an AV nodal blocker within 48 h. The primary outcome occurred in 2.7% of patients who did not receive an AV nodal blocker and 1.6% of those who did (p = 0.297). No significant difference was observed in second-degree or higher AVB at discharge, PPM placement at 30 days, or hospital length of stay. All-cause mortality at 30 days was significantly higher in the AV nodal blocker group (2.4% vs. 0.3%, p = 0.011), but this difference did not remain significant after adjusting for covariates.
Conclusions
AV nodal blocker use within 48 h following TAVR was not associated with an increased rate of second-degree or higher AVB or PPM placement. These findings suggest that AV nodal blockers may be considered in the immediate post-TAVR period based on risk-benefit assessment.
背景：高度房室传导阻滞（AVB）和永久起搏器（PPM）植入仍然是经导管主动脉瓣置换术（TAVR）后常见的并发症。关于术后早期房室（AV）结阻断药物是否影响这些结果的证据有限。目的：本研究旨在评价TAVR术后48小时内使用房室结阻滞剂的安全性。方法：对2016年1月1日至2024年4月2日接受TAVR的成人患者进行回顾性队列研究。根据患者在头48小时内使用房室结阻滞剂的情况，将患者分为两组。主要终点是30天内二度或更高AVB的发生率。结果：共有756例患者符合研究标准，其中381例（50.4%）在48小时内接受房室结阻滞剂治疗。主要结局发生在2.7%未接受房室结阻滞剂治疗的患者和1.6%接受房室结阻滞剂治疗的患者中（p = 0.297）。出院时二度或更高AVB、PPM放置30天或住院时间均无显著差异。房室结阻滞剂组30天的全因死亡率明显更高（2.4% vs. 0.3%, p = 0.011），但在调整协变量后，这种差异并不显著。结论：在TAVR后48小时内使用房室结阻滞剂与二度或更高的AVB或PPM放置率的增加无关。这些发现表明，基于风险-收益评估，可以考虑在tavr后立即使用房室结阻滞剂。
{"title":"Impact of Early Atrioventricular Nodal Blocker Use Post-Transcatheter Aortic Valve Replacement","authors":"Jocelyn Edwards, Zachary Carroll, Mikayla Lovelace, Jorden Mandel, Lindsay Carter, Theresa Kline","doi":"10.1002/ccd.70357","DOIUrl":"10.1002/ccd.70357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-degree atrioventricular block (AVB) and permanent pacemaker (PPM) implantation remain common complications following transcatheter aortic valve replacement (TAVR). Limited evidence exists on whether early postprocedural administration of atrioventricular (AV) nodal blocking medications impacts these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the safety of AV nodal blocker use within the first 48 h after TAVR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted in adults who underwent TAVR from January 1, 2016 to April 2, 2024. The population was divided into two cohorts based on administration of an AV nodal blocker within the first 48 h. The primary endpoint was the rate of second-degree or higher AVB at 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 756 patients met the study criteria, with 381 (50.4%) receiving an AV nodal blocker within 48 h. The primary outcome occurred in 2.7% of patients who did not receive an AV nodal blocker and 1.6% of those who did (<i>p</i> = 0.297). No significant difference was observed in second-degree or higher AVB at discharge, PPM placement at 30 days, or hospital length of stay. All-cause mortality at 30 days was significantly higher in the AV nodal blocker group (2.4% vs. 0.3%, <i>p</i> = 0.011), but this difference did not remain significant after adjusting for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AV nodal blocker use within 48 h following TAVR was not associated with an increased rate of second-degree or higher AVB or PPM placement. These findings suggest that AV nodal blockers may be considered in the immediate post-TAVR period based on risk-benefit assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"351-356"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Data regarding the efficacy and safety of drug-coated balloons (DCBs) versus drug-eluting stents (DES) in patients with chronic kidney disease (CKD) remains limited.
Aims
To assess the prognosis of DCB versus DES in patients with and without CKD.
Methods
REC-CAGEFREE I was an investigator-initiated, non-inferiority trial conducted at 43 sites in China, which randomized 2272 patients to paclitaxel-coated balloons with the option of rescue stenting (DCB group) or second-generation sirolimus-eluting stents (DES group) for treating de novo lesions, regardless of vessel diameter. In this pre-specified subgroup analysis, patients were stratified based on the presence of CKD (kidney damage or estimated glomerular filtration rate < 60 mL/min per 1.73 m²) at baseline. The primary outcome was the device-oriented composite endpoint (DoCE; including cardiovascular death, target vessel myocardial infarction, and clinically and physiologically-indicated target lesion revascularization) at 2 years.
Results
Of 2272 patients enrolled, 203 (8.9%) had CKD, with 95 and 108 treated with DCB and DES, respectively. At 2 years, the risk of DoCE was significantly higher in CKD versus non-CKD patients (22/203 [10.9%] vs. 88/2069 [4.3%], HRIPTW: 2.14, 95% CI: 1.13−4.07, p = 0.022). There was no significant interaction between CKD and treatment allocation (pinteraction = 0.352). Among CKD patients, DoCE occurred in 12/95 (12.7%) and 10/108 (9.3%) patients in the DCB and DES groups (HRIPTW: 1.57, 95% CI: 0.66−3.71, p = 0.317), respectively. Among non-CKD patients, DoCE occurred in 60/1038 (5.8%) versus 28/1031 (2.7%) patients in the DCB and DES groups (HRIPTW: 2.27, 95% CI: 1.38−3.72, p = 0.002), respectively.
Conclusion
Patients with CKD had worse outcomes compared to those without. DCBs were associated with a higher risk of DoCE than DES, irrespective of CKD status.
{"title":"Impact of Chronic Kidney Disease on Outcomes With Drug-Coated Balloons Versus Drug-Eluting Stents: Insights From the REC-CAGEFREE I Trial","authors":"Xiongwei Bai, Haokao Gao, Yuehao Lv, Dongdong Sun, Qiong Wang, Zhiyong Yin, Shangyu Wen, Yuanzhe Jin, Hui Chen, Ming Yuan, Lin Zhong, Sigan Hu, Zhexun Lian, Hesong Zeng, Hongwei Pan, Jianzheng Liu, Guotao Fu, Ruining Zhang, Xingqiang He, Davide Capodanno, Scot Garg, Yoshinobu Onuma, Duolao Wang, Patrick W. Serruys, Chao Gao, Ling Tao","doi":"10.1002/ccd.70348","DOIUrl":"10.1002/ccd.70348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Data regarding the efficacy and safety of drug-coated balloons (DCBs) versus drug-eluting stents (DES) in patients with chronic kidney disease (CKD) remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the prognosis of DCB versus DES in patients with and without CKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>REC-CAGEFREE I was an investigator-initiated, non-inferiority trial conducted at 43 sites in China, which randomized 2272 patients to paclitaxel-coated balloons with the option of rescue stenting (DCB group) or second-generation sirolimus-eluting stents (DES group) for treating de novo lesions, regardless of vessel diameter. In this pre-specified subgroup analysis, patients were stratified based on the presence of CKD (kidney damage or estimated glomerular filtration rate < 60 mL/min per 1.73 m²) at baseline. The primary outcome was the device-oriented composite endpoint (DoCE; including cardiovascular death, target vessel myocardial infarction, and clinically and physiologically-indicated target lesion revascularization) at 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2272 patients enrolled, 203 (8.9%) had CKD, with 95 and 108 treated with DCB and DES, respectively. At 2 years, the risk of DoCE was significantly higher in CKD versus non-CKD patients (22/203 [10.9%] vs<i>.</i> 88/2069 [4.3%], HR<sub>IPTW</sub>: 2.14, 95% CI: 1.13−4.07, <i>p</i> = 0.022). There was no significant interaction between CKD and treatment allocation (<i>p</i><sub>interaction</sub> = 0.352). Among CKD patients, DoCE occurred in 12/95 (12.7%) and 10/108 (9.3%) patients in the DCB and DES groups (HR<sub>IPTW</sub>: 1.57, 95% CI: 0.66−3.71, <i>p</i> = 0.317), respectively. Among non-CKD patients, DoCE occurred in 60/1038 (5.8%) versus 28/1031 (2.7%) patients in the DCB and DES groups (HR<sub>IPTW</sub>: 2.27, 95% CI: 1.38−3.72, <i>p</i> = 0.002), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with CKD had worse outcomes compared to those without. DCBs were associated with a higher risk of DoCE than DES, irrespective of CKD status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Unique Identifier: NCT04561739; URL: https://www.clinicaltrials.gov.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"304-314"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luisa M Parra-Rodas, Ana C Duran-Bustamente, Guillermo Aristizabal-Villa, Yurika López-Alarcon, Eliana Cañas-Arenas, Miguel Ruz-Montes, Rafael Lince-Varela
Background
Cardiac catheterization during extracorporeal membrane oxygenation (ECMO) in pediatric patients with congenital heart disease is increasingly used to evaluate residual lesions and perform transcatheter interventions. However, evidence from Latin American populations remains scarce.
Methods
We conducted a retrospective, single-center cohort study including patients under 18 years who underwent cardiac catheterization while on ECMO support between January 2012 and December 2024. Demographic and procedural variables were collected. Outcomes included successful ECMO decannulation, procedure-related complications, and survival to hospital discharge.
Results
Among 140 pediatric patients supported with ECMO, 36% (n = 51) underwent cardiac catheterization, totaling 59 procedures. Most patients (92%) had complex congenital heart disease, with a predominance of single-ventricle physiology. In 64% of procedures, one or more transcatheter interventions were performed, most frequently balloon angioplasty or stenting of the pulmonary arteries. The median time from ECMO cannulation to catheterization was 1.25 days; 67% of procedures were performed within the first 24 h. Overall survival to hospital discharge was 43%. Major complications were infrequent (3%), and no procedure-related mortality was observed.
Conclusions
Cardiac catheterization during ECMO was feasible and safe in this cohort. Most procedures were performed early and included transcatheter interventions. Although multivariable analysis did not identify independent predictors of survival, catheterization provided essential diagnostic and therapeutic information that influenced management. These findings support its role in selected pediatric patients supported with ECMO.
{"title":"Cardiac Catheterization in Critically Ill Pediatric Patients Supported With Extracorporeal Membrane Oxygenation: A 12-Year Experience From a Latin American Center","authors":"Luisa M Parra-Rodas, Ana C Duran-Bustamente, Guillermo Aristizabal-Villa, Yurika López-Alarcon, Eliana Cañas-Arenas, Miguel Ruz-Montes, Rafael Lince-Varela","doi":"10.1002/ccd.70341","DOIUrl":"10.1002/ccd.70341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac catheterization during extracorporeal membrane oxygenation (ECMO) in pediatric patients with congenital heart disease is increasingly used to evaluate residual lesions and perform transcatheter interventions. However, evidence from Latin American populations remains scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, single-center cohort study including patients under 18 years who underwent cardiac catheterization while on ECMO support between January 2012 and December 2024. Demographic and procedural variables were collected. Outcomes included successful ECMO decannulation, procedure-related complications, and survival to hospital discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 140 pediatric patients supported with ECMO, 36% (<i>n</i> = 51) underwent cardiac catheterization, totaling 59 procedures. Most patients (92%) had complex congenital heart disease, with a predominance of single-ventricle physiology. In 64% of procedures, one or more transcatheter interventions were performed, most frequently balloon angioplasty or stenting of the pulmonary arteries. The median time from ECMO cannulation to catheterization was 1.25 days; 67% of procedures were performed within the first 24 h. Overall survival to hospital discharge was 43%. Major complications were infrequent (3%), and no procedure-related mortality was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cardiac catheterization during ECMO was feasible and safe in this cohort. Most procedures were performed early and included transcatheter interventions. Although multivariable analysis did not identify independent predictors of survival, catheterization provided essential diagnostic and therapeutic information that influenced management. These findings support its role in selected pediatric patients supported with ECMO.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"361-368"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Georgios E. Papadopoulos, Ilias Ninios, Konstantinos Papazoglou, Vlasis Ninios
Background
Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity.
Case
A 74-year-old man with severe symptomatic aortic stenosis and a prior left-subclavian-to-descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter-derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre-shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5-mm balloon-expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak.
Conclusion
Intentional pre-shaping of a stiff wire can facilitate TF device traversal across aorto–subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.
{"title":"Successful Transcatheter Aortic Valve Replacement in a Patient with Previous Aortic Coarctation Bypass Graft: A Case Report","authors":"Georgios E. Papadopoulos, Ilias Ninios, Konstantinos Papazoglou, Vlasis Ninios","doi":"10.1002/ccd.70354","DOIUrl":"10.1002/ccd.70354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>A 74-year-old man with severe symptomatic aortic stenosis and a prior left-subclavian-to-descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter-derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre-shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5-mm balloon-expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Intentional pre-shaping of a stiff wire can facilitate TF device traversal across aorto–subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"391-394"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nathan G. Best, Marienell Talla, Farnaz Rafiee, Sruthy Balakumar, Aviva Moses, Selai Akseer, Douglas S. Lee, Eric M. Horlick, Ella Huszti, Lusine Abrahamyan
While hospital readmission is the most common health system performance metric after transcatheter cardiac interventions, emergency department (ED) visits are rarely evaluated. We aimed to synthesize the incidence, causes, predictors, costs, and outcomes of ED visits following transcatheter procedures in patients undergoing percutaneous coronary interventions (PCI), atrial septal defect (ASD) closures, patent foramen ovale (PFO) closures, and transcatheter aortic valve interventions (TAVI). Embase and Medline databases were searched from January 01, 2004, to July 25, 2024. We descriptively summarized ED visit outcomes for all studies and, when relevant, performed a meta-analysis to obtain a pooled mean cumulative incidence for 30-day ED visits following intervention. Nineteen studies met the eligibility criteria, nine of which were subsequently meta-analyzed. The incidence of 30-day ED visits in individual studies ranged from 2.8% to 22% for PCI patients, 4% to 15.3% for TAVI patients, and 16.9% to 19.5% for ASD/PFO patients. The pooled mean cumulative incidence of 30-day ED visits was 9% (95% CI: 3%–18%) for PCI patients and 12% (95% CI: 9%–15%) for TAVI patients. A high degree of between-study heterogeneity was found in the meta-analysis of these outcomes. Based on limited reporting, risk factors associated with ED visits varied by procedure and included factors such as urgency of procedure, length of stay, sex, age, and dementia. The incidence and predictors of ED visits post-transcatheter cardiac interventions were noteworthy yet highly variable and inconsistently reported. Further research into the risk factors that contribute to ED visits is needed to capture the burden of this outcome.
{"title":"Emergency Department Visits Following Transcatheter Cardiac Interventions: A Systematic Review and Meta-Analysis","authors":"Nathan G. Best, Marienell Talla, Farnaz Rafiee, Sruthy Balakumar, Aviva Moses, Selai Akseer, Douglas S. Lee, Eric M. Horlick, Ella Huszti, Lusine Abrahamyan","doi":"10.1002/ccd.70355","DOIUrl":"10.1002/ccd.70355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>While hospital readmission is the most common health system performance metric after transcatheter cardiac interventions, emergency department (ED) visits are rarely evaluated. We aimed to synthesize the incidence, causes, predictors, costs, and outcomes of ED visits following transcatheter procedures in patients undergoing percutaneous coronary interventions (PCI), atrial septal defect (ASD) closures, patent foramen ovale (PFO) closures, and transcatheter aortic valve interventions (TAVI). Embase and Medline databases were searched from January 01, 2004, to July 25, 2024. We descriptively summarized ED visit outcomes for all studies and, when relevant, performed a meta-analysis to obtain a pooled mean cumulative incidence for 30-day ED visits following intervention. Nineteen studies met the eligibility criteria, nine of which were subsequently meta-analyzed. The incidence of 30-day ED visits in individual studies ranged from 2.8% to 22% for PCI patients, 4% to 15.3% for TAVI patients, and 16.9% to 19.5% for ASD/PFO patients. The pooled mean cumulative incidence of 30-day ED visits was 9% (95% CI: 3%–18%) for PCI patients and 12% (95% CI: 9%–15%) for TAVI patients. A high degree of between-study heterogeneity was found in the meta-analysis of these outcomes. Based on limited reporting, risk factors associated with ED visits varied by procedure and included factors such as urgency of procedure, length of stay, sex, age, and dementia. The incidence and predictors of ED visits post-transcatheter cardiac interventions were noteworthy yet highly variable and inconsistently reported. Further research into the risk factors that contribute to ED visits is needed to capture the burden of this outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"369-382"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessia Callegari, Mathilde Meot, Diala Khraiche, Neil Derridj, Damien Bonnet, Sophie Malekzadeh-Milani
Introduction
Atrial septal defect (ASD) closure in patients with bidirectional or right-to-left shunts presents significant challenges regarding indications, procedure, and follow-up.
Methods
We conducted a retrospective study on 47 patients undergoing percutaneous ASD closure with right-to-left or bidirectional shunts, analyzing clinical features, procedural details, and outcomes.
Results
Median age was 10.2 years (IQR: 6.2–14.1), and weight was 30.9 kg (20.8–50.4). Desaturation (89.4%) was the main indication, with bidirectional (48.9%) or fixed right-to-left shunts (40.4%). Eight patients (16%) were NYHA class III–IV. Diagnoses included pulmonary hypertension (12.8%), restrictive RV physiology (44%), RV outflow tract obstruction (27.7%), tricuspid regurgitation streaming (6.4%), and elevated RA pressure due to tricuspid valve stenosis (8.5%). Median NT-pro-BNP was 1155 pg/mL (827–1692). ASD size on TOE was 11 mm (7.2–14.7); balloon sizing and occlusion were used in 25.5% and 12.8%, respectively. RA and RV pressures remained stable post-closure. First-attempt closure succeeded in 81.1%, mostly with the Amplatzer Septal Occluder (65.9%), oversized by 4 mm. Three early deaths (6.4%) were recorded: 2 with RV failure and Potts shunt in pulmonary hypertension and one from device embolization causing a major stroke. Median hospital stay was 2 days. Over a median 4.7 years follow-up (1.86–10.6), RV function was normal in 83.7%. Reintervention rates were 4.5% (percutaneous) and 11.3% (surgical). One late death and one transplantation occurred.
Conclusions
Percutaneous closure of atrial septal defects offers favorable outcomes even in high-risk patients, despite inherent concerns. Careful patient selection and tailored procedural strategies are essential for optimizing results in this population at risk.
{"title":"Percutaneous Closure of Atrial Septal Defects With Bidirectional or Right-to-Left Shunts","authors":"Alessia Callegari, Mathilde Meot, Diala Khraiche, Neil Derridj, Damien Bonnet, Sophie Malekzadeh-Milani","doi":"10.1002/ccd.70349","DOIUrl":"10.1002/ccd.70349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial septal defect (ASD) closure in patients with bidirectional or right-to-left shunts presents significant challenges regarding indications, procedure, and follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study on 47 patients undergoing percutaneous ASD closure with right-to-left or bidirectional shunts, analyzing clinical features, procedural details, and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median age was 10.2 years (IQR: 6.2–14.1), and weight was 30.9 kg (20.8–50.4). Desaturation (89.4%) was the main indication, with bidirectional (48.9%) or fixed right-to-left shunts (40.4%). Eight patients (16%) were NYHA class III–IV. Diagnoses included pulmonary hypertension (12.8%), restrictive RV physiology (44%), RV outflow tract obstruction (27.7%), tricuspid regurgitation streaming (6.4%), and elevated RA pressure due to tricuspid valve stenosis (8.5%). Median NT-pro-BNP was 1155 pg/mL (827–1692). ASD size on TOE was 11 mm (7.2–14.7); balloon sizing and occlusion were used in 25.5% and 12.8%, respectively. RA and RV pressures remained stable post-closure. First-attempt closure succeeded in 81.1%, mostly with the Amplatzer Septal Occluder (65.9%), oversized by 4 mm. Three early deaths (6.4%) were recorded: 2 with RV failure and Potts shunt in pulmonary hypertension and one from device embolization causing a major stroke. Median hospital stay was 2 days. Over a median 4.7 years follow-up (1.86–10.6), RV function was normal in 83.7%. Reintervention rates were 4.5% (percutaneous) and 11.3% (surgical). One late death and one transplantation occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Percutaneous closure of atrial septal defects offers favorable outcomes even in high-risk patients, despite inherent concerns. Careful patient selection and tailored procedural strategies are essential for optimizing results in this population at risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"288-296"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaan A. Ahmed, Abdullah Al-Qaraghuli, Adam Purvis, Ori Waksman, Ryan Wallace, Gaby Weissman, Ron Waksman, Itsik Ben-Dor
Objectives
We sought to assess the availability and comprehensiveness of interventional cardiology (IC) fellowship program websites.
Background
IC joined the National Resident Matching Program (NRMP) starting in the 2024−2025 fellowship application cycle to enhance fairness and standardization in the application process. It is known that applicants rely on online information and program websites during fellowship recruitment, but no study has evaluated IC program websites.
Methods
The online content of all IC fellowship programs listed in the Electronic Residency Application Service (ERAS) was evaluated. Websites were identified through ERAS, the American Medical Association Residency & Fellowship Database (FREIDA), and Google. Each website was assessed for the presence of 25 variables encapsulating information felt to be valuable to applicants.
Results
One hundred ninety-three IC fellowship programs were listed in ERAS, of which four programs were duplicates and excluded. 32/189 (16.9%) of programs in ERAS and 66/189 (34.9%) of programs in FREIDA provided weblinks that directly linked to the fellowship program website, whereas the remainder had inaccurate or broken links, or no weblink at all. After searching ERAS, FREIDA, and Google, 171/189 (90.5%) of programs had an identifiable website. Among 171 program websites, the mean percentage of variables present was 56.7%, and the occurrence of each variable across 171 websites is shown in Figure 1. Programs listed as participating in ERAS were significantly more likely to have a program website (93.8% vs. 72.4%, p < 0.0001).
Conclusions
Information gaps and areas for improvement are present in the online content provided to prospective applicants of IC fellowship programs.
目的：我们试图评估介入心脏病学（IC）奖学金项目网站的可用性和全面性。背景：IC从2024-2025年奖学金申请周期开始加入国家居民匹配计划（NRMP），以提高申请过程的公平性和标准化。众所周知，申请人在奖学金招聘过程中依赖于在线信息和项目网站，但没有研究评估IC项目网站。方法：对电子居留申请服务（ERAS）中列出的所有IC奖学金项目的在线内容进行评估。网站是通过ERAS、美国医学协会住院医师和奖学金数据库（FREIDA）和谷歌确定的。每个网站都被评估了25个变量的存在，这些变量包含了对申请人有价值的信息。结果：ERAS收录了193个IC奖学金项目，其中4个重复项目被排除。ERAS中32/189（16.9%）的项目和FREIDA中66/189（34.9%）的项目提供了直接链接到奖学金项目网站的网页链接，而其余项目的链接不准确或断裂，或者根本没有网页链接。在搜索ERAS， FREIDA和谷歌后，171/189（90.5%）的程序有可识别的网站。171个节目网站中变量的平均存在率为56.7%，各变量在171个网站中的出现情况如图1所示。被列为参与ERAS的项目更有可能有一个项目网站（93.8% vs. 72.4%, p）。结论：向IC奖学金项目的潜在申请人提供的在线内容存在信息差距和需要改进的领域。
{"title":"Evaluation of Online Content and Websites of Interventional Cardiology Fellowship Programs","authors":"Shaan A. Ahmed, Abdullah Al-Qaraghuli, Adam Purvis, Ori Waksman, Ryan Wallace, Gaby Weissman, Ron Waksman, Itsik Ben-Dor","doi":"10.1002/ccd.70335","DOIUrl":"10.1002/ccd.70335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We sought to assess the availability and comprehensiveness of interventional cardiology (IC) fellowship program websites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>IC joined the National Resident Matching Program (NRMP) starting in the 2024−2025 fellowship application cycle to enhance fairness and standardization in the application process. It is known that applicants rely on online information and program websites during fellowship recruitment, but no study has evaluated IC program websites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The online content of all IC fellowship programs listed in the Electronic Residency Application Service (ERAS) was evaluated. Websites were identified through ERAS, the American Medical Association Residency & Fellowship Database (FREIDA), and Google. Each website was assessed for the presence of 25 variables encapsulating information felt to be valuable to applicants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred ninety-three IC fellowship programs were listed in ERAS, of which four programs were duplicates and excluded. 32/189 (16.9%) of programs in ERAS and 66/189 (34.9%) of programs in FREIDA provided weblinks that directly linked to the fellowship program website, whereas the remainder had inaccurate or broken links, or no weblink at all. After searching ERAS, FREIDA, and Google, 171/189 (90.5%) of programs had an identifiable website. Among 171 program websites, the mean percentage of variables present was 56.7%, and the occurrence of each variable across 171 websites is shown in Figure 1. Programs listed as participating in ERAS were significantly more likely to have a program website (93.8% vs. 72.4%, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Information gaps and areas for improvement are present in the online content provided to prospective applicants of IC fellowship programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"342-350"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anomalies of the inferior vena cava are rare complications of angiogenesis but can have significant implications for the cardiovascular proceduralist. Although rare, advances in diagnostic imaging capabilities and more frequent imaging have resulted in increased observation of these anomalies. The recognition of this anomaly before intervention is essential. In this case report, we present an unusual case of a woman with an interrupted inferior vena cava suffering from an acute pulmonary embolism.
{"title":"Pulmonary Embolism in a Patient With Interrupted Inferior Vena Cava With Azygos Continuation and Polysplenia: A Case Report and Literature Review","authors":"Ronnie Adams, Christopher Ramos, Michael McDaniel","doi":"10.1002/ccd.70364","DOIUrl":"10.1002/ccd.70364","url":null,"abstract":"<div>\u0000 \u0000 <p>Anomalies of the inferior vena cava are rare complications of angiogenesis but can have significant implications for the cardiovascular proceduralist. Although rare, advances in diagnostic imaging capabilities and more frequent imaging have resulted in increased observation of these anomalies. The recognition of this anomaly before intervention is essential. In this case report, we present an unusual case of a woman with an interrupted inferior vena cava suffering from an acute pulmonary embolism.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"383-386"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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