Circulation: Cardiovascular Interventions最新文献

{"title":"Novel Global Platelet Reactivity Biomarker for a More Precise Ischemic Risk Stratification.","authors":"Antonio Landi, Marco Valgimigli","doi":"10.1161/CIRCINTERVENTIONS.125.015282","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015282","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015282"},"PeriodicalIF":6.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcarotid Versus Surgical Aortic Valve Replacement for the Treatment of Severe Aortic Stenosis.","authors":"Juan Hernando Del Portillo, Pedro Cepas-Guillén, Dimitri Kalavrouziotis, Eric Dumont, Jean Porterie, Jean-Michel Paradis, Anthony Poulin, Frederic Beaupré, Marisa Avvedimento, Silvia Mas-Peiro, Siddhartha Mengi, Siamak Mohammadi, Josep Rodés-Cabau","doi":"10.1161/CIRCINTERVENTIONS.124.014928","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014928","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and unfavorable iliofemoral access. Transcarotid transcatheter aortic valve replacement (TC-TAVR) has emerged as an alternative access in suboptimal transfemoral candidates, but no data exist comparing TC-TAVR and SAVR. The main objective of this study was to compare the clinical outcomes in a propensity-matched population of TC-TAVR and SAVR patients with severe aortic stenosis.</p><p><strong>Methods: </strong>A total of 786 patients (SAVR, 352; TC-TAVR, 434) were included, and a total of 182 patients were propensity-matched and included in each group. The primary outcome was a composite of death from any cause, stroke/transient ischemic attack, and procedure-related or valve-related hospitalization at 30 days and at 1 year. Data were prospectively collected in dedicated databases, and clinical events were defined according to Valve Academic Research Consortium-3 criteria.</p><p><strong>Results: </strong>Baseline characteristics were well balanced between the matched groups, and the mean age and Society for Thoracic Surgeons score of the study population were 75 years and 3.6%, respectively. At 30 days, the SAVR group showed a higher rate of the primary composite outcome compared with the TC-TAVR group (12.6% versus 4.3%; hazard ratio, 2.93 [95% CI, 1.45-5.94]). Acute kidney injury stages 2 to 4, bleeding events, and new-onset atrial fibrillation occurred more often in the SAVR group during the hospital period (<i>P</i><0.001). In contrast, vascular complications and the need for permanent pacemaker implantation occurred more often in the TC-TAVR group (<i>P</i>=0.01 and <i>P</i>=0.001, respectively). At 1-year follow-up, there were no significant differences between groups in the primary outcome rates (SAVR, 19.7% versus TC-TAVR, 12.7%; hazard ratio, 1.63 [95% CI, 0.98-2.73]).</p><p><strong>Conclusions: </strong>TC-TAVR was associated with improved 30-day clinical outcomes compared with SAVR, with no significant differences in death, stroke, and hospitalization at 1-year follow-up. These findings suggest that TC-TAVR may be a valid alternative to SAVR in nontransfemoral-TAVR candidates.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014928"},"PeriodicalIF":6.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Platelet FcγRIIa in Patients Treated With PCI Compared With Medical Therapy Alone After Myocardial Infarction.","authors":"David J Schneider, Sean R McMahon, Dominick J Angiolillo, Alexander C Fanaroff, Homam Ibrahim, Patrick K Hohl, Brett L Wanamaker, Mark B Effron, Peter M DiBattiste","doi":"10.1161/CIRCINTERVENTIONS.124.014939","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014939","url":null,"abstract":"<p><strong>Background: </strong>In patients with myocardial infarction (MI), quantifying platelet FcɣRIIa (pFCG) stratifies the risk of subsequent MI, stroke, and death. This report is a subgroup analysis of outcomes in patients treated with percutaneous coronary intervention (PCI) or medical management alone in an 800-patient, 25-center trial.</p><p><strong>Methods: </strong>Patients were enrolled in a prospective, noninterventional trial during hospitalization for type 1 MI (ST-segment elevation and non-ST-segment elevation). Inclusion criteria included at least 2 of the following: aged ≥65 years, multivessel coronary artery disease, prior MI, chronic kidney disease, or diabetes. Flow cytometry was used to quantify pFCG at a core laboratory. High and low pFCG were defined by a prespecified threshold. The primary end point was the composite of MI, stroke, and death.</p><p><strong>Results: </strong>Patients treated with medical therapy alone (n=151) had a greater occurrence of the primary end point (23.8%) than those treated with PCI (n=490, 8.8%). The pFCG test discriminated to a similar extent the risk of the primary end point in both the medical treatment group (hazard ratio, 2.29 [95% CI, 1.18-4.41]; <i>P</i>=0.014) and the PCI group (hazard ratio, 2.57 [95% CI, 1.41-4.69]; <i>P</i>=0.002). There was no significant association between pFCG and clinically relevant bleeding in the medical treatment group (hazard ratio, 1.22 [95% CI, 0.29-5.10]) or the PCI group (hazard ratio, 1.56 [95% CI, 0.67-3.61]).</p><p><strong>Conclusions: </strong>Quantifying pFCG discerned the risk of subsequent cardiovascular events among patients treated with medical therapy alone or PCI. This prognostic information will be useful for clinical decisions that balance ischemic and bleeding risk.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05175261.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014939"},"PeriodicalIF":6.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valve-in-Valve TAVR in Patients With Failed Trifecta Bioprosthetic Aortic Valves.","authors":"Mohammad Zmaili, Nikolaos Spilias, Shivabalan Kathavarayan Ramu, Tikal Kansara, Akhilesh Khuttan, Maryam Muhammad Ali Majeed-Saidan, Besir Besir, Rohan Prasad, Judah Rajendran, Feras Alkhalaileh, Ahmad Gharaibeh, Agam Bansal, Abdelrahman Abushouk, Serge Harb, Rishi Puri, Grant Reed, James Yun, Amar Krishnaswamy, Samir Kapadia","doi":"10.1161/CIRCINTERVENTIONS.124.014532","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014532","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014532"},"PeriodicalIF":6.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antispasmodic Medications to Optimize Long-Term Radial Artery Graft Patency in CABG.","authors":"Dominique Vervoort, Stephen E Fremes","doi":"10.1161/CIRCINTERVENTIONS.125.015199","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015199","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015199"},"PeriodicalIF":6.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Nicorandil, Isosorbide Mononitrate, or Diltiazem on Radial Artery Grafts After CABG: The Randomized ASRAB-Pilot Trial.","authors":"Yunpeng Zhu, Wei Zhang, Kaijie Qin, Yun Liu, Haoyi Yao, Zhe Wang, Xiaofeng Ye, Mi Zhou, Haiqing Li, Jiapei Qiu, Hong Xu, Yanjun Sun, Mario Gaudino, Qiang Zhao","doi":"10.1161/CIRCINTERVENTIONS.124.014542","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014542","url":null,"abstract":"<p><strong>Background: </strong>The optimal antispastic treatment after coronary artery bypass grafting using radial artery (RA) grafts is controversial. This clinical trial aimed to generate pilot comparative data on the effects of nicorandil, isosorbide mononitrate, or diltiazem on RA grafts.</p><p><strong>Methods: </strong>This was a single-center, randomized, open-label, parallel-group pilot trial. Eligible patients who underwent coronary artery bypass grafting using RA grafts were randomized in a 1:1:1 ratio to receive oral nicorandil (15 mg daily), isosorbide mononitrate (50 mg daily), or diltiazem (180 mg daily) for 24 weeks post-coronary artery bypass grafting. The primary outcome was RA graft failure (modified Fitzgibbon grade B, S, or O) at 1 and 24 weeks, assessed by coronary computed tomography angiography.</p><p><strong>Results: </strong>Among 150 randomized participants, 149 (mean age, 56.8 years; 13.4% women) with 177 RA grafts were assessed at least once by coronary computed tomography angiography, including 50 participants with 64 RA grafts in the nicorandil group, 50 participants with 57 RA grafts in the isosorbide mononitrate group, and 49 participants with 56 RA grafts in the diltiazem group, respectively. At 1 week post-coronary artery bypass grafting, the RA graft failure rates were lower with nicorandil versus diltiazem (19.4% versus 25.0%; difference, -5.6% [95% CI, -20.6% to 9.3%]) and isosorbide mononitrate versus diltiazem (18.2% versus 25.0%; difference, -6.8% [95% CI, -21.8% to 8.6%]). The RA graft failure rates were slightly higher with nicorandil versus isosorbide mononitrate (19.4% versus 18.2%; difference, 1.2% [95% CI, -13.3% to 15.2%]). At 24 weeks, RA graft failure rates were lower with nicorandil versus diltiazem (16.1% versus 27.8%; difference, -11.7% [95% CI, -26.6% to 3.4%]), and isosorbide mononitrate versus diltiazem (12.5% versus 27.8%; difference, -15.3% [95% CI, -29.8% to -0.2%]), and slightly higher with nicorandil versus isosorbide mononitrate (16.1% versus 12.5%; difference, 3.6% [95% CI, -9.6% to 16.4%]).</p><p><strong>Conclusions: </strong>In this pilot trial, treatment with nicorandil or isosorbide mononitrate was associated with a lower RA graft failure rate compared with diltiazem. Larger hypothesis-testing trials are warranted.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04310995.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014542"},"PeriodicalIF":6.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Improve Radiation Protection in Interventional Cardiology Procedures.","authors":"Dimitrios Strepkos, Athanasios Rempakos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, Ali Bahbah, Ryan D Madder, Simon R Dixon, Anastasios Milkas, Kevin J Croce, William J Nicholson, Lorenzo Azzalini, Bavana V Rangan, Olga C Mastrodemos, Konstantinos Voudris, Ahmed Al-Ogaili, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis","doi":"10.1161/CIRCINTERVENTIONS.124.014808","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014808","url":null,"abstract":"<p><p>The use of ionizing radiation during cardiac catheterization procedures poses risks to patients and medical staff, both directly and indirectly through orthopedic injuries caused by lead aprons. In this review, we summarize recent advances in radiation protection in the cardiac catheterization laboratory and discuss the effectiveness of traditional and novel radiation protection strategies and equipment.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014808"},"PeriodicalIF":6.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postimplantation Size of WATCHMAN FLX Pro: A New Left Atrial Appendage Closure System.","authors":"Tetsuma Kawaji, Shun Hojo, Ryota Takahashi, Masashi Kato, Takafumi Yokomatsu","doi":"10.1161/CIRCINTERVENTIONS.124.015056","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.015056","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015056"},"PeriodicalIF":6.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Mitral Valve Replacement With Atrial Fixation for Treatment of Atrial Functional Mitral Regurgitation.","authors":"John T Saxon, Philippe Genereux, Vlasis Ninios, Thomas Waggoner, Naeem Tahirkheli, Marek Grygier, Krzysztof Wrobel, Matti Adam, Georg Nickenig, Tsuyoshi Kaneko, Paul Sorajja","doi":"10.1161/CIRCINTERVENTIONS.124.014985","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014985","url":null,"abstract":"<p><strong>Background: </strong>Many patients with atrial functional mitral regurgitation are not suitable candidates for surgery or transcatheter repair. For transcatheter mitral valve replacement, a common contraindication is the risk of left ventricular outflow tract obstruction, particularly in patients with atrial functional mitral regurgitation, who have characteristically small left ventricles. Herein, we examine the outcomes of transcatheter mitral valve replacement using the AltaValve system, which employs atrial fixation thus minimizing left ventricular outflow tract obstruction risk.</p><p><strong>Methods: </strong>Patients with severe, symptomatic mitral regurgitation who were treated in the AltaValve early feasibility study or on the basis of a compassionate use exemption. The definition of atrial functional mitral regurgitation required the presence of: (1) severe mitral regurgitation; (2) atrial fibrillation; (3) normal left ventricular size; (4) left ventricular ejection fraction ≥50%; and (5) absence of organic mitral disease. Procedural outcomes, 30-day survival, and echo findings are reported.</p><p><strong>Results: </strong>Fourteen patients (71% women, mean age 77.9 years, Society of Thoracic Surgeons Predicted Risk of Mortality score 5.4%) were treated, including 11 via transseptal delivery and 3 via a transapical approach. Technical success and mitral regurgitation reduction from severe to none/trace were achieved in all cases. There were no cases of left ventricular outflow tract obstruction. All-cause mortality at 30 days was 14% (2/14). Class III/IV New York Heart Association status was reduced from 79% at baseline to 0% at 30 days. At 30 days, 11 of 12 surviving patients had an available echocardiogram; mitral regurgitation severity was trace/none in 90.9% (10/11) and mild in 9.1% (1/11).</p><p><strong>Conclusions: </strong>The AltaValve system shows promising early procedural and clinical results for the unique anatomy of patients with atrial functional mitral regurgitation. Long-term clinical studies to demonstrate the benefit of this system are warranted.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014985"},"PeriodicalIF":6.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operator Radiation Exposure Comparing the Left Radial Artery Approach and a Uniform Hyper-Adducted Right Radial Artery Approach: The HARRA Study.","authors":"Richard Casazza, Bilal Malik, Arsalan Hashmi, Joshua Fogel, Enrico Montagna, Robert Frankel, Elliot Borgen, Sergey Ayzenberg, Michael Friedman, Norbert Moskovits, Shivani Verma, Jamie Meng, Nailun Chang, Yili Huang, Carlos Rodriguez, Habib Hymie Chera, Shiv Raj, Saurav Chaterjee, Daren Gibson, Andres Palacios, Chirag Agarwal, Maria Victoria Nene, Jacob Shani","doi":"10.1161/CIRCINTERVENTIONS.124.014602","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014602","url":null,"abstract":"<p><strong>Background: </strong>Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Various arterial access sites have shown to yield different operator radiation exposure during diagnostic cardiac catheterization.</p><p><strong>Methods: </strong>This single-center randomized controlled trial assessed the cumulative radiation exposure and normalized radiation exposure at 4 different anatomic locations (thorax, abdomen, left eye, and right eye) of the primary operator when using the left radial artery (LRA) approach compared with a uniform hyper-adducted right radial artery (HARRA) approach. Patients (n=534) were randomized to LRA (n=269) or HARRA (n=265). During diagnostic catheterization, real-time radiation dosimeters were placed on the thorax, abdomen, left eye, and right eye of each operator.</p><p><strong>Results: </strong>Cumulative radiation measurements were as follows: thorax (LRA, 9.66±8.57 microsieverts [μSv] versus HARRA, 12.27±7.09 μSv; <i>P</i><0.001); abdomen (LRA, 27.46±21.20 μSv versus HARRA, 36.56±23.72 μSv; <i>P</i><0.001); left eye (LRA, 2.65±2.59 μSv versus HARRA, 3.77±2.67 μSv; <i>P</i><0.001); and right eye (LRA, 1.13±1.69 μSv versus HARRA, 1.44±1.62 μSv; <i>P</i>=0.01). Normalized radiation measurements were: thorax (LRA, 0.38±0.35 versus HARRA, 0.49±0.24; <i>P</i><0.001); abdomen (LRA, 1.06±0.72 versus HARRA, 1.38±0.69; <i>P</i><0.001); left eye (LRA, 0.10±0.09 versus HARRA, 0.15±0.10; <i>P</i><0.001); and right eye: (LRA, 0.04±0.06 versus HARRA, 0.05±0.06; <i>P</i>=0.02). LRA had lower subclavian tortuosity than HARRA (15.6% versus 32.5%, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>The LRA was associated with significantly less cumulative and normalized radiation exposure to the thorax, abdomen, left eye, and right eye of the primary operator compared with HARRA during diagnostic cardiac catheterization. Operators should consider using LRA more frequently than HARRA for diagnostic cardiac catheterization as this approach can reduce occupational radiation exposure.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05833516.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014602"},"PeriodicalIF":6.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}