Circulation: Cardiovascular Interventions最新文献

{"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}

{"title":"Patent Foramen Ovale Closure in Patients With and Without Nickel Hypersensitivity: A Randomized Trial.","authors":"Anastasios Apostolos, Stamatios Gregoriou, Maria Drakopoulou, Georgios Trantalis, Aikaterini Tsiogka, Nikolaos Ktenopoulos, Constantina Aggeli, Alexander Stratigos, Konstantinos Tsioufis, Konstantinos Toutouzas","doi":"10.1161/CIRCINTERVENTIONS.125.015228","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015228","url":null,"abstract":"<p><p><b>Background:</b> Nickel-containing devices, such as the Amplatzer PFO Occluder and Gore® Cardioform Septal Occluder (GSO), are used for transcatheter patent foramen ovale (PFO) closure. However, the impact of nickel hypersensitivity on post-procedural outcomes remains poorly understood. This study aimed to evaluate the risk of adverse events, in patients with nickel hypersensitivity undergoing PFO closure. <b>Methods:</b> Our study was a prospective, double-blinded, randomized study enrolling patients with cryptogenic stroke and PFO-related ischemic stroke to receive either the Amplatzer or GSO device. Nickel hypersensitivity was assessed using skin patch testing. The primary endpoint was the incidence of device syndrome, a composite of patient-reported symptoms (chest pain, palpitations, migraines, dyspnea, and rash). <b>Results:</b> Of the 96 patients, 28 (29.2%) had nickel hypersensitivity. The incidence of device syndrome was significantly higher in patients with nickel hypersensitivity compared to those without (71.4% vs. 20.6%, p < 0.001). Specifically, new-onset or worsening migraines and palpitations were more frequent in nickel-hypersensitive patients. No significant differences were observed in documented arrhythmias, bleeding, or stroke. Multivariable analysis showed that nickel hypersensitivity was associated with a 10.5-fold increase in the odds of device syndrome (aOR = 10.53, 95% CI: 3.17-35.00, p < 0.001). The incidence of device syndrome was similar for both devices. <b>Conclusions:</b> Patients with nickel hypersensitivity are at significantly higher risk for developing device syndrome after PFO closure. Both the Amplatzer and GSO devices demonstrated comparable safety and efficacy in this population. These findings highlight the need for further research to optimize device selection and improve outcomes in nickel-hypersensitive patients.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585099","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":"Early Versus Delayed Invasive Management of Female Patients With Non-ST-Elevation Acute Coronary Syndrome: An Individual Patient Data Meta-Analysis.","authors":"Gregory B Mills, Christos P Kotanidis, Shamir Mehta, Denise Tiong, Erik A Badings, Thomas Engstrøm, Arnoud W J van 't Hof, Dan Høfsten, Lene Holmvang, Alexander Jobs, Lars Køber, Dejan Milasinovic, Aleksandra Milosevic, Goran Stankovic, Holger Thiele, Roxana Mehran, Vijay Kunadian","doi":"10.1161/CIRCINTERVENTIONS.124.014763","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014763","url":null,"abstract":"<p><strong>Background: </strong>Female patients are at greater risk of adverse events following non-ST-elevation acute coronary syndrome but less frequently receive guideline-recommended coronary angiography and revascularization. Routine invasive management benefits high-risk patients, but evidence informing the optimal timing of angiography specifically in female patients is lacking.</p><p><strong>Methods: </strong>Medline, Web of Science, and Scopus were searched up to November 2023. Randomized controlled trials investigating early versus delayed timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome were included. Individual patient data from female patients were extracted. The primary end point was a composite of all-cause mortality or myocardial infarction at 6 months. We performed a 1-stage individual patient data meta-analysis using random-effects Cox models.</p><p><strong>Results: </strong>Six trials contributed individual patient data from 2257 female patients. Median time to coronary angiography was 5 hours in the early invasive group (n=1141) and 49 hours in the delayed invasive group (n=1116). Overall, there was no significant reduction in the risk of the primary end point in the early invasive group compared with the delayed group (hazard ratio, 0.79 [95% CI, 0.60-1.06]; <i>P</i>=0.12). Early invasive management was associated with a reduction in recurrent ischemia (hazard ratio, 0.60 [95% CI, 0.39-0.94]; <i>P</i>=0.025). In the prespecified subgroup analysis, high-risk female patients with Global Registry of Acute Coronary Events score >140 receiving early invasive management experienced a significantly reduced hazard for all-cause mortality or myocardial infarction at 6 months (hazard ratio, 0.65 [95% CI, 0.45-0.94]; <i>P</i>=0.021; <i>P</i>_interaction=0.035). Similar benefits were observed for female patients with elevated cardiac biomarkers.</p><p><strong>Conclusions: </strong>Early invasive management in female patients with non-ST-elevation acute coronary syndrome, compared with delayed invasive management, was not associated with a significant reduction in the hazard for the primary end point. In prespecified subgroup analysis, high-risk female patients as assessed with Global Registry of Acute Coronary Events score >140 or elevated cardiac biomarkers experienced significant reductions in all-cause mortality or myocardial infarction at 6 months following early invasive management.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023468604.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014763"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540411","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":"Characteristics and Outcomes of PCI Among Patients Ineligible for Surgical Revascularization in the Veterans Affairs Healthcare System.","authors":"Christopher P Kovach, Jerry Lipinski, Elise C Mesenbring, Peter Boulos, Abby Pribish, Michael Sola, Thomas J Glorioso, William F Fearon, Robert W Yeh, Stephen W Waldo","doi":"10.1161/CIRCINTERVENTIONS.124.014899","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014899","url":null,"abstract":"<p><strong>Background: </strong>Ineligibility for surgical revascularization is increasingly prevalent and associated with increased mortality after percutaneous coronary intervention (PCI). High-quality, contemporary, multicenter data regarding clinical outcomes after PCI is scarce and poses a barrier to clinical decision-making for surgically ineligible patients. The aim of this study was to describe and compare the clinical characteristics, institutional variation, and longitudinal outcomes of PCI among surgically eligible and ineligible patients in the Veterans Affairs Healthcare System.</p><p><strong>Methods: </strong>Patients with left main and/or multivessel coronary artery disease undergoing index PCI between October 1, 2017 and September 30, 2022 were identified and the prevalence of surgical ineligibility determined by review of the electronic medical record. The association between surgical ineligibility and mortality and major adverse cardiovascular events (MACE; death, myocardial infarction, repeat revascularization, and stroke) was assessed.</p><p><strong>Results: </strong>A total of 6192 patients with left main and/or multivessel coronary artery disease (842 surgically ineligible and 5350 surgically eligible) underwent PCI during the study period. After adjustment, surgical ineligibility was associated with a significantly decreased time to mortality (time ratio, 0.801 [95% CI, 0.662-0.970]) over a median 1045-day (interquartile range, 583-1600) follow-up period, though not associated with composite MACE (time ratio, 0.859 [95% CI, 0.685-1.078]). After adjustment for target lesion characteristics and procedural complexity, the association between surgical ineligibility and mortality was attenuated (time ratio, 0.842 [95% CI, 0.688-1.030]).</p><p><strong>Conclusions: </strong>Ineligibility for surgical revascularization was associated with increased risk of long-term mortality after PCI. The risk of adverse outcomes after PCI, however, was similar among surgically eligible and ineligible patients after adjusting for measured comorbidities, coronary anatomic features, and procedural complexity.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014899"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655988","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":"Medical, Surgical, and Interventional Management of Hypertrophic Cardiomyopathy.","authors":"Daniele Massera, Mark V Sherrid, Joshua A Scheinerman, Daniel G Swistel, Louai Razzouk","doi":"10.1161/CIRCINTERVENTIONS.124.014023","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014023","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy is a common but underrecognized cardiac disorder characterized by a heterogenous phenotype that includes increased left ventricular thickness, outflow obstruction, diastolic dysfunction, and arrhythmia. Hypertrophic cardiomyopathy is often heritable and associated with pathogenic variants in sarcomeric genes. While not curable, an integrated approach involving medical, interventional, and surgical care can have a considerable impact on disease burden, quality of life, and mortality. This review provides a practical overview of important topics in hypertrophic cardiomyopathy, including evaluation of differential diagnosis, imaging, provocation of left ventricular outflow obstruction, treatment of obstructive and nonobstructive hypertrophic cardiomyopathy with negative inotropic therapy and myosin inhibition, as well as surgical and interventional approaches to septal reduction and mitral valve intervention.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014023"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381738","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":"Does the Timing Matter in Invasive Management of Non-ST-Segment-Elevation Acute Coronary Syndrome?","authors":"Waqar H Ahmed, Simone Biscaglia","doi":"10.1161/CIRCINTERVENTIONS.125.015140","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015140","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015140"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540410","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":"Temporal Changes in Procedural Success and Clinical Outcomes of MTEER by Mechanism of MR: Analysis of the STS/TVT Registry.","authors":"Zach Rozenbaum, Sreekanth Vemulapalli, Miloni Shah, Andrzej Stanislaw Kosinski, Eric Gnall","doi":"10.1161/CIRCINTERVENTIONS.124.014819","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014819","url":null,"abstract":"<p><strong>Background: </strong>With the expansion of indications for mitral transcatheter edge-to-edge repair into nondegenerative etiologies, it is unknown whether changes in technical success and clinical outcomes have occurred.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/TVT) registry was analyzed from 2013 to 2023. Patients in shock were excluded. Patients were grouped by the mechanism of mitral regurgitation (MR) and divided into time periods.</p><p><strong>Results: </strong>Overall, 68 028 patients were included. The application of mitral transcatheter edge-to-edge repair has evolved over the past decade to include more nondegenerative etiologies-increasing from 19% to 43%. The biggest growth was observed in functional MR (atrial and ventricular). Excluding acute ischemic MR, the odds of technical success were significantly higher for all mechanisms compared with degenerative MR (DMR). Over time more procedures were performed using only 1 implanted device (64.7% during 2022-2023 versus 54.6% during 2013-2017), without negatively impacting technical success. In multivariable analyses, the risk of 1-year heart failure readmission for ventricular functional MR was not higher than for DMR (<i>P</i>=0.10642), while patients with chronic ischemic MR and atrial MR had a 19% higher risk of 1-year heart failure readmission compared with DMR (<i>P</i>=0.00493) even if they had a successful procedure. However, the risk of 1-year mortality was not higher in nondegenerative etiologies compared with DMR. There was no statistically significant interaction between MR mechanism and time in outcomes analyses, indicating that the effect of MR mechanism on the technical and 1-year clinical outcomes did not vary significantly over time.</p><p><strong>Conclusions: </strong>The application of mitral transcatheter edge-to-edge repair for nondegenerative etiologies increased considerably. While the odds of technical success were higher for all etiologies except acute ischemic MR, a similar 1-year mortality risk was observed in nondegenerative etiologies compared with DMR in real-world settings. These data support the use of mitral transcatheter edge-to-edge repair in degenerative and nondegenerative etiologies.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014819"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656248","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":"Impact of Bypass Conduit and Early Technical Failure on Revascularization for Chronic Limb-Threatening Ischemia.","authors":"Michael S Conte, Alik Farber, Andrew Barleben, Emiliano Chisci, Gheorghe Doros, Vikram S Kashyap, Ahmed Kayssi, Philippe Kolh, Carla C Moreira, Timothy Nypaver, Kenneth Rosenfield, Vincent L Rowe, Andres Schanzer, Niten Singh, Jeffrey J Siracuse, Michael B Strong, Matthew T Menard","doi":"10.1161/CIRCINTERVENTIONS.124.014716","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014716","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The optimal strategy for lower extremity revascularization (surgical bypass versus endovascular intervention) in patients with chronic limb-threatening ischemia (CLTI) is unclear. We examined the effectiveness of open surgical bypass using single-segment great saphenous vein conduit (SSGSV), alternative conduits (AC), or endovascular interventions (ENDO) among patients with CLTI deemed acceptable for either open surgical bypass or ENDO treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a planned as-treated analysis of the multicenter BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia) randomized controlled trial comparing open surgical bypass and ENDO for CLTI due to infrainguinal peripheral artery disease. Outcomes were tabulated based on the initial revascularization received: SSGSV bypass, AC bypass, and ENDO. Analyses were performed for all treated patients and then excluding those who experienced early technical failure. Multivariable Cox regression models were used. End points included the primary trial outcome (major adverse limb event [MALE] or all-cause death), major amputation, MALE at any time or perioperative (30-day) death, reintervention-amputation-death, and all-cause mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1780 patients with CLTI, treatments received included SSGSV bypass (n=621), AC bypass (n=236), and ENDO (n=923) procedures. There were no significant differences in 30-day mortality, major adverse cardiovascular events, or serious adverse events; subjects treated with ENDO experienced greater MALE within 30 days (13.1% versus 2.7%, 3% for SSGSV, AC; &lt;i&gt;P&lt;/i&gt;&lt;0.001). On risk-adjusted analysis, SSGSV bypass was associated with reduced MALE or all-cause death (hazard ratio, 0.65 [95% CI, 0.56-0.76]; &lt;i&gt;P&lt;/i&gt;&lt;0.001), major amputation (hazard ratio, 0.70 [95% CI, 0.52-0.94]; &lt;i&gt;P&lt;/i&gt;=0.017), MALE or perioperative death (hazard ratio, 0.51 [0.41-0.62]; &lt;i&gt;P&lt;/i&gt;&lt;0.001), and reintervention-amputation-death (hazard ratio, 0.69 [95% CI, 0.61-0.79]; &lt;i&gt;P&lt;/i&gt;&lt;0.001). AC bypass was associated with reduced MALE or perioperative death and reintervention-amputation-death compared with ENDO. Significant benefits of SSGSV over ENDO remained when excluding patients who experienced early technical failure. There were no significant differences in long-term mortality by initial treatment received. When analyzed by the level of disease treated, the improved outcomes of SSGSV were greatest among patients who underwent femoropopliteal revascularization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Analysis of as-treated outcomes from the BEST-CLI trial demonstrates the safety and clinical superiority of bypass with SSGSV among patients with CLTI who were deemed suitable for either open surgical bypass or ENDO revascularization. Assessment of great saphenous vein quality should be incorporated into the evaluation of patients with CLTI who are surgical candidates.&lt;/p&gt;&lt;p&gt;&lt;stron","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014716"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study.","authors":"Konstantin Averin, Michael D Seckeler, Holly Bauser-Heaton, Matthew C Schwartz, Paul Tannous, Cameron Seaman, Wendy Whiteside, George T Nicholson, Priti M Patel, Brent M Gordon, Ryan A Romans, Rajiv Devanagondi, Carrie E Herbert, Sarosh P Batlivala, Brian Boe, Gurumurthy Hiremath, Jeffrey D Zampi","doi":"10.1161/CIRCINTERVENTIONS.124.014243","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014243","url":null,"abstract":"<p><strong>Background: </strong>Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored.</p><p><strong>Methods: </strong>A multicenter retrospective analysis of all neonates with HLH-IAS who underwent LAD in the first 36 hours of life from January 2009 to March 2020 at 14 North American congenital cardiac programs was conducted. Patient and procedural characteristics and patient outcomes were compared between hybrid and percutaneous LAD.</p><p><strong>Results: </strong>Among 128 patients with HLH-IAS, 105 (80%) underwent percutaneous LAD and 23 (17%) hybrid LAD. No significant differences were observed in preprocedural characteristics such as birth weight (3.1±0.6 versus 3.2±0.6 kg; <i>P</i>=0.453), presence of a baseline interatrial communication (66% versus 61%; <i>P</i>=0.659), interatrial communication gradient (14.4±6.9 versus 12.7±4.6 mm Hg; <i>P</i>=0.456), or lowest pH (7.13±0.14 versus 7.09±0.15; <i>P</i>=0.193). Hybrid LAD resulted in a shorter time from birth to procedure (120 versus 52 minutes; <i>P</i>=0.005) and to atrial septal defect creation (55 versus 29 minutes; <i>P</i>=0.002). All hybrid LAD were technically successful, although 11 (10%) percutaneous LAD were unsuccessful with 7 requiring conversion to surgical septectomy. There was a trend toward fewer serious adverse events with hybrid LAD (36% versus 17%; <i>P</i>=0.141). Most patients (67%) who underwent hybrid LAD had simultaneous pulmonary artery band placement and 21% of patients with percutaneous LAD required reoperation for pulmonary artery band. Long-term survival rates were comparably low between groups, with a 30% transplant-free survival at a median 8-month follow-up.</p><p><strong>Conclusions: </strong>In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014243"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656003","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":"PCI for Surgically Ineligible Patients: Another Piece of the Jigsaw.","authors":"Tim Kinnaird","doi":"10.1161/CIRCINTERVENTIONS.125.015200","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015200","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e015200"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656247","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}