Circulation: Cardiovascular Interventions最新文献

{"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":"Effects of Guiding Catheter Disengagement on Resting Indexes for the Assessment of Coronary Artery Stenoses.","authors":"Luigi Di Serafino, Maria Scalamogna, Carlo Carbone, Maria Luisa De Rosa, Lucia Mitrano, Plinio Cirillo, Eugenio Stabile, Marisa Avvedimento, Luca Ciaramella, Salvatore Monaco, Anna Franzone, Raffaele Piccolo, Carmen Anna Maria Spaccarotella, Giovanni Esposito","doi":"10.1161/CIRCINTERVENTIONS.124.014543","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014543","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014543"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078692","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":"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}

{"title":"Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial.","authors":"Jinhwan Jo, Sang Yoon Lee, Woochan Kwon, Seung-Jae Lee, Jong-Young Lee, Seung Hun Lee, Doosup Shin, Sang Min Kim, Kyeong Ho Yun, Jae Young Cho, Chan Joon Kim, Hyo-Suk Ahn, Chang-Wook Nam, Hyuck-Jun Yoon, Yong Hwan Park, Wang Soo Lee, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Young Bin Song, Joo-Yong Hahn, Sang Yeub Lee, Joo Myung Lee","doi":"10.1161/CIRCINTERVENTIONS.124.014952","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014952","url":null,"abstract":"<p><strong>Background: </strong>Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.</p><p><strong>Methods: </strong>This was a secondary analysis of the RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) in which patients with complex coronary artery lesions undergoing PCI were enrolled at 20 sites in Korea from May 2018 through May 2021. Patients were randomized to receive intravascular imaging-guided PCI or angiography-guided PCI and classified according to the presence of HBR. The primary end point was target vessel failure, which was a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.</p><p><strong>Results: </strong>Of 1639 trial population, 478 patients met HBR criteria. There was no significant difference in the risk of the primary end point between HBR and non-HBR patients (11.8% versus 8.2%; adjusted hazard ratio [HR], 1.05 [95% CI, 0.72-1.54]; <i>P</i>=0.790). However, patients with HBR were at higher risk for cardiac death or spontaneous target vessel-related myocardial infarction (adjusted HR, 2.04 [95% CI, 1.09-3.80]; <i>P</i>=0.025), all-cause death (adjusted HR, 3.30 [95% CI, 1.93-5.62]; <i>P</i><0.001), and cardiac death (adjusted HR, 2.36 [95% CI, 1.10-5.09]; <i>P</i>=0.028). Intravascular imaging-guided PCI showed a lower risk of the primary end point compared with angiography-guided PCI in both HBR patients (9.7% versus 15.8%; adjusted HR, 0.57 [95% CI, 0.31-1.02]; <i>P</i>=0.060) and non-HBR patients (6.9% versus 10.8%; adjusted HR, 0.65 [95% CI, 0.43-0.99]; <i>P</i>=0.045), without significant interaction (<i>P</i> for interaction=0.796).</p><p><strong>Conclusions: </strong>Patients with HBR were associated with an increased risk of adverse cardiovascular events after complex PCI compared with those without HBR. Intravascular imaging-guided PCI showed a lower risk of the target vessel failure without significant interaction between treatment strategy and the presence of HBR in patients undergoing complex PCI.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014952"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656186","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":"Novel Real-Time Fluoroscopic Assessment Method of THV Expansion Following Balloon-Expandable TAVR.","authors":"Ali Husain, Georgios Tzimas, Mariama Akodad, Julius Jelisejevas, Sophie Offen, Kevin Millar, Jonathon A Leipsic, Philipp Blanke, David A Wood, Stephanie L Sellers, John G Webb, David Meier, Janarthanan Sathananthan","doi":"10.1161/CIRCINTERVENTIONS.124.014617","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014617","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter heart valve (THV) underexpansion after transcatheter aortic valve replacement may be associated with worse outcomes. THV expansion can be assessed fluoroscopically using a pigtail for calibration; however, the accuracy of this technique specific to transcatheter aortic valve replacement is unknown. We assessed the accuracy and reproducibility of a novel fluoroscopic method to assess THV expansion using the THV commissural post for calibration.</p><p><strong>Methods: </strong>Patients who underwent transcatheter aortic valve replacement with a SAPIEN 3 (S3) THV had documented 3 cusp and cusp overlap views, and post-implant computed tomography was identified. THV expansion was fluoroscopically assessed in the 3 cusp and cusp overlap views using the S3 commissural post height and the pigtail as a reference for calibration. The correlation between the 2 methods and computed tomography was evaluated.</p><p><strong>Results: </strong>Forty patients were included. On the bench, the commissural post height measured 3.3, 3.5, 4.0, and 4.5 mm for the 20 mm S3, 23 mm S3, 26 mm S3, and 29 mm S3, respectively. The Pearson correlation coefficient (r) with computed tomography for measuring the inflow, mid-portion, and outflow THV diameter was 0.98, 0.97, and 0.98 for the commissural post height method and 0.82, 0.81, and 0.78 for the pigtail method, respectively. Unlike the pigtail method, the correlation between the commissural post height method and computed tomography remained strong across all THV sizes and in both the 3 cusp and cusp overlap views.</p><p><strong>Conclusions: </strong>The commissural post height method is a novel real-time fluoroscopic tool that has the potential to assess THV expansion and guide further optimization after balloon-expandable transcatheter aortic valve replacement.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014617"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028077","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}