Circulation: Cardiovascular Interventions最新文献

{"title":"Editors and Editorial Board.","authors":"","doi":"10.1161/HCV.0000000000000096","DOIUrl":"https://doi.org/10.1161/HCV.0000000000000096","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e000096"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001245","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":"Extended Rhythm Monitoring to Assess for Ventricular Arrhythmias After Transcatheter Pulmonary Valve Replacement With the Harmony Valve.","authors":"Jeffrey K Yang, Laura Wattenbarger, Anne C Taylor, Henry Chubb, Anitra W Romfh, Lynn F Peng, Scott R Ceresnak, Anne M Dubin, Doff B McElhinney","doi":"10.1161/CIRCINTERVENTIONS.124.014381","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014381","url":null,"abstract":"<p><strong>Background: </strong>Varying rates of nonsustained ventricular tachycardia (NSVT) have been reported early after transcatheter pulmonary valve replacement (TPVR) with the Harmony valve, but data regarding rhythm outcomes beyond hospital discharge are limited. This study aims to characterize ventricular arrhythmias after Harmony TPVR from implant through mid-term follow-up.</p><p><strong>Methods: </strong>Ventricular arrhythmia data from postimplant telemetry and follow-up extended rhythm monitoring (ERM) were analyzed after Harmony TPVR.</p><p><strong>Results: </strong>Fifty-four patients with tetralogy of Fallot (n=39), valvar pulmonary stenosis (n=10), or pulmonary atresia with intact ventricular septum (n=5) were studied; 22% had prior NSVT and 24% were on prior rhythm medication. On postimplant telemetry, 27 patients (50%) had NSVT, including 1 who had torsade de pointes, but most had <5 episodes. Pre-TPVR NSVT or rhythm medications, diagnosis other than tetralogy, and substantial device contact with the myocardium were associated with more frequent NSVT on telemetry. Ten patients (19%) were started on a new antiarrhythmic medication. On discharge ERM, 37% of patients had NSVT, most with <5 episodes and only 13% with NSVT beyond 5 days post-discharge. On follow-up ERM, 14% of patients had a single episode of NSVT and 1 had 5 episodes. During follow-up, antiarrhythmic medications were discontinued in 8 of 10 patients and no patients died or had sustained ventricular tachycardia.</p><p><strong>Conclusions: </strong>NSVT and ventricular ectopy were common early after TPVR but were infrequent in most cases and diminished rapidly after discharge. The incidence of NSVT on follow-up ERM was similar to preimplant incidence. Few patients had antiarrhythmic medications initiated, and most were discontinued on follow-up. There were no major arrhythmic events after discharge.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014381"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892640","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":"Utilization and Outcomes Associated With Intravascular Ultrasound During Abdominal and Thoracic Endovascular Aortic Interventions in the United States in the Contemporary Era (2016-2023).","authors":"Ramya C Mosarla, Patrick V Heindel, Mohamad A Hussain, Marc Schermerhorn, Toshiki Kuno, Mario D'Oria, Siling Li, Eric A Secemsky","doi":"10.1161/CIRCINTERVENTIONS.124.014332","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014332","url":null,"abstract":"<p><strong>Background: </strong>Intravascular ultrasound (IVUS) use in aortic endovascular interventions, including thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR), may have similar benefits to those seen in coronary and peripheral interventions, but limited utilization and outcome data exist.</p><p><strong>Methods: </strong>Centers for Medicare and Medicaid Services claims data were used to identify patients undergoing TEVAR and EVAR from 2016 to 2023. Utilization trends were stratified by region, urbanicity, distressed communities index, community versus academic center, Medicare versus dual enrollment status, indication, urgency, and presence of dissection with malperfusion. Inverse probability weighting was used to assess the impact of IVUS on a composite outcome of repeat aortic intervention or death. Cox regression was used to estimate weighted hazard ratios.</p><p><strong>Results: </strong>A total of 136 540 patients underwent TEVAR and EVAR, of which 9.8% (13 364) used IVUS. IVUS use increased slightly from 2016 to 2023, driven more by use in TEVAR compared with EVAR, and was higher in academic settings, with Medicare and Medicaid dual enrollment, in the West, with dissections, with malperfusion and for elective procedures. IVUS was associated with a lower risk of the primary outcome at 30-days (hazard ratio, 0.80 [95% CI, 0.73-0.89]; <i>P</i><0.001) and 6-months (hazard ratio, 0.93 [95% CI, 0.87-0.99]; <i>P</i>=0.022) for all-comers. Subgroup analysis suggested lower risks of the primary outcome with IVUS use for aneurysm driven by the abdominal segment, malperfusion, thoracoabdominal dissection with malperfusion, thoracoabdominal repair, and chronic kidney disease.</p><p><strong>Conclusions: </strong>IVUS use has increased slightly in TEVAR and EVAR with heterogeneity in use. IVUS implementation during TEVAR and EVAR was associated with improved early and mid-term outcomes, particularly in certain subsets.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014332"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892650","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":"Radial Access Approach to Peripheral Vascular Interventions: A Scientific Statement From the American Heart Association.","authors":"Jason C Kovacic, Kimberly A Skelding, Shipra Arya, Jennifer Ballard-Hernandez, Mayank Goyal, Nkechinyere N Ijioma, Kimberly Kicielinski, Edwin A Takahashi, Francisco Ujueta, George Dangas","doi":"10.1161/HCV.0000000000000094","DOIUrl":"10.1161/HCV.0000000000000094","url":null,"abstract":"<p><p>Transradial arterial access has transformed the field of coronary interventions, where it has several advantages over femoral access, such as reduced bleeding and access site complications, improved patient comfort, shorter time to ambulation after the procedure, reduced length of hospital stay, and potentially reduced mortality rates. Because of these benefits, as well as the concurrent expanding indications for various endovascular therapies, there is growing interest in adopting radial access for peripheral vascular interventions. However, radial access can present challenges, and specialized equipment for peripheral interventions through this route are under development. Nevertheless, a growing number of studies, largely comprising single-center and registry data, have broadly suggested that transradial arterial access is likely to be safe and associated with reduced bleeding and local access site complications for most peripheral interventions compared with transfemoral access. Large, prospective randomized trials are lacking, and the question of any effect on mortality rates has not been addressed. Whereas the field of transradial arterial access for peripheral vascular interventions is in development, it is clear that this approach, at least with available equipment, will not be suitable for all patients, and careful case selection is paramount. Furthermore, the remaining knowledge gaps must be addressed, and robust outcome data obtained, to allow full understanding of the factors that determine optimal patient, lesion, and equipment selection. Nevertheless, the use of transradial arterial access for peripheral vascular interventions holds great promise, particularly if the necessary technologic advances are rapid and favorable clinical trial data continue to emerge.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e000094"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766787","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":"Optimal Predilatation Treatment Before Implantation of a Magmaris Bioresorbable Scaffold in Coronary Artery Stenosis: The OPTIMIS Trial.","authors":"Kirstine Nørregaard Hansen, Jens Trøan, Akiko Maehara, Manijeh Noori, Mikkel Hougaard, Julia Ellert-Gregersen, Karsten Tange Veien, Anders Junker, Henrik Steen Hansen, Jens Flensted Lassen, Lisette Okkels Jensen","doi":"10.1161/CIRCINTERVENTIONS.124.014665","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014665","url":null,"abstract":"<p><strong>Background: </strong>Bioresorbable scaffolds (BRS) were developed to overcome limitations related to late stent failures of drug-eluting stents, but lumen reductions over time after implantation of BRS have been reported. This study aimed to investigate if lesion preparation with a scoring balloon compared with a standard noncompliant balloon minimizes lumen reduction after implantation of a Magmaris BRS assessed with optical coherence tomography and intravascular ultrasound.</p><p><strong>Methods: </strong>Eighty-two patients with stable angina were randomized in a ratio of 1:1 to lesion preparation with a scoring balloon versus a standard noncompliant balloon before implantation of a Magmaris BRS. The primary end point was minimal lumen area at 6-month follow-up.</p><p><strong>Results: </strong>Following Magmaris BRS implantation, minimal lumen area (6.4±1.6 versus 6.3±1.5 mm²; <i>P</i>=0.65), mean scaffold area (7.8±1.5 versus 7.5±1.7 mm²; <i>P</i>=0.37), and mean lumen area (8.0±1.6 versus 7.7±2.1 mm²; <i>P</i>=0.41) did not differ significantly in patients with lesions prepared with scoring versus standard noncompliant balloon, respectively. Six-month angiographic follow-up with optical coherence tomography and intravascular ultrasound was available in 74 patients. The primary end point, 6-month minimal lumen area, was significantly larger in lesions prepared with a scoring balloon compared with a standard noncompliant balloon (4.7±1.4 versus 3.9±1.9 mm²; <i>P</i>=0.04), whereas mean lumen area (7.2±1.4 versus 6.8±2.2 mm²; <i>P</i>=0.35) did not differ significantly. Intravascular ultrasound findings showed no difference in mean vessel area at the lesion site from baseline to follow-up in the scoring balloon group (16.8±2.9 versus 17.0±3.6 mm²; <i>P</i>=0.62), whereas mean vessel area (17.1±4.4 versus 15.7±4.9 mm²; <i>P</i><0.001) was smaller in lesions prepared with a standard noncompliant balloon due to negative remodeling.</p><p><strong>Conclusions: </strong>Lesion preparation with a scoring balloon before implantation of a Magmaris BRS resulted in a significantly larger minimal lumen area after 6 months due to less negative remodeling compared with lesion preparation with a standard noncompliant balloon.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04666584.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014665"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001266","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":"Validation of the Valve Academic Research Consortium High Bleeding Risk Definition in Patients Undergoing TAVR.","authors":"Marisa Avvedimento, Pedro Cepas-Guillén, Julien Ternacle, Marina Urena, Alberto Alperi, Asim Cheema, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Victoria Vilalta, Giovanni Esposito, Francisco Campelo-Parada, Ciro Indolfi, Maria Del Trigo, Antonio Muñoz-Garcia, Nicolás Maneiro, Lluís Asmarats, Ander Regueiro, David Del Val, Vicenç Serra, Vincent Auffret, Thomas Modine, Guillaume Bonnet, Jules Mesnier, Gaspard Suc, Pablo Avanzas, Effat Rezaei, Victor Fradejas-Sastre, Gabriela Tirado-Conte, Eduard Fernández-Nofrerias, Anna Franzone, Thibaut Guitteny, Sabato Sorrentino, Juan Francisco Oteo, Jorge Nuche, Lola Gutiérrez-Alonso, Eduardo Flores-Umanzor, Fernando Alfonso, Andrea Monastyrski, Maxime Nolf, Mélanie Côté, Roxana Mehran, Marie-Claude Morice, Davide Capodanno, Philippe Garot, Josep Rodés-Cabau","doi":"10.1161/CIRCINTERVENTIONS.124.014800","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014800","url":null,"abstract":"<p><strong>Background: </strong>The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk in patients undergoing transcatheter aortic valve replacement. The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale transcatheter aortic valve replacement population.</p><p><strong>Methods: </strong>Multicenter study including 10 449 patients undergoing transcatheter aortic valve replacement. Based on consensus, 21 clinical and laboratory criteria were identified and classified as major or minor. Patients were stratified as at low, moderate, high, and very high bleeding risk according to the VARC-HBR definition. The primary end point was the rate of Bleeding Academic Research Consortium type 3 or 5 bleeding at 1 year, defined as the composite of periprocedural (within 30 days) or late (after 30 days) bleeding.</p><p><strong>Results: </strong>Patients with at least 1 VARC-HBR criterion (n=9267, 88.7%) had a higher risk of Bleeding Academic Research Consortium 3 or 5 bleeding, proportional to the severity of risk assessment (10.8%, 16.1%, and 24.6% for moderate, high, and very-high-risk groups, respectively). However, a comparable rate of bleeding events was observed in the low-risk and moderate-risk groups. The area under receiver operating characteristic curve was 0.58. Patients with VARC-HBR criteria also exhibited a gradual increase in 1-year all-cause mortality, with an up to 2-fold increased mortality risk for high and very-high-risk groups (hazard ratio, 1.33 [95% CI, 1.04-1.70] and 1.97 [95% CI, 1.53-2.53], respectively).</p><p><strong>Conclusions: </strong>The VARC-HBR consensus offered a pragmatic approach to guide bleeding risk stratification in transcatheter aortic valve replacement. The results of the present study would support the predictive validity of the new definition and promote its application in clinical practice to minimize bleeding risk and improve patient outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014800"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544095","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":"Use of Claims to Assess Outcomes and Treatment Effects in the Evolut Low Risk Trial.","authors":"Neel M Butala, Christina Lalani, Archana Tale, Yang Song, Dhaval Kolte, Suzanne Baron, Jordan Strom, David J Cohen, Robert W Yeh","doi":"10.1161/CIRCINTERVENTIONS.124.014592","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014592","url":null,"abstract":"<p><strong>Background: </strong>Food and Drug Administration-mandated postmarket studies for transcatheter aortic valve replacement in low-risk populations plan to use passively collected registry data linked to claims for long-term follow-up out to 10 years. Therefore, it is critically important to understand the validity of these claims-based end points. We sought to evaluate the ability of administrative claims with <i>International Classification of Diseases-Tenth Revision</i> (<i>ICD-10</i>) codes to identify trial-adjudicated end points and reproduce treatment comparisons of aortic valve replacement in the Evolut Low Risk Trial.</p><p><strong>Methods: </strong>We linked Evolut Low Risk trial patients to the Medicare Provider Analysis and Review database. We calculated sensitivity, specificity, positive predictive value, negative predictive value, and <i>κ</i> agreement statistic of claims to detect clinical end points through 2 years in trial patients. We additionally compared end points across treatment arms using trial-adjudicated outcomes versus claims-based outcomes.</p><p><strong>Results: </strong>Trial-adjudicated deaths were perfectly identified by claims. Claims had good performance in identifying trial-adjudicated disabling stroke (sensitivity 68.8%, specificity 99.0%, positive predictive value 64.7%, negative predictive value 99.1%, <i>κ</i>=0.66) and pacemaker placement (sensitivity 85.2%, specificity 98.4%, positive predictive value 90.4%, negative predictive value 97.5%, <i>κ</i>=0.86), but more modest performance in identifying trial-adjudicated myocardial infarction (<i>κ</i>=0.46) and vascular complications (<i>κ</i>=0.45). There was no difference between treatment arms for the primary end point of death or disabling stroke using trial data (hazard ratio, 0.83 [95% CI, 0.41-1.68]) or claims data (hazard ratio, 0.89 [95% CI, 0.43-1.81]; interaction <i>P</i>=0.71).</p><p><strong>Conclusions: </strong>Claims-based end points performed well in ascertaining death, disabling stroke, and pacemaker placement and were able to reproduce principal trial findings. These results support the selective use of claims-based end points for transcatheter aortic valve replacement postmarketing surveillance.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014592"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001268","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":"Impact of Time to Catheter-Based Therapy on Outcomes in Acute Pulmonary Embolism.","authors":"Robert S Zhang, Eugene Yuriditsky, Peter Zhang, Bedros Taslakian, Lindsay Elbaum, Allison A Greco, Vikramjit Mukherjee, Radu Postelnicu, Nancy E Amoroso, Thomas S Maldonado, James M Horowitz, Sripal Bangalore","doi":"10.1161/CIRCINTERVENTIONS.124.014499","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014499","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to examine the impact of early versus delayed catheter-based therapies (CBTs) on clinical outcomes in patients with acute intermediate-risk pulmonary embolism (PE).</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 2 academic centers involving patients with intermediate-risk PE from January 2020 to January 2024. Patients were divided into early (<12 hours) and delayed CBT (≥12 hours) groups. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, hemodynamic instability, and 90-day readmission. Secondary outcomes included a composite of 30-day mortality, resuscitated cardiac arrest, and hemodynamic instability. Inverse probability of treatment weighting was used to balance covariates.</p><p><strong>Results: </strong>A total of 133 patients were included (mean age, 58.3 years; 44% women; 29% catheter-directed thrombolysis; 68% mechanical thrombectomy; and 3% both). The median time to intervention was 6.1 hours in the early group and 20.8 hours in the delayed group (<i>P</i><0.001). A total of 16 patients (12% of patients) experienced the primary composite outcome. Early CBT was associated with a significantly lower rate of the primary composite outcome (4% versus 18%; log-rank <i>P</i><0.001; inverse probability of treatment weighting [hazard ratio, 0.13 (95% CI, 0.03-0.58); <i>P</i>=0.007]) and secondary composite outcome (0% versus 9%; log-rank <i>P</i>=0.02). The early CBT group also had lower intensive care unit (3.0 versus 3.4 days; <i>P</i>=0.01) and hospital length of stay (5.0 versus 6.1 days; <i>P</i>=0.046). When patients were stratified by timing of CBT (early/late) and the composite PE shock score (high ≥3; low <3), all 16 patients who experienced the primary composite outcome had a high composite PE shock score, with 14/16 (87.5%) having a high composite PE shock score and delayed intervention.</p><p><strong>Conclusions: </strong>Early CBT was associated with improved clinical outcomes in patients with acute intermediate-risk PE. The composite PE shock score may help identify patients who will benefit from early CBT. Further prospective studies are needed to validate these findings.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014499"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001265","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":"Contemporary Outcomes of TAVR Using a Balloon-Expandable Valve in Patients With Severe Mitral Stenosis: Insights From the Transcatheter Valve Therapies Registry.","authors":"Anirudh Kumar, Imran N Ahmad, James D Flaherty, Vinayak Nagaraja, Chetan P Huded, Grant W Reed, Rishi Puri, Andrew N Rassi, Sachin S Goel, Hani Jneid, James M McCabe, Mayra Guerrero, Firas Zahr, Amar Krishnaswamy, Samir R Kapadia","doi":"10.1161/CIRCINTERVENTIONS.124.014216","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014216","url":null,"abstract":"<p><strong>Background: </strong>While initial data for transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with mitral stenosis (MS) suggested a poor short-term prognosis, outcomes for contemporary balloon-expandable valves remain unknown. The aim of this retrospective multicenter registry study was to compare the potential impact of MS on TAVR outcomes with balloon-expandable valves.</p><p><strong>Methods: </strong>Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry and Centers for Medicare & Medicaid Services claims data were used to obtain a cohort of 327 925 patients who underwent TAVR with current balloon-expandable valves (SAPIEN 3, SAPIEN 3 Ultra, or SAPIEN 3 Ultra Resilia) between June 2015 and December 2022 across 791 sites. Severe MS (defined as >10 mm Hg mean gradient or <1.5 cm² area) was compared with mild or less MS (defined as <5 mm Hg mean gradient and >2 cm² area) using propensity matching to minimize confounding variables.</p><p><strong>Results: </strong>Patients with severe MS (n=8500; 2.6%) had a higher number of comorbid conditions, Society of Thoracic Surgeons risk scores, and were more often women than patients with mild or less MS at the time of index TAVR. While patients with severe MS had worse outcomes at 30 days, when propensity-matched, patients exhibited similar 30-day rates of death (3.2% versus 3.0%), stroke (2.4% versus 2.2%), major vascular complications (1.6% versus 1.6%), device implant success (98.9% versus 99.2%), and new dialysis (0.7% versus 0.5%), with higher rates of pacemaker implantation (11.3% versus 9.4%; <i>P</i><0.001). By 1 year, there was no difference in the change in the KCCQ (Kansas City Cardiomyopathy Questionnaire) overall score from baseline to 1 year (30.7±27.0 versus 31.9±27.0; <i>P</i>=0.07). By 3 years, an increase in the mortality rate (45.1% versus 40.9%; <i>P</i><0.001) of patients with severe MS was observed.</p><p><strong>Conclusions: </strong>MS in isolation is not associated with worsened short-term outcomes among patients undergoing contemporary TAVR with balloon-expandable valves.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014216"},"PeriodicalIF":6.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685993","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 Interventions in Adults With Fontan Palliation.","authors":"Eduardo Flores-Umanzor, Raquel Luna-López, Pedro Cepas-Guillen, Sílvia Montserrat, Bandar Alshehri, Rajesh Keshvara, Lusine Abrahamyan, Juan M Carretero Bellón, Rafael Alonso-Gonzalez, Mark Osten, Xavier Freixa, Josep Rodes-Cabau, Lee Benson, Eric Horlick","doi":"10.1161/CIRCINTERVENTIONS.124.014699","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014699","url":null,"abstract":"<p><p>The Fontan circuit is associated with chronically elevated systemic venous pressures and decreased cardiac output, often leading to circuit failure. Managing Fontan circuit failure is complex and requires multiple therapeutic options. Transcatheter interventions have emerged as a reliable approach. They can alleviate obstructions and improve cyanosis by enhancing pulmonary blood flow and oxygen saturation. These procedures can also increase cardiac output and reduce systemic venous pressure, contributing to patient stabilization. In addition, they help mitigate volume overload and decrease the risk of bleeding during heart or combined heart and liver transplants. In recent years, percutaneous interventions have rapidly evolved and become a key therapeutic option for addressing various aspects of Fontan circuit failure. These interventions should be considered integral to the management strategy for this specific patient population.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014699"},"PeriodicalIF":6.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709708","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}