Circulation: Cardiovascular Interventions最新文献

{"title":"What Are the Implications of Choosing a TAVR-First Strategy in the Lifetime Management of Aortic Stenosis?: A Critical Review of TAVR-Explant- and Redo-TAVR.","authors":"Pavan Reddy, Jeffrey Cohen, Kalyan R Chitturi, Ilan Merdler, Itsik Ben-Dor, Lowell F Satler, Ron Waksman, Thomas MacGillivray, Toby Rogers","doi":"10.1161/CIRCINTERVENTIONS.124.014882","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014882","url":null,"abstract":"<p><p>Some patients with aortic stenosis may require multiple valve interventions in their lifetime, and choosing transcatheter aortic valve replacement (TAVR) as the initial intervention may be appealing to many. If their transcatheter heart valve degenerates later in life, most will hope to undergo redo-TAVR. However, if redo-TAVR is not feasible, some may have to undergo surgical explantation of their transcatheter heart valve (TAVR-explant). With rising numbers of TAVR in younger patients, we address the practical implications of choosing a TAVR-first strategy. In this review we explore potential factors contributing to higher-than-expected mortality after TAVR-explant, synthesize available outcomes data for TAVR-explant for structurally degenerated valves, and describe strategies to standardize and optimize surgical techniques for TAVR-explant. We also discuss clinical outcomes of redo-TAVR within the context of limitations in currently published series and highlight the potential benefit of virtual planning to assess the feasibility of future redo-TAVR before implanting the first valve. Finally, we highlight areas for future investigation to inform management strategies in patients who may require multiple aortic valve interventions.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014882"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001230","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":"Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening.","authors":"Yu Sato, Sho Torii, Kenji Kawai, Kazuyuki Yahagi, Matthew Kutyna, Rika Kawakami, Takao Konishi, Aimee E Vozenilek, Hiroyuki Jinnouchi, Atsushi Sakamoto, Hiroyoshi Mori, Anne Cornelissen, Masayuki Mori, Takamasa Tanaka, Teruo Sekimoto, Robert Kutys, Saikat Kumar B Ghosh, John K Forrest, Michael J Reardon, Maria E Romero, Frank D Kolodgie, Renu Virmani, Aloke V Finn","doi":"10.1161/CIRCINTERVENTIONS.124.014523","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014523","url":null,"abstract":"<p><strong>Background: </strong>Hypoattenuated leaflet thickening (HALT) is believed to reflect leaflet thrombosis; however, no systematic histological examination of HALT has ever been performed. The aim of this study was to evaluate histological findings of explanted self-expanding transcatheter aortic bioprosthetic valves from clinical trials and to compare microCT findings of suspected HALT with histology findings of valve thrombosis and its characterization over time.</p><p><strong>Methods: </strong>A total of 123 self-expanding transcatheter aortic valves were collected through autopsy (n=89) or surgical explant (n=34) from 11 CoreValve/Evolut clinical trials. Histological findings in transcatheter aortic valve leaflets were evaluated. MicroCT imaging was used to evaluate HALT in histology. Cases with infective endocarditis (10/123) or transcatheter aortic valve-in-surgical aortic valve procedures (3/123) were excluded.</p><p><strong>Results: </strong>A total of 110 cases were divided into 3 groups based on implant duration: <30 days (n=42), 30 to 365 days (n=35), and >365 days (n=33). Thrombus and inflammation scores were consistent across groups, while scores for pannus, calcification, and structural change increased over time. The analysis of leaflet thickening by histology was performed on 320 leaflets and any degree of leaflet thickening was observed in 46.5% (149/320) of leaflets. Histologically, leaflet thickening was confirmed as an acute, organizing, and organized thrombus (ie, pannus). In the <30 days group, all leaflet thickening was due to acute thrombus, while most thrombi were organized >30 days. The types of thrombi could not be differentiated by microCT imaging.</p><p><strong>Conclusions: </strong>HALT represents the presence of a thrombus and its progression. Our data suggest that treatment of HALT would likely be most effective in the early stages before the thrombus becomes organized and emphasizes the need for early detection.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 2","pages":"e014523"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448256","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":"FFR-Negative Nonculprit High-Risk Plaques and Clinical Outcomes in High-Risk Populations: An Individual Patient-Data Pooled Analysis From COMBINE (OCT-FFR) and PECTUS-obs.","authors":"Rick H J A Volleberg, Andi Rroku, Jan-Quinten Mol, Renicus S Hermanides, Maarten van Leeuwen, Balázs Berta, Martijn Meuwissen, Fernando Alfonso, Wojciech Wojakowski, Anouar Belkacemi, Tomasz Roleder, Elvin Kedhi, Niels van Royen","doi":"10.1161/CIRCINTERVENTIONS.124.014667","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014667","url":null,"abstract":"<p><strong>Background: </strong>Despite fractional flow reserve (FFR)-guided deferral of revascularization, recurrent events in patients with diabetes or after myocardial infarction remain common. This study aimed to assess the association between FFR-negative but high-risk nonculprit lesions and clinical outcomes.</p><p><strong>Methods: </strong>This is a patient-level pooled analysis of the prospective natural-history COMBINE (OCT-FFR) study (Optical Coherence Tomography Morphologic and Fractional Flow Reserve Assessment in Diabetes Mellitus Patients) and PECTUS-obs study (Identification of Risk Factors for Acute Coronary Events by OCT After STEMI and NSTEMI Patients With Residual Non- Flow Limiting Lesions). Optical coherence tomography was performed on all FFR-negative (FFR >0.80) native nonculprit lesions. Patients or lesions with a high-risk plaque were compared with those without a high-risk plaque. A high-risk plaque was defined in the presence of at least 2 prespecified criteria: (1) lipid arc ≥90^o, (2) minimum fibrous cap thickness <65 µm, and (3) presence of either plaque rupture or thrombus. The primary end points were native major adverse cardiovascular events (composite of all-cause mortality, nonfatal myocardial infarction, or unplanned revascularization excluding stent-failure-related events and nonattributable events) and target lesion failure (composite of cardiac death, target vessel myocardial infarction, or target lesion revascularization).</p><p><strong>Results: </strong>Among 810 patients, 450 (55.6%) had a history of diabetes and 482 (59.5%) presented with myocardial infarction. At least 1 high-risk plaque was identified in 271 (33.5%) patients and 287 (30.6%) lesions. Over a median follow-up of 761 (interquartile range, 731-1175) days, the presence of a high-risk plaque was associated with patient-level native major adverse cardiovascular events (hazard ratio, 2.127 [95% CI, 1.451-3.120]; <i>P</i><0.001) and lesion-level target lesion failure (hazard ratio, 2.623 [95% CI, 1.559-4.414]; <i>P</i><0.001). The risk of adverse outcomes increased with the copresence of multiple high-risk features.</p><p><strong>Conclusions: </strong>FFR-negative but high-risk nonculprit lesions are associated with adverse patient- and lesion-level clinical outcomes. These findings emphasize the additional value of intracoronary imaging in patients with FFR-negative nonculprit lesions.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov; Unique identifier: NCT02989740; Unique identifier: NCT03857971.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014667"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001219","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":"Ultra-Low Contrast IVUS-Guided PCI in Patients With Severe Chronic Kidney Disease: An Observational Prospective Study.","authors":"Tony Truong, Marouane Boukhris, Anne Sophie Tuffreau-Martin, Antoine Molho, Paul-Matthieu Chiaroni, Patrick Zamora, Aurélien De Pommereau, Laura Rostain, Andrea Mangiameli, Andrea Cianci, Victor Aboyans, Emmanuel Teiger, Madjid Boukantar, Romain Gallet","doi":"10.1161/CIRCINTERVENTIONS.124.014854","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014854","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014854"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064240","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 Predictors Associated With Cardiovascular Events After Complex PCIs.","authors":"Joo Myung Lee, Sang Yoon Lee, Woochan Kwon, Seung-Jae Lee, Jong-Young Lee, Seung Hun Lee, Doosup Shin, Sang Yeub Lee, 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","doi":"10.1161/CIRCINTERVENTIONS.124.014920","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014920","url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging-guided percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with complex coronary artery lesions compared with angiography-guided PCI. However, the prognostic impact of suboptimal findings on intravascular imaging such as stent underexpansion, malapposition, or dissection is unclear in the era of contemporary drug-eluting stents.</p><p><strong>Methods: </strong>From RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) which compared imaging-guided PCI with angiography-guided PCI in patients with complex lesions, post-PCI intravascular imaging findings, including minimum stent area (MSA), relative stent underexpansion (MSA≤80% of the average reference lumen area), malapposition, or dissection, were assessed in nonleft main target lesions. The primary end point was target lesion failure (TLF), a composite of cardiac death, target lesion-related myocardial infarction, target lesion revascularization, or definite stent thrombosis.</p><p><strong>Results: </strong>A total of 897 nonleft main lesions from 714 patients undergoing imaging-guided PCI were included. During a median follow-up duration of 2.1 years, the optimal cutoff value of MSA to predict the occurrence of TLF was 5.5 mm², and MSA<5.5 mm² was associated with a significantly higher risk of TLF than MSA≥5.5 mm² (2.2% versus 4.8%; adjusted hazard ratio, 3.09 [95% CI, 1.01-9.50]; <i>P</i>=0.048). Compared with the reference group (MSA≥5.5 mm² and no suboptimal findings), the subgroup of patients with MSA≥5.5 mm² and post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, or major dissection was associated with a numerically increased risk of TLF (0.0% versus 3.2%; <i>P</i>=0.057). Compared with the same reference group, the subgroup of patients with MSA<5.5 mm² and suboptimal post-PCI intravascular imaging findings was associated with a significantly increased risk of TLF (0.0% versus 4.7%; <i>P</i>=0.017).</p><p><strong>Conclusions: </strong>After intravascular imaging-guided PCI with contemporary drug-eluting stents for nonleft main complex lesions, inadequate absolute stent expansion was independently associated with a higher risk of TLF. Suboptimal post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, and major dissection seem to contribute to the risk of TLF.</p><p><strong>Registration: </strong>https://www.clinicaltrials.gov; Unique identifier: NCT03381872.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 2","pages":"e014920"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448249","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":"HALT and Catch Fire: Understanding the Histopathologic Processes of Hypoattenuated Leaflet Thickening in TAVR.","authors":"Rahul Gupta, Matthew W Sherwood, Amit N Vora","doi":"10.1161/CIRCINTERVENTIONS.125.015088","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015088","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 2","pages":"e015088"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448247","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 as a Performance Measure for Percutaneous Coronary Intervention.","authors":"Elliot J Stein, Elise Mesenbring, Tracy Smith, Annika Hebbe, Taufiq Salahuddin, Stephen W Waldo, Michael D Dyal, Jacob A Doll","doi":"10.1161/CIRCINTERVENTIONS.124.014528","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014528","url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging (IVI) is widely recognized to improve outcomes after percutaneous coronary intervention (PCI). However, IVI is underutilized and is not yet established as a performance measure for quality PCI.</p><p><strong>Methods: </strong>We examined temporal trends of IVI use for all PCIs performed at Veterans Affairs hospitals in the United States from 2010 to 2022 using retrospective observational cohorts. IVI was defined as intravascular ultrasound or optical coherence tomography. A contemporary subset of PCIs from 2020 to 2022 was used to examine clinical characteristics associated with IVI use and test the reliability of IVI as a pass/fail performance measure. We then used a generalized linear mixed model to estimate the proportion of IVI use variability attributable to the hospital, physician, and patient level. Cox proportional hazard models were used to assess the association of IVI with clinical outcomes at 1 year.</p><p><strong>Results: </strong>IVI use increased from 12.3% in 2010 to 43.1% in 2022 in 136 071 PCIs included in the study. Among 22 918 PCIs in the contemporary cohort, IVI was more frequent with nonemergent presentations, chronic total occlusions, and left main lesions but usage variability was primarily attributable to hospital (54%) and physician (33%) levels. As a pass/fail performance measure, reliability was high (>0.96) at hospital and physician levels. However, IVI use was not associated with statistically significant differences in mortality or major adverse cardiovascular events in this cohort.</p><p><strong>Conclusions: </strong>IVI use for PCI is increasing rapidly at Veterans Affairs hospitals in the United States but with marked variation at the hospital and physician levels. IVI meets established criteria for an effective performance measure and should be measured and reported by local and national organizations to encourage further uptake. Ongoing training and quality improvement may be required to maximize the benefit of IVI as it is more widely utilized.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014528"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027609","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 Can We Optimize the Results of Coronary Bioresorbable Scaffolds?","authors":"Fernando Alfonso, Teresa Bastante, Fernando Rivero","doi":"10.1161/CIRCINTERVENTIONS.124.014889","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014889","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014889"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001188","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":"Door to Pulmonary Artery Perfusion: Are We Ready for a New Time-Based Metric?","authors":"Sanjum S Sethi, Mehdi H Shishehbor","doi":"10.1161/CIRCINTERVENTIONS.124.014990","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014990","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014990"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001244","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":"Outcomes of Intracoronary Imaging-Guided PCI With Optimal Versus Suboptimal Results: A Meta-Analysis.","authors":"Mohamed Hamed, Sheref A Mohamed, Asmaa Ahmed, Muhammad Adnan Haider, El-Moatasem Gabr, Dharam J Kumbhani, Anthony Bavry, Emmanouil S Brilakis, Mamas A Mamas, Ayman Elbadawi","doi":"10.1161/CIRCINTERVENTIONS.124.014681","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014681","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014681"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001267","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}