European Heart Journal Supplements最新文献

{"title":"Protected complex high-risk indicated percutaneous coronary intervention in severe left ventricular dysfunction: an illustrative case highlighting patient selection, procedural planning, execution, and device management.","authors":"Saad M Ezad, Mohammad Alkhalil, María Monteagudo-Vela, Christophe Vandenbriele, Vasileios Panoulas, Norman Mangner","doi":"10.1093/eurheartjsupp/suag008","DOIUrl":"10.1093/eurheartjsupp/suag008","url":null,"abstract":"<p><p>Ischaemic left ventricular dysfunction (ILVD) is the leading cause of heart failure and is commonly encountered in cardiac catheterization laboratories. Patients presenting with ILVD are typically older and often have complex coronary anatomy, making revascularization challenging. Although coronary artery bypass grafting improves long-term survival in patients with ILVD compared with medical therapy, the benefit emerges only after a decade and appears limited to younger patients, leaving many older, frail, or comorbid individuals at untenable risk. Such patients are frequently considered for complex high-risk indicated percutaneous coronary intervention (CHIP), where the primary determinant of procedural risk is intra-procedural haemodynamic instability due to limited ventricular reserve and anticipated prolonged ischaemia. Registry data underscore the heightened risk in patients with multiple CHIP features, including ejection fraction ≤30%, left main or multivessel percutaneous coronary intervention, and extensive calcification. Here, temporary mechanical circulatory support has emerged as a strategy to mitigate haemodynamic compromise during CHIP procedures. Although trial data have demonstrated no early benefit with the intra-aortic balloon pump, long-term follow-up suggests improved survival. Alternatively, microaxial flow pumps, such as Impella™, can offer robust haemodynamic support and a reduction in late major adverse events. Although results from the ongoing randomized clinical trials with Impella are pending, careful Heart Team evaluation and procedural planning remain essential to ensure the best possible patient outcomes. Here, we illustrate a structured approach to Impella-supported CHIP in an elderly patient with the presence of ILVD, severely impaired ventricular reserve, and heavily calcified multivessel disease.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii14-vii19"},"PeriodicalIF":2.7,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protected percutaneous coronary intervention of complex distal left main disease with Impella CP™ support.","authors":"Jan-Malte Sinning, Matthias Bossard, Christophe Vandenbriele, Assad Haneya, Nilesh Pareek, Alexander Geppert, Nikos Werner","doi":"10.1093/eurheartjsupp/suag004","DOIUrl":"10.1093/eurheartjsupp/suag004","url":null,"abstract":"<p><p>Complex distal left main (LM) coronary artery disease with bifurcation involvement and chronic total occlusion (CTO) is usually treated with coronary artery bypass grafting (CABG). Patient refusal of surgery necessitates high-risk percutaneous revascularization that may require mechanical circulatory support. Here, we present a case of a 66-year-old male with Canadian Cardiovascular Society Class III angina and preserved left ventricular ejection fraction (LVEF; 60%) who was diagnosed with severe calcified distal LM stenosis extending into the left ostial circumflex (LCx), and a proximal left anterior descending (LAD) CTO. CABG was recommended but declined by the patient and high-risk PCI was performed with haemodynamic support using Impella CP™ with SmartAssist. Lesion preparation included rotational atherectomy followed by intravascular lithotripsy of the LM, LAD, and LCx. The LAD CTO was successfully recanalized and treated with two drug-eluting stents and two drug-coated balloons. A double-kissing culotte two-stent strategy was applied for the distal LM bifurcation, guided by intravascular ultrasound. Haemodynamics remained stable, with Impella support successfully preventing instability during hypotensive phases and during extensive lesion modification of the LM using rotational atherectomy. The patient was discharged on dual antiplatelet therapy and remained free of angina with preserved LVEF and an excellent angiographic result at 6-month follow-up. This case demonstrates how Impella support enabled safe, complete revascularization of high-risk LM bifurcation CTO disease when CABG was declined. Moreover, it illustrates that protected PCI with an Impella device can provide a safe alternative to surgery in anatomically complex LM disease, ensuring procedural stability and complete revascularization.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii32-vii38"},"PeriodicalIF":2.7,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing protected PCI strategies in the setting of chronic kidney disease and advanced coronary artery disease: a clinical case-based discussion.","authors":"Mario Iannaccone, Jerzy Sacha, María Monteagudo-Vela, Mohammad Alkhalil, Norman Mangner, Vasileios Panoulas","doi":"10.1093/eurheartjsupp/suag005","DOIUrl":"10.1093/eurheartjsupp/suag005","url":null,"abstract":"<p><p>Patients with chronic coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF) represent a particularly high-risk population often deemed unsuitable for conventional revascularization strategies. Procedural challenges arise from complex coronary anatomy, impaired cardiac reserve, and frequent comorbidities, such as frailty and chronic kidney disease, all of which predispose patients to haemodynamic instability and adverse outcomes during percutaneous coronary intervention (PCI). The use of mechanical circulatory support (MCS) devices, such as a microaxial flow pump (mAFP), has emerged as an important strategy to mitigate these risks by providing continuous left ventricular unloading and augmenting cardiac output. Moreover, improved perfusion may attenuate the risk of acute kidney injury (AKI), a major determinant of post-PCI morbidity and mortality. Herein, we present a case of Impella™-supported PCI in an elderly male patient with multivessel CAD, markedly reduced LVEF, chronic kidney disease, and multiple comorbidities, highlighting the role of MCS in optimizing procedural safety and expanding revascularization options for this vulnerable patient population.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii39-vii47"},"PeriodicalIF":2.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protected PCI-contemporary evidence and experience in perspective: bridging the gap between guidelines and reality in high-risk coronary interventions.","authors":"Nikos Werner, Vasileios Panoulas","doi":"10.1093/eurheartjsupp/suag003","DOIUrl":"10.1093/eurheartjsupp/suag003","url":null,"abstract":"","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii1-vii2"},"PeriodicalIF":2.7,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The fate of the Fontan circulation.","authors":"Rosaria Barracano, Claudia Montanaro, Sebastien Hascoet, Nastasja M S de Groot, Raquel Prieto-Arévalo, Paul Clift, Marc Gewillig, Margarita Brida, Giancarlo Scognamiglio","doi":"10.1093/eurheartjsupp/suaf088","DOIUrl":"10.1093/eurheartjsupp/suaf088","url":null,"abstract":"<p><p>Since the first operation performed in 1968, the worldwide population of patients living with Fontan circulation is dramatically growing, with 40% reaching adulthood in the current era. Despite this remarkable improvement in survival, some patients struggle with Fontan-related complications including heart failure, arrhythmias, end-organ dysfunction, and premature death. This review aims at describing common complications of the Fontan circulation, proposing a clinical and mortality risk score to better stratify this complex population as well as exploring the current state of art in catheter interventions and transplant.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i7-i16"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New strategies for valve replacement and interventional options in adults with congenital heart disease: new insights from Euro-ACHD 2025.","authors":"Gianfranco Butera, Massimo Chessa, Gianpiero Gaio, Aleksander Kempny, Anselm Uebing, Guido Michielon, Jamil Aboulhosn, Alessandro Giamberti, Andreas Hoschtitzky, Yves d'Udekem","doi":"10.1093/eurheartjsupp/suaf089","DOIUrl":"10.1093/eurheartjsupp/suaf089","url":null,"abstract":"<p><p>Recent advances in congenital heart disease management reflect a paradigm shift towards less invasive, physiology-preserving, and durable interventions. Transcatheter pulmonary valve implantation has become an established therapy for right ventricular outflow tract dysfunction, supported by multiple valve systems tailored to increasingly complex anatomies. These devices have demonstrated high procedural success and sustained hemodynamic performance, although infective endocarditis and arrhythmic complications remain clinical concerns. In parallel, transcatheter edge-to-edge repair for atrioventricular valve regurgitation (AVVR) has expanded from acquired disease to congenital populations, particularly in patients with single-ventricle physiology or systemic AVVR where surgical risk is prohibitive. Early experiences with devices such as MitraClip™, TriClip™, and Pascal have shown promising results in improving valve competence and functional status. From a surgical perspective, the Ross procedure continues to offer a unique, physiological alternative for aortic valve replacement in selected young adults, achieving excellent long-term outcomes when performed in high-volume centres with reinforcement strategies to prevent autograft dilation. Similarly, percutaneous correction of sinus venosus atrial septal defect using covered stents has emerged as a safe and effective alternative to conventional repair, providing anatomical reconstruction with low complication rates. The modern Fontan circulation exemplifies the evolution of single-ventricle palliation, emphasizing conduit optimization, pro-active re-intervention, and individualized surgical planning to sustain function over time. Collectively, these innovations underscore the growing integration of transcatheter and surgical therapies, re-defining long-term management paradigms and improving survival and quality of life in patients with congenital heart disease.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i33-i41"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in congenital heart disease with a systemic right ventricle: new insights for heart failure treatment from last EURO-ACHD Congress 2025.","authors":"Flavia Fusco, Giovanni Di Salvo, Eva Nyktari, Magalie Ladouceur, Matthias Greutmann, Katrijn Jansen, Maria Giovanna Russo, Giancarlo Scognamiglio","doi":"10.1093/eurheartjsupp/suaf092","DOIUrl":"10.1093/eurheartjsupp/suaf092","url":null,"abstract":"<p><p>Patients with a systemic right ventricle (sRV)-including those with transposition of the great arteries (TGA) following atrial switch repair (Mustard or Senning procedures) and congenitally corrected TGA-represent one of the greatest challenges in the management of adults with congenital heart disease (ACHD). The right ventricle is not anatomically designed to sustain systemic pressure over a lifetime. As a result, sRV failure is almost inevitable and follows a progressive, multifactorial process that initiates with maladaptive functional and structural changes. In later stages, arrhythmias, conduction delays, and pacing-induced dyssynchrony emerge, accelerating deterioration. Finally, lifestyle and environmental factors such as inactivity, obesity, or pregnancy may trigger clinical decompensation. Recognizing where a patient lies along this continuum and identifying those at highest risk is essential to anticipate deterioration and implement timely interventions. Despite significant advances in the management of ACHD, important gaps in knowledge and research remain regarding the sRV, particularly in understanding its long-term adaptation, predictors of failure, optimal medical therapy, prevention of dyssynchrony, and timing for transplant. We herewith summarize latest evidences on prognostic determinants, multimodality imaging, heart failure therapy, electrical therapy for heart failure, mechanical circulatory systems, and heart transplant in sRV.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i42-i49"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily issues in the life of adults with congenital heart disease: new insights from EURO-ACHD Congress 2025.","authors":"Alexandra C van Dissel, Philip Moons, Pastora Gallego, Katja Prokselj, Jolien W Roos-Hesselink, Lorna Swan, Michael A Gatzoulis, Craig Broberg, Berardo Sarubbi","doi":"10.1093/eurheartjsupp/suaf087","DOIUrl":"10.1093/eurheartjsupp/suaf087","url":null,"abstract":"<p><p>In recent years, remarkable advancements in paediatric cardiology and surgical techniques have dramatically increased the survival of patients with congenital heart disease. As a result, adults with congenital heart disease (ACHD) are now living longer, and many, despite having residual lesions and sequelae, may have near-normal life expectancy. Adults with congenital heart disease patients should no longer be viewed merely as survivors; instead, medical care should shift its focus from simply prolonging life to enhancing quality of life and overall well-being. Moreover, as ACHD population ages, they are increasingly exposed to a burden of acquired cardiovascular and extracardiac disease, making early intervention on modifiable risk factors a key priority. Herewith, we provide an overview of the multiple aspects that should be considered in this holistic approach to guide everyday issues of ACHD patients, including nutrition, physical activity, sexual health, cancer prevention, respiratory disease, and infective endocarditis.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i17-i24"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who will be our adult congenital heart disease patient tomorrow?","authors":"Berardo Sarubbi, Giancarlo Scognamiglio","doi":"10.1093/eurheartjsupp/suaf091","DOIUrl":"10.1093/eurheartjsupp/suaf091","url":null,"abstract":"<p><p>Advances in paediatric cardiology and surgery have transformed congenital heart disease from a fatal condition into a chronic, lifelong one. As a result, the adult congenital heart disease (ACHD) population is rapidly expanding and aging, with rising medical complexity and growing workforce shortages. The ACHD patient of tomorrow will present with diverse needs-ranging from management of complex congenital repairs and heart failure (HF) to acquired comorbidities typical of aging populations. This shift necessitates a reimagined model of care emphasizing accessibility, precision, and patient partnership. Telemedicine, remote monitoring, and digital health platforms will decentralize ACHD care, improving follow-up and reducing disparities. Precision medicine, integrating genomics, proteomics, metabolomics, and microbiomics, will enable individualized diagnosis and therapy. Artificial intelligence (AI) will enhance early detection, risk prediction, and surgical planning while supporting patient education and engagement. Future ACHD patients will be empowered participants in shared decision-making, supported by AI-driven tools and online communities. Personalized strategies for HF management, especially in Fontan circulation and systemic right ventricles, along with advances in transcatheter interventions, will minimize surgical trauma and improve quality of life. Equally, mental health and social integration will be central to holistic care. Ultimately, tomorrow's ACHD care will merge technology and humanity-leveraging innovation to deliver compassionate, individualized treatment across a patient's lifespan.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i1-i6"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New perspectives in the management of adults with congenital heart disease: insights from the 2025 ACHD Congress.","authors":"Nunzia Borrelli, Jolanda Sabatino, Francisco Javier Ruperti-Repilado, Oktay Tutarel, George Giannakoulas, Michele D'Alto, Emanuele Romeo, Daniel Tobler, Gerhard Paul Diller","doi":"10.1093/eurheartjsupp/suaf086","DOIUrl":"10.1093/eurheartjsupp/suaf086","url":null,"abstract":"<p><p>The population of adult patients with congenital heart disease (ACHD) is rapidly growing thanks to advances in diagnostics and therapeutics. However, these patients now encounter new clinical and healthcare challenges. The '<i>New perspectives in ACHD management'</i> session at the ACHD 2025 Congress highlighted the key areas of innovation aimed at improving prognosis and quality of life. The aging ACHD population places substantial demands on geriatric medicine, with significant implications for the healthcare system. Similarly, the increasing arrhythmic burden, in particular atrial fibrillation, requires specific preventive and therapeutic strategies, including ablation procedures tailored to the anatomical peculiarities of ACHD patients. Pulmonary hypertension is a major contributor to morbidity and mortality in ACHD, requiring precision medicine approaches, dedicated risk stratification, and multidisciplinary approach. A central role is played by adequate prevention of acquired cardiovascular diseases, whose incidence is higher and occur earlier than in the general population. Specific risk stratification tools and an integrated approach of lifestyle modification and innovative pharmacological therapy are necessary. Telemedicine offers new opportunities for remote monitoring, access to specialized expertise, and comprehensive support, particularly for frail patients or those living in remote areas. Lastly, emerging technologies such as 3D printing, virtual reality, computational modelling, and artificial intelligence are transforming treatment planning and enabling personalized care. A multidisciplinary and technologically advanced approach is essential for shifting the focus from merely prolonging survival to truly improving the quality of life of ACHD patients.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 1","pages":"i50-i57"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}