{"title":"Leaving Little or Nothing Behind","authors":"H. V. (‘Skip’) Anderson MD","doi":"10.1016/j.jcin.2026.08.005","DOIUrl":"10.1016/j.jcin.2026.08.005","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2455-2458"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067856","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}
Dennis Rottländer MD, Taoufik Ouarrak MSc, Jörg Hausleiter MD, Thomas Schmitz MD, Alexander Bufe MD, Melchior Seyfarth MD, Harald Beucher MD, Steffen Schneider PhD, Peter Boekstegers MD, MITRA-PRO Investigators
{"title":"Residual Mitral Regurgitation as a Long-Term Predictor of Mortality After Mitral TEER","authors":"Dennis Rottländer MD, Taoufik Ouarrak MSc, Jörg Hausleiter MD, Thomas Schmitz MD, Alexander Bufe MD, Melchior Seyfarth MD, Harald Beucher MD, Steffen Schneider PhD, Peter Boekstegers MD, MITRA-PRO Investigators","doi":"10.1016/j.jcin.2026.06.034","DOIUrl":"10.1016/j.jcin.2026.06.034","url":null,"abstract":"<div><h3>Background</h3><div>The MITRA-PRO registry revealed residual mitral regurgitation (MR) as an important predictor of 1-year and 3-year mortality following mitral transcatheter edge-to-edge repair (M-TEER).</div></div><div><h3>Objectives</h3><div>The 5-year follow-up of the MITRA-PRO registry (N = 1,491) aimed to assess the impact of residual MR on 5-year mortality. Furthermore, time-dependent predictors of mortality after M-TEER should be assessed.</div></div><div><h3>Methods</h3><div>Patients with a MitraScore of ≤3 were classified as patients with mild residual MR after M-TEER, while a MitraScore of ≥4 was defined as relevant residual MR. Adjusted HRs were calculated for multivariate analysis of time-dependent predictors.</div></div><div><h3>Results</h3><div>Five-year mortality was significantly lower in patients with mild or less residual MR compared with patients with more than mild residual MR (MitraScore ≤3 group: 55.1% vs MitraScore ≥4 group: 67.7%). The relationship between intraprocedural MitraScore after M-TEER and mortality was almost linear. In patients with degenerative MR, 5-year mortality was 53.1% in the MitraScore ≤3 group and 73.2% in the MitraScore ≥4 group. Regarding functional MR, the corresponding 5-year mortality rates were 55.0% and 64.6%. Mortality predictors after M-TEER were time dependent: Early risk was driven by advanced disease and procedural factors, whereas residual MR became prognostic after 30 days and remained associated with excess long-term mortality.</div></div><div><h3>Conclusions</h3><div>Residual MR assessed by intraprocedural MitraScore after M-TEER independently predicts 5-year mortality. This finding underscores the importance of achieving optimal MR reduction during M-TEER and supports quantitative multimodal intraprocedural assessment to guide strategy and improve long-term outcomes.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2474-2486"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067858","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}
Lene Dohn Andreasen MD, PhD, Emil Nielsen Holck MD, PhD, Omeed Neghabat MD, PhD, Peep Laanmets MD, PhD, James C. Spratt MD, PhD, Irene Santos-Pardo MD, PhD, Lars Jakobsen MD, PhD, Kiril Aleksov Ahtarovski MD, PhD, Lone Juul Hune Mogensen MSc, Johan Bennett MD, PhD, Peter O’kane MD, PhD, James Cockburn MD, PhD, Evald Høj Christiansen MD, PhD
{"title":"Stenting Technique and Clinical Outcome in True Bifurcation PCI","authors":"Lene Dohn Andreasen MD, PhD, Emil Nielsen Holck MD, PhD, Omeed Neghabat MD, PhD, Peep Laanmets MD, PhD, James C. Spratt MD, PhD, Irene Santos-Pardo MD, PhD, Lars Jakobsen MD, PhD, Kiril Aleksov Ahtarovski MD, PhD, Lone Juul Hune Mogensen MSc, Johan Bennett MD, PhD, Peter O’kane MD, PhD, James Cockburn MD, PhD, Evald Høj Christiansen MD, PhD","doi":"10.1016/j.jcin.2026.06.027","DOIUrl":"10.1016/j.jcin.2026.06.027","url":null,"abstract":"<div><h3>Background</h3><div>Optimal stenting for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes.</div></div><div><h3>Methods</h3><div>This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; <span><span>NCT03171311</span><svg><path></path></svg></span>) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique.</div></div><div><h3>Results</h3><div>Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (<em>P</em> for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)–crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24).</div></div><div><h3>Conclusions</h3><div>Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2444-2454"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067855","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}
Raj R. Makkar MD, Aakriti Gupta MD, MSc, Ignacio Inglessis MD, Curtiss T. Stinis MD, Pradeep K. Yadav MD, Vinod H. Thourani MD, Stanley J. Chetcuti MD, Matthew Summers MD, Vivek Patel MS, Bassem M. Chehab MD, Apurva Patel MD, Gilbert H.L. Tang MD, Sahil Khera MD, Michael Rinaldi MD, Trevor Simard MD, Jeffrey Southard MD, Benjamin R. Stripe MD, Brian Whisenant MD, Keith Allen MD, Yoseph Rozenman MD, Philippe Généreux MD
{"title":"Real-World Outcomes of Dedicated Leaflet Modification for Bioprosthetic Valve-In-Valve TAVR","authors":"Raj R. Makkar MD, Aakriti Gupta MD, MSc, Ignacio Inglessis MD, Curtiss T. Stinis MD, Pradeep K. Yadav MD, Vinod H. Thourani MD, Stanley J. Chetcuti MD, Matthew Summers MD, Vivek Patel MS, Bassem M. Chehab MD, Apurva Patel MD, Gilbert H.L. Tang MD, Sahil Khera MD, Michael Rinaldi MD, Trevor Simard MD, Jeffrey Southard MD, Benjamin R. Stripe MD, Brian Whisenant MD, Keith Allen MD, Yoseph Rozenman MD, Philippe Généreux MD","doi":"10.1016/j.jcin.2026.06.002","DOIUrl":"10.1016/j.jcin.2026.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Coronary obstruction during valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is infrequent but catastrophic. Mechanical splitting of bioprosthetic leaflets may mitigate this risk, but real-world experience remains limited.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate procedural performance and in-hospital outcomes of a dedicated mechanical leaflet-splitting device in ViV TAVR.</div></div><div><h3>Methods</h3><div>Consecutive postapproval cases were performed at 28 centers from February to November 2025. Patients were selected for elevated risk based on preprocedural computed tomography criteria, including virtual valve-to-coronary distance ≤4 mm and/or virtual valve-to-sinotubular junction distance ≤3 mm. Procedural outcomes were assessed among patients in whom splitting was attempted; safety outcomes were assessed among all patients in whom the device was introduced. Events were adjudicated using Valve Academic Research Consortium-3 definitions.</div></div><div><h3>Results</h3><div>Among 150 patients (age 78.9 ± 8.5 years; 60.0% female), 95 of 150 (63.3%) underwent ViV TAVR for failed surgical and 55 of 150 (36.7%) for failed transcatheter valves. Computed tomography analysis showed predicted acute coronary obstruction risk in 131 of 150 (87.3%) patients, including combined sinus sequestration and direct ostial obstruction in 76 of 150 (50.7%). Leaflet splitting was attempted in 145 patients and was successful in 144 of 145 (99.3%); dual-leaflet splitting was performed in 83 of 145 (57.2%). Coronary obstruction occurred in 3 of 150 (2.0%; 95% CI: 0.7-5.7). All-cause mortality occurred in 3 of 150 (2.0%; 95% CI: 0.7-5.7), including 2 deaths from left ventricular perforation and 1 after stroke. Conversion to surgery occurred in 2 of 150 (1.3%; 95% CI: 0.4-4.7).</div></div><div><h3>Conclusions</h3><div>In this early U.S. commercial experience, mechanical leaflet splitting demonstrated high procedural success in an anatomically high-risk ViV TAVR cohort. Serious complications occurred, and longer-term systematic follow-up remains important.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2459-2470"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335987","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":"LIRA-Guided Supra-Annular Sizing for TAVR in Bicuspid Aortic Valve Disease","authors":"Won-Keun Kim MD, Derk Frank MD","doi":"10.1016/j.jcin.2026.07.003","DOIUrl":"10.1016/j.jcin.2026.07.003","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2512-2514"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149071833","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":"1-Year Outcomes of Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent for Coronary Artery Bypass Graft Lesions","authors":"Tadao Aikawa MD, PhD, Kyohei Yamaji MD, PhD, Toshiki Kuno MD, PhD, Shun Kohsaka MD, PhD, Hideki Ishii MD, PhD, Yuya Matsue MD, PhD, Kazunori Omote MD, PhD, Naohiro Funayama MD, Kazuyuki Ozaki MD, PhD, Hiroyuki Kunii MD, PhD, Tetsuya Amano MD, PhD, Tohru Minamino MD, PhD, Ken Kozuma MD, PhD","doi":"10.1016/j.jcin.2026.06.023","DOIUrl":"10.1016/j.jcin.2026.06.023","url":null,"abstract":"<div><h3>Background</h3><div>Graft failure after coronary artery bypass grafting is a common clinical problem associated with adverse cardiovascular outcomes. Although percutaneous coronary intervention (PCI) for bypass graft lesions is frequently performed, the optimal device strategy remains debated. Recently, drug-coated balloon (DCB) has emerged as a stentless alternative.</div></div><div><h3>Objectives</h3><div>This study aimed to compare 1-year clinical outcomes between drug-eluting stent (DES) and DCB-only strategies in patients undergoing PCI for bypass graft lesions.</div></div><div><h3>Methods</h3><div>We analyzed data from the J-PCI OUTCOME (Japanese Percutaneous Coronary Intervention Outcome Registry), a nationwide registry in Japan. Patients who underwent PCI with DES or stentless PCI with DCB for bypass graft lesions between 2017 and 2020 were included. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, acute coronary syndrome, and stroke within 1 year after PCI. Secondary endpoints included individual components of MACE, major bleeding, and planned repeat revascularization.</div></div><div><h3>Results</h3><div>Of the 610 PCIs for bypass graft lesions, 184 (30.2%) were stentless PCIs with DCB. One-year MACE rates did not differ significantly between the DES and DCB-only strategies (10.3% vs 8.6%; <em>P</em> = 0.69). No statistically significant differences were observed in the secondary endpoints. After multivariable adjustment, the DCB-only strategy was not associated with a significant difference in MACE risk after PCI compared with the DES-based strategy (adjusted HR: 1.01; 95% CI: 0.58-1.76; <em>P</em> = 0.96).</div></div><div><h3>Conclusions</h3><div>Stentless PCI with DCB was frequently used in patients undergoing PCI for bypass graft lesions in Japan and was not associated with a significant difference in 1-year clinical outcomes compared with contemporary DES-based PCI strategies.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2429-2440"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865006","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}
Barbara Bellini MD, Vittorio Romano RT, Gianmarco Iannopollo MD, Riccardo Gorla MD, Federico Moccetti MD, Francesco De Felice MD, Andrea Buono MD, Mauro Massussi MD, Greca Zanda MD, Rene Hameau Davanzo MD, Celeste Manzo MD, Diana Chin MD, Greta Cattaneo MD, Gianluca Ricchetti MD, Ciro Vella MD, Francesca Napoli MD, Luca Angelo Ferri MD, Filippo Russo MD, Marco Bruno Ancona MD, Marianna Adamo MD, Matteo Montorfano MD
{"title":"Clinical Performance and Reproducibility of the LIRA Method for TAVR in Bicuspid Anatomy","authors":"Barbara Bellini MD, Vittorio Romano RT, Gianmarco Iannopollo MD, Riccardo Gorla MD, Federico Moccetti MD, Francesco De Felice MD, Andrea Buono MD, Mauro Massussi MD, Greca Zanda MD, Rene Hameau Davanzo MD, Celeste Manzo MD, Diana Chin MD, Greta Cattaneo MD, Gianluca Ricchetti MD, Ciro Vella MD, Francesca Napoli MD, Luca Angelo Ferri MD, Filippo Russo MD, Marco Bruno Ancona MD, Marianna Adamo MD, Matteo Montorfano MD","doi":"10.1016/j.jcin.2026.06.018","DOIUrl":"10.1016/j.jcin.2026.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) anatomy remains challenging, with heterogeneous outcomes and no standardized sizing strategy. The LIRA (level of implantation at the raphe) method is a bicuspid-dedicated approach that complements standard annular sizing with a single perimeter measurement at the raphe level. A previous single-center experience suggested favorable results.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate clinical performance and reproducibility of the LIRA method for TAVR sizing in a large BAV multicenter cohort.</div></div><div><h3>Methods</h3><div>A total of 215 BAV patients undergoing TAVR with the LIRA method at 6 centers were retrospectively analyzed. Procedural and clinical outcomes were adjudicated according to Valve Academic Research Consortium 3 criteria and assessed at 30 days and 1 year. Available full-cycle computed tomographic data sets from external centers were reanalyzed in a blinded centralized core laboratory to assess reproducibility of the LIRA method.</div></div><div><h3>Results</h3><div>The application of the LIRA method led to prosthesis downsizing in 74.4% of cases. At 30 days, device success was 93%, and moderate or greater paravalvular leak had occurred in 4.6% of patients, new permanent pacemaker implantation in 10.7%, and stroke in 1.9%. At 1 year, all-cause mortality was 5.7%, and clinical efficacy was observed in 92.8% of patients. Clinical outcomes were consistent across centers. Prosthesis sizing agreement was excellent (κ = 0.85; 95% CI: 0.74-0.96), and perimeter concordance was good (intraclass correlation coefficient = 0.76; 95% CI: 0.63-0.85).</div></div><div><h3>Conclusions</h3><div>In this large multicenter cohort, the LIRA method demonstrated good reproducibility across centers and was associated with favorable procedural and clinical outcomes in BAV patients undergoing TAVR. These findings support its clinical applicability as a bicuspid-dedicated sizing strategy.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2501-2511"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067861","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}
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