Seth Bergstedt, Judit Karacsonyi, Emmanouil S Brilakis, Larissa I Stanberry
{"title":"Lack of Calibration Degrades the Performance of Clinical Prediction Models: A Case of CTO Scores.","authors":"Seth Bergstedt, Judit Karacsonyi, Emmanouil S Brilakis, Larissa I Stanberry","doi":"10.1016/j.jcin.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.jcin.2025.08.001","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006200","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}
Parasuram Krishnamoorthy MD , Takayuki Onishi MD , Syed Zaid MD , Stamatios Lerakis MD, PhD , Lucy M. Safi DO , Sahil Khera MD, MPH , Amit Hooda MD , Sunny Goel MD , George D. Dangas MD, PhD , Samin K. Sharma MD , Annapoorna S. Kini MD , Gilbert H.L. Tang MD, MSc, MBA
{"title":"CT and Fluoroscopic Analyses of Valve Expansion in Redo-TAVR","authors":"Parasuram Krishnamoorthy MD , Takayuki Onishi MD , Syed Zaid MD , Stamatios Lerakis MD, PhD , Lucy M. Safi DO , Sahil Khera MD, MPH , Amit Hooda MD , Sunny Goel MD , George D. Dangas MD, PhD , Samin K. Sharma MD , Annapoorna S. Kini MD , Gilbert H.L. Tang MD, MSc, MBA","doi":"10.1016/j.jcin.2025.06.017","DOIUrl":"10.1016/j.jcin.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Redo transcatheter aortic valve replacement (TAVR) for transcatheter aortic valve (TAV) failure is becoming increasingly common. Although short-term outcomes appear favorable, no imaging after redo-TAVR has been performed to evaluate frame expansion and geometry.</div></div><div><h3>Objectives</h3><div>The authors report a first-in-human experience using multidetector computed tomography (MDCT) and fluoroscopy to evaluate valve frame expansion and geometry of both index and second TAVs.</div></div><div><h3>Methods</h3><div>From January 2023 to April 2025, 30 of 40 consecutive patients underwent redo-TAVR for bioprosthetic valve failure and had evaluable postprocedural MDCT. Index TAVs were predilated in 80% (24 of 30), and both TAVs were postdilated in all cases for frame optimization. Frame dimensions were measured using MDCT and fluoroscopy for both index and second TAVs at different levels. Valve expansion and eccentricity were calculated by comparing observed measurements with expected nominal measurements validated from previous studies.</div></div><div><h3>Results</h3><div>TAV-in-TAV combinations were as follows: 8 of 30 (26.7%) short-in-short, 16 of 30 (53.3%) short-in-tall (15 Evolut, 1 Navitor), and 6 of 30 (20%) tall-in-short. Structural valve deterioration was the common mechanism of failure. Both MDCT and fluoroscopy showed that index TAVs were all underexpanded, and expansion was seen after redo-TAVR in all cases. The second TAVs were underexpanded across all valve types, but more so with tall-in-short (Evolut-in-SAPIEN) combination. No elevated valve gradients and no hypoattenuated leaflet thickening were observed at 30 days.</div></div><div><h3>Conclusions</h3><div>There was significant underexpansion of both index and second TAVs after redo-TAVR, irrespective of valve type and combinations. Larger studies are needed to validate this finding and determine the longer term impact of underexpansion of the second TAV, despite acceptable short-term hemodynamic performance.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 16","pages":"Pages 1971-1985"},"PeriodicalIF":11.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528017","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":"Comprehensive Cardiac Imaging Before and During Microaxial Flow Pump Support for Cardiogenic Shock","authors":"Luca Baldetti MD , Alessandro Beneduce MD , Guglielmo Gallone MD , Christophe Vandenbriele MD , Hatem Soliman-Aboumarie MD , Giacomo Ingallina MD , Anna Palmisano MD , Antonio Esposito MD , Elena Busnardo MD , Claudia Francescon CCP , Marina Pieri MD , Silvia Ajello MD , Eustachio Agricola MD , Nicolò Piazza MD , Jamie Hernandez-Montfort MD , Claudius Mahr MD , Jacob Eifer Møller MD , Anna Mara Scandroglio MD","doi":"10.1016/j.jcin.2025.06.040","DOIUrl":"10.1016/j.jcin.2025.06.040","url":null,"abstract":"<div><div>The increasing use of microaxial flow pumps (mAFP) underpins the need for a comprehensive approach to manage critically ill patients in an effort to maximize the benefits of this temporary mechanical circulatory support (tMCS) while minimizing its potential complications. Multimodality cardiac imaging offers an irreplaceable array of tools to address device position, device–heart hemodynamic interaction, myocardial recovery assessment, and identification of complications. This review provides a comprehensive and pragmatic summary of the cardiovascular imaging modalities currently available throughout the pathway of care of mAFP-supported patients, from device insertion, to intensive cardiac care hemodynamic monitoring, weaning guidance, and myocardial recovery assessment. The specific logistical and technical challenges related to pump management and potential interference with the imaging technology performed during mAFP are also discussed. Comprehensive cardiovascular imaging represents a fundamental pillar to ensure the best care to mAFP-supported patients and plays a pivotal role in any successful critical care and tMCS program.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 16","pages":"Pages 1955-1970"},"PeriodicalIF":11.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895965","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}