Reviews in cardiovascular medicine最新文献

{"title":"The Financial Divide in Congenital Heart Surgery: Global Challenges and Solutions.","authors":"Sneha Prothasis, Janett Francis, Priya Prothasis, Vivienne Mathews, Jeevan Francis","doi":"10.31083/RCM43778","DOIUrl":"10.31083/RCM43778","url":null,"abstract":"","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"43778"},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800097","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":"Electrophysiology Models for End-Stage Renal Disease Maladaptations That Promote Asystole.","authors":"Ikeotunye Royal Chinyere","doi":"10.31083/RCM37400","DOIUrl":"10.31083/RCM37400","url":null,"abstract":"<p><p>Many patients with chronic renal impairment experience cardiac comorbidities throughout their lives, and the incidence of electrophysiological demise for patients with terminal renal impairment requiring renal replacement therapy is higher than in patients with normal renal function. Thus, this relationship warrants continued examination, such that the risk of subsequent cardiac complications might eventually be mitigated. This review aims to outline the electrophysiology concepts, both basic and clinical, underlying the pathophysiology mediated by end-stage renal disease (ESRD). An evaluation of how chronic kidney disease may accelerate adverse cardiac remodeling, as well as the mechanisms through which hemodialysis may precipitate electrophysiological aberrations that impair the ability of the conduction system to maintain normal sinus rhythm, are provided. Furthermore, relevant animal models for this pathophysiology, with respect to their innate ability to recapitulate human renal and cardiac electrophysiology, are outlined. Specifically, the concepts of hyperkalemia, pericarditis, and arrhythmia are discussed in relation to ESRD. Furthermore, murine, porcine, and human species are compared and contrasted on all structural levels, from subcellular to clinical, illustrating which models best recapitulate this propensity to asystole.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"37400"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800068","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":"Epigenetic Mechanisms in Heart Diseases.","authors":"Mustafa Yildiz","doi":"10.31083/RCM38696","DOIUrl":"10.31083/RCM38696","url":null,"abstract":"<p><p>Heart diseases (HDs) continue to be among the major diseases that adversely affect human health worldwide, with complex interactions between genetic, environmental, and biochemical factors contributing to their progression. These include coronary heart disease, hypertension, heart failure, vascular calcification, etc. Cardiovascular diseases have been extensively studied in the Framingham Heart Study since 1948, spanning three generations over the past 70 years, and are highly correlated with various factors, including biochemical, environmental, behavioral, and genetic factors. In recent years, epigenetic mechanisms have emerged as crucial regulators of cardiovascular pathology, influencing gene expression without altering the underlying DNA sequence. Moreover, early detection and diagnosis of heart diseases are crucial for improving treatment and prognosis. Recent studies on heart disease have found that the expression of potential candidate genes related to the disease is associated with epigenetic mechanisms. Indeed, abnormal methylation states have been detected in candidate genes that can serve as biomarkers to assess the progression of heart disease. Recent advances in next-generation sequencing techniques have contributed significantly to our understanding of heart diseases, including the role of DNA methylation, adenosine triphosphate (ATP)-dependent chromatin conformation and remodeling, post-translational modifications of histones and non-coding RNAs. Lastly, this review examines the latest discoveries in the epigenetic regulation of heart diseases, highlighting the roles of DNA methyltransferases (DNMTs), histone deacetylases (HDACs), sirtuins (SIRTs), and ten-eleven translocation proteins (TETs). Additionally, this review highlights preclinical therapeutic strategies targeting epigenetic modifiers, offering new avenues for precision medicine in cardiology. Understanding these epigenetic pathways is crucial for developing novel biomarkers and epigenetic-based therapies that aim to reverse maladaptive cardiac remodeling and enhance clinical outcomes.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"38696"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800069","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":"Predictors of Long-Term Mortality in Medically Treated Patients With Chronic Heart Failure in Kosovo.","authors":"Gani Bajraktari, Shpend Elezi, Pranvera Ibrahimi, Genc Abdyli, Artan Bajraktari, Arlind Batalli, Afrim Poniku, Frank L Dini, Michael Y Henein","doi":"10.31083/RCM38127","DOIUrl":"10.31083/RCM38127","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a complex clinical syndrome that is associated with high morbidity and mortality. The prognosis of chronic HF in Kosovo has never been objectively assessed and compared with other countries. Thus, this study aimed to investigate the long-term prognostic value of clinical and cardiac function parameters in predicting the mortality of patients in Kosovo with chronic HF.</p><p><strong>Methods: </strong>This study included 203 consecutive patients with chronic HF who were followed up for a mean of 86 ± 40 months. The primary outcome of the study was all-cause mortality.</p><p><strong>Results: </strong>During the follow-up period, there were 94 deaths (46.3%). Deceased patients were older (<i>p</i> < 0.001), commonly in New York Heart Association (NYHA) class ≥III (<i>p</i> < 0.001), had lower 6-minute walk distances (<i>p</i> = 0.014), higher prevalence of type 2 diabetes mellitus (T2DM) (<i>p</i> = 0.018), raised creatinine (<i>p</i> = 0.001), and lower hemoglobin (<i>p</i> = 0.004). Moreover, these patients often had left bundle branch block (<i>p</i> = 0.001), lower left ventricular (LV) ejection fraction (EF) (<i>p</i> < 0.001), larger left atrium (LA) (<i>p</i> < 0.001), lower lateral and septal mitral annular plane systolic excursion (MAPSE) values (<i>p</i> = 0.001 and <i>p</i> < 0.001, respectively), and tricuspid annular plane systolic excursion (TAPSE) (<i>p</i> = 0.009), reduced lateral systolic myocardial velocity (s') (<i>p</i> = 0.018), early diastolic myocardial velocity (e') (<i>p</i> = 0.011) and late diastolic myocardial velocity (a') (<i>p</i> = 0.010) velocities, reduced septal e' (<i>p</i> < 0.001) and a' (<i>p</i> = 0.032) velocities, and had higher E/e' (<i>p</i> = 0.021), compared to survivors. Multivariate analysis identified NYHA class ≥III (odds ratio (OR) = 5.573, 95% CI 1.688-18.39; <i>p</i> = 0.005), raised creatinine (OR = 1.027, 95% CI 1.006-1.047; <i>p</i> = 0.011), advanced age (OR = 1.069, 95% CI 1.011-1.132; <i>p</i> = 0.020), enlarged LA (OR = 3.279, 95% CI 1.033-10.41; <i>p</i> = 0.044), and left ventricular ejection fraction (LVEF) ≤45% (OR = 3.887, 95% CI 1.221-12.38; <i>p</i> = 0.022), as independent predictors of mortality.</p><p><strong>Conclusions: </strong>In medically treated patients with chronic HF from Kosovo, worse functional NYHA class, impaired kidney function, age, compromised LV systolic function, and enlarged LA were independently associated with increased risk of long-term all-cause mortality.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"38127"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800084","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":"Atrial Fibrillation Termination Success During Ablation: Insights From Pooled Clinical Studies.","authors":"Changjian He, Wenchang Zhang, Feng Li, Huaiqiang Wang, Xiongyi Han, Zihan Zhao, Guojie Ye, Tengfei Liu, Da Zhang, Haiyan Liu, Jie Liu, Jingning Zhao, Chunhua Ding","doi":"10.31083/RCM33419","DOIUrl":"10.31083/RCM33419","url":null,"abstract":"<p><strong>Background: </strong>The optimal endpoint for ablation in persistent atrial fibrillation (pers-AF) remains unclear. This study aimed to systematically evaluate the prognostic value of acute AF termination in predicting the recurrence of arrhythmias.</p><p><strong>Methods: </strong>A systematic search of the PubMed, Cochrane Library, Web of Science, and Embase databases was conducted from inception to July 2023. Only studies with reports of acute termination for pers-AF and its predictive role in arrhythmia recurrence were included. Subgroup analysis was performed to identify potential confounders for the effect of AF termination.</p><p><strong>Results: </strong>A total of 22 studies were included in the meta-analysis. The pooled analysis indicated that acute termination of AF is significantly associated with an increased long-term success rate (relative risk (RR), 1.53; 95% CI, 1.41-1.66; <i>p</i> < 0.001; I² = 35.4%). Moreover, subgroup analysis revealed that patients with an AF duration >12 months (RR, 1.92; 95% CI, 1.57-2.35; <i>p</i> < 0.001), aged >60 years (RR, 1.92; 95% CI, 1.60-2.31; <i>p</i> < 0.001) may derive benefits from AF termination during ablation. Interestingly, a significant interaction was observed in the study design subgroup, where multi-center studies showed a success rate of RR, 1.31 (95% CI, 1.14-1.50; <i>p</i> < 0.001), while single-center studies exhibited a higher success rate of RR, 1.65 (95% CI, 1.49-1.82; <i>p</i> < 0.001), with an interaction <i>p</i>-value of 0.008. Importantly, acute termination of AF did not significantly increase procedural complications (RR, 1.19; 95% CI, 0.59-2.39; <i>p</i> = 0.627; I² = 0.0%).</p><p><strong>Conclusions: </strong>Our study suggests that AF acute termination during ablation for pers-AF provides a better long-term clinical outcome.</p><p><strong>The prospero registration: </strong>CRD42023431015, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023431015.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"33419"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800034","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":"Identification and Management Strategies for Intracoronary High Thrombus Burden in Patients With STEMI: A Practical Experience and Literature Review.","authors":"Xing Feng, Tongku Liu","doi":"10.31083/RCM37466","DOIUrl":"10.31083/RCM37466","url":null,"abstract":"<p><p>Acute myocardial infarction (AMI) includes ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). STEMI is the most severe type of AMI and is a life-threatening disease. The onset and progress of STEMI are accompanied by thrombosis in coronary arteries, which leads to the occlusion of coronary vessels. The main pathogenesis of STEMI is the presence of unstable atherosclerotic plaques (vulnerable plaques) in the vessel wall of the coronary arteries. The vulnerable plaques may rupture, initiating a cascade of blood coagulation, ultimately leading to the formation and progression of thrombus. Treating STEMI patients with high thrombus burden is a challenging problem in the field of percutaneous coronary intervention (PCI). During the PCI procedure, the thrombus may be squeezed and dislodged, leading to a distal embolism in the infarction-related artery (IRA), resulting in slow blood flow (slow flow) or no blood flow (no reflow), which can enlarge the ischemic necrosis area of myocardial infarction, aggravate myocardial damage, endanger the life of the patient, and lead to PCI failure. Identifying and treating high thrombus burden in the IRA has been a subject of debate and is currently a focal point in research. Clinical strategies such as the use of thrombus aspiration catheters and antiplatelet agents (platelet glycoprotein IIb/IIIa receptor inhibitors, such as tirofiban), as well as the importance of early intervention to prevent complications, such as no reflow and in-stent thrombosis, are highlighted in recent studies. Thrombus aspiration is an effective therapeutic approach for removing intracoronary thrombus, thereby decreasing the incidence of slow flow/no reflow phenomena and enhancing myocardial tissue perfusion, ultimately benefiting from protecting heart function and improving the prognosis of STEMI patients. Notably, deferred stenting benefits STEMI patients with high thrombus burden and hemodynamic instability. Meanwhile, antithrombotic and thrombolytic agents serve as adjuvant therapies alongside PCI. Primary PCI and stenting are reasonable for patients with low intracoronary thrombus burden. The article describes the practical experience of the author and includes a literature review that details the research progress in identifying and managing STEMI patients with intracoronary high thrombus burden, and provides valuable insights into managing patients with high thrombus burden in coronary arteries. Finally, this article serves as a reference for clinicians.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"37466"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800035","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":"Metabolic Alterations Associated With Right Ventricular Dysfunction in Pulmonary Arterial Hypertension: The Modulatory Effects and Improvement Mechanisms of Exercise.","authors":"Sitong Chen, Gengmin Liang, Lokfai Cheang, Qiang Qu, Xinli Li","doi":"10.31083/RCM37460","DOIUrl":"10.31083/RCM37460","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is characterized by a significant increase in pulmonary arterial pressure, leading to right ventricular failure (RVF), limited exercise capacity, and increased mortality risk. Right ventricular function is a critical determinant of exercise capacity and prognosis in patients with PAH. Meanwhile, alterations in cellular metabolism and bioenergy are common features in PAH, with the differential regulation of metabolic pathways playing a significant role in right ventricular dysfunction (RVD). Mitochondria, essential organelles responsible for energy production, biosynthetic pathways, and signal transduction, are particularly implicated in differential regulation. Exercise is increasingly recognized as a beneficial adjunct therapy; however, specific recommendations are often lacking in official guidelines. This review examines the changes in metabolic pathways associated with RVD in PAH, including glycolysis, glucose oxidation, fatty acid oxidation, glutamine metabolism, and arginine metabolism. Furthermore, this article discusses how exercise can modulate the aforementioned metabolic pathways to improve metabolic disturbances in the right ventricle and enhance right heart function. These are essential for developing effective rehabilitation strategies.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"37460"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800081","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 Diagnosis and Therapeutic Management of Anomalous Aortic Origin of the Coronary Artery: A Retrospective Study Conducted at a Single Center in China.","authors":"Cheng Zhang, Dan Shi, Xiaonan He","doi":"10.31083/RCM33432","DOIUrl":"10.31083/RCM33432","url":null,"abstract":"<p><strong>Background: </strong>This study collected data on the incidence and management of anomalous aortic origin of the coronary artery (AAOCA). We described the incidence of AAOCA and the observed outcomes after management.</p><p><strong>Methods: </strong>This retrospective study focused on patients treated for AAOCA in a tertiary hospital during the last 20 years. Patients were divided into the anomalous left coronary artery from the pulmonary artery (ALCAPA) group, the non-ALCAPA group, and the symptomatic and asymptomatic groups. Clinical manifestations and related data after surgery were compared among the different groups.</p><p><strong>Results: </strong>From April 2003 to July 2022, 102 patients were diagnosed with AAOCA and treated at Beijing Anzhen Hospital. ALCAPA was identified as the most prevalent anomaly. The incidence of syncope and heart failure was significantly lower and higher, respectively, in the ALCAPA group. Surgical intervention yielded immediate benefits not only for ALCAPA patients but also for patients who underwent AAOCA. In total, 64.7% of the patients underwent coronary artery osteoplasty, which provided a comprehensive surgical approach addressing all anatomical issues associated with AAOCA. Compared to preoperative measurements, there was a significant reduction in the left ventricular end-diastolic diameter (LVEDD) after surgical intervention (<i>p</i> < 0.001). Both the ejection fraction (EF) before and after surgery and the incidence of inter-arterial abnormal vessels in the asymptomatic group were significantly higher than those observed in the symptomatic group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>ALCAPA is most frequently observed among patients with AAOCA. Thus, surgical intervention benefits AAOCA patients, particularly asymptomatic individuals.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"33432"},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800096","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":"Cardiovascular-Kidney-Metabolic Effects: Steroidal and Nonsteroidal Mineralocorticoid Receptor Antagonists.","authors":"Biykem Bozkurt, James L Januzzi, Shweta Bansal","doi":"10.31083/RCM38690","DOIUrl":"10.31083/RCM38690","url":null,"abstract":"<p><p>Cardiovascular (CV)-kidney-metabolic (CKM) syndrome is a complex disorder characterized by the co-occurrence of CV risk factors, including chronic kidney disease (CKD), hypertension, and metabolic dysfunction, which creates a vicious cycle where one factor negatively impacts the others, ultimately leading to poor overall CV and kidney outcomes. Overactivation of the mineralocorticoid receptor, through binding with aldosterone and ligand-independent mechanisms, is implicated in the pathogenesis of CKM; mineralocorticoid receptor antagonists (MRAs) can block this interaction. Steroidal MRAs are currently recommended for people with heart failure (HF) with reduced ejection fraction and hypertension; however, the role of nonsteroidal MRAs in CKM is evolving. Indeed, steroidal MRAs have demonstrated efficacy against composite CV-related mortality and hospitalization, elevated systolic blood pressure, and hospitalizations for worsening HF in clinical trials of individuals with HF, CKD, and treatment-resistant hypertension. Moreover, the nonsteroidal MRA finerenone has demonstrated risk reductions for composite CV-related outcomes and CKD progression in patients with HF with mildly reduced or preserved ejection fraction and people with CKD associated with type 2 diabetes. Ongoing phase 3 trials are evaluating the efficacy and safety of nonsteroidal MRAs in individuals with HF and reduced ejection fraction, as well as those with mildly reduced or preserved ejection fraction, potentially expanding their role in managing CKM conditions. This review examines current clinical evidence for the use of MRAs in people with CKM syndrome.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"38690"},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800063","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":"Incidence of Coronary Obstruction During Aortic Valve Implantation: Meta-Analysis and Mixt-Treatment Comparison of Self-Expandable Versus Balloon-Expandable Valve Prostheses.","authors":"Yu Fei Wang, Zai Qiang Liu, Xiao Teng Ma, Li Xia Yang, Zhi Jian Wang, Yu Jie Zhou","doi":"10.31083/RCM36208","DOIUrl":"10.31083/RCM36208","url":null,"abstract":"<p><strong>Background: </strong>Recently, the transcatheter aortic valve replacement (TAVR) indications have expanded; meanwhile, valve systems have continuously evolved and improved. However, coronary occlusion (CO), a rare but catastrophic consequence of TAVR surgery, limits the expansion of indications for TAVR. Moreover, comparisons between different systems remain scarce. This study aimed to evaluate the incidence of CO associated with TAVR, specifically comparing self-expanding valves (SEVs) and balloon-expandable valves (BEVs), and further assess the safety profile of these valve subtypes.</p><p><strong>Methods: </strong>The primary outcome of interest was the incidence of CO during TAVR using BEVs or SEVs. Electronic databases were searched from January 2009 to June 2023, and this study included randomized controlled trials, observational studies, and propensity pair-matched studies. Heterogeneity and inter-study variance were assessed using Cochran's Q, I², and τ² (Sidik-Jonkman estimator). Random effects models were used based on the Bayesian theory framework. The node-splitting approach was generated to determine study network inconsistency. The convergence of the model was evaluated using the trajectory map, density map, and the potential scale reduction factor (PSRF). Rank sort graphs illustrate the best valve deployment techniques or valve types.</p><p><strong>Results: </strong>A total of 830 articles were searched referring to the incidence of CO using the valve deployment system of SEVs or BEVs during the TAVR procedure, from which 51 were included (27,784 patients). The procedure incidence of coronary obstruction was 0.4% for the SEVs and 0.6% for the BEVs. Treatment ranking based on network analysis revealed SAPIEN 3 (Edwards Lifesciences (Irvine, CA, USA)) possessed the best procedural CO incidence (0.05%) performance, whereas SAPIEN (Edwards Lifesciences (Irvine, CA, USA)) produced the worst (1.04%).</p><p><strong>Conclusions: </strong>Our study indicates that CO incidence was not reduced during TAVR with BEVs compared to SEVs. SAPIEN 3 and SAPIEN had the lowest and highest TAVR-associated CO rates, respectively. These findings suggest that the SAPIEN 3 valve may be the best choice for reducing CO risk, and future studies should focus on its applicability in different populations. More randomized controlled trials with head-to-head comparisons of SEVs and BEVs are needed to address this open question.</p><p><strong>The prospero registration: </strong>CRD42024528269, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528269.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"36208"},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800036","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}