Cardiovascular Revascularization Medicine最新文献

{"title":"Expanding the differential for a bounding popliteal artery pulsation on physical exam.","authors":"Robert S Dieter, Robert S Dieter, Elizabeth G Dieter","doi":"10.1016/j.carrev.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.025","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The AltaValve system for transcatheter mitral valve replacement: A narrative review of early safety and efficacy data.","authors":"Michail Penteris","doi":"10.1016/j.carrev.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.008","url":null,"abstract":"<p><p>Mitral regurgitation (MR) is a prevalent and progressive condition associated with poor outcomes in high-risk patients who are often ineligible for surgery or transcatheter repair. The AltaValve system (4C Medical Technologies, Maple Grove, MN), a novel transcatheter mitral valve replacement (TMVR) device, employs a unique supra-annular, atrial-only fixation mechanism designed to minimize left ventricular outflow tract (LVOT) obstruction and paravalvular leak. This narrative review summarizes current clinical evidence on AltaValve, including case reports, single-center, and multicenter experiences, as well as findings from the recent AltaValve Early Feasibility Study. Across diverse patient populations, such as those with functional, primary, and atrial MR, the device has demonstrated high technical success, favorable safety, and significant reduction in MR severity. Transseptal delivery has emerged as a less invasive and safer approach compared to transapical access, further expanding the device's applicability. Short-term follow-up reveals consistent improvement in hemodynamics, functional capacity, and quality of life measures, with low procedural complication rates. No cases of valve embolization, significant thrombosis, or structural degeneration have been reported yet. While early outcomes are promising, the data are limited to small, non-randomized cohorts, and long-term durability remains to be established. The AltaValve system represents a significant step forward in TMVR, particularly for patients with anatomically complex or inoperable MR. Ongoing pivotal trials will be essential to confirm its role within the transcatheter valve therapy landscape.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of transcatheter edge-to-edge repair vs surgery for secondary mitral regurgitation.","authors":"Sahib Singh, Muhammad Asim Shabbir, Nidhish Tiwari, Kevin Bliden, Udaya S Tantry, Paul A Gurbel, Mohammed Y Kanjwal, Scott W Lundgren","doi":"10.1016/j.carrev.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.012","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair (TEER) in patients with secondary mitral regurgitation (MR) has shown variable outcomes in clinical studies when compared with mitral valve surgery. We conducted a meta-analysis to reconcile the data.</p><p><strong>Methods: </strong>Online databases were searched for studies assessing TEER vs surgery for secondary MR. The outcomes of interest were length of hospital stay, all deaths, heart failure (HF) rehospitalization, mitral valve reintervention, implantation of left ventricular assist device (LVAD), stroke and recurrence of grade 3 or 4 MR. Pooled odds ratios (OR) and standardized mean difference (SMD), with 95 % confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>Eight studies (1 randomized and 7 observational) with a total of 1436 patients (TEER n = 826, surgery n = 610) were included. Length of hospital stay was shorter in the TEER group (SMD -2.50, 95 % CI -4.65 to -0.35, p = 0.02). No significant differences were found between the two groups with respect to all deaths (p = 0.80), HF rehospitalization, mitral valve reintervention, implantation of LVAD and stroke. Recurrence of grade 3 or 4 MR was higher in the TEER group (OR 5.33, 95 % CI 2.57 to 11.03, p < 0.00001).</p><p><strong>Conclusions: </strong>In patients with secondary MR, TEER and surgery have comparable outcomes such as mortality, except for the lower recurrence of grade 3 or 4 MR in the surgical group. Thus, TEER may be the first approach in such patients, except in low surgical risk cases who need other concomitant cardiac surgeries.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early readmissions after percutaneous mechanical circulatory support-assisted percutaneous coronary intervention: Insights from the nationwide readmissions database.","authors":"Sean DeAngelo, Badri Aryal, Gianfranco Bittar-Carlini, Rohan Gajjar, Jeremiah Bello, Sharan Malkani, Ufuk Vardar, Abhimanyu Saini","doi":"10.1016/j.carrev.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The use of percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) has seen an increase in use over the past five years. It remains unclear how the increased prevalence has affected the rate of readmissions and what clinical predictors may play a role in a patient's readmission. We aimed to assess the cardiovascular causes, mortality rate, and clinical predictors of patients readmitted after experiencing pMCS-assisted PCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent pMCS (intra-aortic balloon pump, Impella, or percutaneous left ventricular assist device) and PCI between January 2016 and November 2020 were selected from the nationwide readmission database. The frequency and underlying causes of cardiovascular-related 30-day readmissions were assessed, as delineated by the International Classification of Diseases, Tenth Revision (ICD-10) codes. Additionally, readmission mortality rates, mean hospital stay length, cumulative hospital charges, and independent factors predictive of 30-day all-cause readmissions were analyzed. A secondary analysis of mortality and readmission rate in patients with cardiogenic shock who underwent pMCS were compared to those with pMCS-assisted PCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 77,099 patients discharged alive after receiving pMCS-assisted PCI, 12,072 (15.6%) had a readmission within 30 days. Among the readmissions, the all-cause mortality was 876 (7.26%). The most common cardiovascular causes for readmission were hypertensive heart disease with heart failure (8.6%), hypertensive heart and chronic kidney disease stage 1-4 (8.3%), and non-ST elevation myocardial infarction (4.1 %). Readmitted patients exhibited a shorter mean length of stay in contrast to their index admission (5.9 vs 9.9 days, p &lt; 0.0001). Patients who were readmitted incurred total hospital charges of $1.01 billion US. Factors independently associated with 30-day readmissions were female sex, leaving against medical advice, renal insufficiency, congestive heart failure, prior valve replacement, and length of stay &gt; 10 days. Index mortality was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (32.6% vs 26.4%; CI: 5.8-6.6, p &lt; 0.001). Readmission rate was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (16.4% vs 15.7 %; CI: 0.4-1.1, p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study revealed that 15.6% of patients discharged after receiving pMCS-assisted PCI were readmitted within 30 days, with an all-cause mortality rate of 7.26% among these readmissions. The most common causes of readmission were related to hypertensive heart disease and NSTEMI. These findings underscore the need for targeted interventions to reduce readmissions and associated healthcare costs, as well as the importance of identifying high-risk patients for more intensive foll","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fall in love with the problem, not the solution.","authors":"Spencer B King","doi":"10.1016/j.carrev.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.001","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of clopidogrel vs aspirin monotherapy in post- pci patients: An updated systematic review and meta-analysis.","authors":"Shariq Ahmad Wani, Muhammad Abdullah Naveed, Bazil Azeem, Saad Ashraf, Ahila Ali, Talha Ali, Faiza Fatima, Momin Shah, M D Sivaram Neppala, Raheel Ahmed","doi":"10.1016/j.carrev.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.006","url":null,"abstract":"<p><p>Current guidelines recommend 6-12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention(PCI) followed by aspirinin monotherapy indefinitely. We aimed to assess efficacy and safety of Clopidogrel as compared to aspirin in patients undrgoing PCI after completing DAPT. We systematically searched 3 electronic databases and identified studies comparing clopidogrel to aspirin in post PCI population after completing DAPT. We included 7 studies with 20,360 patients. We pooled outcomes for major adverse cardiac events (MACE), typically comprising a composite of death, myocardial infarction (MI), or stroke; all-cause mortality; cardiac death; major bleeding; any stroke; ischemic stroke; hemorrhagic stroke; repeat revascularization; target-vessel revascularization (TVR); and definite stent thrombosis. Mean follow up was 12-36 months. Duration of DAPT was 1-18 months. Clopidogrel was associated with reductions in MACE than aspirin (RR: 0.82; 95 % CI: 0.69-0.98; p = 0.03), showed reduced risk of MI (RR 0.93 CI 0.60-1.44; p 0.74, I² 63%) indicating a relative reduction of 7 %, reduced strokes numerically but non-significantly (RR: 0.72; 95 % CI: 0.48-1.07; p = 0.11), RRR 28 %, all cause mortality did not exhibit a significant difference between clopidogrel and aspirin (RR: 0.99; 95 % CI: 0.67-1.44; p = 0.94). Cardiac death (RR: 0.81; 95 % CI: 0.56-1.17; p = 0.26), major bleeding (RR: 0.90; 95 % CI: 0.61-1.33; p = 0.61), reflecting a 10 % non-significant relative reduction, repeat revascularization showed no significant difference (RR: 0.95; 95 % CI: 0.74-1.23; p = 0.72) representing a slight 5 % relative reduction, target vessel revascularization did not reveal any significant differences (RR: 0.89; 95 % CI: 0.69-1.16; p = 0.40) corresponding to a non-significant relative risk reduction of 11 %, stent thrombosis demonstrated no statistically significant difference (RR: 0.78; 95 % CI: 0.27-2.31; p = 0.66) RRR of 22 %. Compared to aspirin Clopidogrel was associated with reduction in MACE with no significant differences in Mortality, Major bleeding, MI, and repeat revascularization between groups. PROSPERO REGISTRATION NUMBER: CRD420251042349.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual reality use in TAVR: impact on procedural anxiety and patient comfort.","authors":"Ioannis Skalidis, Stéphane Champagne, Thomas Hovasse, Neila Sayah, Mariama Akodad","doi":"10.1016/j.carrev.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.005","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of CTO revascularization post-ACS: the role of lesion complexity and viability-guided selection.","authors":"Ioannis Skalidis, Andrei Georgian Florescu, Luca Esposito, Serigne Cheikh Tidiane Ndao, Mariama Akodad, Thomas Hovasse","doi":"10.1016/j.carrev.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.007","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic utility of fractional flow reserve for in-stent restenosis.","authors":"Malek Al-Hawwas, Srikanth Vallurupalli, Sandeep Randhawa, Abdul Hakeem, Shiv Agarwal, Kristen Miller, Barry F Uretsky","doi":"10.1016/j.carrev.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.004","url":null,"abstract":"<p><strong>Introduction: </strong>Functionally optimizing percutaneous coronary intervention (PCI) with post-PCI fractional flow reserve (FFR) measurement has been associated with improved outcomes in native vessels. However, its role in in-stent restenosis (ISR) PCI is not well understood.</p><p><strong>Methods: </strong>Consecutive patients undergoing PCI for stable angina or stabilized acute coronary syndrome enrolled in a PCI registry were included. FFR was measured pre- and post-PCI with the goal of further optimization of the PCI result based on post-PCI FFR. Target vessel revascularization (TVR) was evaluated in those with optimized FFR (≥0.86) in the ISR and native vessel lesions.</p><p><strong>Results: </strong>There were 675 lesions in 574 patients who underwent pre- and post-PCI FFR with 101 lesions with ISR. ISR group was more likely to present with acute coronary syndrome and to have hypertension and chronic kidney disease. Both groups had long to diffuse disease. Median pre-PCI stenosis (70 %, IQR 60-80 %) and pre-PCI FFR (0.69 vs 0.70) were similar in native and ISR groups. There was similar and modest correlation between angiographic severity and pre-PCI FFR in native and ISR lesions (-0.57[-0.62 to -0.51] and -0.54 [-0.67 to -0.38], both p < 0.0001). Similar proportions of stenosis were functionally optimized to a post-PCI FFR ≥0.86 (66 % vs 71 %, p = 0.7). Despite functional optimization, TVR was significantly higher in ISR compared to native lesions [HR 0.71, 95 % CI 0.08-0.38 Log rank P < 0.001] even when ISR was treated with a drug-eluting stent.</p><p><strong>Conclusion: </strong>Despite functional optimization by post-PCI FFR, TVR is significantly higher after ISR PCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural characteristics and outcomes of patients undergoing Impella-assisted high-risk percutaneous coronary interventions in the IMPELLA-PL registry.","authors":"Aleksandra Gąsecka, Arkadiusz Pietrasik, Tomasz Pawłowski, Jerzy Sacha, Marek Grygier, Gabriel Bielawski, Wojciech Balak, Adam Sukiennik, Paulina Burzyńska, Adam Witkowski, Mateusz Warniełło, Stanisław Bartuś, Łukasz Rzeszutko, Artur Pawlik, Mateusz Kaczyński, Robert Gil, Wiktor Kuliczkowski, Krzysztof Reczuch, Marcin Protasiewicz, Paweł Kleczyński, Piotr Wańczura, Sebastian Gurba, Michał Łomiak, Martyna Świerkowska, Kacper Karaban, Włodzimierz Skorupski, Maciej Zarębiński, Piotr Pawluczuk, Szymon Włodarczak, Adrian Włodarczak, Krzysztof Ściborski, Artur Telichowski, Mieszko Pluciński, Jarosław Hiczkiewicz, Karolina Konsek, Michał Hawranek, Mariusz Gąsior, Jan Peruga, Marcin Fiutowski, Robert Romanek, Piotr Kasprzyk, Dariusz Ciećwierz, Andrzej Ochała, Wojciech Wojakowski, Jacek Legutko, Janusz Kochman","doi":"10.1016/j.carrev.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.</p><p><strong>Methods: </strong>Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).</p><p><strong>Results: </strong>The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38-8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06-7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02-0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08-0.89).</p><p><strong>Conclusions: </strong>Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}