Cardiovascular Revascularization Medicine最新文献

{"title":"Clinical outcomes of complete versus incomplete revascularization in NSTEMI with multivessel disease.","authors":"Ioannis Skalidis, Thierry Unterseeh, Philippe Garot, Francesca Sanguineti, Thomas Hovasse","doi":"10.1016/j.carrev.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.002","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609897","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":"Aortic root replacement with a mechanical valve conduit: A single-institutional experience.","authors":"Danial Ahmad, Sarah Yousef, Derek Serna-Gallegos, James A Brown, Johannes Bonatti, David Kaczorowski, Danny Chu, Floyd Thoma, Yisi Wang, Irsa Hasan, Takuya Ogami, Ibrahim Sultan","doi":"10.1016/j.carrev.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.001","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus regarding the best strategy for aortic root replacement with current guidelines supporting the use of mechanical valves in younger patients when a valve repair is not possible. We sought to describe our institutional experience with mechanical aortic root replacement.</p><p><strong>Methods: </strong>This was a descriptive study using an institutional database of aortic root replacements with a mechanical valve composite graft performed at our center from 2010 to 2022. All patients undergoing aortic root replacements with a mechanical valve were included. Patients undergoing concomitant operations were also included and descriptive statistics were reported.</p><p><strong>Results: </strong>A total of 217 patients underwent aortic root replacement with a mechanical valve of which women comprised 26.3 %. Bicuspid aortic valves were present in 30.41 % of patients. Aortic dissection and aneurysm were observed in 20.3 % and 35.5 % of patients, respectively, while moderate to severe aortic insufficiency was seen in 62.67 % of patients. Concomitant surgeries included coronary artery bypass graft surgery in 18 % and mitral valve replacement in 7.8 % of patients. Postoperatively, 18 % of patients required prolonged ventilation, while 3.7 % and 3.2 % had postoperative stroke or required dialysis, respectively. Reoperation for mediastinal bleeding was undertaken in 12.4 % of patients. Aortic reintervention over the period of the study was needed in eight patients (3.7 %). The operative/30-day mortality was 6.9 %. Mortality was 17.5 % at a median follow-up of 4 years (1.6-6.1).</p><p><strong>Conclusion: </strong>Mechanical aortic root replacement is a relatively safe procedure for aortic root pathology with institutional outcomes comparable to other centers.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601897","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":"Coronary artery disease burden in kidney transplant candidates: Risk factors, outcomes, and impact on transplant eligibility.","authors":"Roger R Godinho, José Jayme Galvão de Lima, Carlos M Campos, Luís Henrique Wolff Gowdak, Henrique B Ribeiro, Gabriel Paz S Mota, Luciano de Moura Santos, Neuza Lopes, Elias David-Neto, Luiz A Bortolotto, Roberto Kalil Filho, Stephen G Ellis, Alexandre Abizaid, Expedito Ribeiro","doi":"10.1016/j.carrev.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.028","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) independently predicts cardiovascular outcomes. However, the quantification of coronary artery disease (CAD) burden in patients undergoing renal replacement therapy (RRT), its risk factors, its relationship with transplant eligibility, and long-term prognosis still need to be fully established.</p><p><strong>Objectives: </strong>This study aimed to identify the risk factors associated with a high CAD burden and evaluate its impact on renal transplant eligibility and long-term outcomes in CKD patients undergoing RRT.</p><p><strong>Methods: </strong>This is a retrospective cohort study of CKD patients undergoing RRT and coronary angiography for kidney transplant stratification. CAD burden was evaluated using the SYNTAX Score (SS) and categorized into four groups: non-obstructive CAD, low, intermediate, and high CAD burden. The primary endpoint was Major Adverse Cardiac and Cerebrovascular Events (MACCE), which comprised all-cause mortality, myocardial infarction, stroke, and coronary revascularization.</p><p><strong>Results: </strong>Of the 1226 participants, 466 (38.0 %) had no CAD, 256 (20.9 %) had low, 257 (21.0 %) had intermediate, and 247 (20.1 %) had high CAD burden. Male sex (p < 0.001), diabetes (p < 0.01), peripheral artery disease (p < 0.001), and positive myocardial perfusion scintigraphy (p < 0.001) were the main predictors of high atherosclerotic burden. After 985 days, MACCE occurred in 26.6 % of the non-obstructive CAD group and 41.6 %, 43.9 %, and 59.7 % of the low, intermediate, and high CAD burden groups, respectively (p < 0.01). Age (p < 0.01), Left Ventricular Ejection Fraction (p < 0.01), and SS >7 (p < 0.01) were predictors of MACCE. Renal transplantation during follow-up reduced the incidence of MACCE (p < 0.01). However, the likelihood of transplantation decreased as CAD burden increased: 19.74 % in the non-obstructive CAD group and 16.80 %, 14.40 %, and 5.67 % in the low, intermediate, and high CAD groups, respectively (p < 0.01).</p><p><strong>Conclusions: </strong>Our results revealed a rising risk of major outcomes with increasing CAD burden. Kidney transplantation mitigated MACCE but was limited by CAD severity.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609898","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":"Cardiovascular Research Technologies 2025: Beyond the Guidelines: DAPT selection and duration before and after PCI.","authors":"Kalyan R Chitturi, Gregg W Stone, Roxana Mehran, Pieter C Smits, Douglas E Drachman, Dominick J Angiolillo, Grant W Reed, Usman Baber, C Michael Gibson, Ron Waksman","doi":"10.1016/j.carrev.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.035","url":null,"abstract":"<p><p>Dual antiplatelet therapy (DAPT) remains a cornerstone of secondary prevention in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). The balance between ischemic protection and bleeding risk has driven refinements in therapy duration. In 2025, the American College of Cardiology (ACC), American Heart Association (AHA), American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), and the Society of Cardiovascular Angiography and Interventions (SCAI) released joint guidelines on the management of patients with ACS, with a particular emphasis on DAPT duration. Considering these recently updated guidelines, the 2025 Cardiovascular Research Technologies (CRT) conference convened a session with leading interventional cardiology experts, entitled \"Beyond the Guidelines - DAPT Selection and Duration Before and After PCI\" to discuss implementation strategies for DAPT based on unique clinical scenarios and the new guideline recommendations. This article synthesizes the current guideline-directed recommendations and expert discussion to provide an evidence-based perspective on beyond the guidelines topics such as optimal DAPT duration, individualized de-escalation strategies, and evolving treatment paradigms for special populations.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620852","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":"Intravascular brachytherapy versus drug-coated balloons for in-stent restenosis: A two-center two-strategy comparison.","authors":"Gal Sella, Gera Gandelman, Alex Blatt, Jacob George, Haitham Abu Khadija, Omar Ayyad, Devin Olek, Bin S Teh, Yueh-Yun Lin, Anshuj Deva, Chloe Kharsa, Mangesh Kritya, Muhammad Faraz Anwaar, Joseph Elias, Elia El Hajj, Albert E Raizner, Andrew Farach, Neal S Kleiman, Alpesh Shah","doi":"10.1016/j.carrev.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.030","url":null,"abstract":"<p><strong>Background: </strong>In-stent restenosis remains a persistent challenge in interventional cardiology. While both intravascular brachytherapy (IVB) and drug-coated balloons (DCB) have been used to treat this condition, their comparative effectiveness has never been evaluated.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of IVB versus DCB for the treatment of in-stent restenosis.</p><p><strong>Methods: </strong>This dual-center study compared 2-year outcomes between patients treated with IVB and DCB. Propensity score matching was performed for age, sex, vessel size, and ejection fraction. Primary outcomes included all-cause mortality and target lesion revascularization (TLR).</p><p><strong>Results: </strong>DCB treatment was associated with shorter procedure times median 52 IQR[40.0,68.0] vs 72 IQR[60.0,92.0] min, p < 0.01) and reduced contrast use (median 121 IQR[76.50,155.0] vs 140 IQR[100.0,200.0] mL, p = 0.03). In the propensity-matched cohort, MACE rates were similar (43.3 % vs 47.7 %, p = 0.55). DCB treatment demonstrated significantly lower TLR rates compared to IVB (4.4 % vs 18.9 %, p < 0.01) and reduced target vessel myocardial infarctions (3.3 % vs 13.3 %, p = 0.02). All-cause mortality (14.4 % vs 7.8 %, p = 0.15) and cardiac death rates (6.7 % vs 4.4 %, p = 0.52) were similar between groups.</p><p><strong>Conclusions: </strong>In this first-ever comparison with 2-year follow-up, DCB was associated with similar MACE rates compared to IVB but demonstrated lower TLR rates. All-cause mortality and cardiac death rates were comparable. These findings may suggest that DCB offers superior efficacy for ISR treatment, though careful patient selection remains important when considering treatment modalities.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609899","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 SAPIEN M3 system for transcatheter mitral valve replacement: A new era begins.","authors":"Michail Penteris, Konstantinos Lampropoulos","doi":"10.1016/j.carrev.2025.06.034","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.034","url":null,"abstract":"<p><p>Mitral regurgitation (MR) remains a prevalent and undertreated valvular heart disease, particularly in patients at prohibitive surgical risk. While mitral transcatheter edge-to-edge repair (M-TEER) offers a less invasive alternative, anatomical limitations and incomplete MR reduction in some patients have fueled the development of transcatheter mitral valve replacement (TMVR) technologies. The SAPIEN M3 system (Edwards Lifesciences, Irvine, CA, USA) introduces a novel, fully percutaneous TMVR approach utilizing a two-component system: a self-expanding nitinol dock that encircles the subvalvular apparatus and a balloon-expandable SAPIEN 3 valve adapted for the mitral position. This design minimizes the risk of left ventricular outflow tract (LVOT) obstruction and enables stable, anatomy-independent anchoring without requiring annular calcification. Early feasibility studies have shown high technical success rates (>85 %), effective MR reduction, and a favorable safety profile in high-risk patients. The ongoing ENCIRCLE trial and a planned European post-market study aim to further evaluate the system's safety, durability, and long-term outcomes. Despite promising early results, challenges remain, including procedural complexity, the potential for LVOT obstruction, and limited long-term durability data.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561521","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":"Editorial: Beyond the valve: Racial disparities and structural burdens in infective endocarditis.","authors":"Vitor Emer Egypto Rosa, Carlos M Campos","doi":"10.1016/j.carrev.2025.06.033","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.033","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592673","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":"Transcatheter treatment of tricuspid regurgitation: a state of art review.","authors":"Claudio Sanfilippo, Marco Frazzetto, Michela Bonanni, Andrea Matteucci, Laura Anna Leo, Ridha Umar, Giuseppe Imperatore, Paulo de Coelho Castro, Guilherme Attizzani, Giuseppe Massimo Sangiorgi, Carmelo Grasso, Corrado Tamburino","doi":"10.1016/j.carrev.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.029","url":null,"abstract":"<p><p>Recent advancements in transcatheter techniques for the treatment of severe tricuspid regurgitation (TR) have introduced minimally invasive therapies with significantly lower risk profiles compared to traditional surgical approaches. Despite this progress, the latest European guidelines still recommend surgery as the \"gold standard\" for severe primary and secondary TR, particularly during left heart surgery or in cases with right ventricular dilation. However, surgical interventions are associated with high mortality and morbidity rates, making them less desirable for high-risk patients. As a result, transcatheter tricuspid valve interventions (TTVI) have emerged as promising alternatives, reshaping treatment paradigms. Among these, the tricuspid edge-to-edge repair (T-TEER) technique, using devices like the TriClip and PASCAL, has demonstrated significant clinical benefits, including improved valve function, symptom relief, and quality of life. While the TRI-SCORE and TRIVALVE risk scores help guide patient selection, further research is needed to refine outcomes across diverse clinical settings. Additionally, newer technologies like transcatheter valve replacement (TTVR) offer viable solutions for patients with complex anatomies. TTVR, exemplified by the EVOQUE valve, has shown promise in reducing TR and improving functional status, though it carries risks such as bleeding and pacemaker implantation. Moreover, heterotopic valve implantation, such as the TricValve, provides a less invasive option for symptom management, although it does not address the underlying valve pathology. Overall, the expanding range of transcatheter treatments is providing safer, effective alternatives for high-risk patients, with ongoing research critical to optimizing outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568001","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 use of the Medina coronary bifurcation classification has led to inaccuracy by mixing non-true with true bifurcation lesions thus making reported outcome data meaningless. The use of the Movahed classification that categorizes all true bifurcation lesions in one simple category B2 lesions could have prevented this flaw.","authors":"Mohammad Reza Movahed","doi":"10.1016/j.carrev.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.031","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601898","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":"Outcomes of intravascular brachytherapy for in-stent restenosis in small versus large coronary vessels.","authors":"Gal Sella, Chloe Kharsa, Mangesh Kritya, Devin Olek, Bin S Teh, Muhammad Faraz Anwaar, Joseph Elias, Elia El Hajj, Albert E Raizner, Andrew Farach, Neal S Kleiman, Alpesh Shah","doi":"10.1016/j.carrev.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.022","url":null,"abstract":"<p><strong>Background: </strong>In-stent restenosis (ISR) remains a significant challenge in coronary intervention. Vessel size is recognized as an important predictor of outcomes following percutaneous coronary interventions, with smaller vessels traditionally associated with higher rates of restenosis. This study evaluates the clinical outcomes of vascular brachytherapy for ISR stratified by vessel size.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 224 patients who underwent vascular brachytherapy for coronary ISR between June 2016 and January 2024 at the Houston Methodist Hospital. Patients were stratified based on vessel size: small vessel (≤3 mm, n = 70) or large vessel (>3 mm, n = 154). The primary endpoint was major adverse cardiovascular events (MACE) at one year. Secondary endpoints included target lesion revascularization (TLR), stent thrombosis, bleeding complications, and mortality.</p><p><strong>Results: </strong>Patients with small vessel disease were younger (62.8 ± 10.2 vs. 66.6 ± 10.7 years, p = 0.01). Procedural characteristics revealed similar fluoroscopy radiation doses (DAP), although a trend toward lower radiation dose area products in the small vessel group was observed (18,836 ± 17,655 vs. 24,908 ± 24,811 mGy/cm², p = 0.07). Small vessels were more frequently prepared with semi-compliant balloons (17.1 % vs. 3.2 %, p = 0.0009), while cutting balloons were more commonly used in large vessels (22.9 % vs. 35.1 %, p = 0.04). At one-year follow-up, MACE rates for patients with small vessels were 27.1 % vs. 32.5 %, (p = 0.44); Similarly, TLR rates were 18.6 % vs. 23.4 % (p = 0.49). Notably, a small number of thromboses and bleeding complications were observed exclusively in the large vessel group.</p><p><strong>Conclusions: </strong>Despite traditional concerns regarding higher restenosis rates in small vessels, our analysis demonstrates comparable outcomes following vascular brachytherapy for in-stent restenosis regardless of vessel size. These findings suggest that vascular brachytherapy may help mitigate the historically poor outcomes associated with small vessel interventions, potentially by effectively suppressing neointimal hyperplasia across different vessel diameters with our precise and effective radiation dosing protocol.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530363","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}