Cardiovascular Revascularization Medicine最新文献

{"title":"TAVR vs. SAVR for severe aortic stenosis in the low and intermediate surgical risk population: An updated meta-analysis, meta-regression, and trial sequential analysis.","authors":"Mrinal Murali Krishna, Meghna Joseph, Chidubem Ezenna, Vinicius Pereira, Raiza Rossi, Zafer Akman, Muni Rubens, Vaikom S Mahadevan, Michael G Nanna, Andrew M Goldsweig","doi":"10.1016/j.carrev.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.021","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of age > 65 years. The relative risks and benefits of TAVR vs. SAVR in low and intermediate surgical risk remain incompletely described.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, and Cochrane Central databases identified randomized controlled trials (RCTs) comparing clinical outcomes of TAVR vs. SAVR in low and intermediate surgical risk.</p><p><strong>Results: </strong>Ten RCTs (9239 patients, TAVR 50.8 %) were included. TAVR was associated with lower rates of all-cause death or stroke at 30-day (rate ratio [RR] 0.70; 95%CI 0.55-0.89; p = 0.003; I² = 26 %) and 1-year (RR 0.77; 95%CI 0.60-0.98; p = 0.033; I² = 54 %) follow-up. Bleeding complications, new-onset atrial fibrillation (AF), acute kidney injury (AKI), and severe patient-prosthesis mismatch (PPM) were lower with TAVR at 30 days and 1-year. Permanent pacemaker implantation, aortic valve reintervention, major vascular complications, and paravalvular leak (PVL) were significantly higher with TAVR at 30-day and 1-year follow-ups. Rates of all-cause death, stroke, MI, endocarditis, and rehospitalization were comparable between the groups at 30-day and 1-year follow-up.</p><p><strong>Conclusion: </strong>In patients with severe AS and low to intermediate surgical risk, TAVR is associated with reduced rates of all-cause death or stroke, bleeding, new-onset AF, AKI, and severe PPM compared to SAVR. However, despite these short-term benefits, higher rates of permanent pacemaker implantation, PVL, and reintervention raise significant concerns about the long-term safety of TAVR, particularly for younger, lower-risk patients.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162912","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":"Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry.","authors":"Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, Ozgur S Ser, Jaskanwal Deep Singh Sara, Oleg Krestyaninov, Dimitri Khelimskii, Barkin Kultursay, Ali Karagoz, Ufuk Yildirim, Korhan Soylu, Mahmut Uluganyan, Olga Mastrodemos, Bavana V Rangan, Sandeep Jalli, Konstantinos Voudris, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis","doi":"10.1016/j.carrev.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.018","url":null,"abstract":"<p><strong>Background: </strong>Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).</p><p><strong>Objectives: </strong>We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.</p><p><strong>Methods: </strong>We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.</p><p><strong>Results: </strong>Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.</p><p><strong>Conclusions: </strong>Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182261","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 chronic total occlusion percutaneous coronary intervention in acute coronary syndromes: Early versus late complete revascularization and clinical outcomes.","authors":"Luca Paolucci, Alejandro Diego-Nieto, Alfonso Jurado-Román, Ignacio Amat-Santos, Rocco Stio, Laura Novelli, Jorge Sanz-Sánchez, Ana Laffond, Mattia Basile, Mateo Giordano, Francesco De Felice, Adrián Jerónimo, Giulia Nardi, Javier Martín-Moreiras, Gabriele Gasparini, Nieves Gonzalo, Javier Escaned, Pablo Salinas","doi":"10.1016/j.carrev.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.019","url":null,"abstract":"<p><strong>Background: </strong>European guidelines recommend early complete revascularization in patients with multivessel disease presenting with acute coronary syndrome (ACS). However, it remains unclear whether this strategy should also apply to patients with non-culprit chronic total occlusions (CTO).</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter analysis of patients with ACS who underwent successful percutaneous coronary intervention (PCI) of the culprit lesion and later underwent CTO-PCI of a non-culprit lesion as part of a complete revascularization strategy. Patients were divided into two groups: \"early CTO-PCI\" (≤45 days) and \"late CTO-PCI\" (> 45 days to ≤ 6 months). The primary endpoint was a composite of all-cause death, myocardial infarction, any revascularization, and cardiac re-hospitalization.</p><p><strong>Results: </strong>Overall, 215 patients were included (119 early CTO-PCI, 96 late CTO-PCI). Patients in the late CTO-PCI group had more complex procedural features, reduced ventricular function, and a higher prevalence of demonstrable myocardial viability. The incidence of the primary outcome was comparable between the two groups at three years of follow-up (HR 0.94, 95 % CI 0.52-1.62). The same results were evident for its individual components, in sensitivity analysis at one year of follow-up, and after adjusting for major confounders.</p><p><strong>Conclusions: </strong>Among ACS patients who underwent successful revascularization of non-culprit CTO lesions as part of complete revascularization, an early CTO-PCI strategy within 45 days does not confer additional clinical benefit compared to delayed intervention.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188285","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":"Refining the prognostic role of red cell distribution width in TAVR patients.","authors":"Artur Dziewierz","doi":"10.1016/j.carrev.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.020","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128864","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":"Anxiety during transcatheter aortic valve replacement under local anesthesia - the ART-VR trial.","authors":"Sraman Chatterjee, Joris Ooms, Marjo de Ronde, Stefan van Gorsel, Antonio Maarten Mattace-Raso, Jeannette Goudzwaard, Francesco Mattace-Raso, Isabella Kardys, Rutger-Jan Nuis, Joost Daemen, Nicolas Van Mieghem","doi":"10.1016/j.carrev.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.015","url":null,"abstract":"<p><strong>Background: </strong>The use of local anesthesia during transcatheter aortic valve replacement (TAVR) could result in patient discomfort. Application of immersive virtual reality (VR) during TAVR might distract the patient and enhance the overall experience.</p><p><strong>Objective: </strong>To evaluate the effect of an immersive VR environment on periprocedural anxiety and patient discomfort, compared to standard of care in patients undergoing transfemoral (TF) TAVR under local anesthesia.</p><p><strong>Methods: </strong>In this single-center, randomized controlled pilot study, patients were randomized to either VR immersion during TAVR or standard of care. The intervention was a VR headset to create 3D experiences during percutaneous transfemoral TAVR. The main outcome was patient-reported procedural anxiety assessed directly after the procedure on a visual analog scale (VAS). Secondary outcomes were procedural satisfaction, pain, and change in anxiety. Personality scores were obtained at baseline to explore associations between personality types and relevant outcomes.</p><p><strong>Results: </strong>A total of 75 patients (VR = 37, control = 38) were included between September 2021 and January 2023. The median age was 79 (25th-75th: 75-84) years and 32 patients (43 %) were female. Overall procedural anxiety VAS was 1.0 (0.0-3.0) and satisfaction was 9.0 (8.0-10.0). There was no difference in procedural anxiety between VR and control (VAS: 1.0 [25th-75th: 0.0-3.0] versus 1.0 [25th-75th: 0.0-3.0], p = 0.59). Procedural satisfaction, pain perception and change in anxiety were not affected by VR use.</p><p><strong>Conclusion: </strong>Patients undergoing TF-TAVR under local anesthesia experienced mild procedural anxiety and high satisfaction levels. Procedural VR use did not affect procedural anxiety or pain perception.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112287","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: Keeping them honest MAUDE! But can we do better?","authors":"Georges Ephrem","doi":"10.1016/j.carrev.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.017","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095493","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":"Renal denervation for resistant hypertension: A review of current literature.","authors":"Aparna Iyer, Shim Roh, Haris Muhammad, Amer Hammad, Vicky Kumar, Dipal Patel, Jason Sayanlar","doi":"10.1016/j.carrev.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.014","url":null,"abstract":"<p><p>Resistant hypertension is defined by persistently elevated blood pressure (BP) despite being treated with three or more antihypertensive medications including a diuretic, leading to an increased risk of cardiovascular events and mortality. It presents a substantial global health challenge, impacting about 10 % of individuals with hypertension. Renal denervation (RDN) has come up as a promising interventional strategy to address this condition by modulating the renal sympathetic nervous system. This review article explores the mechanisms underlying RDN, its historical evolution, recent procedural advancements, clinical evidence supporting its efficacy, and the existing guidelines guiding its application. Recent advances in RDN research and potential future implications are also discussed, highlighting its role in achieving improved BP control and reducing cardiovascular risks in patients with resistant hypertension.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227255","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":"Prognostic impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement.","authors":"Max B Sayers, Krishnaraj Rathod, Mohammed Akhtar, Asha Pavithran, Michael Michail, Vincenzo Tufaro, Sumanto Mukhopadhyay, Thomas A Treibel, Simon Kennon, Mick Ozkor, Andreas Baumbach, Daniel Jones, Anthony Mathur, Michael J Mullen, Kush P Patel","doi":"10.1016/j.carrev.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.010","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains unclear. We assessed the impact of CAD on TAVR procedural safety and long-term adverse outcomes by stratifying patients according to CAD burden.</p><p><strong>Methods: </strong>This single-centre, retrospective study stratified patients into low-, intermediate- and high-burden according to angiographic severity and location. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) death, myocardial infarction (MI), hospitalization for heart failure (HHF) and major adverse coronary events (MACE).</p><p><strong>Results: </strong>Of 1803 consecutive patients, low-, intermediate- and high-coronary burden was identified in 1281 (71 %), 382 (21 %) and 140 (8 %) patients, respectively. There were no differences in procedural outcomes or in-hospital mortality between groups. At a median follow-up of 4.8 (3.7-6.1) years, the incidence of all-cause mortality was 49 % vs 54 % vs 62 %, respectively. After adjusting for age and comorbidities, high-burden CAD was associated with all-cause mortality (HR: 1.35, 95 % CI 1.07-1.70, P = 0.011), CV-mortality (HR: 1.54, 95 % CI 1.07-2.17, P = 0.02) and MACE (adjusted HR 1.63, 95 % CI 1.23-2.15, P = 0.001), but not HHF (HR: 1.43, 95 % CI: 0.96-2.13, P = 0.082). Both intermediate- (HR 2.87, CI 1.83-4.50, P < 0.001) and high-burden groups (HR 2.69, 95 % CI 1.38-5.25, P = 0.004) were associated with MI.</p><p><strong>Conclusions: </strong>Increasing CAD burden does not impact TAVR procedural safety and therefore revascularization should not be a pre-requisite before TAVR. High CAD burden is associated with long-term adverse events. This group would benefit from future studies addressing CAD management in TAVR patients.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095496","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: Drug-coated balloons for small vessel disease: Navigating between randomized clinical trials evidence and real-world data.","authors":"Marco Frazzetto, Nicholas Pennza, Bernardo Cortese","doi":"10.1016/j.carrev.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.012","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112289","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":"Periprocedural myocardial injury after recanalization of chronically occluded right coronary arteries, relation to side-branch occlusion and procedural technique.","authors":"Kenji Yaginuma, Thanu Subramoniam, Gerald S Werner","doi":"10.1016/j.carrev.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.011","url":null,"abstract":"<p><strong>Background: </strong>Recanalization of chronic total coronary occlusions (CTO) is associated with a high incidence of periprocedural myocardial ischemia (PMI).</p><p><strong>Aims: </strong>This study should assess its causes with special focus on the relation to side branch occlusions (SBO) of the right coronary artery (RCA) with its specific anatomy of side branches.</p><p><strong>Methods: </strong>1574 recanalizations of a RCA CTO were analyzed with high-sensitive troponin T (hsTnT) drawn before and after the procedure. All angiograms were checked for SBO after the procedure. PMI was defined as hsTnT increase >5× upper limit of normal. Additional thresholds were > 18× (PMI₁₈) and > 35× (PMI₃₅).</p><p><strong>Results: </strong>PMI occurred in 51.6 %, PMI₁₈ in 19.9 %, and PMI₃₅ in 8.9 %. Excluding procedures with major complications (3.1 %), the major determinants of PMI were chronic kidney disease, a long fluoroscopy time, and single and multiple SBO. Overall side branch occlusions occurred in 26.8 % even without PMI, and with increasing rate with higher PMI thresholds up to 56.4 % with PMI₃₅. Proximal SBO caused the highest hsTnT increase, followed by mid and distal location. The highest incidence occurred with retrograde approach (50.8 %) and antegrade dissection re-entry (71.4 %). The combination of PMI and SBO would lead to the diagnosis of type IVa myocardial infarction in 23.4 %, with PMI₁₈ in 10.2 %, and with PMI₃₅ in 4.7 %.</p><p><strong>Conclusions: </strong>SBO occur frequently after CTO PCI of the RCA and are a major determinant of PMI. Even without clinical complications the combination of various thresholds of PMI and SBO would yield a high incidence of type IVa myocardial infarction.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095495","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}