Cardiovascular Revascularization Medicine最新文献

{"title":"Baseline TRI-SCORE for risk stratification before tricuspid transcatheter edge-to-edge repair: A systematic review and meta-analysis.","authors":"Anan Abu Rmilah, Thekrayat Asad, Ameer Awashra, Alaa Hmeedan, Lana Khatib, Abdalhakim Shubietah, Hossam Alzu'bi, Raad Al-Muhaisen, Ali Alzeghoul, Alexandra Lackey, Jose Arias","doi":"10.1016/j.carrev.2026.06.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.010","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair (TEER) has expanded treatment options for severe tricuspid regurgitation (TR), but outcomes remain heterogeneous and patient selection remains challenging. TRI-SCORE, a disease-specific score developed for isolated tricuspid valve surgery, may help identify high-risk patients before tricuspid TEER. We performed a systematic review and meta-analysis evaluating the association between baseline TRI-SCORE and outcomes after tricuspid TEER.</p><p><strong>Methods: </strong>MEDLINE and Embase were searched from inception through January 2026. Eligible studies included adults undergoing tricuspid TEER and reported outcomes according to baseline TRI-SCORE category, most commonly ≥6 versus <6. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Five observational studies including 2074 patients were included. Higher TRI-SCORE was associated with greater all-cause mortality at in-hospital/30-day (RR, 3.17; 95% CI, 1.71-5.89), 3-month (RR, 4.03; 95% CI, 2.62-6.17), 6-month (RR, 2.97; 95% CI, 2.05-4.32), and 1-year follow-up (RR, 2.62; 95% CI, 1.88-3.66). Higher TRI-SCORE was also associated with lower likelihood of residual TR grade ≤2 in-hospital (RR, 0.88; 95% CI, 0.81-0.97), at 30 days (RR, 0.86; 95% CI, 0.76-0.97), and at 3 months (RR, 0.75; 95% CI, 0.58-0.98). The composite of death and/or heart failure rehospitalization was more frequent in high-risk patients.</p><p><strong>Conclusions: </strong>In patients undergoing tricuspid TEER, high baseline TRI-SCORE identifies advanced clinical risk associated with excess mortality, less frequent TR reduction, and more adverse events. TRI-SCORE may support interventional heart-team evaluation but should complement anatomy, right ventricular function, frailty, and hemodynamic assessment.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333570","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":"Is the diagnostic performance of FFRangio affected by coronary microvascular dysfunction?","authors":"Takuya Makita, Hiroyuki Omori, Yusuke Miyazaki, Makoto Iwama, Kentaro Morishita, Yukio Umeda, Toshiyuki Noda","doi":"10.1016/j.carrev.2026.06.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.008","url":null,"abstract":"<p><strong>Background: </strong>FFRangio, which derives FFR from coronary angiography, has been reported to exhibit high diagnostic concordance with invasive FFR, rendering it an appealing diagnostic tool. However, its diagnostic performance in the presence of coronary microvascular dysfunction (CMD) remains unexamined. Consequently, we conducted a study to assess the diagnostic performance of FFRangio in patients with CMD.</p><p><strong>Methods: </strong>The study included 111 vessels (94 patients) in which FFRangio, invasive FFR, and the index of microcirculatory resistance (IMR) were measured. CMD status was categorized into two groups: low IMR (IMR < 25) and high IMR (IMR ≥ 25). The impact of CMD on the diagnostic performance of FFRangio was assessed with invasive FFR as the reference standard.</p><p><strong>Results: </strong>The diagnostic performance (area under the curve: AUC) of FFRangio was high in the overall cohort (AUC: 0.92 [95% CI: 0.87 to 0.98]). However, when assessed according to microcirculatory status, the AUC of FFRangio was significantly lower in the high-IMR group compared to the low-IMR group (low-IMR group 0.98 [95% CI: 0.94 to 1.00] vs. high-IMR group 0.83 [95% CI: 0.69 to 0.96]; p = 0.04). The correlation between invasive FFR and FFRangio was lower in the high-IMR group than in the low-IMR group (r = 0.60 vs. 0.79). The agreement between FFRangio and invasive FFR was -0.03 (limits of agreement: -0.14-0.08) in the low-IMR group and - 0.06 (limits of agreement: -0.22-0.09) in the high-IMR group.</p><p><strong>Conclusions: </strong>CMD may contribute to reduced diagnostic concordance between FFRangio and invasive FFR.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333600","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":"10-year experience with transcatheter aortic valve explants in a high-volume center.","authors":"Marcell Szekely, Maria G Lopez-Trevino, Imre I Gecse, Mangesh Kritya, Chloe Kharsa, Ziyab K Sarfaraz, Joe Aoun, Ross M Reul, Andrea G Quarti, Gerald M Lawrie, Sachin S Goel, Mahesh Ramchandani, Fernando Ramirez Del Val, Neal S Kleiman, Michael J Reardon, Marvin D Atkins","doi":"10.1016/j.carrev.2026.06.007","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.007","url":null,"abstract":"<p><strong>Objective: </strong>Indications for transcatheter aortic valve replacement (TAVR) are expanding into younger, lower-risk patients, and TAVR explants are increasing. We report our 10-year single-center experience and outcomes following TAVR explant.</p><p><strong>Methods: </strong>All TAVR explants performed between January 2015 and September 2025 were retrospectively reviewed. Patients were stratified into early-explant (≤30 days from index TAVR) and late-explant (>30 days) groups. Late-explant patients were further categorized as lower-risk (SAVR after TAVR risk score ≤ 8) or high-risk (>8). The primary endpoint was operative mortality; secondary endpoints included observed-to-expected (O/E) mortality and midterm survival.</p><p><strong>Results: </strong>Sixty-six TAVR explants were performed: 9 (13.6%) early and 57 (86.4%) late. Among late explants, 40 (70.2%) were lower-risk and 17 (29.8%) high-risk. Median time to explant in this cohort was 37.3 months (IQR:17.2-66.1). Indications were structural valve degeneration (33.3%), endocarditis (30%), valve thrombosis (6.1%), non-structural dysfunction (16.7%) and acute causes (13.6%). Within the late-explant cohort, only 13 patients (22.8%) had an isolated aortic valve replacement; most required concomitant procedures. Operative mortality was 22.2% for early and 15.8% for late explants. Among late cases, operative mortality was higher in the high-risk group (41.2% vs 5%, p = 0.002), with a substantially increased O/E mortality ratio (2.81 vs 1.40). Survival at 1, 2, and 3 years was 82.8%, 78.4%, and 65.8% in the lower-risk group versus 45.3% at all time points in the high-risk group.</p><p><strong>Conclusions: </strong>TAVR explantation carries operative mortality higher than anticipated, particularly in high-risk patients. A TAVR-first strategy in younger and lower-risk populations warrants careful consideration within a lifetime management framework.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279309","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":"Pullback pressure gradients: Redefining the functional landscape of coronary artery disease.","authors":"Debabrata Dash, Umanshi Dash, Naveed Ahmed, Rohit Mody","doi":"10.1016/j.carrev.2026.06.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.005","url":null,"abstract":"<p><p>Fractional flow reserve (FFR) remains the most widely adopted invasive physiologic index for determining the functional significance of epicardial coronary artery disease (CAD). By applying a validated binary threshold for myocardial ischemia, FFR guides clinical decision-making regarding the need for coronary revascularization. However, CAD is often heterogeneous, with varying patterns of focal and diffuse atherosclerotic involvement that are not fully captured by a single distal FFR value. Assessment of pressure changes along the vessel using hyperaemic pullback recordings provides additional pathophysiologic insight by depicting the spatial distribution of pressure loss as a pullback curve. Traditionally, interpretation of these curves has been largely visual and subjective, resulting in considerable interobserver variability and limited reproducibility. The pullback pressure gradient (PPG) index has emerged as a novel quantitative tool to overcome these limitations. By integrating the magnitude and longitudinal distribution of pressure gradients, PPG characterizes CAD patterns on a continuous scale from 0 to 1, where higher values indicate predominantly focal disease and lower values reflect diffuse disease. This review critically appraises the conceptual framework, clinical evidence, practical implications, and future directions of PPG in contemporary coronary physiology.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279242","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":"Clinical outcomes of TAVR with self-expanding valves for non- or minimally calcified aortic regurgitation.","authors":"Rade R Jibawi Rivera, Rachel M Heschke, Phillip G Rowse, Juan A Crestanello, Benjamin Hibbert, Rajiv Gulati, Mackram F Eleid","doi":"10.1016/j.carrev.2026.06.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.006","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical intervention for aortic regurgitation (AR) is often deferred for high-risk patients. Our study evaluated patient outcomes with non- or minimally calcified AR undergoing TAVR with self-expanding valves, regardless of anatomical features, including those with LVAD support.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted at a single academic center from 01/01/2012 to 12/01/2024. Eligible patients were those with greater than moderate AR, high/inoperable surgical risk, aortic valve calcium score < 400. Primary outcomes were all-cause and cardiovascular (CV)-related mortality rates at 1 and 12 months. Secondary outcomes included rehospitalization rates, procedural complications, in-hospital events, and Valve Academic Research Consortium-3 (VARC) success rates at 1 month.</p><p><strong>Results: </strong>25 patients who underwent TAVR were included, 13 were female with mean age 67 ± 14 years. The majority (76%) of patients presented with severe AR with a mean aortic valve calcium score of 61.5 ± 109.2. No intraprocedural death or conversion to open surgery occurred. Only one all-cause mortality occurred within 30 days, with Kaplan-Meier survival rate of 96% and 84%, at 1 month and 12 months, respectively. Heart failure-related hospitalization occurred in less than 10% of patients at 12 months. Technical success rate was 80%, with ventricular device migration occurring in five patients (20%), two of which were on LVAD support. In those cases, a second balloon-expandable valve was implanted achieving ≤ mild AR. All patients achieved mild or less residual AR at 12 months.</p><p><strong>Conclusion: </strong>Off-label TAVR use with self-expanding valves for AR is achievable with favorable safety and efficacy in select patients with and without LVADs.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279302","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":"Impact of baseline tricuspid regurgitation on outcomes after mitral transcatheter edge-to-edge repair: A systematic review and meta-analysis.","authors":"Ricardo F O Suruagy-Motta, Renato Martins-Pedrosa, Marina Amaral Barros, Ana Beatriz de Brito Pontes, Ana Beatriz P Aguiar-Barros, Maria Clara Bert de Mendonça, João Augusto Souza-Carvalho, Gabriel Lima Vieira Barbosa, Brunna Pileggi, Matheus Oliveira Souza, Alberto Colella Cervone, Evandro Martins Filho, João Ricardo Fernandes, Gregg W Stone","doi":"10.1016/j.carrev.2026.06.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.002","url":null,"abstract":"<p><strong>Introduction: </strong>Mitral transcatheter edge-to-edge repair (M-TEER) has become a cornerstone for treating patients with mitral regurgitation (MR). However, the prognostic impact of baseline tricuspid regurgitation (TR) on outcomes after M-TEER remains uncertain. This systematic review and meta-analysis evaluates the influence of baseline TR in patients undergoing M-TEER.</p><p><strong>Methods: </strong>We searched PubMed, Embase, SCOPUS, Cochrane Library, and Web of Science through January 2026. Studies comparing outcomes in patients with none/mild TR versus moderate/severe TR after M-TEER were included. Data were synthesized using random-effects models.</p><p><strong>Results: </strong>Eight observational studies involving 24,129 patients were included. Compared to patients with none/mild TR, those with baseline moderate/severe TR had a 2.05-fold higher risk of all-cause mortality (RR 2.05; 95% CI: 1.41-2.98) and an 82% higher risk of heart failure rehospitalization (RR 1.82; 95% CI: 1.22-2.73). Moderate/severe TR was also associated with a 5% lower likelihood of procedural success (RR 0.95; 95% CI: 0.94-0.97). Regarding echocardiographic outcomes, patients with baseline moderate/severe TR had a 12% lower probability of achieving none/mild residual MR (RR 0.88; 95% CI: 0.80-0.97) and a 20% higher risk of moderate residual MR (RR 1.20; 95% CI: 1.05-1.38), though the risk of severe residual MR did not differ significantly between groups. Baseline moderate/severe TR was associated with a 48% higher risk of NYHA class ≥ III at follow-up (RR 1.48; 95% CI: 1.27-1.73). Although statistically significant, the pooled differences in follow-up sPAP (MD: 0.25 mmHg) and LVEF (MD: -0.08%) were clinically negligible, while no significant differences were observed in TAPSE.</p><p><strong>Conclusions: </strong>Baseline moderate/severe TR is strongly associated with a worse prognosis and limited functional recovery following M-TEER. Further studies are warranted to determine whether simultaneous or staged TR interventions improve outcomes in patients undergoing M-TEER.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212885","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":"Real-world adverse events and device failure modes of the sentinel cerebral protection system: An analysis of the FDA MAUDE database 2022 to 2026.","authors":"Own Khraisat, Triston Messer, Ahmed Aljabali, Ahmad Alqaseer, Waleed Ismail, Hashem Samardali, Ehab Alkhawaldeh, Anas Alahmad, Dipal Patel, Aron Schwarcz, Ramin S Hastings","doi":"10.1016/j.carrev.2026.06.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.004","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a significant complication after transcatheter aortic valve replacement (TAVR), and embolic debris generated during the procedure is a major contributor. The Sentinel Cerebral Protection System is designed to reduce periprocedural stroke and stroke-related complications, but real-world data on device-related complications remain limited.</p><p><strong>Methods: </strong>We performed a retrospective descriptive analysis of post-marketing surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database (September 2022-January 2026) to assess Sentinel-related adverse events, including deaths, injuries, and device malfunctions. Reports were categorized by event type, and findings were summarized as counts and percentages.</p><p><strong>Results: </strong>A total of 340 reports were included. Malfunctions were most frequent (77.9%), followed by injuries (20.6%) and deaths (1.5%). Stroke and associated cerebrovascular events accounted for 48 of patient-related adverse events. Common device issues included difficulty in removal in 147 cases, breakage in 64 cases, and positioning problems in 57 cases. Rare complications such as detachment, contamination, and mechanical failure were also noted.</p><p><strong>Conclusions: </strong>This MAUDE database analysis found that reported Sentinel-related events were predominantly technical in nature, although clinically important adverse events were also identified. These findings provide real-world insights into device performance, highlight areas for procedural and design improvement, and underscore the importance of ongoing post-market surveillance.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195160","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":"Age modifies the prognostic value of post-procedural high-sensitivity troponin T for mortality in patients with acute coronary syndrome: A registry study of 14,210 patients.","authors":"Kun Na, Miaohan Qiu, Zizhao Qi, Jing Li, Yi Li, Yaling Han","doi":"10.1016/j.carrev.2026.05.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.05.013","url":null,"abstract":"<p><strong>Background: </strong>Post-procedural high-sensitivity cardiac troponin T (hs-TnT) is an established prognostic marker after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), yet its prognostic value may not be uniform across age groups, particularly when mortality and ischemic endpoints are considered separately.</p><p><strong>Methods: </strong>From a prospective PCI registry (March 2016-March 2019), 14,210 ACS patients were stratified by age (<65 vs ≥65 years) and post-procedural hs-TnT (<5× vs ≥5× upper reference limit). The primary endpoint was 12-month all-cause mortality; the secondary endpoint was ischemic events (cardiac death, myocardial infarction, or stroke). Age × hs-TnT interaction was assessed using multivariable Cox models and tensor product restricted cubic spline models.</p><p><strong>Results: </strong>At 12 months, 221 deaths and 312 ischemic events occurred. Elevated hs-TnT was associated with increased mortality in patients aged ≥65 (adjusted hazard ratio [aHR], 2.80; 95% CI, 1.84-4.27) but not in those aged <65 (aHR, 1.25; 95% CI, 0.75-2.07; P for interaction = 0.006). A concordant pattern was observed for cardiac death (P for interaction = 0.020). In contrast, elevated hs-TnT predicted ischemic events equally regardless of age (aged <65: aHR, 2.18; aged ≥65: aHR, 2.17; P for interaction = 0.995). Tensor product analysis confirmed a significant interaction for mortality (P = 0.048) but not for ischemic events (P = 0.935).</p><p><strong>Conclusions: </strong>Age selectively modified the prognostic value of post-procedural hs-TnT for mortality, but not for ischemic events, in patients with ACS undergoing PCI. Age-stratified interpretation of post-procedural hs-TnT may improve post-PCI risk stratification if externally validated.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176939","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":"Hemodynamic improvement immediately following percutaneous recanalization of chronic total occlusions.","authors":"Rajesh Sachdeva, Noah Towbin, Billy Mullinax, Rachel Warnock, Gautam Kumar","doi":"10.1016/j.carrev.2026.05.011","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.05.011","url":null,"abstract":"<p><strong>Background: </strong>Resting distal-to-aortic coronary pressure (Pd/Pa), resting full-cycle ratio (RFR), fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR) are established tools for assessing obstructive coronary artery disease but remain poorly characterized in chronic total occlusion (CTO). Evaluating immediate hemodynamic changes after CTO revascularization may serve as a marker of benefit from intervention.</p><p><strong>Methods: </strong>We retrospectively analyzed hemodynamic data from patients undergoing CTO percutaneous coronary intervention (PCI) at a Veterans Affairs hospital between January 2024 and July 2025. Measurements (Pd/Pa, RFR, FFR, CFR, IMR) were obtained after successful CTO crossing and compared pre- and post-PCI using the CoroFlow system (Abbott Vascular, Lake County, IL). Demographics, procedural characteristics, and clinical outcomes-including death, myocardial infarction (MI), target lesion revascularization (TLR), and angina improvement-were recorded.</p><p><strong>Results: </strong>Twenty patients were included. CTO locations were the left anterior descending (35%), right coronary artery (35%), and left circumflex (25%). Mean lesion length was 47.6 ± 23.1 mm, with a median J-CTO score of 2 ± 1. Pre-PCI Pd/Pa (0.60 ± 0.14), RFR (0.51 ± 0.18), and FFR (0.46 ± 0.10) improved significantly post-PCI to 0.96 ± 0.04, 0.95 ± 0.04, and 0.87 ± 0.08, respectively. Post-PCI CFR was 3.30 ± 2.74 and IMR 23.9 ± 33.5. No peri-procedural complications occurred; 5% experienced MI and 10% required TLR at 7.2 ± 3.5 months.</p><p><strong>Conclusion: </strong>There was marked improvement in hemodynamic indices after PCI of the evaluated CTO lesions, and microvascular function was normalized immediately following revascularization.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200574","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":"A novel generation balloon-expandable versus supra-annular self-expanding trans-catheter heart valve in patients with severe aortic stenosis and calcified left ventricle outflow tract","authors":"Alfonso Ielasi ,&nbsp;Rodolfo Caminiti ,&nbsp;Pasquale Simeoli ,&nbsp;Won-Keun Kim ,&nbsp;Andrea Scotti ,&nbsp;Arturo Giordano ,&nbsp;Andreas Holzamer ,&nbsp;Luca Testa ,&nbsp;Mihajlo Farkic ,&nbsp;Nikolay Stoyanov ,&nbsp;Francesco Gallo ,&nbsp;Alessia Azzano ,&nbsp;Juergen Leick ,&nbsp;Federico De Marco ,&nbsp;Mila Kovacevic ,&nbsp;Eike Tigges ,&nbsp;Marcin Protasiewicz ,&nbsp;Sebastiano Immè ,&nbsp;Antonio Mangieri ,&nbsp;Giampaolo Vetta ,&nbsp;Maurizio Tespili","doi":"10.1016/j.carrev.2025.09.013","DOIUrl":"10.1016/j.carrev.2025.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe left ventricular outflow tract (LVOT) calcification remains a challenging anatomy for transcatheter aortic valve replacement (TAVR), with increased risk of paravalvular leak (PVL), annular injury, and conduction disturbances. Evidence on the performance of new-generation balloon-expandable (BE) valves in this setting is limited.</div></div><div><h3>Methods</h3><div>An international, multicenter, cohort analysis comparing outcomes of patients with severe LVOT calcification treated with the novel Octacor BE versus two self-expanding (SE) transcatheter heart valves (THVs: Acurate Neo2 and Evolut Pro/Pro+). The primary endpoint was Valve Academic Research Consortium-3 (VARC-3) technical success. Secondary endpoints were: overall mortality, overall stroke, moderate-to-severe paravalvular leak (PVL), permanent pacemaker implantation (PPI), annulus rupture and major bleeding rates at 30 days.</div></div><div><h3>Results</h3><div>A total of 257 patients were analyzed of whom 35 in the BE group while 222 in the SE group. VARC-3 technical success was 100 % in the BE versus 94.6 % in the SE group (<em>p</em> = 0.127). No significant differences were reported between BE and SEs in terms of VARC-3 device success (82.9 % vs. 77 %; <em>p</em> = 0.3), all-cause mortality (0 % vs. 1.6 %; <em>p</em> = 0.4) and stroke (0 % vs. 2.7 %; <em>p</em> = 0.2) rates. Moderate-to-severe PVL was significantly lower in the BE versus SE group (0 % vs. 9.9 %; <em>p</em> = 0.03). At sub-group analysis Octacor showed a significantly lower moderate-to-severe PVL compared to Evolut Pro/Pro+ (0 % vs. 11.2 %; p = 0.03) while no significant difference versus Neo2 (0 % vs. 6.6 %, <em>p</em> = 0.1). In a prespecified sub-analysis excluding Acurate Neo2, Octacor remained associated with lower post-dilatation and PVL compared with Evolut. These results were consistent after annulus-adjusted sensitivity analysis.</div></div><div><h3>Conclusions</h3><div>In patients with severe AS and significant LVOT calcifications undergoing TAVR, novel generation BE and SE THVs demonstrated favorable safety and efficacy outcomes at 30-day.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"87 ","pages":"Pages 25-32"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276476","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}