Cardiovascular Revascularization Medicine最新文献

{"title":"Association between pathophysiological coronary artery disease patterns and perivascular adipose tissue density.","authors":"Chieh Yang Koo, Carlos Collet, Kazumasa Ikeda, Daniel Munhoz, Frédéric Bouisset, Jeroen Sonck, Toshiro Shinke, Hirohiko Ando, Brian Ko, Evald Høj Christiansen, Thomas Engstrøm, Fernando Rivero, Antonio Maria Leone, Simone Biscaglia, Andy Yong, Ashkan Eftekhari, Stephane Fournier, Masafumi Nakayama, Lokien X van Nunen, Liyew Desta, Adriaan Wilgenhof, Colin Berry, Divaka Perera, Nils Johnson, Bernard De Bruyne, Hitoshi Matsuo, Takuya Mizukami","doi":"10.1016/j.carrev.2025.05.026","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.026","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276305","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":"Predictors and prognosis of progression of aortic valve stenosis in patients hospitalized with heart failure with mildly reduced ejection fraction.","authors":"Noah Abel, Michael Behnes, Alexander Schmitt, Marielen Reinhardt, Felix Lau, Kathrin Weidner, Mohamed Ayoub, Kambis Mashayekhi, Thomas Bertsch, Ibrahim Akin, Tobias Schupp","doi":"10.1016/j.carrev.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.028","url":null,"abstract":"<p><strong>Background: </strong>Although aortic valve stenosis (AS) is a recognized predictor of outcomes in heart failure (HF), limited data is available concerning predictors for and the prognostic value of progressive AS in patients with HF with mildly reduced ejection fraction (HFmrEF).</p><p><strong>Methods: </strong>From 2016 to 2022, consecutive patients hospitalized with HFmrEF at one institution were retrospectively included. AS progression was assessed during follow-up echocardiography and patients with and without progression were compared regarding the primary endpoint long-term all-cause mortality at 30 months (median follow-up) using Kaplan-Meier and Cox regression analyses. Key secondary endpoint was rehospitalization for worsening HF. Predictors of AS progression were investigated using logistic regression analyses.</p><p><strong>Results: </strong>From 603 included patients hospitalized with HFmrEF, progressive AS was observed in 55 patients, which was associated with an increased risk of long-term all-cause mortality (HR = 1.697; 95 % CI 1.094-2.633; p = 0.018), but not with HF-related rehospitalization (p = 0.585). The association with long-term all-cause mortality was still evident after multivariable adjustment (p = 0.044). Independent predictors of AS progression were older age at baseline (HR = 1.033; 95 % CI 1.001-1.065; p = 0.042; per year increase), diabetes mellitus (HR = 1.851; 95 % CI 1.019-3.363; p = 0.043) and baseline AS severity (mild AS: HR = 3.923; 95 % CI = 1.605-9.588; p = 0.003, moderate AS: HR = 6.122; 95 % CI 2.587-14.488; p = 0.001).</p><p><strong>Conclusion: </strong>AS progression in HFmrEF patients is independently associated with impaired long-term survival.</p><p><strong>Clinicaltrials: </strong>gov identifier: NCT05603390, ethical approval code: 2022-818 (Medical Ethics Committee II of the Medical Faculty Mannheim, University of Heidelberg, Germany).</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235587","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":"Comparison between severe R-L and R-NC raphe-type bicuspid aortic valve stenosis treated with TAVI: insights from the international AD HOC Registry.","authors":"Andrea Viceré, Won-Keun Kim, Andrea Zito, Tommaso Fabris, Chiara De Biase, Attilio Restivo, Nicholas Montarello, Giuliano Costa, Michele Colucci, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Andrea Scotti, Michele Galasso, Giulia Costa, Alessandro Mazzapicchi, Enrico Giacomin, Riccardo Gorla, Tobias Rheude, Michele Bellamoli, Carlo Briguori, Pier Pasquale Leone, Emmanuel Villa, Fabio Casamassima, Cristina Aurigemma, Matthias Renker, Mario Garcia Gomez, Ciro Pollio Benvenuto, Antonio Maria Leone, Giulia Laterra, Mauro Gitto, Greta Cattaneo, Enrico Romagnoli, Giovanni Esposito, Alfonso Ielasi, Ady Orbach, Nedy Brambilla, Ignacio Amat-Santos, Antonio Mangieri, Francesco Saia, Luca Favero, Mao Chen, Marianna Adamo, Azeem Latib, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Carlo Trani, Francesco Burzotta, Marco Barbanti, Ole De Backer, Didier Tchètchè, Diego Maffeo, Giuseppe Tarantini, Andrea Buono","doi":"10.1016/j.carrev.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.023","url":null,"abstract":"<p><strong>Background: </strong>Sievers type 1 bicuspid aortic valve (BAV) stenosis presents unique challenges for trans-catheter aortic valve implantation (TAVI), particularly when calcified raphe is present. The impact of raphe localization on TAVI outcomes remains unclear.</p><p><strong>Objectives: </strong>This study aimed to compare procedural and clinical outcomes in patients with right-left (R-L) and right-non coronary (R-NC) raphe-type BAV treated with TAVI.</p><p><strong>Methods: </strong>Between January 2016 and October 2023, 956 consecutive patients with severe Sievers type 1 BAV stenosis underwent trans-femoral (TF)-TAVI across 24 tertiary centers. Pre-procedural computed tomography was retrospectively analyzed. To address the non-randomized study's design, 2:1 propensity score matching (PSM) was performed between R-L and R-NC groups. Primary endpoints included VARC-3 technical success, 30-day device success, early safety, and mid-term major adverse events (death, stroke, or heart failure hospitalization at the last follow-up).</p><p><strong>Results: </strong>825 had R-L raphe whereas 131 had R-NC pattern. After PSM, 251 R-L and 128 R-NC were analyzed. Baseline clinical, electrocardiographic, echocardiographic, computed tomography and procedural features were similar. Technical success was high in both groups (92.8 % vs 96.1 %; OR 0.53; 95%CI 0.19-1.45; p = 0.215), with comparable short- and mid-term outcomes. However, permanent pacemaker implantation (PPI) incidence was 3 times higher in R-L compared to R-NC (16.1 % vs. 6.7 %; OR 0.37, CI 0.16-0.89).</p><p><strong>Conclusions: </strong>Raphe localization in Sievers type 1 BAV does not affect major TAVI outcomes except for PPI risk, which is 3-fold higher in R-L patients.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188284","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":"Right ventricular-pulmonary arterial coupling in transcatheter structural heart interventions.","authors":"Panagiotis Theofilis, Panayotis K Vlachakis, Paschalis Karakasis, Evangelos Oikonomou, Athanasios Sakalidis, Kyriakos Dimitriadis, Konstantinos Tsioufis, Dimitris Tousoulis","doi":"10.1016/j.carrev.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.022","url":null,"abstract":"<p><p>Right ventricular-pulmonary arterial (RV-PA) coupling describes the interaction between right ventricular contractility and pulmonary arterial afterload, offering a comprehensive assessment of right heart function. In the context of structural heart interventions such as transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge mitral repair (TEER), and transcatheter tricuspid therapies, RV-PA coupling has emerged as a powerful prognostic indicator. Impaired coupling, typically defined using echocardiographic surrogates such as the tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio, is consistently associated with increased mortality and heart failure hospitalization. RV-PA coupling also demonstrates dynamic behavior, with potential for improvement following intervention-though persistent uncoupling portends worse outcomes. Despite its clinical promise, significant limitations exist. Commonly used non-invasive indices, while practical, only moderately correlate with gold-standard invasive pressure-volume loop assessments and are subject to measurement variability and lack of standardization. Furthermore, current surrogates do not distinguish between the underlying drivers of uncoupling-whether impaired contractility or increased afterload-each with distinct therapeutic implications. As structural heart interventions expand to broader patient populations, a more refined understanding of RV-PA coupling may enhance risk stratification, procedural planning, and long-term management. Future research should focus on standardizing assessment techniques and establishing evidence-based thresholds to support its routine clinical use.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175206","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":"Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention.","authors":"Raef Ali Fadel, Benjamin Hofeld, Herbert D Aronow, Ahmad Jabri, Pedro Engel, Gerald Koenig, Muhammad Memon, Mohammad Alqarqaz, Khaldoon Alaswad, Brittany Fuller, Asaad Nakhle, Vikas Aggarwal, Brian O'Neill, Tiberio Frisoli, Mir Babar Basir, Henry Kim, William O'Neill, Pedro Villablanca","doi":"10.1016/j.carrev.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.024","url":null,"abstract":"<p><strong>Background: </strong>The single access for high-risk percutaneous coronary intervention (SHiPCI) technique is an intriguing alternative to traditional dual access Impella-assisted PCI, potentially reducing access-site complications. Current data is limited to retrospective case studies.</p><p><strong>Objectives: </strong>To analyze procedural complications and clinical outcomes of SHiPCI.</p><p><strong>Methods: </strong>This single-center retrospective observational study evaluated consecutively admitted patients undergoing high-risk unprotected left main PCI (UPLM-PCI) from 2018 through 2023. Patients were grouped according to index strategy of single or dual access Impella-assisted UPLM-PCI, and propensity score matching without replacement was used to match patients 1:1. The primary outcome was a composite of all-cause in-hospital mortality, major bleeding, vascular access site complications, and blood transfusion.</p><p><strong>Results: </strong>Six-hundred patients underwent UPLM-PCI during the study period, and one hundred patients were matched (50 patients per group). There were no significant differences in baseline characteristics between the two groups. Up-front balloon tamponade assistance was higher in the dual access group (14 % vs 4.0 %, p = 0.027), and rate of successful hemostasis post-closure was lower (82 % vs 100 %, p = 0.001). The primary composite outcome occurred in 7 patients (14 %) in the single access group, compared to 16 patients (32 %) in the dual access group (p = 0.033). Patients in the dual-access group had higher rates of major bleeding (17 % vs 2 %, p = 0.014).</p><p><strong>Conclusions: </strong>SHiPCI compared to standard dual access for Impella-assisted UPLM-PCI demonstrated a lower rate lower rate of the composite outcome, driven primarily by a lower rate of major bleeding. Prospective randomized controlled trials are needed to delineate the efficacy and safety of SHiPCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174905","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":"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}