Cardiovascular Revascularization Medicine最新文献

{"title":"Decision-making in valve reintervention: Redo-Transcatheter aortic valve replacement vs. explant surgery.","authors":"Lior Lupu, Pavan Reddy, Dan Haberman, Matteo Cellamare, Cheng Zhang, Vaishnavi Sawant, Hank Rappaport, Kalyan R Chitturi, Abhishek Chaturvedi, Waiel Abusnina, Jeffrey E Cohen, Christian C Shults, Thomas E MacGillivray, Lowell F Satler, Itsik Ben-Dor, Ron Waksman, Toby Rogers","doi":"10.1016/j.carrev.2025.08.018","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.018","url":null,"abstract":"<p><strong>Objective: </strong>Data remain limited on factors influencing the selection of redo-transcatheter aortic valve replacement (TAVR) versus surgical explant in patients with failing transcatheter heart valves. This study aimed to identify clinical and procedural factors guiding treatment decisions.</p><p><strong>Methods: </strong>This single-center, retrospective study included all patients who underwent aortic valve reintervention following prior TAVR at a U.S. tertiary referral center between January 2015 and June 2024. Clinical records, imaging, and Heart Team notes were reviewed to determine rationale for treatment selection. Procedural details and major adverse cardiac events (MACE: death, rehospitalization, or stroke) were collected.</p><p><strong>Results: </strong>Among 47 patients, 24 (51 %) underwent surgical explant and 23 (49 %) redo-TAVR. The explant group was significantly younger (75 vs. 79 years; p = 0.018), with similar gender distribution (31.9 % female). Time to reintervention was comparable (27.8 vs. 34.2 months; p = 0.75). Common indications for explant included endocarditis (33.3 %), patient-prosthesis mismatch (16.7 %), prior valve-in-valve (16.7 %), annular rupture risk (12.5 %), need for concomitant surgery (8.3 %), and coronary obstruction risk (8.3 %). Thirty-day and one-year MACE rates were significantly higher with explant (30.4 % vs. 0 %, p = 0.029; 59.1 % vs. 21.4 %, p = 0.041). Mortality was numerically higher but not statistically significant. Patients undergoing explant often had more comorbidities and required complex procedures.</p><p><strong>Conclusion: </strong>Among patients undergoing reintervention after TAVR, treatment was evenly split between redo-TAVR and explant, underscoring the importance of lifetime planning at initial TAVR. This analysis shows the two groups represent inherently different patient populations and highlights the need for randomized trials to define optimal treatment pathways.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001627","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":"Safety of pre-procedure fasting versus non-fasting protocols before cardiac catheterization - a Bayesian meta-analysis of randomized clinical trials.","authors":"Abhishek Chaturvedi, Abdullah K Al Qaraghuli, Beni R Verma, Dan Haberman, Matteo Cellamare, Cheng Zhang, Jason Galo, Waiel Abusnina, Lior Lupu, Hayder D Hashim, Toby Rogers, Itsik Ben-Dor, Lowell F Satler, Ron Waksman","doi":"10.1016/j.carrev.2025.08.019","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.019","url":null,"abstract":"<p><strong>Background: </strong>Fasting prior to cardiac catheterization is a routine practice to minimize the risk of complications. Recent studies suggest that non-fasting protocols may be equally safe and increase patient satisfaction. We performed a meta-analysis of randomized controlled trials (RCTs) to examine the safety of fasting versus non-fasting prior to cardiac catheterization.</p><p><strong>Methods: </strong>We searched for eligible RCTs comparing fasting versus non-fasting protocols prior to cardiac catheterization from inception through December 21, 2024. Studies were included if they reported at least one of the outcomes of interest- nausea/vomiting, aspiration event, new ventilation/oxygen requirements, hypotension, hypoglycemia, and acute kidney injury. The treatment effect of each outcome was measured using the logarithmic odds ratios (logOR) and estimated under the Bayesian paradigm. Under the hierarchical Bayesian random effect model, we elicited an informative prior for the logOR ∼ (0, 0.1), representing the null hypothesis of no treatment effect. Between-study heterogeneity was elicited with a weakly informative half-Cauchy prior of a 0.5 scale. All analyses were conducted using R version 4.0.</p><p><strong>Results: </strong>9 studies met the inclusion criteria with a total of 3567 patients (1805 in fasting and 1762 in non-fasting). The Bayesian meta-analysis yielded a posterior mean OR of 0.99 [95 % credible interval (CrI): 0.82-1.20] for nausea and vomiting, 0.99 (95 % CrI: 0.82-1.21) for aspiration event, 1.003 (95 % CrI: 0.83-1.22) for new ventilation and oxygen requirements, 1.04 (95 % CrI: 0.87-1.25) for hypotension, 1.02 (95 % CrI: 0.85-1.24) for hypoglycemia, and 0.97 (95 % CrI: 0.81-1.18) for acute kidney injury. All CrI include 1 and the point estimates are very close to 1, indicating a lack of evidence to drive away from the prior assumption of no average effect size. Sensitivity analyses using three distinct prior scenarios (non-informative, optimistic informative, and skeptical informative) and a subset of studies conducted in 2023-2024 yielded similar findings.</p><p><strong>Conclusion: </strong>Our study demonstrates that a non-fasting strategy prior to cardiac catheterization is as safe as the usual fasting strategy. Pre-procedural fasting should be individualized based on patient and procedure-related factors, and guidelines should be updated with regard to pre-cardiac procedure protocols that minimize fasting and improve patient satisfaction.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066084","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":"Safety of cardioversion without anticoagulation in patients' status post left atrial appendage occlusion: A systematic review and meta-analysis.","authors":"Khalid Sawalha, Mohammad Alakchar, Mamas A Mamas, Dana Johnson, Adarsh Bhan, Andrew M Goldsweig","doi":"10.1016/j.carrev.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.013","url":null,"abstract":"<p><strong>Background: </strong>Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain.</p><p><strong>Objective: </strong>To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I² statistic.</p><p><strong>Results: </strong>Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I² = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I² = 0 %). Pre-DCCV imaging protocols varied widely among studies.</p><p><strong>Conclusions: </strong>In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974165","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: Refining the hemocompatibility paradigm in AMI-cardiogenic shock: Insights from an early impella 5+ experience with DAPT and bivalirudin.","authors":"Ezequiel J Molina","doi":"10.1016/j.carrev.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974175","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":"Embolic stroke of undetermined source: A cardiovascular approach to diagnostic uncertainty.","authors":"Adishwar Rao, Hammad Rahman, Hitesh Bhatia, Akriti Agrawal, Asna Aafreen, Saurabh Sharma, Carlos Y Lopez, Edo Kaluski","doi":"10.1016/j.carrev.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.008","url":null,"abstract":"<p><p>Embolic stroke of undetermined source (ESUS) is a clinical event with an undelineated embolic etiology after the initial stroke workup. Once stroke specialists confirm ESUS, evaluation of rhythm disorders such as atrial fibrillation, specific cardiac pathologies (cardiomyopathy, left atrial cardiopathy, left-atrial septal pouch, aortic or mitral valve disease, cardiac neoplasm, right-to-left shunts, or device-related thrombus), and acquired hypercoagulable states, which may occasionally be related to malignancy, should be performed. While most ESUS patients require appropriate antiplatelet therapy, certain subsets may require oral anticoagulation. However, routine prescription of oral anticoagulants in the absence of documented atrial fibrillation, cancer-related thrombosis, or cardiac thrombosis is discouraged. Shared decision-making between the patient and the physician about additional diagnostic and therapeutic decisions is particularly encouraged in this condition, given the limited availability of high-quality clinical data and considerable uncertainty about the safety and efficacy of therapeutic options and clinical outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974208","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 HighLife transcatheter mitral valve replacement system: A novel two-component platform.","authors":"Michail Penteris, Konstantinos Lampropoulos","doi":"10.1016/j.carrev.2025.08.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.012","url":null,"abstract":"<p><p>Mitral regurgitation (MR) remains a prevalent and undertreated condition, particularly in patients at high surgical risk or unsuitable for mitral transcatheter edge-to-edge repair (M-TEER). The HighLife (HighLife SAS, Paris, France) transcatheter mitral valve replacement (TMVR) system offers a novel solution with its unique two-component design comprising a subannular ring and a self-expanding bioprosthetic valve. Delivered via a transfemoral arterial and transseptal venous approach, this \"valve-in-ring\" system enables circumferential anchoring without the need for annular calcification or transapical access. Early clinical experience, including first-in-human and feasibility studies, has demonstrated high technical success, significant MR reduction, and favorable short- and mid-term outcomes. Recent device iterations, such as the large annulus valve and Clarity prosthesis, address prior limitations related to annular size and left ventricular outflow tract (LVOT) obstruction risk, broadening the range of suitable anatomies. Despite its promise, the HighLife system presents challenges including procedural complexity, bleeding risk, and the need for precise imaging and experienced operators. Ongoing clinical trials will be critical to further define its safety, durability, and long-term efficacy. With further evidence, the HighLife system may offer a viable TMVR option for patients previously deemed untreatable by conventional transcatheter or surgical approaches.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876007","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":"Critique of the OPTIMIS study on magnesium-based bioresorbable scaffolds.","authors":"Çağrı Zorlu, Sefa Erdi Ömür","doi":"10.1016/j.carrev.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862538","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: Chronic total occlusion and survival: The never-ending debate.","authors":"Sant Kumar, Lorenzo Azzalini","doi":"10.1016/j.carrev.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.006","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876006","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":"Physiology assessment in bifurcation percutaneous coronary intervention: Insights from PROGRESS-BIFURCATION registry.","authors":"Pedro E P Carvalho, Deniz Mutlu, Dimitrios Strepkos, Michaella Alexandrou, Eleni Kladou, Sandeep Jalli, Ozgur Selim Ser, Bavana V Rangan, Emmanouil S Brilakis, Yader Sandoval","doi":"10.1016/j.carrev.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.005","url":null,"abstract":"<p><p>Fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPR) are established physiologic indices that can help inform the need for percutaneous coronary intervention (PCI), however, their use in patients undergoing bifurcation PCI is uncertain. The PROGRESS-BIFURCATION study is an ongoing multi-center, international registry conducted across six centers. Among 2494 bifurcation lesions treated (2271 patients), only 158 (6.3 %) had pressure-wire based physiology assessment. Pre-PCI, 127 (5.1 %) lesions had assessments of the main vessel (MV), 32 (1.3 %) of the side branches (SB), and 18 (0.7 %) had assessments of both MV and SB. Post-PCI, 23 (0.9 %) had assessments of the MV, and 9 (0.4 %) of the SB. NHPR were used in 55 % and FFR in 45 % of cases. Technical and procedural success rates, as well as complication rates, were comparable between bifurcation PCIs performed with and without physiology assessments. However, the use of physiology assessment was associated with a lower incidence of in-hospital major adverse cardiac events (MACE) (0.0 % vs. 3.8 %; p = 0.02). Despite randomized controlled trials showing benefits of coronary physiology to inform the need for PCI and improve clinical outcomes, real-world adoption of physiology-based assessment in bifurcation PCI remains low.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974245","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":"Heparin pretreatment in patients with ST-segment elevation myocardial infarction: A meta-analysis.","authors":"Luca Franchin, Federico Angriman, Andrea Pezzato, Luca Siega Vignut, Enrico Fabris, Gianfranco Sinagra, Arnoud W J van 't Hof, Massimo Imazio","doi":"10.1016/j.carrev.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.004","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction.</p><p><strong>Background: </strong>There is a paucity of data regarding the best timing for heparin administration in STEMI.</p><p><strong>Methods: </strong>We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.</p><p><strong>Results: </strong>11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56-0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48-0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR = 1.54; 95 % CI 1.37-1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74-1.24).</p><p><strong>Conclusion: </strong>A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862539","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}