Catheterization and Cardiovascular Interventions最新文献

{"title":"The Impact of Permanent Pacemaker Implantation After TAVI on Mortality and Quality of Life: A POPular TAVI Substudy","authors":"P. J. A. van Nuland,&nbsp;J. Halim,&nbsp;D. J. van Ginkel,&nbsp;D. C. Overduin,&nbsp;J. Brouwer,&nbsp;V. J. Nijenhuis,&nbsp;A. W. J. van't Hof,&nbsp;P. A. L. Tonino,&nbsp;J. M. ten Berg,&nbsp;P. A. Vriesendorp","doi":"10.1002/ccd.31431","DOIUrl":"10.1002/ccd.31431","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI). Data regarding its impact on mortality and morbidity are conflicting. This study aims to assess the impact of PPI before or within 30 days after TAVI on mortality and health-related Quality of Life (QoL) during the first year after TAVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this POPular TAVI substudy, 978 patients were included and categorized into three groups: Neither PPI before or within 30 days after TAVI (no PPI, <i>n</i> = 779), PPI before TAVI (PPI pre-TAVI, <i>n</i> = 102), PPI within 30 days after TAVI (PPI post-TAVI, n = 97). All-cause death and cardiac death were evaluated at 1 year. QoL was assessed using the SF-12 and EQ-5D-5L questionnaires at baseline and 3, 6, and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 1-year, all-cause death was seen in 6.9% (PPI pre-TAVI, <i>p</i> = 0.53) and 10.3% (PPI post-TAVI, <i>p</i> = 0.66) of the patients compared to 8.7% of the patients (no PPI). Cardiac death was observed in 4.9% (PPI pre-TAVI, <i>p</i> = 0.58) and 6.2% (PPI post-TAVI, <i>p</i> = 0.94) of the patients compared to 6.2% of patients (no PPI). Regarding QoL, the PPI pre-TAVI group showed lower PCS-12 over time compared to the no PPI group (<i>p</i> = 0.04), while MCS-12, EQ-5D Index and EQ-5D VAS scores were equal. No significant differences in QoL were seen between the PPI post-TAVI group and the no PPI group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PPI before or within 30 days after TAVI was not associated with increased mortality within 1 year. PPI pre-TAVI was associated with lower physical QoL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1098-1107"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Left Main Coronary Artery Compression After Harmony-TPV Implantation","authors":"Sergio López-Tejero,&nbsp;Lee Benson,&nbsp;Eric Horlick,&nbsp;Mark Osten","doi":"10.1002/ccd.31427","DOIUrl":"10.1002/ccd.31427","url":null,"abstract":"<div>\u0000 \u0000 <p>We present an 18-year-old male with Fallot's tetralogy (ToF) repaired with a transannular and main pulmonary artery (PA) patch, who suffered an acute coronary artery compression after a Harmony-TPV deployment. Left main coronary artery compression was confirmed with angiography and IVUS. He underwent emergent surgery, with a bioprosthetic valve replacement.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1108-1111"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon Dilation Technique Influences Stent Shortening and Intentional Stent Fracture During Overexpansion of Drug-Eluting Stents: A Bench-Testing Study","authors":"Mudit Gupta,&nbsp;Ella B. Leeth,&nbsp;Yuval Barak-Corren,&nbsp;Ari J. Gartenberg,&nbsp;Elizabeth Silvestro,&nbsp;Michael L. O'Byrne,&nbsp;Ryan Callahan","doi":"10.1002/ccd.31428","DOIUrl":"10.1002/ccd.31428","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Drug-eluting stents (DES) are not designed for overexpansion to supra-nominal diameters or intentional stent fracture (ISF). The optimal dilation technique to minimize stent shortening (SS) and achieve ISF to accommodate pediatric somatic growth has not been described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three sizes of two commonly used DES were implanted within a silicone model to simulate blood vessels. Each stent was serially dilated in 1 mm increments under fluoroscopy using three techniques: 2 cm length, semi-compliant balloons (Technique 1), 2 cm, noncompliant balloons straddling the entire stent (Technique 2), or noncompliant balloons in an “inside-out” manner (balloon shorter than stent or 2 cm balloon aligned with distal end of stent (no straddle); (Technique 3). Technique 1 crossed over to noncompliant balloons once stent “napkin-ringed” (NR). Percent SS = (L_nominal – L_final)/L_nominal* 100.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Technique 1 resulted in the greatest SS (median 85%, IQR 82, 87) and universal napkin ringing. Technique 2 caused less SS (median 14%, IQR 7, 15), and Technique 3 caused the least SS (median 7%, IQR 3, 11). ISF was achieved in all, however, the inside–out technique caused ISF at smaller stent diameters (median 114% recommended postdilation limit vs. 122%–131%) and lower inflation pressures (median 15 vs. 28–29 ATM). ISF was achieved in Technique 1 after napkin ringing but required larger noncompliant balloons than other techniques (median 8.5 vs. 7 mm).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Inside–out dilation resulted in less SS and fracture at smaller diameters with lower inflation pressures. This technique may improve the ISF success rate of DES in pediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1112-1119"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Coronary Microvascular Dysfunction in Patients With Type 2 Diabetes Mellitus","authors":"Kalyan R. Chitturi,&nbsp;Sant Kumar,&nbsp;Flavia Tejada Frisancho,&nbsp;Sana Rahman,&nbsp;Beni Rai Verma,&nbsp;Matteo Cellamare,&nbsp;Ilan Merdler,&nbsp;Sevket Tolga Ozturk,&nbsp;Vijoli Cermak,&nbsp;Vaishnavi Sawant,&nbsp;Cheng Zhang,&nbsp;Itsik Ben-Dor,&nbsp;Ron Waksman,&nbsp;Hayder D. Hashim,&nbsp;Brian C. Case","doi":"10.1002/ccd.31429","DOIUrl":"10.1002/ccd.31429","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Patients with type 2 diabetes mellitus (DM) are more susceptible to microvascular complications. However, whether DM is associated with coronary microvascular dysfunction (CMD) is unclear. This observational study used data from the Coronary Microvascular Disease Registry (CMDR) (NCT05960474) and included patients with angina and no obstructive coronary artery disease (ANOCA) who underwent invasive CMD evaluation using the CoroVentis CoroFlow System (Abbott Vascular, Santa Clara, CA). Patient demographics, comorbidities, laboratory data, echocardiography, coronary angiography, and microvascular physiology results were analyzed. Among the 271 patients, 73 (26.9%) had DM. These patients were more likely to be African American (68.1% vs. 47.0%) and had higher rates of hypertension (93.2% vs. 74.2%), hyperlipidemia (89.0% vs. 68.7%), and chronic kidney disease (17.8% vs. 8.1%) than those without DM. Invasive coronary functional testing showed no significant differences in the index of microcirculatory resistance (IMR) (17.82 ± 8.17 vs. 19.37 ± 13.14, <i>p </i>= 0.268) or coronary flow reserve (CFR) (3.24 ± 1.73 vs. 3.21 ± 1.86, <i>p </i>= 0.909) between diabetic and nondiabetic patients. Similarly, in those testing positive for CMD, there were no significant differences in IMR (27.8 ± 7.4 vs. 32.35 ± 15.22, <i>p </i>= 0.108) or CFR (2.42 ± 1.09 vs. 2.05 ± 0.94, <i>p </i>= 0.199). Although patients with DM exhibited more comorbidities, CMD physiology indices were comparable between the groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1120-1123"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Predictors of Access-Related Vascular Complications Following Transfemoral Transcatheter Aortic Valve Replacement","authors":"Gökhan Demirci,&nbsp;Serkan Aslan,&nbsp;Ahmet Anıl Şahin,&nbsp;Ali R. Demir,&nbsp;Yunus Emre Erata,&nbsp;İrem Türkmen,&nbsp;Mehmet Kanyılmaz,&nbsp;Aysel Türkvatan,&nbsp;Mehmet Ertürk","doi":"10.1002/ccd.31422","DOIUrl":"10.1002/ccd.31422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Access-related vascular complications (VCs) after percutaneous transfemoral transcatheter aortic valve replacement (TAVR) are associated with poor clinical outcomes and remain a significant challenge despite technological advances. The aim of this study was to identify anatomic predictors of access-related VCs after TAVR on preprocedural contrast-enhanced multidetector computed tomography (MDCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to identify anatomical predictors of access-related VCs after TAVR on preprocedural contrast-enhanced MDCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 348 consecutive patients with symptomatic severe AS who underwent transfemoral TAVR were included retrospectively. The primary endpoint of the study was the composite of minor and major access site complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. The study population was divided into two groups according to the VC including VC (+) and VC (−).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 101 patients (29%) developed VC (8.7% major, 20.3% minor) following TAVR. Regression analysis identified severe CFA calcification (<i>p</i> = 0.004), CFA depth (<i>p</i> &lt; 0.001), minimum CFA diameter (<i>p</i> &lt; 0.001), CFA depth-to-diameter ratio ≥ 5.6 (<i>p</i> &lt; 0.001), and sheath-to-femoral artery ratio (SFAR) (<i>p</i> &lt; 0.001) as significant predictors of VC. ROC curves generated for the occurrence of VC, the AUC for the femoral artery depth-to-diameter ratio (0.720) was higher than the AUC for the SFAR and the depth of the femoral artery (0.636, 0.630).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Complications related to vascular access sites continue to be a significant concern for patients undergoing TF-TAVR. The CFA depth-to-diameter ratio has demonstrated superior predictive performance for VC compared to SFAR as expressed in the literature. Utilizing this criterion may enhance risk stratification for VC in high-risk patients, potentially reducing associated morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1077-1085"},"PeriodicalIF":2.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Technique of “Drag-Drill” for Retrograde Chronic Total Occlusion Revascularization in Heavily Calcified Tortuous Lesions: A Case Report","authors":"Shengwen Yang,&nbsp;Lin Zhao,&nbsp;Tao Zhang","doi":"10.1002/ccd.31424","DOIUrl":"10.1002/ccd.31424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>We report the case of a 73-year-old male with a history of recurrent coronary interventions who presented with progressive angina and was diagnosed with a chronic total occlusion (CTO) of a heavily calcified and tortuous right coronary artery (RCA). Standard antegrade and retrograde techniques were attempted but failed due to the complexity of the lesion. A novel “Drag-Drill” technique was employed, utilizing a retrogradely externalized RG3 guidewire as a rotational atherectomy wire, enabling successful rotational atherectomy and percutaneous coronary intervention (PCI). The technique involved protecting the distal tip of the guidewire with a retrograde microcatheter to maintain stability and prevent vascular injury. At the 3-month follow-up, the patient remained angina-free. This case highlights the “Drag-Drill” strategy as an innovative and effective approach for the treatment of severely calcified and tortuous CTO lesions, underscoring the importance of tailored techniques in complex cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1094-1097"},"PeriodicalIF":2.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beaware of Intracardiac Potentials Induced by Intravascular Lithotripsy","authors":"Daiki Niizeki,&nbsp;Masataka Nakano","doi":"10.1002/ccd.31425","DOIUrl":"10.1002/ccd.31425","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intravascular lithotripsy (IVL), that generates shockwaves through spark gap discharge between emitters, has been increasingly used to treat severely calcified coronary artery lesions. However, there is a question as to whether IVL has no electrical effects on endocardial tissues or cardiac implantable devices (CIEDs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to investigate the effects of IVL<b>-</b>induced intracardiac potentials on cardiac electrophysiology and CIEDs. Specifically, we examined how spark gap discharge of IVL influence myocardial electrical activity and the sensing function of CIEDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We conducted a preliminary in vitro experiment using an IVL and a pacemaker placed in a saline-filled container, where we observed that the pacemaker did indeed detect the discharge of IVL, leading to pacing inhibition. Then, 13 patients undergoing PCI with IVL were investigated with real-time monitoring of in vivo intracardiac electrogram (EGM) synchronized with body surface ECG, with an external temporary pacing lead placed in the right ventricle. Similar to the above experiment, we found that IVL pulses were indeed detected on the EGM and sensed by the temporary pacemaker. Of the 287 IVL pulses outside the range of absolute refractory period, 59 (20.6%) captured the ventricle, while the remaining 228 (79.4%) did not elicit any electrical myocardial activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our observations indicate concerns about the use of IVL: the risk of inducing fatal arrhythmia and the occurrence of cardiac arrest or bradycardia in the CIED-dependent patients. IVL users should be aware of the potential risk of such events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1086-1089"},"PeriodicalIF":2.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Main Coronary Occlusion During TAVI Procedure: Calcium Embolization Matters","authors":"Rajesh Vijayvergiya,&nbsp;Basant Kumar,&nbsp;Arghadip Bose,&nbsp;Sunder Negi","doi":"10.1002/ccd.31426","DOIUrl":"10.1002/ccd.31426","url":null,"abstract":"<div>\u0000 \u0000 <p>Acute coronary occlusion during transcatheter aortic valve implantation (TAVI) is an unwarranted complication associated with high mortality. The current TAVI practices recommend a multidetector computed tomography (MDCT) evaluation of the aortic valve, the left ventricular outflow tract, and the aortic root to determine the conventional risk factors for coronary obstruction like low-lying coronary ostia and narrow sinuses of Valsalva, mandating prophylactic coronary protection or native valve leaflet modification in high-risk patients. Despite optimal anatomy, acute coronary occlusion can still occur due to multiple mechanisms, one of which is coronary embolism due to thrombus, calcium, or native aortic valve fragments. A sudden hemodynamic collapse during a TAVI procedure in the absence of apparent causes always raises the suspicion of coronary occlusion, which requires a prompt percutaneous coronary intervention (PCI) to save the patient's life. This report describes a case of acute coronary occlusion during TAVI in a seemingly low-risk patient salvaged with an emergent left main (LM) bifurcation PCI.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1090-1093"},"PeriodicalIF":2.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-Based Analysis of Correlation Between Valve Stent Deformation and Valve Function in Transcatheter Aortic Valve Replacement","authors":"Min Jin,&nbsp;Qing Zhou,&nbsp;Shuchun li,&nbsp;Haitao Zhang,&nbsp;Dongjin Wang","doi":"10.1002/ccd.31421","DOIUrl":"10.1002/ccd.31421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Currently, there remains a paucity of research on the deformation and valve function of transcatheter heart valves (THV) in patients with aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR). This study aimed to thoroughly explore the correlation between THV deformation and postoperative hemodynamics in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we assessed 39 AR patients treated with the J-Valve THV system during TAVR. We utilized postoperative cardiac-enhanced computed tomography angiography (CTA) to examine the extent of stent deformation, correlating these measurements with concurrent echocardiographic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among patients with AR, the J-Valve exhibited three distinct configurations: rectangular, trapezoidal, and inverted trapezoidal shapes. The rectangular configuration showed a trend toward a larger effective orifice area (EOA) compared to the trapezoidal and inverted trapezoidal configurations (rectangular: 2.20 ± 0.11 cm², trapezoidal: 1.88 ± 0.08 cm², inverted trapezoidal: 2.04 ± 0.08 cm²; <i>p</i> = 0.068). Stratified analysis of the degree of inclined commissural posts indicated that THVs with all three commissural angles &lt; 5° exhibited the highest standard EOA (sEOA). An increase in the number and degree of inclined commissural posts correlated with a decrease in sEOA. Furthermore, a higher EOA was observed when the expansion in the mid and transition level exceeded 80%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>During the TAVR procedure, ensuring sufficient expansion in the mid and transition level of the stent, maintaining the stent in a rectangular configuration, and avoiding tilting of the commissural posts contribute to achieving favorable postoperative hemodynamics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1056-1066"},"PeriodicalIF":2.1,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow-Up","authors":"Leire Unzue,&nbsp;Belén Díaz Antón,&nbsp;Adrián Peláez Laderas,&nbsp;Lorena Martín Polo,&nbsp;Jose María Castellano Vázquez,&nbsp;Francisco José Rodríguez Rodrigo,&nbsp;Francisco Javier Parra Jimenez,&nbsp;Leticia Fernández-Friera,&nbsp;Rodrigo Teijeiro Mestre,&nbsp;Eulogio García Fernández","doi":"10.1002/ccd.31418","DOIUrl":"https://doi.org/10.1002/ccd.31418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Commissural misalignment (CMA) has demonstrated to difficult future coronary access in self-expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow-up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3-cusp view pre and post-valve deployment. CMA was defined as a neocommissure deviation &gt; 30° compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow-up and compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as “aligned” (CMA &lt; 30°) and 42 (60%) as “misaligned” (CMA &gt; 30°). Patients with CMA &gt; 30° presented smaller aortic annulus (23.8 vs. 20.7, <i>p</i> &lt; 0.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow-up (9.2−10.3 mmHg, <i>p</i> &lt; 0.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Significant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1067-1076"},"PeriodicalIF":2.1,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}