Albenque G, Smolka G, Blanchard D
… +26 more, Kloëckner M, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Dumonteil N, Bauer F, Nejjari M, Pillière R, Dauphin C, Bonnet G, Ciobotaru V, Kételers R, Gallet R, Hammoudi N, Mangin L, Bouvaist H, Spaulding C, Aminian A, Kilic T, Popovic B, Armero S, Champagnac D, Gérardin B, Hascoet S
EuroIntervention
· 2026 Jan · PMID 41549689
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BACKGROUND: Medium- and long-term outcomes after transcatheter paravalvular leak (PVL) closure remain poorly documented, with limited prospective data on predictors of morbidity and mortality. AIMS: This study aimed to a...BACKGROUND: Medium- and long-term outcomes after transcatheter paravalvular leak (PVL) closure remain poorly documented, with limited prospective data on predictors of morbidity and mortality. AIMS: This study aimed to assess medium-term outcomes and identify key predictive factors of mortality or surgical reintervention at 2 years after transcatheter PVL closure. METHODS: The prospective Fermeture de Fuite ParaProthétique (FFPP) Registry included consecutive symptomatic patients undergoing transcatheter PVL closure across 24 European centres between 2017 and 2019. Predictive factors for mortality and surgical reintervention were analysed over a 2-year follow-up. RESULTS: A total of 213 symptomatic patients underwent 237 procedures. The mean age was 68±11 years, with a median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of 6 (interquartile range [IQR] 4-10). PVL involved the mitral valve in 64.6% of cases and mechanical prostheses in 53.3%. Heart failure and haemolytic anaemia were present in 89.5% and 49.8% of patients, respectively. The transapical approach was used in 6.8% of cases. Technical success was achieved in 87.3% of procedures, and clinical success at 1 month was achieved in 70.5% of patients. The median follow-up was 24.4 months (IQR 23.2-26.4). The survival rate at 2 years without the need for surgical reintervention was 66.1% (95% confidence interval [CI]: 60.1-72.7). Multivariate analysis identified mitral PVL, mechanical valves, and haemolytic anaemia as independent risk factors for adverse outcomes during follow-up. The absence of clinical success at 1 month was the strongest predictor of adverse outcomes (hazard ratio 5.00, 95% CI: 2.70-9.09; p=0.001). CONCLUSIONS: Transcatheter PVL closure offers a durable therapeutic option for high-risk patients when early clinical success is achieved. Mitral valve involvement, mechanical prostheses, and haemolytic anaemia remain key predictors of poor outcomes over a 2-year follow-up.
Palmerini T, Saia F, Bruno AG
… +26 more, Adamo M, Chizzola G, Massussi M, De Carlo M, Costa G, Angelillis M, Testa L, Bedogni F, Bellini B, Montorfano M, Taglieri N, Ghetti G, Orzalkiewicz M, Bruschi G, Merlanti B, Ferrara E, Poli A, De Felice F, Musto C, Foroni M, Lombardi L, Conte A, Regazzoli D, Pierri A, Attisano T, Galiè N
EuroIntervention
· 2026 Jan · PMID 41549685
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BACKGROUND: Independent predictors and prognostic correlates of structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI) have not been investigated beyond 5-year follow-up. AIMS: We aimed...BACKGROUND: Independent predictors and prognostic correlates of structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI) have not been investigated beyond 5-year follow-up. AIMS: We aimed to investigate the association between the early residual mean postprocedural gradient (ERMPG) after TAVI and long-term SVD rates as well as the association of SVD with bioprosthetic valve failure (BVF) and 10-year mortality rates. METHODS: Patients with severe aortic valve stenosis enrolled in the Medtronic One Hospital Clinical Service at 10 Italian centres were included in the study. ERMPG was measured with echo-Doppler at hospital discharge or within 3 months from TAVI. RESULTS: Between September 2007 and December 2014, 1,291 patients undergoing TAVI with a CoreValve/Evolut valve met the enrolment criteria of the study. After a median follow-up of 59.4 months, there were 46 patients with SVD (cumulative incidence rate 3.6%). A significant stepwise increase in the risk of SVD was apparent across tertiles of ERMPG (p=0.009), and in the multivariable analysis, ERMPG was an independent predictor of SVD (adjusted subdistribution hazard ratio [sHR] 1.05, 95% confidence interval [CI]: 1.01-1.08; p=0.004). Among the 46 patients with SVD, 25 (54.3%) had or developed BVF. SVD was associated with increased 10-year rates of all-cause mortality (adjusted hazard ratio 2.12, 95% CI: 1.49-3.00; p<0.001) and cardiac mortality (adjusted sHR 5.78, 95% CI: 2.63-12.71; p<0.001) compared with no SVD. CONCLUSIONS: Echo-Doppler-derived ERMPG measured within 90 days from TAVI is an independent predictor of SVD. SVD is associated with high rates of BVF, and it is an independent predictor of all-cause mortality and cardiovascular mortality.
McGarvey M, Silva K, Keeble TR
… +11 more, Johnson TW, O'Kane P, Ali ZA, Tu S, Kalra S, Perera D, MacCarthy P, Hill JM, Byrne J, Dworakowski R, Pareek N
EuroIntervention
· 2026 Jan · PMID 41549684
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Intracoronary (IC) imaging-guided percutaneous coronary intervention (PCI) improves clinical outcomes in patients with high clinical and anatomical risk when compared to interventions guided by angiography alone. Recent...Intracoronary (IC) imaging-guided percutaneous coronary intervention (PCI) improves clinical outcomes in patients with high clinical and anatomical risk when compared to interventions guided by angiography alone. Recent Class I recommendations for the use of IC imaging guidance when performing PCI in left main stem or complex lesions may result in a significant uptake as the technology is embraced as standard of care. Routine application of IC imaging will provide interventional cardiologists with a wealth of high-fidelity intracoronary data on plaque composition and distribution. When paired with emerging data regarding the importance of plaque anatomical characteristics, developments in artificial intelligence and computational fluid dynamics, lesion stratification with IC imaging may herald the next paradigm shift in this field. In this review, we will explore this important emerging application of IC imaging to inform morphology-guided PCI, identify high-risk lesions for targeted therapies, and consider the prospects of harnessing automated image interpretation with artificial intelligence technologies to achieve an integrated physiological and morphological assessment. Lesion stratification with IC imaging has the potential to shape the future of interventional cardiology practice to guide therapies within and beyond the confines of the cardiac catheterisation laboratory.
Galea R, La Fazia VM, Della Rocca DG
… +13 more, Gasys A, Bini T, Siontis GCM, Gianni C, Roten L, Mohanty S, Brugger N, Torlapati PG, Horton R, Al-Ahmad A, Biase LD, Natale A, Räber L
EuroIntervention
· 2025 Dec · PMID 41489742
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BACKGROUND: Evidence supporting the clinical superiority of the Watchman FLX with respect to its previous iteration, the Watchman 2.5, is still sparse. AIMS: We aimed to compare the Watchman FLX and Watchman 2.5 in terms...BACKGROUND: Evidence supporting the clinical superiority of the Watchman FLX with respect to its previous iteration, the Watchman 2.5, is still sparse. AIMS: We aimed to compare the Watchman FLX and Watchman 2.5 in terms of device-related complications and clinical outcomes. METHODS: All consecutive left atrial appendage closures (LAACs) completed with implantation of a Watchman device at two high-volume centres between July 2018 and January 2023 were considered. Based on the type of implanted device, patients were assigned to either the Watchman FLX or Watchman 2.5 group. The study endpoints included device-related thrombus (DRT) and peridevice leak (PDL), as evaluated by transoesophageal echocardiography (TOE), and stroke rate at the longest available follow-up. Propensity score matching (PSM) analysis was used to minimise baseline differences between groups. RESULTS: After performing PSM, 1,128 patients were included in each group. In the TOE follow-up, performed at a mean of 2.3 months, both DRT (0.2% vs 3.1%; hazard ratio [HR] 0.35, 95% confidence interval [CI]: 0.21-0.38; p=0.017) and PDL (21.0% vs 30.6%; HR 0.68, 95% CI: 0.59-0.77; p=0.031) were significantly lower in the Watchman FLX group compared with the Watchman 2.5 group. At a mean of 1.6 years of follow-up, the stroke rate was numerically lower in the Watchman FLX group compared with the Watchman 2.5 group (3.4% vs 5.1%; HR 0.56, 95% CI: 0.15-1.69; p=0.078). CONCLUSIONS: In a large dual-centre cohort of consecutive, successful LAAC procedures using two iterations of the Watchman device, the Watchman FLX was associated with significantly lower rates of both DRT and PDL compared to the Watchman 2.5.
Alvarez-Covarrubias HA, Taniguchi Y, Jurisic M
… +12 more, Altaner N, Syryca F, Blum E, Pellegrini C, Duesmann C, Mayr NP, Rheude T, Schunkert H, Kastrati A, Cassese S, Xhepa E, Joner M
EuroIntervention
· 2025 Dec · PMID 41489738
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BACKGROUND: Transcatheter heart valve (THV) deformation after transcatheter aortic valve implantation (TAVI) using the self-expanding ACURATE platform has been associated with impaired clinical outcomes in a randomised t...BACKGROUND: Transcatheter heart valve (THV) deformation after transcatheter aortic valve implantation (TAVI) using the self-expanding ACURATE platform has been associated with impaired clinical outcomes in a randomised trial. Procedural factors associated with THV deformation remain incompletely understood. AIMS: We aimed to investigate procedural factors associated with valve underexpansion, mainly derived from preprocedural computed tomography angiography (CTA) imaging. METHODS: A single-centre, retrospective, observational study was carried out, including patients who underwent TAVI with an ACURATE THV between January 2014 and December 2022, with available CTA and procedural fluoroscopy. Aortic calcium volume was quantified using 3mensio software. Fluoroscopy was used to determine valve frame underexpansion. RESULTS: Of 3,027 patients, 480 were eligible (74 [15.4%] with an underexpanded and 406 [84.6%] with an expanded ACURATE THV). There were no differences regarding baseline clinical and procedural characteristics. Preprocedural CTA assessment showed more calcium at the annulus level in underexpanded versus expanded THVs (60.3 [interquartile range [IQR] 21.3; 135.2] mm vs 45.3 [IQR 15.8; 96.1] mm, respectively; p=0.042), while post-dilatation was less frequently performed in underexpanded compared to expanded THVs (44.6% vs 64.8%, respectively; p=0.001). Multivariable regression analysis revealed that annulus calcium volume (odds ratio [OR] 2.333, 95% confidence interval [CI]: 1.331-4.089; p=0.003) and post-dilatation (OR 0.350, 95% CI: 0.203-0.602; p<0.001) were significantly associated with underexpanded THVs. Sensitivity analysis using annulus calcium volume as a dichotomised variable (>54 mm) confirmed the significant association with valve frame underexpansion (OR 2.38, 95% CI: 1.37-4.19; p=0.002). CONCLUSIONS: Annular calcium volume was shown to be associated with underexpanded ACURATE THVs, while post-dilatation may reduce valve deformation.
Rodés-Cabau J, Mengi S, Salaun E
… +2 more, Paradis JM, Abraham WT
EuroIntervention
· 2025 Dec · PMID 41489737
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Secondary mitral regurgitation (SMR) is frequent among patients with heart failure (HF) with reduced ejection fraction (HFrEF), and it is strongly associated with increased mortality, frequent hospitalisations, and poor...Secondary mitral regurgitation (SMR) is frequent among patients with heart failure (HF) with reduced ejection fraction (HFrEF), and it is strongly associated with increased mortality, frequent hospitalisations, and poor quality of life. The mechanisms underlying SMR are multifactorial. While guideline-directed medical therapy and cardiac resynchronisation therapy remain the cornerstone of HFrEF management, many patients with significant SMR continue to experience significant symptoms and adverse outcomes. Managing SMR within the context of HF necessitates a multifaceted approach. Transcatheter edge-to-edge repair (TEER) has emerged as a transformative intervention, demonstrating improvements in survival, functional capacity, and HF-related hospitalisations in clinical trials and real-world registries in selected patients. This review provides a comprehensive overview of the evidence supporting TEER, focusing on procedural and follow-up outcomes, and its role in reshaping the therapeutic approach for HF patients with SMR. Additionally, we highlight the critical role of patient selection and identify predictors of poor outcomes as key determinants of TEER success.
Rahoual G, Procopi N, Beaupré F
… +11 more, Michon M, Martinez C, Guedeney P, Hammoudi N, Hatem S, Vicaut E, Kerneis M, Silvain J, Montalescot G, Zeitouni M, Of The Action Study Group OB
EuroIntervention
· 2025 Dec · PMID 41489736
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Zientara A, Brizzi F, von Zur Mühlen C
… +14 more, Bruijnen H, Kreibich M, Berger T, Kondov S, Siepe M, Rylski B, Benk J, Beyersdorf F, Rilinger J, Maier A, Oettinger V, Westermann D, Czerny M, Gottardi R
EuroIntervention
· 2025 Dec · PMID 41489735
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BACKGROUND: Despite excellent long-term results, patients who have undergone valve-sparing root repair (VSRR) or a Bio-Bentall procedure may require a future secondary valve-related intervention. AIMS: We aimed to assess...BACKGROUND: Despite excellent long-term results, patients who have undergone valve-sparing root repair (VSRR) or a Bio-Bentall procedure may require a future secondary valve-related intervention. AIMS: We aimed to assess the feasibility of transcatheter valve-in-root procedures in patients who have previously undergone either a VSRR or a root replacement with a Bio-Bentall, in anticipation of lifetime management. METHODS: Between 2012 and 2022, 537 patients underwent a VSRR or a Bio-Bentall procedure in our institution. In 363 patients, a postoperative computed tomography angiography was available (VSRR n=250; Bio-Bentall n=113) to evaluate the feasibility of a transcatheter valve-in-root implantation. Annulus area, annulus-to-coronary distance, coronary ostium size, and the valve-to-coronary distance (VTC) were measured using dedicated software. RESULTS: After VSRR, 4.8% of patients had an annulus area over 840 mm, thus being unsuitable for a valve-in-root procedure. In 12.4% of cases after a Bio-Bentall procedure, the annulus area was below 300 mm, which complicates valve-in-root implantation due to potential patient-prosthesis mismatch. The annulus-to-coronary distance for both coronary arteries was significantly higher after VSRR compared to Bio-Bentall (right coronary artery: 18.0±5.8 mm vs 12.5±5.4 mm; p<0.001; left coronary artery [LCA]: 11.6±4.6 mm vs 8.0±4.5 mm; p<0.001). Out of a total of 98 coronary ostia located below the upper frame level, 63.3% had a VTC below 4 mm. The VTC to the LCA was significantly larger after Bio-Bentall with a Valsalva graft, with a median of 4.95 (interquartile range [IQR] 4.2-5.9) mm compared with 3.1 (IQR 2.3-4.2) mm (p<0.001) in patients who had a straight graft implanted. CONCLUSIONS: The feasibility of a future transcatheter valve-in-root procedure depends on the anatomical conditions of the aortic root after the initial operation. A high reimplantation of coronary ostia, the choice of the vascular graft, and a foresighted valve sizing may facilitate a future transcatheter valve-in-root implantation.
Lee YJ, Kim Y, Lee OH
… +29 more, Cho DK, Lee SH, Lee SJ, Lee JY, Kim JW, Kim SM, Hur SH, Heo JH, Jang JY, Koh JS, Won H, Lee JW, Hong SJ, Kim DK, Choe JC, Lee JB, Yang TH, Lee JH, Hong YJ, Ahn JH, Hong SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y, Kim BK, Occupi Investigators OBOT
EuroIntervention
· 2025 Nov · PMID 41489717
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BACKGROUND: The role of optical coherence tomography (OCT) guidance during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains inconclusive. AIMS: This study aimed to evaluate...BACKGROUND: The role of optical coherence tomography (OCT) guidance during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains inconclusive. AIMS: This study aimed to evaluate the impact of OCT-guided PCI in ACS patients with complex lesions. METHODS: The Optical CoherenCe Tomography-gUided Coronary Intervention in Patients With Complex Lesions (OCCUPI) Trial compared PCI with OCT guidance versus angiography guidance in patients who required drug-eluting stent implantation for complex lesions. This post hoc analysis focused on participants presenting with ACS. The primary outcome was 1-year major adverse cardiac events (a composite of cardiac death, myocardial infarction, stent thrombosis, or ischaemia-driven target vessel revascularisation). RESULTS: Out of 1,604 randomised patients, 790 (49.3%) and 814 (50.7%) presented with ACS and chronic coronary syndrome (CCS), respectively. Among patients with ACS, the incidence of the primary outcome was 4.9% in the OCT-guided group and 9.5% in the angiography-guided group (hazard ratio [HR] 0.50, 95% confidence interval [CI]: 0.29-0.87; p=0.011). Among patients with CCS, its incidence was 4.4% and 5.4%, respectively (HR 0.80, 95% CI: 0.43-1.50; p=0.479). No significant interaction between clinical presentation and imaging guidance strategy was observed for the primary outcome (p=0.273). Among patients with ACS randomised to OCT guidance, the achievement of stent optimisation by OCT was associated with a lower incidence of the primary outcome compared with suboptimisation (2.9% vs 9.7%; HR 0.29, 95% CI: 0.12-0.72; p=0.004). CONCLUSIONS: In ACS patients with complex lesions, OCT-guided PCI demonstrated an evident cardiovascular benefit over angiography-guided PCI, a finding endorsed by current guidelines. (ClinicalTrials.gov: NCT03625908).
Schmieder RE, Mahfoud F, Mancia G
… +7 more, Townsend RR, Kandzari DE, Kario K, Bhatt DL, Whitbourn R, Liu M, Böhm M
EuroIntervention
· 2025 Nov · PMID 41489714
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BACKGROUND: Renal denervation (RDN) is a guideline-recommended treatment to reduce blood pressure (BP) in patients with uncontrolled hypertension. However, it is unclear if there are patient characteristics that are pred...BACKGROUND: Renal denervation (RDN) is a guideline-recommended treatment to reduce blood pressure (BP) in patients with uncontrolled hypertension. However, it is unclear if there are patient characteristics that are predictive of greater BP reduction. Baseline systolic blood pressure (SBP) has consistently been identified as an indicator of BP reduction after RDN. AIMS: Our study aimed to quantify the expected SBP change after RDN based on baseline SBP. METHODS: Patients undergoing radiofrequency RDN were pooled from multiple clinical studies, including SPYRAL First-In-Human (n=50), SYMPLICITY HTN-3 (n=364), SYMPLICITY HTN-Japan (n=22), SPYRAL HTN ON-MED (n=206), and the Global SYMPLICITY Registry DEFINE (n=2,735). Office and 24-hour ambulatory BP were measured at baseline and 6 months. Linear regression modelled patient-level 6-month SBP changes against baseline SBP. RESULTS: The pooled cohort (N=3,377) had a mean age of 60±12 years, and 41% were female. Baseline office SBP (OSBP) and 24h ambulatory SBP (ASBP) were 171.8±20.5 mmHg and 155.9±17.3 mmHg, respectively. At 6 months, OSBP and 24h ASBP decreased by 16.3±24.0 and 7.5±16.7 mmHg, respectively. Patients were prescribed 4.4±1.5 antihypertensive drug classes at baseline and 4.3±1.5 at 6 months (p<0.0001). Higher baseline SBP correlated with greater SBP reductions (p<0.0001; r=0.21 for OSBP; r=0.13 for ASBP). Baseline OSBP of 150, 160, 170, and 180 mmHg were associated with 6-month reductions of 4.2, 9.8, 15.4, and 21.0 mmHg, respectively. CONCLUSIONS: Baseline SBP was associated with 6-month SBP reductions after RDN in hypertensive patients. This relationship provides guidance for shared patient-clinician decision-making about what BP change to expect following radiofrequency RDN based on baseline SBP alone.