BACKGROUND: The management of severe tricuspid regurgitation (TR) remains challenging. Although several promising transcatheter devices have been developed, procedural complexity and the need for special imaging techniqu...BACKGROUND: The management of severe tricuspid regurgitation (TR) remains challenging. Although several promising transcatheter devices have been developed, procedural complexity and the need for special imaging techniques are hurdles to their widespread clinical application. AIMS: The study aimed to evaluate the safety and efficacy of a novel atraumatic vertical spacer, Pivot-Bridge, for severe TR. METHODS: Patients with severe TR who were considered surgical candidates were enrolled. All procedures were guided by fluoroscopy and transthoracic echocardiography (TTE). Baseline characteristics, serious adverse events, and functional status were collected. TTE and cardiac computed tomography (CT) were serially performed for evaluation of TR and right ventricular (RV) remodeling. RESULTS: Fifteen patients (68 ± 11 years old, 27% women) were enrolled. Procedural success was achieved in all patients (the mean procedural time of 47 ± 24 min). During the device implantation (median 5 days), no serious adverse events occurred. TR was reduced by one grade or more in all patients. In TTE, vena contracta width and effective regurgitant orifice area significantly decreased by Pivot-Bridge (1.6 ± 0.8 to 0.8 ± 0.3 mm; p < 0.001 and 1.2 ± 0.5 to 0.6 ± 0.3 cm; p < 0.001). RV end diastolic volume also significantly reduced at follow-up CT (320.2 ± 93.7 to 294.4 ± 81.1 mm; p = 0.026). Ten patients underwent surgery with removal of the device, and five patients were stabilized by medical treatment, in whom the Pivot-Bridge was removed percutaneously. CONCLUSIONS: The Pivot-Bridge was safe and effective in patients with severe TR. TR reduction was observed in all patients without periprocedural complications or adverse cardiovascular events during device placement. REGISTRATION: ClinicalTrials.gov number: NCT05854095.
Acute postoperative bioprosthetic valve thrombosis is a rare complication with challenging treatment. We present two consecutive cases of patients with myocardial infarction and papillary muscle rupture requiring urgent...Acute postoperative bioprosthetic valve thrombosis is a rare complication with challenging treatment. We present two consecutive cases of patients with myocardial infarction and papillary muscle rupture requiring urgent surgical mitral valve replacement and venoarterial extracorporeal membrane oxygenation support. Both patients developed early postoperative bioprosthetic mitral valve thrombosis and were successfully treated with emergent transcatheter valve-in-valve replacement.
Mitral stenosis (MS) is still a significant cause of cardiovascular morbidity and mortality in low- and middle-income countries, despite being nearly eradicated in the developed world. Percutaneous balloon mitral valvulo...Mitral stenosis (MS) is still a significant cause of cardiovascular morbidity and mortality in low- and middle-income countries, despite being nearly eradicated in the developed world. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for appropriate patients with MS, but traditional predictors such as mitral valve area and regurgitation grade fail to fully reflect long-term prognosis. This review aims to analyze pre- and post-PBMV hemodynamic changes in the left atrium and determine their prognostic significance in predicting clinical outcomes in patients with MS. This meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251017356). PubMed, Scopus, and Web of Science were searched on March 23, 2025, for studies on adults ≥ 18 years with isolated MS undergoing PBMV. Eligible studies reported both pre- and post-procedure valve and hemodynamic parameters. Primary outcomes included mitral valve area, mean gradient, and left atrial indices. Pooled analyses were conducted in R (v 4.5.1). This meta-analysis included the outcomes of PBMV by comparing pre- and post-procedural data from 30 studies consisting of 2239 participants. Post-PBMV outcomes revealed a significant increase in mitral valve area (MD 0.8834, 95% CI: 0.80; 0.96, p < 0.0001), cardiac output (MD 0.70, 95% CI: 0.58; 0.81, p < 0.0001), and alongside significant reductions in left atrial diameter (MD -4.47; 95% CI: -6.23 to -2.71, p < 0.0001), left atrial pressure (MD -9.51, 95% CI: -11.19; -7.84, p < 0.0001), mitral valve pressure (MD -8.58, 95% CI: -9.41; -7.74, p < 0.0001), and systolic pulmonary pressure (MD -17.96, 95% CI: -21.48; -14.45, p < 0.0001). Out of 2239 patients, 71, 37, and 32 had valve replacement, PBMV repetition, and experienced death, respectively. PBMV showed promising effectiveness and safety in treating patients with MS with a significant increase in cardiac output and MV area and a significant decrease in LA diameter, LA pressure, MV pressure, and systolic pulmonary pressure post-PBMV, while observing low adverse events.
BACKGROUND: Excimer laser coronary angioplasty (ELCA) is used in complex percutaneous coronary intervention (PCI). ELCA-related coronary artery perforation (CAP) is uncommon, and its long-term outcomes remain poorly defi...BACKGROUND: Excimer laser coronary angioplasty (ELCA) is used in complex percutaneous coronary intervention (PCI). ELCA-related coronary artery perforation (CAP) is uncommon, and its long-term outcomes remain poorly defined. AIM: The aim of this study was to characterize the long-term clinical and angiographic course of ELCA-related CAP. METHODS: We retrospectively reviewed 1023 consecutive ELCA-assisted PCI procedures. CAP incidence was assessed, and the clinical and procedural features of CAP and non-CAP cases were compared. The predictors of CAP were explored using univariable logistic regression analysis. All patients with CAP underwent follow-up angiography, and CAP was graded using the Ellis criteria. Pseudoaneurysm (PsA)-defined as a contrast-filled outpouching with delayed washout-was confirmed using intravascular ultrasound/optical coherence tomography. RESULTS: CAP occurred in 10/1023 procedures (1.0%). Baseline characteristics, including age, sex, and acute coronary syndrome presentation, were similar between the groups. ELCA catheter sizes and nominal laser settings were also comparable. Bifurcation lesions were more frequent in patients with CAP than in those without CAP (8/10 [80.0%] vs. 335/1013 [32.8%]; p = 0.002). Diabetes mellitus was also more common (7/10 [70.0%] vs. 376/1013 [37.1%]; p = 0.033). No in-hospital deaths were observed in the CAP group. At the index event, 6/10 CAP cases received a covered stent (CS) and 4/10 did not. On follow-up angiography (median 65 days; range 11-790 days), PsA was present in 4/4 non-CS patients and 0/6 CS patients. CONCLUSIONS: CAP occurred in 1.0% of patients, and PsA developed in every non-CS case. These findings support planned follow-up imaging for selected ELCA-related perforations.
Pulmonary artery pseudoaneurysm (PAP) is a rare but potentially life-threatening condition that can arise secondary to infections, including COVID-19. Early recognition and timely intervention are crucial to prevent comp...Pulmonary artery pseudoaneurysm (PAP) is a rare but potentially life-threatening condition that can arise secondary to infections, including COVID-19. Early recognition and timely intervention are crucial to prevent complications. We describe a 41-year-old woman with type 2 diabetes who presented with hemoptysis and persistent dry cough 2 months after recovering from COVID-19 pneumonitis. Computed tomography angiography revealed a 2.3 cm pseudoaneurysm in the right lower lobe pulmonary artery, associated with a cavitary lesion. Selective angiography confirmed a 25 mm PAP. Owing to its wide neck, coil or glue embolization was considered unsuitable. A 10-mm muscular-type Amplatzer ventricular septal occluder was successfully deployed, achieving complete exclusion of the pseudoaneurysm while maintaining distal arterial flow. The patient remained free of hemoptysis, and follow-up imaging demonstrated effective occlusion with a small residual sac. PAP should be considered in COVID-19 survivors presenting with hemoptysis. Endovascular closure using Amplatzer devices offers a safe and effective treatment, particularly for large or wide-necked pseudoaneurysms where coil or glue embolization techniques may be inadequate.
Emergency surgery is the gold standard for acute mitral insufficiency complicated by cardiogenic shock, but it is burdened by a high perioperative risk. The evidence on the potential benefit of emergency mitral transcath...Emergency surgery is the gold standard for acute mitral insufficiency complicated by cardiogenic shock, but it is burdened by a high perioperative risk. The evidence on the potential benefit of emergency mitral transcatheter edge-to-edge repair (M-TEER) in the acute setting is lacking. We describe the successful emergency M-TEER in a 80 years old patient with a highly complex anatomy, as a bridge to surgery, in the setting of cardiogenic shock due to acute severe mitral and tricuspid regurgitation. M-TEER as a bridge to surgery could be considered to decrease perioperative risk in selected patients and enlarged to acute settings even under unfavorable anatomical conditions.
Holck EN, Vadalá G, Ayoub M
… +19 more, Gorgulu S, Avran A, Werner GS, Mashayekhi K, Kalay N, Goktekin O, Wojcik J, Zaczkiewicz M, Garbo R, Arenz J, Dalibor J, Schölzel B, Boudou N, Behnes M, Agostoni P, Mario CD, Diletti R, Guitiérrez-Chico JL, Christiansen EH
Catheter Cardiovasc Interv
· 2026 May · PMID 41878935
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BACKGROUND: Long-term outcome in patients with chronic total occlusions (CTO) depends on the target vessel and proximity of the lesion. AIMS: To investigate of the target vessel was associated with procedural efficacy an...BACKGROUND: Long-term outcome in patients with chronic total occlusions (CTO) depends on the target vessel and proximity of the lesion. AIMS: To investigate of the target vessel was associated with procedural efficacy and safety in patients with proximal CTO lesions. METHODS: Patients treated for a CTO lesion in the European CTO registry (ERCTO) between January 1, 2021, and December 31, 2023, were included in the study. Patients were categorized based on the treated vessel and the proximity of the lesion. The outcome was compared between proximal lesions in the three native vessels. The co-primary endpoints were procedural success and 30-day safety. Procedural success was defined as technical success without in-hospital major adverse cardiac events. RESULTS: A total of 14,744 patients were screened, and 7128 were included in the analysis of proximal CTO PCI. Technical success rates proximal in the three native vessel territories were 91.0% (left anterior descending [LAD]), 92.1% (left circumflex [LCX]), and 88.5% (right coronary artery [RCA]). In the adjusted analysis, the probability of procedural success was higher for LCX compared to RCA, but not for the LAD (OR (95% CI): LCX: 1.35, (1.05-1.75); LAD: 1.06 [0.86-1.31]). The adjusted 30-day safety was better in the LAD, but not LCX, compared with RCA (LAD: OR 0.69, 95% CI: 0.50; 0.94, LCX: OR 0.77, 95% CI 0.54; 1.09). CONCLUSIONS: Modern CTO PCI for proximal lesions generally yields a very high success rate. The procedure tends to be more successful in the LAD and LCX territories compared to the RCA, with LAD lesion treatment being the safest option.
BACKGROUND: Hereditary antithrombin III (AT III) deficiency is a rare thrombophilic disorder that may cause resistance to systemic thrombolytic therapy. We report a case of massive iliofemoral deep-vein thrombosis (DVT)...BACKGROUND: Hereditary antithrombin III (AT III) deficiency is a rare thrombophilic disorder that may cause resistance to systemic thrombolytic therapy. We report a case of massive iliofemoral deep-vein thrombosis (DVT) with high-risk pulmonary thromboembolism (PTE) refractory to systemic thrombolysis, successfully treated with catheter-directed thrombolysis (CDT). CASE SUMMARY: A previously healthy 33-year-old man presented with dyspnoea and left-leg swelling. Imaging revealed bilateral pulmonary-artery thrombi with acute right-ventricular failure and extensive iliofemoral DVT. Despite systemic alteplase infusion, thrombus resolution was incomplete, and hereditary AT III deficiency (53% activity) was diagnosed. CDT via the right femoral vein was performed using alteplase (0.02 mg/kg/h for 48 h), achieving near-complete thrombus resolution and restoration of venous flow without bleeding complications. DISCUSSION: This case highlights systemic thrombolysis failure associated with AT III deficiency and demonstrates that CDT can serve as an effective, low-bleeding-risk rescue therapy for extensive DVT when systemic treatment is inadequate. These findings underscore the importance of early recognition of AT III deficiency and consideration of catheter-based intervention in similar high-risk settings.
BACKGROUND: Angina, ischemia, or myocardial infarction without non-obstructive coronary arteries (ANOCA, INOCA, or MINOCA) are common conditions yet often underdiagnosed. Invasive coronary function testing (CFT), which i...BACKGROUND: Angina, ischemia, or myocardial infarction without non-obstructive coronary arteries (ANOCA, INOCA, or MINOCA) are common conditions yet often underdiagnosed. Invasive coronary function testing (CFT), which includes coronary thermodilution and coronary reactivity testing, can provide accurate diagnoses and improve patient outcomes. AIMS: This study describes the diagnostic yield of an invasive CFT program at a single tertiary care center and presents the findings of coronary thermodilution and coronary reactivity testing in the first 104 patients from 2021 to 2025. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent invasive CFT. Descriptive statistics summarized patient characteristics, diagnostic outcomes, and changes in management following invasive CFT. RESULTS: One hundred and four patients (mean age 61.6 ± 10.5 years; 48.1% female) included patients tested ad hoc during an index coronary angiogram (n = 23) or during a scheduled functional assessment (n = 81). Testing indications were post-revascularization angina (39%), ANOCA (35%), INOCA (14%), MINOCA (6%), or heart transplant (5%). Invasive CFT consisted of thermodilution-based coronary flow reserve only (35%), coronary reactivity testing only (10%), or both (55%). A definitive diagnosis was achieved in 74 of 104 patients (71.2%). Of these, 28 (27%) were diagnosed with epicardial coronary spasm, 9 (9%) with microvascular spasm, 6 (6%) with endothelial dysfunction, 13 (13%) with CMD, and 18 (17%) with a mixed phenotype. Management changes occurred in 76 of 104 (73%) patients, primarily through the adjustment of antianginal therapy. Nitrates, calcium channel blockers, and β-blockers were modified in 52%, 51%, and 52% of patients, respectively. The association of CFR values derived from PET and by Thermodilution demonstrated a fair overall agreement (k = 0.39, 95% CI 0.09-0.68). Dose-response to acetylcholine (2-200 ucg) showed that diagnostic criteria were achieved with the 100 mcg dose in most participants. Invasive CFT was safe with only two safety events recorded. CONCLUSIONS: An invasive CFT program was safely implemented, demonstrating high diagnostic yield and an association with frequent changes in anti-anginal therapy of patients with non-obstructive coronary artery disease.
Crivelaro PCF, Hastenteufel L, Machado GP
… +6 more, Fuchs F, Pinotti A, Wainstein MV, Clausell N, Goldraich LA, Valle FH
Catheter Cardiovasc Interv
· 2026 May · PMID 41869991
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BACKGROUND: Advanced heart failure (HF) remains a clinical challenge, and mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a potential bridging strategy. AIMS: To describe the clinical outcomes of M-TEER...BACKGROUND: Advanced heart failure (HF) remains a clinical challenge, and mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a potential bridging strategy. AIMS: To describe the clinical outcomes of M-TEER in a single-center cohort of patients with advanced HF and to identify anatomical and clinical features potentially associated with increased procedural complexity. METHODS: This retrospective case series included 13 consecutive patients with advanced HF and moderate-to-severe or severe mitral regurgitation (MR) who underwent M-TEER using the MitraClip system. Clinical, echocardiographic, and hemodynamic data were analyzed. RESULTS: The median age was 58 years (range 39-64), and the median EuroSCORE II was 10.4% (3.86-15.07). All patients had reduced left ventricular (LV) ejection fraction (median 22%) and enlarged LV dimensions (end-systolic diameter > 70 mm in 38%). The mean tenting height was 15.4 ± 2.5 mm. Five patients (38.4%) required continuous inotropic support. Procedural success was achieved in all cases, with no periprocedural or 30-day mortality. Over a median follow-up of 287 days (171-483), four patients (30.7%) died, one (7.6%) underwent urgent heart transplantation, and two (15.3%) had elective transplantation. Four of five patients on inotropes (80%) were weaned off support. At 1 year, 61.5% of patients remained free from the composite endpoint of death, HF hospitalization, urgent transplant, or LV assist device implantation. CONCLUSIONS: M-TEER was feasible and safe in selected patients with advanced HF. This cohort presented anatomical and clinical features that may have contributed to greater procedural complexity.
BACKGROUND: Bilateral superior vena cava (BilSVC) is common in sinus venosus defects (SVD) and can impact transcatheter closure (TCC) as venacaval diameter is smaller. METHODS: Between 2015 and 2025, baseline characteris...BACKGROUND: Bilateral superior vena cava (BilSVC) is common in sinus venosus defects (SVD) and can impact transcatheter closure (TCC) as venacaval diameter is smaller. METHODS: Between 2015 and 2025, baseline characteristics, post-interrogation feasibility, procedural details, and outcomes of 33 BilSVC cases were compared with 122 single SVC controls after TCC. The interrogation balloon was 4 mm larger than the venacaval diameter in controls but matched the SVD edge-to-right atrial appendage distance measured on computed tomography in BilSVC. Children required > 16 mm stents among controls, whereas smaller diameters were allowed in BilSVC. RESULTS: Feasibility post-interrogation was 87.8% in controls and 80.5% in cases; the first chosen balloon was appropriate in 68.9% and 45.5%, respectively. While the balloon was downsized in 18.9% controls, 42.4% cases needed upsizing. Success was 96.7% in controls (four embolizations) and 100% in cases. Stent diameter variation between upper and lower ends was less in controls (0.81%) than in cases (0.63%). Stent overlaps successfully managed instability observed in 9% controls and 21.2% cases. After the stenting, a small, insignificant residual shunt was noted in 66.1% controls and 42.4% cases. During a median follow-up of 27 months (1-113 months), asymptomatic stent thrombi were identified in 4.3% of controls and 15.2% of cases and were treated medically. Reintervention rates for residual shunt were similar. CONCLUSIONS: Post-interrogation feasibility was lower in BilSVC, with frequent balloon upsizing despite imaging predictions. Tapered stent diameters caused instability in BilSVC, even with a long SVC anchor. Residual leak was lower, but thrombosis rates were higher, impacting thromboprophylaxis.
Major procedural complications are an unavoidable feature of interventional cardiology and often represent pivotal inflection points in an operator's professional development. Beyond their immediate clinical consequences...Major procedural complications are an unavoidable feature of interventional cardiology and often represent pivotal inflection points in an operator's professional development. Beyond their immediate clinical consequences, these events can profoundly influence confidence, judgment, risk tolerance, and subsequent technical growth. Whether complications stimulate learning or precipitate persistent distress depends largely on how they are interpreted, discussed, and supported. This review examines the emotional and cognitive responses of interventional cardiologists following major procedural complications. We explore how cognitive bias, cognitive heuristics, perfectionism, moral injury, and threats to professional identity shape recovery, decision-making, and future procedural behavior. These forces may foster adaptive learning or drive maladaptive responses, including rumination, self-doubt, withdrawal, and risk aversion. Drawing on evidence from cognitive psychology, aviation safety, and established peer-support frameworks, we outline practical strategies to transform complications into opportunities for emotional and technical growth. Institutional approaches include psychologically safe debriefing, process-focused morbidity and mortality conferences, peer-support programs, leadership development, and accessible mental health resources. Individual strategies such as internal validation, narrative reframing, patient reconnection, mentorship, and structured reflective practice help restore confidence, preserve moral integrity, and reinforce professional identity by explicitly separating decision quality from outcomes. Supporting operator recovery after procedural complications is not ancillary to patient care; it is foundational to sustained technical excellence, sound clinical judgment, and compassionate practice. Integrating structured, stigma-free recovery pathways into interventional training and institutional culture should be recognized as a core component of patient safety and professional sustainability.
Mechanical circulatory support (MCS) devices can be helpful to maintain hemodynamic stability during high-risk percutaneous coronary intervention (PCI). Iliofemoral arterial disease limits the use of transfemoral MCS dev...Mechanical circulatory support (MCS) devices can be helpful to maintain hemodynamic stability during high-risk percutaneous coronary intervention (PCI). Iliofemoral arterial disease limits the use of transfemoral MCS devices. Impella 5.5, a surgical transaxillary MCS device, represents a viable option for MCS-protected PCI. We report a 74-year-old man with prior endovascular aneurysm repair (EVAR), severe peripheral artery disease (PAD), and newly diagnosed NSTEMI was found to have three-vessel and left main coronary disease with an ejection fraction (EF) of 13%. Due to aortoiliac occlusion, transfemoral MCS was not feasible. Instead, an Impella 5.5 was implanted via a right axillary artery graft, enabling successful orbital atherectomy and bifurcation PCI. In summary, axillary Impella 5.5 insertion is a viable option in anatomically complex patients where femoral access is contraindicated. This approach allows full left ventricular hemodynamic support for revascularization in otherwise inoperable patients.
Transcatheter edge-to-edge repair (TEER) has emerged as a prominent therapeutic approach for mitral regurgitation (MR) in recent years. For commissural, a higher grade of MR would be detected post-TEER compared to it dur...Transcatheter edge-to-edge repair (TEER) has emerged as a prominent therapeutic approach for mitral regurgitation (MR) in recent years. For commissural, a higher grade of MR would be detected post-TEER compared to it during the procedure, while the mechanism hasn't been elucidated yet. Two patients with commissural MR underwent TEER at our center. Through these cases, we identifies and names a novel phenomenon ("small orifice regurgitation increasing" ["SORI"]) in TEER procedures, providing key insights to better understand and prevent residual commissural MR.
BACKGROUND: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide, and catheter ablation has been established as an effective treatment modality. The outcomes can vary based on medical expertise and the loc...BACKGROUND: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide, and catheter ablation has been established as an effective treatment modality. The outcomes can vary based on medical expertise and the location of the procedure. This study evaluates the differences in outcomes of catheter ablation performed at non-academic compared to academic institutions. AIMS: To compare the outcomes of atrial fibrillation procedures executed in non-academic versus academic centers. METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Adults (35-90 years) who underwent AF ablation between January 1, 2010, and January 1, 2020, were included. Those with congenital malformations of circulatory system, rheumatic heart disease, ischemic cardiomyopathy, or prior myocardial infarction (MI) were excluded. Groups were stratified by hospital academic status and balanced using 1:1 propensity score matching. Outcomes were assessed within 365 days post-ablation. Patients with outcome prior to the time window were excluded, and the odds ratio was used for statistical comparisons with significance set at p < 0.05. RESULTS: Following propensity score matching, the analysis revealed that patients undergoing AF ablation at non-academic institutions had significantly higher odds of requiring additional or redo ablation (OR: 1.844; 95% CI: 1.409-2.415) and developing acute kidney injury (OR: 1.534; 95% CI: 1.054-2.232) compared to those treated at academic institutions. Other post-ablation complications, including cardiac arrest (OR: 1.101; 95% CI: 0.466-2.599), cardiac tamponade (OR: 1.101; 95% CI: 0.466-2.599), esophageal perforation (OR: 1.000; 95% CI: 0.415-2.409), and hemorrhages or hematomas (OR: 0.909; 95% CI: 0.385-2.145), did not differ significantly between the two groups. CONCLUSION: Catheter ablation of AF performed at academic hospitals resulted in better outcomes, potentially reflecting advanced technical expertise, post-op care, and better institutional resources. These results highlight the importance of standardization of care and the need for increased access of high-standard care across healthcare settings. Future studies should investigate modifiable institutional factors and patient-level variables driving this disparity.
Long lower-extremity chronic total occlusions (CTOs) often require subintimal passage, and controlled true-lumen crossing can be challenging, particularly when (1) the distal true lumen is reached, but part of the CTO is...Long lower-extremity chronic total occlusions (CTOs) often require subintimal passage, and controlled true-lumen crossing can be challenging, particularly when (1) the distal true lumen is reached, but part of the CTO is subintimal or (2) the first wire stalls subintimally without distal access. We report 2 patients with common iliac or superficial femoral artery CTOs treated with AnteOwl WR intravascular ultrasound (AO-IVUS)-guided slipstream and tip-detection. AO-IVUS was advanced over the first wire using the first-wire lumen only, and a dual-lumen microcatheter was tracked along the same wire (slipstream). Under IVUS tip-detection, a second guidewire was redirected into an all-true-lumen or functionally intraluminal course, enabling definitive stent or drug-coated balloon therapy without distal puncture or dedicated re-entry devices. AO-IVUS-guided slipstream and tip-detection may be a practical bailout strategy for complex aortoiliac and femoropopliteal CTOs.
Catheter Cardiovasc Interv
· 2026 May · PMID 41857799
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Mitral regurgitation (MR) is the valent type of valvular heart disease, caused by primary leaflet lesions or annular dilatation secondary to left ventricular dysfunction. It can lead to a series of complications such as...Mitral regurgitation (MR) is the valent type of valvular heart disease, caused by primary leaflet lesions or annular dilatation secondary to left ventricular dysfunction. It can lead to a series of complications such as volume overload, exacerbated pulmonary congestion, and heart failure, significantly impacting patient prognosis. Surgical mitral valve repair or replacement is currently the gold standard for MR treatment but is associated with substantial trauma, numerous complications, and poor tolerance in elderly high-risk patients. As an emerging minimally invasive technique, transcatheter mitral valve repair with MitraClip alleviates MR by tethering the edges of the anterior and posterior leaflets to create a bileaflet orifice (Peng et al. 2025). Compared with surgical procedures, it offers advantages of minimal trauma and rapid recovery, making it more suitable for elderly high-risk patients with multiple comorbidities. Mirror-image dextrocardia is a rare anatomical variation with an incidence of approximately 1/10,000. The heart is located in the right hemithorax with the apex pointing to the right lower quadrant, and the positions of great vessels and cardiac chambers are completely reversed from normal. This unique anatomy poses significant challenges to MitraClip surgery. This article summarizes the nursing experience of the first domestic case of a patient with mirror-image dextrocardia complicated by MR who underwent MitraClip implantation, aiming to explore the key perioperative management points for such high-risk cases and provide references for future similar surgeries.
OBJECTIVES: Bleeding from large-bore mechanical circulatory support catheters like Impella CP® and arterial extracorporeal membrane oxygenation (ECMO) cannulas is a significant problem with clear adverse prognosis. This...OBJECTIVES: Bleeding from large-bore mechanical circulatory support catheters like Impella CP® and arterial extracorporeal membrane oxygenation (ECMO) cannulas is a significant problem with clear adverse prognosis. This study evaluated a simple mechanical strategy-the Side-arm Technique On Perclose (STOP)-to reduce bleeding. METHODS: We performed a retrospective evaluation in a series of patients managed by one operator from a community hospital with large ECMO and shock programs. The STOP method complements pre-closure with Perclose sutures; it involves threading the longer "blue" string through a cut sheath side-arm, tightening the suture around the entry site, and using the side-arm stopcock for temporary wire locking and hemostasis. This pull-push action tightens the suture loop around the device entry site, achieving hemostasis. Main endpoints included bleeding after STOP, leg ischemia needing intervention, and successful hemostasis at removal. MAIN RESULTS: Among 21 patients (24 devices), all underwent pre-closure with two Perclose devices. Most devices (81%) were placed in the femoral artery; five Impella CPs used the axillary approach. STOP was started post-insertion or, in two cases, at bedside. No patients presented bleeding or oozing after STOP; no limb ischemia occurred. Only two required extra Perclose at decannulation (median 2 [1-4] days later). CONCLUSION: The STOP method effectively prevents or controls arterial bleeding around large-bore catheters, offering a straightforward, low-cost solution with good results in this small cohort.
BACKGROUND: Vascular closure devices (VCDs) are the standard alternative to surgical cutdown for large-bore arterial access (LBAA) but can lead to complications like bleeding and common femoral artery (CFA) occlusion tha...BACKGROUND: Vascular closure devices (VCDs) are the standard alternative to surgical cutdown for large-bore arterial access (LBAA) but can lead to complications like bleeding and common femoral artery (CFA) occlusion that require intervention. This manuscript outlines our approach using percutaneous endovascular intervention (PEI) to manage femoral artery occlusion caused by the MANTA (Teleflex, Morrisville, SC), the only collagen plug-based VCD indicated for LBAA. METHODS: Consecutive patients who experienced occlusive complications following MANTA deployment at the conclusion of transcutaneous aortic valve replacement (TAVR) underwent PEI to address occlusion. Clinical and procedural characteristics of the patients, as well as their short- and long-term follow-up data, were analyzed. RESULTS: A total of 1445 patients underwent TAVR, in whom LBAA was closed with MANTA VCD between August 2017 and July 2024, among whom 34 patients (2.4%) experienced occlusive complications. These patients had a mean age of 79 ± 8 years, and 59% were female. The mean CFA diameter was 7.8 ± 1.1 mm, with mild vessel stenosis present in 41% and calcification in 44% of patients. An 18 French MANTA device was used for closure in 82% of patients. The primary mechanism was plug internalization, which was observed in 88% of our cohort and led to total vessel occlusion in 56% of patients. Bleeding occurred in 38% of patients in association with occlusion. All patients were approached with PEI, achieving an overall procedural success rate of 97%. Lesion crossing was accomplished via an antegrade approach in 71% of patients, with the remaining 29% requiring a retrograde approach. Stenting was the definitive treatment in 85% of patients, with 90% of these involving an oversized VIABAHN (Gore Medical, Newark, DE) self-expanding stent. One patient experienced profunda artery occlusion after stent placement that required surgery. At 1-month follow-up, no vessel occlusions or bleeding were reported. CONCLUSION: Femoral artery occlusion from MANTA deployment after TAVR can be effectively treated with PEI. Low complication rates at 1 month suggest PEI is safe and reliable, but longer follow-up is needed to assess long-term vessel outcomes.