Shatla I, Elgendy IY, Balla S
… +10 more, Saleh Y, Khalife W, Qamar A, Darki A, Elkaryoni A, Abbott JD, Gordon P, Saad M, Hulten EA, Ellerbeck E
Cardiovasc Revasc Med
· 2026 Feb · PMID 41087219
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The incidence of in-stent restenosis (ISR) remains significant at 5-10 %, despite the widespread use of drug-eluting stents. Patients with ISR frequently present with acute coronary syndrome. End-stage renal disease (ESR...The incidence of in-stent restenosis (ISR) remains significant at 5-10 %, despite the widespread use of drug-eluting stents. Patients with ISR frequently present with acute coronary syndrome. End-stage renal disease (ESRD) is associated with accelerated atherosclerosis, and prior studies have demonstrated worse outcomes and higher mortality rates among ESRD patients undergoing percutaneous coronary intervention (PCI) compared to those without renal insufficiency. However, contemporary data regarding outcomes of acute myocardial infarction (AMI) in the setting of ISR in ESRD patients are limited. To this end, we sought to evaluate in-hospital outcomes of AMI and ISR for ESRD patients in the United States. Using the National Inpatient Sample between 2016 and 2020, we identified patients with discharge diagnoses of AMI associated with an ISR based on International Classification of Diseases, Tenth Revision (ICD-10) discharge diagnosis codes. Patients were stratified into two groups by ESRD status. The primary outcome was a comparison of in-hospital mortality between both groups and temporal trends in mortality over time. The study population included 142,455 patients hospitalized with AMI and ISR, of whom 11,905 (8.4 %) had an ESRD diagnosis. ESRD patients were more likely to present with a NSTEMI (90.6 % vs 77.3 %, p < 0.001). In-hospital mortality was higher among the ESRD group versus non-ESRD patients (7.9 % vs 3.0 %, P < 0.001). Mortality among ESRD patients increased by 3.8 % from 2016 to 2020 (p = 0.01), whereas mortality remained stable among non-ESRD (p = 0.10). On multivariate analysis, independent predictors of in-hospital mortality among the study cohort included ESRD (OR, 2.3; 95 % CI, 2.2-2.6; P < 0.001), advancing age, heart failure, STEMI, and cardiogenic shock. In conclusion, ESRD is an independent predictor of in-hospital mortality among patients hospitalized with AMI and ISR. These findings highlight the need for strategies to improve outcomes in this high-risk population.
Issany A, Alsheikh-Kassim M, Gupta A
… +1 more, Iyer V
Cardiovasc Revasc Med
· 2025 Oct · PMID 41087218
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BACKGROUND: Patent foramen ovale (PFO) is a risk factor for stroke, and closure reduces this risk. However, atrial fibrillation (AF) occurs post-procedure in 3-7 % of cases. OBJECTIVES: We aimed to (1) assess AF rates af...BACKGROUND: Patent foramen ovale (PFO) is a risk factor for stroke, and closure reduces this risk. However, atrial fibrillation (AF) occurs post-procedure in 3-7 % of cases. OBJECTIVES: We aimed to (1) assess AF rates after PFO closure at our institution and (2) identify associated risk factors. METHODS: The records of 279 patients with no prior AF history who underwent PFO closure since 2019 were reviewed. Patients who developed AF were compared to a propensity matched control group of non-AF patients. The groups were assessed for occurrence of AF, comorbidities, echocardiographic parameters, and anticoagulation use. AF was reported from either loop recorder data, EKG, or emergency department or clinic documentation. Continuous variables (age, BMI, LA size, LAVI) were compared using t-tests; categorical variables (alcohol use, hypertension, hyperlipidemia, and diabetes) were assessed via odds ratios. RESULTS: AF developed in 35 patients (12.54 %), with an average onset of 100 days post-closure. Of these, 66 % were on anti-coagulation. AF patients had significantly higher alcohol use (OR = 6, p-value <0.01), older age (t = 2.3, p-value <0.03), and had a larger mean LAVI on echocardiography (t = 2.01, p-value <0.05) compared to patients who did not develop AF. CONCLUSIONS: The incidence of AF is higher at our hospital compared to other institutions. The occurrence of AF seems to be concentrated in the first 4 months after PFO closure. Alcohol and age were associated with an increased risk for the development of AF post PFO closure. A greater LAVI may correlate with increased risk of developing AF.
Papadopoulos GE, Ninios I, Evangelou S
… +4 more, Ioannides A, Nikitopoulos A, Giamouzis G, Ninios V
Cardiovasc Revasc Med
· 2026 Jun · PMID 41077517
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BACKGROUND: The coexistence of severe aortic stenosis and coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is a common and clinically significant scenario. However, the...BACKGROUND: The coexistence of severe aortic stenosis and coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is a common and clinically significant scenario. However, the optimal timing of percutaneous coronary intervention (PCI) in this population remains an unresolved question. This study aimed to compare the outcomes of patients undergoing PCI either prior to (Pre-TAVI) or simultaneously with (Simultaneous PCI-TAVI) transfemoral TAVI. METHODS: We retrospectively analyzed consecutive patients with severe symptomatic aortic stenosis and significant CAD who underwent transfemoral TAVI at the Interbalkan Medical Center between January 2019 and December 2024. We included 212 patients, that were categorized into two groups based on the timing of PCI: Pre-TAVI PCI and Simultaneous PCI-TAVI. A 1:1 propensity score matching (PSM) was performed based on baseline clinical and anatomical characteristics, yielding 50 matched pairs. The primary outcome was all-cause mortality at 3 years. Secondary endpoints, adjudicated per VARC-3, included in-hospital mortality, bleeding (types 1-4), major vascular complications, stroke, myocardial infarction, and unplanned rehospitalization. Transfusion ≥2 units was assessed separately as a safety/resource-use endpoint. Survival was analyzed using Kaplan-Meier and restricted mean survival time (RMST). Logistic regression was used for in-hospital composite safety events, and landmark/sensitivity analyses explored the impact of bleeding and transfusion. RESULTS: In-hospital mortality was low and comparable between groups (4.1 % vs. 2.6 % in the unmatched cohort, p = 0.62; 4.0 % vs. 2.0 % in matched pairs, p = 1.00). Simultaneous PCI-TAVI was associated with fewer VARC-3 type 2-4 bleeds (10 % vs. 4 %, p = 0.048), fewer transfusions ≥2 units (26 % vs. 12 %, p = 0.014), and numerically fewer major vascular complications. At 3 years, RMST analysis demonstrated longer survival with Simultaneous PCI-TAVI: +75 days in the unmatched cohort (95 % CI 10-140; p = 0.024) and + 68 days in matched pairs (95 % CI 5-131; p = 0.033). In a discharge-landmark analysis excluding in-hospital deaths, the survival benefit persisted in both cohorts. Logistic regression identified Pre-TAVI PCI as an independent predictor of the in-hospital composite safety endpoint (aOR 2.52, 95 % CI 1.25-5.07; p = 0.010). RMST regression adjusted for bleeding and transfusion confirmed that the survival benefit of Simultaneous PCI-TAVI was not explained solely by peri-procedural complications. CONCLUSIONS: In patients undergoing transfemoral TAVI with concomitant CAD, a strategy of Simultaneous PCI-TAVI was associated with improved survival and a lower incidence of bleeding, vascular complications, and transfusion needs compared to Pre-TAVI PCI. These findings support a tailored single-session approach in appropriately selected patients and highlight the value of procedural consolidation to minimize risk.
BACKGROUND: The present study aims to compare the 10-year outcomes of patients with heart failure and left ventricular systolic dysfunction undergoing myocardial revascularization through coronary artery bypass grafting...BACKGROUND: The present study aims to compare the 10-year outcomes of patients with heart failure and left ventricular systolic dysfunction undergoing myocardial revascularization through coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: This retrospective, single-center study enrolled 707 patients (pts) treated with CABG (429 pts) or PCI (278 pts) for multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF <50 %). Data were collected between January 2002 and December 2023. Preoperative covariates were adjusted using 1:1 propensity-score matching. The primary endpoints were 30-day and long-term all-cause mortality. Secondary endpoints included the incidence of stroke and repeat target revascularization. RESULTS: After propensity-score matching, 196 comparable pairs were identified. The 30-day mortality rates were similar between the groups (CABG: 6 pts., 3.1 % vs. PCI: 5 pts., 2.6 %; p = 0.99). At the 10-year follow-up, CABG group showed higher overall survival (CABG: 55 % vs. PCI: 37 %, p < 0.001), a lower incidence of cardiac death (CABG: 12.3 % vs. PCI: 23.4 %, p = 0.049) and repeat target revascularization (CABG: 7.4 % vs. PCI: 23.4 %, p = 0.003). The incidence of stroke was comparable between the two groups (CABG: 5.3 % vs. PCI: 10.2 %, p = 0.440). CONCLUSIONS: Early outcomes were comparable between PCI and CABG. However, at 10 years, CABG was associated with superior overall survival, lower cardiac death and reduced repeat revascularization rates. Therefore, surgical revascularization should be strongly considered in patients with multivessel coronary artery disease and heart failure with left ventricular systolic dysfunction to achieve long-term survival benefits.
Lim Y, Park S, Joo D
… +11 more, Lee YK, Oh S, Lee SH, Ahn JH, Hyun DY, Cho KH, Sim DS, Hong YJ, Kim JH, Ahn Y, Kim MC
Cardiovasc Revasc Med
· 2026 Feb · PMID 41073186
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BACKGROUND AND OBJECTIVES: Immediate coronary angiography (CAG) is recommended for patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) complicated by acute decompensated heart failure (ADHF). The EA...BACKGROUND AND OBJECTIVES: Immediate coronary angiography (CAG) is recommended for patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) complicated by acute decompensated heart failure (ADHF). The EARLY-HF trial (ClinicalTrials.gov, NCT04810806) was conducted to evaluate the optimal timing of coronary angiography (CAG) in this population. METHODS: Patients were randomized in a 1:1 ratio to receive either immediate CAG within 2 h of randomization (immediate CAG group) or delayed CAG following stabilization of heart failure (HF) (delayed CAG group). The primary outcome was the composite of 12-month composite of all-cause mortality, nonfatal myocardial infarction (MI), and recurrent ischemia. RESULTS: A total of 85 patients were randomly divided into the immediate CAG group (43 patients) or delayed CAG group (42 patients, performed at a median of 82.7 h post-randomization). The EARLY-HF trial was prematurely terminated due to COVID-19-related constraints. Revascularization was performed in 67.4 % and 69.1 % of patients in the immediate and delayed CAG groups, respectively. The incidence of the primary outcome was 35.6 % vs. 24.2 % in the two groups, respectively (P = 0.240, HR [95 % CI] =1.60 [0.72-3.57]). No statistically significant differences were observed in the individual components of the primary outcome at 1 month, 12 months, or during hospitalization except for a higher 12-month cardiovascular mortality rate in the immediate CAG group (23.7 % vs. 7.3 %, P = 0.039). CONCLUSION: Immediate CAG within 2 h of randomization did not demonstrate a clinical benefit over delayed CAG in this trial. However, the premature termination limits the ability to draw definitive conclusions. TRIAL REGISTRATION:URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04810806, registered on March 14, 2021.
Ielasi A, Caminiti R, Simeoli P
… +20 more, Kim WK, Scotti A, Giordano A, Holzamer A, Testa L, Farkic M, Stoyanov N, Gallo F, Azzano A, Leick J, De Marco F, Kovacevic M, Tigges E, Protasiewicz M, Immè S, Mangieri A, Vetta G, Barbanti M, Latib A, Tespili M
Cardiovasc Revasc Med
· 2026 Jun · PMID 41073185
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INTRODUCTION: Severe left ventricular outflow tract (LVOT) calcification remains a challenging anatomy for transcatheter aortic valve replacement (TAVR), with increased risk of paravalvular leak (PVL), annular injury, an...INTRODUCTION: Severe left ventricular outflow tract (LVOT) calcification remains a challenging anatomy for transcatheter aortic valve replacement (TAVR), with increased risk of paravalvular leak (PVL), annular injury, and conduction disturbances. Evidence on the performance of new-generation balloon-expandable (BE) valves in this setting is limited. METHODS: An international, multicenter, cohort analysis comparing outcomes of patients with severe LVOT calcification treated with the novel Octacor BE versus two self-expanding (SE) transcatheter heart valves (THVs: Acurate Neo2 and Evolut Pro/Pro+). The primary endpoint was Valve Academic Research Consortium-3 (VARC-3) technical success. Secondary endpoints were: overall mortality, overall stroke, moderate-to-severe paravalvular leak (PVL), permanent pacemaker implantation (PPI), annulus rupture and major bleeding rates at 30 days. RESULTS: A total of 257 patients were analyzed of whom 35 in the BE group while 222 in the SE group. VARC-3 technical success was 100 % in the BE versus 94.6 % in the SE group (p = 0.127). No significant differences were reported between BE and SEs in terms of VARC-3 device success (82.9 % vs. 77 %; p = 0.3), all-cause mortality (0 % vs. 1.6 %; p = 0.4) and stroke (0 % vs. 2.7 %; p = 0.2) rates. Moderate-to-severe PVL was significantly lower in the BE versus SE group (0 % vs. 9.9 %; p = 0.03). At sub-group analysis Octacor showed a significantly lower moderate-to-severe PVL compared to Evolut Pro/Pro+ (0 % vs. 11.2 %; p = 0.03) while no significant difference versus Neo2 (0 % vs. 6.6 %, p = 0.1). In a prespecified sub-analysis excluding Acurate Neo2, Octacor remained associated with lower post-dilatation and PVL compared with Evolut. These results were consistent after annulus-adjusted sensitivity analysis. CONCLUSIONS: In patients with severe AS and significant LVOT calcifications undergoing TAVR, novel generation BE and SE THVs demonstrated favorable safety and efficacy outcomes at 30-day.
Leung ECH, Blankenship JC, Orellana CP
… +2 more, Hill D, Yarlagadda B
Cardiovasc Revasc Med
· 2025 Dec · PMID 41044036
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BACKGROUND: Ischemic heart disease is the leading cause of cardiovascular mortality in the United States, with percutaneous coronary intervention (PCI) being one of the definitive treatments. Historically, data suggested...BACKGROUND: Ischemic heart disease is the leading cause of cardiovascular mortality in the United States, with percutaneous coronary intervention (PCI) being one of the definitive treatments. Historically, data suggested Hispanics, when compared to non-Hispanic Whites, suffer worse acute coronary syndrome mortality rates. Therefore, we conducted a comprehensive literature review to summarize factors influencing PCI outcomes in this population. METHODS: In accordance with PRISMA guidelines for systematic reviews, we performed a literature search encompassing PCI for any indication with Hispanic-specific outcomes using the PubMed database through April 2025 yielding 69 studies. Authors independently screened search results and resolved discrepancies through consensus. Meta-analysis was performed where ever feasible using random effects models due to expected study heterogeneity. RESULTS/DATA: Hispanics experience acute myocardial infarction more frequently and are more likely to present urgently or emergently than Whites. Hispanic ethnicity correlates with delayed door-to-balloon and catheterization laboratory activation times. Additionally, Hispanics are disproportionately admitted to low procedure volume hospitals with disparities in hospital quality resulting in inferior PCI outcomes. High Medicaid and uninsured rates in Hispanics reflect cost-prohibitive healthcare access limitations, resulting in a trend towards lower rates of resvascularization and procedural differences like stent utilization. However, in-hospital and long-term outcomes between Hispanic and White populations undergoing PCI are similar. CONCLUSION(S): This review uncovers an incongruity between profound disparities in access and utilization of PCI, driven by socio-economic determinants, and comparable in-hospital and mortality outcomes between Hispanics and Whites. Consequently, it highlights the need for increased research to improve patient outcomes and reduce health disparities.
Younes AM, Mahmoud AK, Kamel I
… +3 more, Albeyoumi H, Maraey A, Khalil M
Cardiovasc Revasc Med
· 2025 Oct · PMID 41043945
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BACKGROUND: The effect of ejection fraction on outcomes after transcatheter aortic valve replacement (TAVR) in heart failure (HF) patients remains unclear. METHODS: Using the National Readmission Database (2016-2020), ad...BACKGROUND: The effect of ejection fraction on outcomes after transcatheter aortic valve replacement (TAVR) in heart failure (HF) patients remains unclear. METHODS: Using the National Readmission Database (2016-2020), adult HF patients who underwent TAVR were identified, and outcomes were compared between those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The primary outcome was all-cause inpatient mortality, while secondary outcomes included major bleeding, packed red blood cell (pRBC) transfusion, acute kidney injury (AKI), ischemic cerebrovascular accidents (CVA), valvular complications, conversion to open surgery, length of stay, and total charges. RESULTS: Among 231,092 HF patients who underwent TAVR, 89,782 had HFrEF. Compared to HFpEF patients, HFrEF was associated with higher inpatient mortality (adjusted odds ratio [aOR] 1.97, 95 % CI 1.78-2.19, P < 0.001), major bleeding (aOR 1.49, 95 % CI 1.36-1.63, P < 0.001), pRBC transfusion (aOR 1.28, 95 % CI 1.19-1.38, P < 0.001), AKI (aOR 1.89, 95 % CI 1.79-1.99, P < 0.001), valvular complications (aOR 1.41, 95 % CI 1.21-1.64, P < 0.001), and conversion to open surgery (aOR 1.72, 95 % CI 1.28-2.34, P < 0.001), with no significant difference in ischemic CVA (aOR 1.12, 95 % CI 0.97-1.29, P = 0.13). HFrEF was also associated with longer hospital stays (adjusted mean difference [aMD] 2.06 days, 95 % CI 1.93-2.18, P < 0.001) and higher total charges (aMD $29,783, 95 % CI 25,106-34,460, P < 0.001). CONCLUSION: Patients with HFrEF undergoing TAVR experienced worse outcomes compared to those with HFpEF. These findings underscore the need for meticulous patient selection and risk evaluation before performing TAVR in HF patients.
Cardiovasc Revasc Med
· 2026 Jun · PMID 41033925
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BACKGROUND: Small aortic annulus (SAA) is associated to suboptimal results after aortic valve replacement. The optimal treatment for aortic disease in SAA remains unclear. METHODS: We conducted a systematic review and Ba...BACKGROUND: Small aortic annulus (SAA) is associated to suboptimal results after aortic valve replacement. The optimal treatment for aortic disease in SAA remains unclear. METHODS: We conducted a systematic review and Bayesian random-effects meta-analysis to compare transcatheter (TAVR) versus surgical aortic valve replacement (SAVR) in patients with small aortic annulus. A comprehensive search of PubMed, Scopus, and Cochrane Library was performed through May 2024. Binary outcomes were synthesized using a binomial-normal hierarchical model to estimate posterior distributions of log odds ratios (log OR) and corresponding 95 % credible intervals (CrIs). Posterior probabilities of treatment effects were calculated to assess the certainty of benefit or harm. All statistical analyses were performed using R version 4.5.0. RESULTS: Nine studies comprising 2548 patients (50.9 % TAVR) were included. TAVR was associated with reduced risk of severe patient-prosthesis mismatch (OR 0.47; 95 % CrI 0.31-0.72; posterior probability of benefit 99.8 %) and moderate mismatch (OR 0.56; 95 % CrI 0.40-0.79; posterior probability 99.7 %). In contrast, SAVR was associated with lower risk of moderate/severe aortic regurgitation (OR 4.74; 95 % CrI 2.43-9.27; posterior probability of harm with TAVR 98.1 %) and permanent pacemaker implantation (OR 2.66; 95 % CrI 1.69-4.20; posterior probability of harm with TAVR 98.5 %). No meaningful differences were observed for stroke at 30 days (OR 1.51; 95 % CrI 0.69-3.36) or all-cause mortality at 1 year (OR 0.78; 95 % CrI 0.51-1.17). CONCLUSIONS: TAVR is superior to SAVR regarding severe and moderate PPM in SAA patients. SAVR is associated with lower risk of aortic regurgitation and new pacemaker implant, with no significant differences in mortality and stroke.
Umeh C, Kaur G, Richie I
… +2 more, Yoshihara M, Gupta R
Cardiovasc Revasc Med
· 2026 Jun · PMID 41015744
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BACKGROUND: Catheter-based therapies (CBT), including both catheter-directed thrombolysis (CT) and mechanical thrombectomy (MT), are current treatments for intermediate- and high-risk pulmonary embolism (PE). Although th...BACKGROUND: Catheter-based therapies (CBT), including both catheter-directed thrombolysis (CT) and mechanical thrombectomy (MT), are current treatments for intermediate- and high-risk pulmonary embolism (PE). Although the safety and efficacy of CT and MT have previously been explored, limited studies have investigated utilization patterns. This study aims to examine the trends and correlations between CT and MT use and various clinical patient factors. METHODS: Retrospective cohort analysis of data from the 2017 to 2021 National Inpatient Sample (NIS), the largest publicly available database of hospitalized patients in the United States, focusing on adult patients admitted with a diagnosis of pulmonary embolism. Using demographic and clinical variables extracted from the NIS, we evaluated the factors that affect the use of CT and MT. RESULTS: 1,983,074 cases of pulmonary embolism were identified in patients 18 years and above. 63,205 received CBT (3.19 %), of which 23,930 (37.86 %) received MT, 36,470 (57.7 %) received CT, and 2805 (4.43 %) received both. The proportion of CBT that was MT increased from 14.1 % in 2017 to 68.7 % in 2021, while the proportion of CT decreased from 85.9 % in 2017 to 31.3 % in 2021. In the multivariate analysis, patients 65 years and older (aOR 1.07, p < 0.001) and those with saddle pulmonary embolism (aOR 1.29, p < 0.001) and sicker patients, such as those with acute kidney injury (aOR 1.305, 95 % CI 1.255-1.356, p < 0.001) and acute myocardial infarction (aOR 1.298, 95 % CI 1.232-1.367, p < 0.001), were more likely to receive MT than CT. However, in 2021, when MT became the main CBT, MT was no longer associated with older or sicker patients. In addition, compared to rural hospitals, patients in urban non-teaching hospitals (aOR 1.317, 95 % CI 1.191-1.456, p < 0.001) and urban teaching hospitals (aOR 2.024, 95 % CI 1.843-2.223, p < 0.001) were more likely to receive MT than CT. Furthermore, patients in medium-sized (aOR 1.078, 95 % CI 1.022-1.136, p = 0.005) or large-sized hospitals (aOR 1.516, 95 % CI 1.445-1.590, p < 0.001) were more likely to receive MT than CT compared to those in small-sized hospitals. CONCLUSION: MT became the primary form of CBT in patients with pulmonary embolism in 2021, although its use in this condition remains low. Before 2021, MT was mainly used for sicker patients and those with co-morbidities, but that changed when it became the predominant CBT.
Laterra G, Sacchetta G, Barrano G
… +7 more, Artale C, Motta S, Mazzone P, Ruscica G, Costa S, Barbanti M, Contarini M
Cardiovasc Revasc Med
· 2026 May · PMID 40998648
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OBJECTIVES: This study sought to compare intracardiac echocardiography (ICE) probe via the esophageal route (TE-ICE) and transesophageal echocardiography (TEE) guidance for the LAAO procedure. BACKGROUND: Intraprocedural...OBJECTIVES: This study sought to compare intracardiac echocardiography (ICE) probe via the esophageal route (TE-ICE) and transesophageal echocardiography (TEE) guidance for the LAAO procedure. BACKGROUND: Intraprocedural imaging guidance is recommended for all LAAO procedures. Currently, both femoral-ICE-guided and TEE-guided LAAO demonstrated similar outcomes. TE-ICE may serve as a potential alternative imaging modality in LAAO. This approach avoids general anesthesia and its potential complications, while maintaining a favorable learning curve, as it is highly similar to standard transesophageal echocardiography, with whose imaging operators are generally more familiar. METHODS: A pooled analysis of the FLXiEST and DIONISIO registries was conducted. For the purposes of this study, TE-ICE patients were compared to TEE patients. All TE-ICE procedures were performed using a 2D ICE catheter introduced via the transesophageal route. One-to-one propensity score matching was applied to compare the TE-ICE technique with the gold standard TEE in guiding LAAO. Technical success and procedural success were defined as the primary outcomes of the study. RESULTS: A total of 282 patients were included in the present study. After adjustment for clinical and echocardiographic characteristics, 99 matched-pair treated with LAAO using TE-ICE and TEE were compared. The technical success did not differ between TE-ICE and TEE patients (98 % vs 96 %; p = 0.6827). The procedural success, defined as technical success in the absence of in- hospital device or procedure-related clinical events, was comparable between the two groups (93 % vs 92 %; p = 0.7673). No statistically significant differences were found for all procedural complications assessed: death, stroke, TIA, pericardial effusion, device embolization, systemic arteria embolization and major bleeding. CONCLUSIONS: The present pooled analysis of the DIONISO and the FLXiEST demonstrated that LAAO procedure guidance can be performed with equivalent outcomes using either TE-ICE and TEE. Indeed, the use of TE-ICE technique could be particularly advantageous in high-volume centers to reduce the need for anesthesia, especially in fragile and elderly patients. This approach offers significant organizational benefits by potentially eliminating the requirement for an anesthesiologist in the cath lab, thereby streamlining workflow and improving resource allocation.
Mohamoud AA, Khalif A, Abdallah N
… +3 more, Ismayl M, Wardhere A, Goldsweig AM
Cardiovasc Revasc Med
· 2026 Jun · PMID 40973535
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BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a promising strategy for refractory cardiac arrest. However, the role of left ventricul...BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a promising strategy for refractory cardiac arrest. However, the role of left ventricular (LV) unloading during ECPR remains uncertain. METHODS: We queried the United States National Inpatient Sample (2016-2021) to identify adult patients with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) who received ECPR. Patients were stratified based on the use of either VA-ECMO only or VA-ECMO with intra-aortic balloon pump (IABP) or VA-ECMO with Impella (ECPELLA) for ventricular unloading. Multivariable logistic regression was used to compare in-hospital outcomes between the groups. RESULTS: Among 6915 patients receiving ECPR, VA-ECMO alone was used in 5147 (74.4 %), VA-ECMO-IABP in 811 (11.7 %), and ECPELLA in 957 (13.9 %). In IHCA patients, ECPELLA was associated with 50 % lower odds of in-hospital mortality compared to VA-ECMO alone (adjusted odds ratio [aOR] 0.50, 95 % CI 0.31-0.81, p < 0.01). No significant difference was found in OHCA patients. VA-ECMO-IABP was not associated with a mortality benefit vs. VA-ECMO alone in either OHCA or IHCA. CONCLUSION: LV mechanical unloading with ECPELLA was associated with improved survival in IHCA patients but not in OHCA patients compared to VA-ECMO alone. The addition of an IABP to VA-ECMO was not associated with a mortality benefit.
Cardiovasc Revasc Med
· 2026 Jun · PMID 40973534
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BACKGROUND: TAVR is associated with better outcomes for patients with classical low-flow low-gradient aortic stenosis (C-LFLG AS) and normal-flow low-gradient (NFLG AS) compared to medical management. Left ventricular ej...BACKGROUND: TAVR is associated with better outcomes for patients with classical low-flow low-gradient aortic stenosis (C-LFLG AS) and normal-flow low-gradient (NFLG AS) compared to medical management. Left ventricular ejection fraction (LVEF) predicts mortality in patients undergoing TAVR. However, the outcomes based on flow in patients with lower LVEF undergoing TAVR remain unclear. OBJECTIVES: This study explored the outcomes of patients with reduced LVEF undergoing TAVR with C-LFLG AS and NFLG AS. It also explored the hemodynamic changes post-TAVR in these populations and identified factors determining their outcomes. METHODS: In this retrospective, single-center study involving 305 patients with severe AS, patients were classified into 2 groups: 1) C-LFLG AS, AV mean gradient (MG) <40 mmHg, stroke volume index (SVI) <35 mL/m, LVEF <50 %; 2) Low LVEF NFLG AS: MG <40 mmHg, SVI ≥35 mL/m, LVEF <50 %. Binary logistic regression was used to assess the determinants of C-LFLG AS and NFLG AS. Cox regression was used to determine the clinical outcomes. RESULTS: Of 2600 patients undergoing TAVR, low LVEF patients meeting the inclusion criteria were 305. NFLG AS was less common (18 %). Patients in the C-LFLG AS had similar mortality (hazard ratio (HR) = 1.07, 95 % confidence interval (CI) 0.64-1.80), and heart failure rehospitalization (HR = 1.31, CI 0.69-2.48) rates 3 years post-TAVR, compared to patients with low LVEF NFLG AS. End-stage renal disease was associated with NFLG AS, whereas diabetes predicted C-LFLG AS. CONCLUSIONS: Mortality after TAVR was similar in patients with low-gradient severe AS and LV systolic dysfunction regardless of flow.
Tanaka T, Kawakami R, Shiraki T
… +8 more, Nakayama T, Fujiyoshi K, Hamana T, Adachi Y, Sakamoto A, Grogan A, Virmani R, Finn AV
Cardiovasc Revasc Med
· 2026 Mar · PMID 40947326
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BACKGROUND: Catheter-based drug delivery systems have evolved in percutaneous coronary interventions (PCI). Drug-coated balloons (DCBs) deliver agents to obstructive atherosclerotic lesions without permanent implants, bu...BACKGROUND: Catheter-based drug delivery systems have evolved in percutaneous coronary interventions (PCI). Drug-coated balloons (DCBs) deliver agents to obstructive atherosclerotic lesions without permanent implants, but their pharmacokinetic profiles vary and may affect efficacy and safety. METHOD: Twenty-seven Yucatan Miniature Swine underwent treatment with SEL-SEB (SELUTION SLR™), MT-SCB (MagicTouch™), or EES (XIENCE™) in the right coronary or left circumflex arteries. Drug levels were measured in treated arteries and downstream myocardium at 7, 60, and 90 days. MT-SCB samples were extracted with ZnSO₄/methanol, whereas SEL-SEB samples underwent two-step extraction (ZnSO₄/methanol followed by acetonitrile/acetone). RESULT: A total of 54 arteries underwent pharmacokinetic evaluation (n = 6 treated arteries per time point) from 27 swine. At 7 days, the mean of arterial drug levels was 1767.5 ng/g for SEL-SEB, 1136.5 ng/g for MT-SCB, and 1057.4 ng/g for EES (p = 0.94). By 60 days, SEL-SEB and EES maintained high levels (1146.3 and 837.3 ng/g), while MT-SCB fell sharply to 5.8 ng/g (p < 0.05). At 90 days, SEL-SEB and EES remained stable (360.7 ng/g and 916.5 ng/g, respectively), although MT-SCB was negligible, 2.0 ng/g (p < 0.05). Drug levels in the downstream myocardium at 7 days were lowest with EES (0.1 ng/g), higher with SEL-SEB (11.3 ng/g), and highest with MT-SCB (281.5 ng/g) (p < 0.05). CONCLUSIONS: SEL-SEB shows sustained arterial drug retention, more closely resembling the gold-standard EES. This data suggests that SEL-SEB should produce durable outcomes without the need for a permanent implant.
Chaturvedi A, Al Qaraghuli AK, Verma BR
… +11 more, Haberman D, Cellamare M, Zhang C, Galo J, Abusnina W, Lupu L, Hashim HD, Rogers T, Ben-Dor I, Satler LF, Waksman R
Cardiovasc Revasc Med
· 2026 May · PMID 40947325
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BACKGROUND: 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. W...BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.