Nagai S, Kondo T, Kazama S
… +12 more, Nozaki A, Imaizumi T, Komeyama S, Mizuno C, Ito R, Hiraiwa H, Morimoto R, Hayashi Y, Yoshizumi T, Mutsuga M, Murohara T, J-Pvad Investigators OBOT
EuroIntervention
· 2026 Jun · PMID 42290318
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<span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Microaxial flow pumps (mAFPs) provide left ventricular unloading and haemodynamic stabilisation, with evidence suggesting a survival benefit in pati...<span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Microaxial flow pumps (mAFPs) provide left ventricular unloading and haemodynamic stabilisation, with evidence suggesting a survival benefit in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). The prognostic impact of early mAFP placement after hospital arrival remains unclear.</span></span> Aims: <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">We aimed to investigate the association between door-to-unload time and in-hospital mortality in patients with STEMI-CS.</span></span> Methods: <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">We analysed data from the Japan Registry for Percutaneous Ventricular Assist Devices, including consecutive patients with STEMI-CS who underwent mAFP placement between February 2020 and December 2023. The primary outcome was in-hospital mortality.</span></span> Results: <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Among 1,783 patients, the median door-to-unload time was 99 min. The overall in-hospital mortality rate was 39.2%, and this increased with longer door-to-unload times: 32.9% (≤60 min), 33.0% (61-90 min), 40.1% (91-150 min), and 48.3% (>150 min). Using a 90 min cutoff, delayed placement (>90 min) was associated with higher mortality (adjusted odds ratio 1.56, 95% confidence interval: 1.26-1.95). A restricted cubic spline model showed that mortality remained stable when placement was within 90 min, followed by an increase. When stratified by no prior mechanical circulatory support and prior venoarterial extracorporeal membrane oxygenation (VA-ECMO) only, the patients with prior VA-ECMO only had more severe baseline characteristics and higher mortality; however, the association of longer door-to-unload time with higher mortality was consistent. Predictors of delayed mAFP placement included older age, lower institutional volume, higher heart rate, higher creatinine levels, prior use of an intra-aortic balloon pump or VA-ECMO, and percutaneous coronary intervention before mAFP placement.</span></span> Conclusions: <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A shorter door-to-unload time, particularly within 90 min, is associated with better survival in patients with STEMI-CS.</span></span>.
Kuwata S, Izumo M, Tanaka T
… +26 more, Okuno T, Akashi YJ, Yamamoto M, Shimura T, Sugiura A, Kubo S, Saji M, Izumi Y, Enta Y, Shirai S, Mizuno S, Watanabe Y, Amaki M, Kodama K, Yamaguchi J, Naganuma T, Bota H, Ohno Y, Asami M, Hachinohe D, Yamawaki M, Ueno H, Nakazawa G, Otsuka T, Hayashida K, The Ocean-Mitral Investigators OB
EuroIntervention
· 2026 Jun · PMID 42290317
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BACKGROUND: While the mean left atrial pressure (mLAP) reduction during mitral transcatheter edge-to-edge repair (M-TEER) has been suggested as a potential prognostic marker, comprehensive evidence from large-scale, real...BACKGROUND: While the mean left atrial pressure (mLAP) reduction during mitral transcatheter edge-to-edge repair (M-TEER) has been suggested as a potential prognostic marker, comprehensive evidence from large-scale, real-world cohorts is limited, especially with stratification by mitral regurgitation (MR) aetiology. AIMS: This study aimed to evaluate the prognostic significance of intraprocedural haemodynamic changes, particularly the mLAP reduction, during M-TEER for MR, using multicentre registry data. METHODS: From the OCEAN-Mitral registry, 2,629 patients undergoing M-TEER with intraprocedural direct mLAP measurements were included. A decrease in the mLAP was defined as follows: postprocedural mLAP-preprocedural mLAP<0. The primary outcome was the composite of all-cause mortality and heart failure (HF) rehospitalisation. RESULTS: Among 2,629 patients (degenerative MR [DMR]: 825 [31.4%], functional MR [FMR]: 1,804 [68.6%]), the postprocedural mLAP decreased in 1,548 patients (58.9%). In the DMR cohort, the mLAP reduction was associated with a significantly lower risk of the composite outcome (adjusted hazard ratio [HR] 0.66, 95% confidence interval [CI]: 0.45-0.96; p=0.028), while no such association was observed in the FMR cohort (adjusted HR 0.90, 95% CI: 0.75-1.08; p=0.251). Interaction analysis confirmed a significant difference in prognostic impact based on MR aetiology (p for interaction=0.006). Pulmonary vein flow patterns improved, with systolic waves becoming greater than diastolic waves across both groups; however, their combination with the mLAP reduction predicted better outcomes only in DMR patients. CONCLUSIONS: A reduction in the mLAP during M-TEER is independently associated with improved clinical outcomes in patients with DMR but not in those with FMR. These findings underscore the importance of real-time haemodynamic assessment - especially in DMR - as a valuable procedural endpoint that may aid in optimising long-term outcomes beyond anatomical MR reduction alone.
Gorog DA, Ten Berg JM, Campo G
… +16 more, Geisler T, Gigante B, Grove EL, Halvorsen S, Huber K, Jeong YH, Lip GYH, Navarese EP, Rubboli A, Siller Matula JM, Storey RF, Valgimigli M, Vandenbriele C, Vilahur G, Ahrens I, Ferreiro JL
EuroIntervention
· 2026 Jun · PMID 42290315
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Dual antiplatelet therapy (DAPT) is required to prevent atherothrombotic events in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). The default DAPT strategy, namely a po...Dual antiplatelet therapy (DAPT) is required to prevent atherothrombotic events in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). The default DAPT strategy, namely a potent P2Y inhibitor combined with aspirin for 12 months, exposes many patients to excess bleeding risk. Over the past years, alternative antithrombotic regimens have been proposed to reduce bleeding (DAPT abbreviation or de-escalation) or ischaemic (prolonged dual antithrombotic therapy) events. Abbreviation or de-escalation of DAPT is supported by (i) multiple trials showing these strategies to significantly reduce bleeding, particularly for the 20-40% of patients classified as high bleeding risk (HBR); (ii) low prevalence of stent thrombosis and recurrent myocardial infarction beyond 1-3 months post-ACS with the latest generation of drug-eluting stents, and (iii) the recognition that HBR is far more prevalent than high ischaemic risk. Amongst patients at HBR, standard DAPT, in comparison to abbreviated or de-escalated DAPT, increases the net risk of major adverse events, even in the presence of high ischaemic risk. Conversely, amongst patients at high ischaemic risk, without HBR, prolonged dual antithrombotic therapy reduces longer-term thrombotic risk. Recognizing risk factors and assessing the magnitude of bleeding and ischaemic risks are essential. Since there are no ideal scoring systems to balance ischaemic and bleeding risks, and many overlap, focus should be on managing the risk most amenable to modification, namely bleeding, which should dominate the decision-making over ischaemic risk when choosing a DAPT regimen. This document provides practical advice regarding best practice for personalizing DAPT in patients with ACS undergoing PCI, with evidence-based clinical consensus statements on selecting the most appropriate antiplatelet strategy to optimize clinical outcomes.
Koell B, Ludwig S, Weimann J
… +39 more, Patel D, Stolz L, Tanaka T, Trenkwalder T, Rudolph F, Samim D, von Stein P, Giannini C, Dreyfus J, Scotti A, Paradis JM, Adamo M, Karam N, Bohbot Y, Bernard A, Melica B, Kobari Y, Lavie-Badie Y, Kessler M, Chehab O, Redwood S, Lubos E, de Backer O, Metra M, Latib A, Primerano C, Iliadis C, Praz F, Gerçek M, Xhepa E, Weber M, Makkar R, Granada J, Modine T, Donal E, Hausleiter J, Coisne A, Kalbacher D, Prime-Mr Investigators OBOT
EuroIntervention
· 2026 Jun · PMID 42290314
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BACKGROUND: The evolving landscape of mitral valve transcatheter edge-to-edge repair (M-TEER) for mitral regurgitation (MR) has seen continuous advancements, driving improvements in therapeutic efficacy. Particularly in...BACKGROUND: The evolving landscape of mitral valve transcatheter edge-to-edge repair (M-TEER) for mitral regurgitation (MR) has seen continuous advancements, driving improvements in therapeutic efficacy. Particularly in primary MR (PMR), contemporary device iterations of M-TEER offer technical advantages for improved management of complex anatomies. However, data on temporal trends in M-TEER for PMR are limited. AIMS: The primary objective of our study was to analyse temporal trends in the safety, efficacy, and stability of M-TEER treatment. METHODS: The PRIME-MR registry, a retrospective multicentre study, enrolled consecutive patients undergoing M-TEER for PMR at 27 centres in Europe and North America. M-TEER procedures were categorised into four time periods (2009-2013, 2014-2016, 2017-2019, and 2020-2023), to align with major device updates. RESULTS: The analysis included 3,082 consecutive patients (median age 82 years [interquartile range 76.0-85.0], 45.1% female). Patients treated were highly symptomatic (New York Heart Association [NYHA] Class ≥III in 80.4%). Patient characteristics showed a decline in symptomatic severity (NYHA Class ≥III 85.9% in 2009-2013 vs 71.8% in 2020-2023), accompanied by lower mean Society of Thoracic Surgeons scores (5.6% [2009-2013] vs 4.6% [2020-2023]; p for trend<0.0001), and less severe MR. Over time, complication rates decreased (procedures with complications: 42.4% [2009-2013] vs 23.1% [2020-2023]; p for trend<0.0001), whereas technical efficacy increased (residual MR ≤1+: 54.0% [2009-2013] vs 68.4% [2020-2023]; p for trend<0.001). There was an increased occurrence of stable results without any deterioration at one-year follow-up (63.6% [2009-2013] vs 74.4% [2020-2023]; p for trend=0.03). CONCLUSIONS: Findings from the PRIME-MR registry highlight substantial reductions in residual MR severity and complication rates over time in PMR patients undergoing M-TEER.
Tarantini G, Fovino LN, Alvarez Covarrubias HA
… +76 more, Wolny R, Fabris T, Skipirzepa JN, Eden M, Zamorano JL, Joner M, Cuisset T, Delgado V, Rodés-Cabau J, Saia F, Bieliauskas G, Van Belle E, Modine T, Rheude T, Garot P, Jung C, Rudolph TK, Leroux L, Rottbauer W, Nestelberger T, Lhermusier T, Nejjari M, Regueiro A, Meier D, Fraccaro C, Hartikainen T, Karam N, Swaans M, Rodrigues A, Dreger H, Hengstenberg C, Schmitz T, Mauler-Wittwer S, Piazza N, Combaret N, Letocart V, Auffret V, Durand E, Urena-Alcázar M, Del Valle-Fernández R, Drago A, De Carlo M, Jimenez Diaz VA, Dąbrowski M, Mascherbauer J, Sudre A, Ong P, Gonska B, Mancone M, Fabris E, Teles RC, Nombela-Franco L, Asmarats L, Vilalta V, Protasiewicz M, Webb JG, Tóth-Gayor G, Zierer A, Rioufol G, Seiffert M, Adamo M, Meucci F, Ielasi A, Burzotta F, Lopez Benito M, Loewenstein I, Kralisz P, Legutko J, Huczek Z, Pavei A, Raková R, Wesselink W, Zielinski M, Trushina N, Bramlage P, Parma R
EuroIntervention
· 2026 Jun · PMID 42219979
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BACKGROUND: Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedur...BACKGROUND: Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedures are expected to rise in number. Yet, real-world evidence on the procedural safety and efficacy of redo-TAVI remains limited. AIMS: We aimed to evaluate the 30-day procedural and clinical outcomes of redo-TAVI using the balloon-expandable SAPIEN 3 platform. METHODS: The ReTAVI registry is a prospective, international study enrolling consecutive patients with a failed aortic THV undergoing redo-TAVI with a balloon-expandable SAPIEN 3 THV. Data were collected across 59 international centres. All imaging was centrally analysed, and major clinical events were adjudicated by an independent committee. RESULTS: â¨A total of 143 patients (median age 84 years; 40.6% female; median Society of Thoracic Surgeons risk score 7.0%) were enrolled. The predominant failing THVs were balloon-expandable SAPIEN 3 (30.1%), self-expanding CoreValve/Evolut (53.1%), and ACURATE (14.0%) platforms. The most common failure mode was isolated regurgitation (48.6%), followed by stenosis (35.2%) and a mixed pathology (16.2%). The replacement valve was successfully implanted in 95.1% of patients, with a 30-day mortality rate of 3.5%. The 30-day stroke and pacemaker implantation rates were 0.7% and 6.3%, respectively. Redo-TAVI significantly improved valve haemodynamics, with mean gradients decreasing overall (Δ=-12.0 mmHg), and a more pronounced reduction in stenotic failures (Δ=-29.0 mmHg). Coronary obstruction was observed in 1.4% of cases. CONCLUSIONS: Redo-TAVI with a balloon-expandable SAPIEN 3 THV platform is a safe and effective reintervention strategy across diverse failed THV types, when guided by the Heart Team, standardised procedural planning, and comprehensive imaging. CLINICALTRIALS: gov: NCT05601453.
Aquino Bruno H, De Backer O, Tang GHL
… +13 more, Amat-Santos IJ, Lønborg J, Tchetche D, Barbanti M, García-García JF, Plata-Corona JC, Fuentes-Moreno JC, Gayosso-Ortiz JR, Vela-Vizcaino H, Alcántara-Meléndez MA, Regueiro A, Piazza N, Tarantini G
EuroIntervention
· 2026 Jun · PMID 42219978
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Transcatheter aortic valve implantation (TAVI) has become the preferred treatment for severe aortic stenosis. Nonetheless, interplay between aortic valve disease, transcatheter valve implantation, and the coronary arteri...Transcatheter aortic valve implantation (TAVI) has become the preferred treatment for severe aortic stenosis. Nonetheless, interplay between aortic valve disease, transcatheter valve implantation, and the coronary arteries is frequent and clinically relevant. Coronary intervention in the context of TAVI encompasses distinct but interrelated scenarios, including the management of concomitant coronary artery disease and the prevention or treatment of coronary artery obstruction. These aspects introduce additional complexity to procedural planning and long-term management. This review provides a comprehensive and practical overview of coronary interventions related to TAVI, encompassing coronary evaluation and physiological assessment, the indications and timing of percutaneous coronary intervention before and after valve implantation, and strategies for managing coronary obstruction. Particular emphasis is placed on anatomical and device-related factors influencing coronary access, including transcatheter heart valve design, aortic root anatomy, and commissural alignment. By structuring coronary interventions according to distinct clinical scenarios, this article aims to support tailored decision-making and optimise procedural safety, feasibility, and long-term coronary management in patients undergoing TAVI.
Estévez-Loureiro R, Barreiro-Perez M, Altisent OA
… +9 more, Freixa X, Bartunek J, Vanderheyden M, Sherif M, Trippel T, Gogorishvili I, Hausleiter J, Alnasser S, Fam N
EuroIntervention
· 2026 Jun · PMID 42219977
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Khawaja SA, Hanna L, Singh A
… +10 more, Lucarelli C, Garg P, Malik I, Hadjiloizou N, Ruparelia N, Hartley A, Khamis R, Shin MS, Gibbs R, Mikhail GW
EuroIntervention
· 2026 May · PMID 42200667
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BACKGROUND: Stroke remains a significant concern in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Despite advances in TAVI technology and techniques, rates have remained unchanged, with trials of Ce...BACKGROUND: Stroke remains a significant concern in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Despite advances in TAVI technology and techniques, rates have remained unchanged, with trials of Cerebral embolic protection devices (CEPD) failing to reduce rates. The concept of air emboli has never been previously investigated in TAVI procedures. We hypothesize that gaseous emboli could play a significant role in TAVI and that carbon dioxide (COâ) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI. AIMS: To demonstrate the neuroprotective benefits of COâ flushing in TAVI. METHODS: INTERCEPTavi is a pilot single centre, blinded, randomized controlled trial that studied the effects of flushing TAVI valves with COâ versus conventional saline on neurological outcomes post TAVI assessed using MRI and transcranial doppler(TCD). Patients with aortic stenosis were randomised after access was obtained. Peri-procedure TCD assessed solid and gas emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD data. RESULTS: 60 patients were recruited and randomised 1:1 to COâ and saline flushing (TAVI-COâ) versus saline flushing only (TAVI-S). COâ flushing significantly reduced the average number of lesions per patient (TAVI-COâ 4 lesions/patient vs TAVI-S 8.5 lesions/patient; P=0.031). The total infarct area was numerically lower in the COâ group (40.32 mm² vs 93.20 mm²), although this did not reach statistical significance (p=0.111). Similarly, Transcranial Doppler (TCD) showed fewer micro-embolic signals in the COâ arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5). CONCLUSIONS: INTERCEPTavi is a pioneering first-in-man randomised trial that demonstrated that COâ flushing of the TAVI reduces the number of cerebral lesions measured on MRI. COâ is an accessible, cost-effective method that can be easily implemented in any catheter laboratory to provide neurological advantages.
Nakamura D, Ishihara T, Dohi T
… +20 more, Sakamoto D, Kosugi S, Kida H, Okamoto N, Kikuchi A, Kawai T, Mori N, Shutta R, Ichikawa M, Ueda Y, Mano T, Nishino M, Watanabe T, Higuchi Y, Hida E, Sato T, Hikoso S, Nakatani D, Sotomi Y, Sakata Y
EuroIntervention
· 2026 May · PMID 42200666
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BACKGROUND: Coronary bifurcation lesions remain prone to side-branch (SB) ostial restenosis. Kissing balloon inflation (KBI) is the standard for provisional stenting but induces mechanical injury. Drug-coated balloons (D...BACKGROUND: Coronary bifurcation lesions remain prone to side-branch (SB) ostial restenosis. Kissing balloon inflation (KBI) is the standard for provisional stenting but induces mechanical injury. Drug-coated balloons (DCB) may pharmacologically inhibit neointimal hyperplasia to improve long-term patency. AIMS: To evaluate mechanistic vascular healing and luminal changes at the SB after adjunctive SB-DCB versus SB-conventional balloon treatment using high-resolution serial optical coherence tomography (OCT). METHODS: The randomized OCVC-BIF trial compared adjunctive SB-DCB (n=149) to Non-DCB (n=150) following main-vessel stenting and protocolled KBI. The present pre-specified study was restricted to those patients who completed evaluable follow-up OCT pullbacks (n=221). Endpoints included the SB volume change and the main vessel stent healing parameters. RESULTS: There is no significant difference in the ostium, minimum SB area, and SB volume between the DCB and Non-DCB groups post percutaneous coronary intervention (PCI). Serial OCT analysis showed that the DCB group exhibited lumen volume gain at SB of 0.14±5.64 mm from post PCI to 9-month follow-up, whereas the Non-DCB group showed a mean loss of -2.15±9.51 mm. Although difference reached statistical significance in the prespecified parametric analysis (p=0.042), in sensitivity analysis using the Wilcoxon rank-sum test, the difference was attenuated (0.45 [-3.83, 4.00] in DCB vs -0.65 [-5.00, 2.50] in Non-DCB, p=0.093). While in the DCB group, SB lumen volume change from immediately after PCI to follow-up was not statistically significant (p=0.81), the Non-DCB group demonstrated a statistically significant reduction in SB lumen volume (p=0.03). At 9 months, the incidence of uncovered and malapposed struts was low and comparable between groups across all segments. CONCLUSIONS: Adjunctive SB-DCB treatment after KBI showed no adverse effect on main-vessel stent healing and a possible signal toward preservation of SB lumen. These findings may support the mechanistic feasibility of this strategy in selected bifurcation lesions. (Japan Registry of Clinical Trials: 052200077).