bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of coronary computed tomography angiography derived full Moon calcifications in CTO-PCI
Authors: Panuccio G , Tonini G , Erbay A , Skurk C , Landmesser U , Werner G , Leistner D M , Abdelwahed Y 
Published: November 2023

Abstract

Background
There is an increasing incidence of chronic total coronary occlusions (CTO). CTO are complex coronary lesions and known to represent a technical challenge for percutaneous recanalization procedures. However, the success rates of CTO- percutaneous coronary interventions (CTO-PCI) have increased tremendously with the continuous innovations in equipment and procedural techniques. Circular heavily calcified "Full Moon"- like plaques have been observed in CTO patients, however their frequency and relevance for CTO-PCI outcomes remain unclear, despite they can be straightforward identified by Coronary Computed Tomographic Angiography (CCTA) during CT-scans to select the CTO-PCI recanalization strategy.

Purpose
The aim of this study was to investigate the clinical value of CCTA – derived "Full Moon"-like plaques and to analyze its impact on percutaneous CTO recanalization.

Methods
Out of the Charité CTO-PCI registry a total of 29 consecutive patients undergoing CTO-PCI and upstream CCTA-imaging for CTO planning were enrolled into the entire analysis. One patient was excluded due to stent artefacts with insufficient CCTA quality.

Results
Within the study cohort 17.9% (n=5) presented a "Full Moon"-like stenosis as CTO-causing target lesion. During CTO-PCI all these lesions (100%) required extensive debulking techniques as rotablation or ultrasound lithoplasty due to difficulties in device crossing compared to 13% (n=3) lesions in the non "Full Moon" group (p&lt;0.001). In detail, 40% of lesions in the "Full Moon" group had to be prepared by rotablation-therapy (compared to 0% in the non- "Full Moon" group; p&lt;0.05) and 20% of lesions underwent shockwave therapy as compared to 13% non- "Full Moon" lesions (n=3; p=.0.69). However, 40% of the "Full Moon" interventions resulted in a complete failure of crossing the device compared to 13.0% in the non- "Full Moon" group (p=0.15).

Conclusions
"Full Moon"- like calcification derived by CCTA represents a frequently observed phenomenon in CTO and represents an important predictor for complexity during CTO-PCI. Coronary Computed Tomography can be used to identify such a marker of calcium complexity and therefore to plan the procedure in advance.
Same day discharge after large bore vascular access in percutaneous coronary intervention of chronic total coronary occlusions
Authors: Somsen Y B O , Wilgenhof A , De Winter R W , Schumacher S P , Van Diemen P A , Jukema R A , Hoek R , Stuijfzand W J , Twisk J W R , Danad I , Verouden N J , Nap A , Henriques J P , Knaapen P 
Published: November 2023

Abstract

Background
Same day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) of a chronic total coronary occlusion (CTO) appears feasible, safe, and carries economic advantage. However, SDD may be hampered by the application of large bore dual arterial access, due to its association with vascular complications. Nevertheless, increasing French size augments therapeutic options and is therefore considered fundamental in complex CTO PCI.

Purpose
The present study investigated the feasibility of SDD in patients undergoing CTO PCI with large bore dual arterial access.

Methods
Between 2013 and 2018, a total of 683 patients were prospectively enrolled in a single-center CTO registry and underwent single-vessel CTO PCI. Large bore arterial access was defined as the application of 7 and/or 8 French sheaths in at least one access site. Technical success was defined as Thrombolysis in Myocardial Infarction flow grade 3 and residual stenosis &lt;30%. Vascular access complications were defined as a composite of clinically significant bleeding and/or hematoma, urgent transfusion, dissection, pseudoaneurysm, arteriovenous fistula formation, and thrombosis.

Results
Mean age was 66 ± 11 years; 83% were male. Large bore arterial access was applied in 87%; the most common set-up was radial-femoral (68%) and bifemoral (23%) access. In 432 (62%) patients, SDD was achieved. Patients within the SDD group were younger and had lower rates of prior MI, prior CABG, renal insufficiency, and peripheral artery disease. A high Japanese CTO score (≥2) was less common in patients with versus without SDD (58% vs. 72%, p&lt;0.001). In addition, technical success rate was higher in the SDD group (96% vs. 89%, p&lt;0.001). Vascular access complications were found in 22 (3,2%) cases, with 17 (77,2%) occurring in the non-SDD group. Local access site bleeding was found to be the most common complication (82,4% of total vascular access complications). Finally, multivariable analysis showed that female gender (OR 2.22, 95% CI: 1.30 – 3.78) and local access site bleeding (OR 12.0, 95% CI: 4.37 – 33.21) were significantly associated with a lower probability of SDD.

Conclusions
Our study demonstrates the feasibility of SDD in the majority of patients undergoing CTO PCI with large bore dual arterial access, with high rates of technical CTO PCI success and acceptable vascular access complication rates. Care should be taken to avoid local access site bleeding since this hinders SDD.
Clinical outcomes of percutaneous coronary intervention of chronic total occlusion vs. non-chronic total occlusion: a multicentre registry
Authors: Griffioen A M , Woelders E C I , Luijkx J J P , Peeters D A M , Ilhan M , Winkler P J C , Damman P , Remkes W S , Van 'T Hof A W J , Van Geuns R J M 
Published: November 2023

Abstract

Background
Revascularization of Chronic Total Occlusions (CTO) has gained popularity in recent decades. However, there is still debate about the benefits of treating a chronic total occlusion, resulting in a class IIa indication in the ESC Guidelines. Especially data regarding bleedings is scarce which could be expected due to the use of multiple and large-bore access and the use of prolonged and strong dual antiplatelet therapy after percutaneous coronary intervention (PCI). Providing more insight in the benefits and risks of CTO treatment in the context of PCI revascularization could be performed on a more evidence-based assessment.

Purpose
This study aims to provide additional data about outcomes and complications of patients undergoing revascularization of a CTO.

Methods
Patients from an ongoing, multicentre registry (‘Zuid-Oost Nederland Hart Registratie’ (ZON-HR)), which has started in November 2020, are included, in which patient- and angiography characteristics and 30-day and 1-year outcomes are collected. MACCE was defined as a composite endpoint of cardiovascular death, myocardial infarction, ischemic cerebrovascular accidents and stent thrombosis.

Results
A total of 3996 patients with complete 30-day follow-up were included in the registry, of which 185 patients underwent a PCI of a CTO and 3811 patients underwent a PCI of a non-CTO lesion between November 2020 and June 2022. Baseline characteristics are described in Table 1. The mean age of the entire population was 67.9 (± 12.1) years and predominantly male (72.7%). Analysis showed a significantly higher incidence of bleedings in patients treated with CTO (7.6% vs. 3.4%, p &lt; 0.01) and especially access bleedings (5.9% vs. 1.9%, p &lt; 0.01). In patients with access bleedings double access-site punction was more frequently applied for CTO PCI (80% vs. 25%, p &lt; 0.01). Patients with CTO PCI showed more coronary dissection/perforation with the need for covered stent treatment (2.7% vs. 0.6%, p &lt; 0.01) as well. No significant difference for MACCE within 30 days was present. Additionally, multivariate analysis were performed for baseline variables showing no association with the occurrence of access bleedings and peripheral artery vessel disease and the indication of PCI. Ancillary analyses were performed with patients with 1-year follow-up (n = 1356; CTO = 64 vs. non-CTO = 1292), showing no significant differences in MACCE and bleedings.

Conclusion(s)
This registry shows that CTO PCI results in higher incidence of complications and access bleedings. Access bleedings are possibly related to the frequent use of double access-site punction in patients with CTO PCI which should be investigated further, as well as the role of DAPT after PCI.
Impact of carotid artery stenosis on outcomes of transcatheter aortic valve replacement: a systematic review and meta-analysis
Authors: Gibicoski T B , Caetano L , Silva E P , Rodriguez F A , Scabello I , Iplinski B 
Published: November 2023

Abstract

Background/Introduction
Carotid Artery Stenosis (CAS) is common in elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR). However, the impact of CAS on the outcomes of TAVR is unclear.

Purpose
This systematic review and meta-analysis aimed to compare the clinical and periprocedural outcomes in patients with and without CAS undergoing TAVR.

Methods
PubMed, Embase, and Cochrane databases were searched up to February 2023. We included studies that performed a direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data were extracted from published reports and the ROBINS-I tool was utilised for quality assessment. Review Manager 5.1 was adopted for statistical analysis. A random-effects model was used to calculate a pooled effect size and 95% confidence interval.

Results
Five observational studies and 111,915 patients were included. Follow-up ranged from 30 days to 1 year. The mean age was 80.7 ± 8.2 years and 46.3% were female. The risk of stroke or transient ischaemic attack was elevated in the group of patients with CAS (OR 1.44; 95% CI 1.05-1.99; p=0.02; Figure 1A). Similarly, there was an increased risk of myocardial infarction in the CAS group (OR 1.25; 95% CI 1.06-1.47; p= 0.008; Figure 1B). In contrast, all-cause mortality (OR 0.99; 95% CI 0.71-1.37; p=0.94; Figure 2A) and major bleeding (OR 1.14; 95% CI 0.98-1.32; p=0.08; Figure 2B) were not significantly different between CAS and non-CAS groups. There was also no significant difference in acute kidney injury (OR 0.99; 95% CI 0.79-1.23; p=0.99) and new pacemaker implantation (OR 0.95; 95% CI 0.70-1.30; p=0.76) between patients with and without CAS.

Conclusions
Our findings suggest that CAS is significantly associated with cerebrovascular events and myocardial infarction in patients who undergo TAVR, without a significant impact on all-cause mortality. Further prospective studies are needed for a more granular assessment of additional determinants of this association, such as unilateral vs. bilateral involvement and whether there is a threshold of CAS severity for increased risk.
Pressure-regulated deployment for balloon-expandable TAVI is safe, effective and results in superior valve haemodynamics regardless of prosthesis size
Authors: Snir A , Wilson M , Ng M K 
Published: November 2023

Abstract

Background
A novel pressure-regulated deployment method for balloon-expandable transcatheter heart valves (THVs) has been developed(1) to improve clinical outcomes by regulating maximal annular wall tension during prosthesis expansion – to both optimise prosthesis-annulus apposition and diminish annular injury. The previous feasibility study(1) showed that THV deployment at wall tensions between 3-3.5 MPa may be associated with reduced paravalvular-leak (PVL) severity and avoidance of annular rupture.

Objective
To prospectively evaluate the safety and efficacy of the pressure-regulated THV deployment strategy.

Methods
341 consecutive patients with severe native aortic stenosis and moderate-severe surgical risk who underwent TAVI with Sapien 3 THVs using a pressure-regulated deployment strategy were included. Target (maximal) deployment pressure was adjusted according to valve size: 5 atm for 29mm, 5.5 atm for 26mm and 6.25 atm for 23mm THVs. Key procedural and clinical outcomes were recorded and analysed using uni- and multi-variate analyses.

Results
The average patient age was 82.1±6.9 years and 28.2% were female (see attached table). 29.3% had moderate-severe subannular calcification and 14.5% had estimated ≥20% THV oversizing based on TAVI CT. 112 patients (32.8%) were considered at high-risk of annular rupture(2). Post-dilatation rate was 8.2% and was independently associated only with the degree of THV oversizing (OR 3.5, p=0.007, for ≤5% oversizing). On TTE prior to discharge, 85.6% had none/trivial PVL and 14.4% had mild PVL with no observed moderate/severe PVL. Mild PVL was independently associated with age (OR 1.07, p=0.02, per year) and degree of THV oversizing (OR 2.4, p=0.02, for ≤5% oversizing). Resulting THV mean gradient on TTE was 9.7±3.5mmHg overall, with similar results between 23mm (10.5±3.2mmHg) and 26/29mm valves (9.6±3.5mmHg, p=0.2). New PPM rate was 9.6% and was independently associated only with pre-existing RBBB (OR 13.5, p&lt;0.001). New LBBB rate was 11.2% was independently associated only with low THV implantation depth (OR 4.3, p=0.009, for ≤60% of THV length above native aortic annulus). There were no cases of aortic/annular rupture.

Conclusions
The pressure-regulated strategy for balloon-expandable THV deployment is associated with an excellent safety and efficacy outcomes profile. Notably, there was no significant difference in valve haemodynamics and degree of PVL post-implantation between the smaller (23mm) and larger (26/29mm) THV sizes. These findings suggest that standardisation of THV deployment pressure to achieve target wall tension results in improved haemodynamics, particularly in small-sized valves.Main Table (Truncated)PVL and MG according to THV size
Comparison of direct oral anticoagulants and vitamin-k antagonists after transcatheter mitral valve implantation
Authors: El Beze N , Himbert D , Suc G , Brochet E , Ajzenberg N , Cailliau A , Kikoine J , Delhomme C , Carrasco J L , Ou P , Iung B , Urena M 
Published: November 2023

Abstract

Background
No recommendation exists regarding antithrombotic treatment after transcatheter mitral valve implantation (TMVI). By analogy with surgical mitral bioprosthesis, vitamin-k antagonists (VKA) are mostly used after TMVI.

Purpose
To compare, in a prospective cohort of trans-septal TMVI using a prosthesis of the SAPIEN family, the bleeding and thrombotic risks according to the anticoagulant treatment by direct oral anticoagulants (DOAC) or VKA.

Methods
We included all consecutive patients undergoing trans-septal TMVI in our center from March 2011 to August 2022. Patients were followed up after the procedure at 1 month, 6 months and 1 year. The primary endpoint was the occurrence of bleeding under anticoagulant treatment. Patients were treated with VKA until October 2019 and with DOAC thereafter.

Results
A total of 145 patients were included. The mean age was 65.4 ± 18.6 years old and 96 patients (66.2%) were women. The mean EuroSCORE II was 10.3 ± 9,3 %. Regarding treatment, 24 patients were treated with DOAC and 121 patients with VKA. The occurrence of the primary endpoint was observed in 48 (40%) patients in the VKA group and 2 (8%) patients in the DOAC group (multivariate HR 0.21, 95%CI [0.05-0.97], p=0.047). In multivariate analysis, there were less vascular complications and stay duration was shorter in the DOAC group. There were no significant differences between groups regarding thromboembolic events, stroke, and death.

Conclusion
Treatment with DOAC after TMVI compared with VKA appears to decrease the risk of bleeding complications and to decrease the length of stay of patients without a significant increase in the risk of thromboembolic events.
Transcatheter mitral valve repair and its impact on reverse right ventricular remodelling
Authors: De Almeida Fernandes D , Guimaraes J , Costa G , Monteiro E , Gomes R , Rosa J , Campos G , Marinho A V , Paiva L , Oliveira-Santos M , Jorge E , Botelho A , Teixeira R , Costa M , Goncalves L 
Published: November 2023

Abstract

Introduction
Transcatheter edge-to-edge repair (TEER) has been proven to reduce cardiovascular events in a particular subset of patients with severe mitral insufficiency (MR) and left ventricle dysfunction. Nevertheless, its short and long-term impact on the right ventricle (RV) remained to be determined. Our goal was to assess the effect of TEER on the RV and right chamber pressures.

Methods
Patients were consecutively enrolled from Nov 2018 to Jul 2022. Clinical, laboratory echocardiographic and procedural data were collected. Follow-up information of admissions for heart failure, New York Heart Association (NYHA) functional class and survival was collected. The data was analysed prior to and at 3 and 12 months after the procedure. RV dysfunction was defined as Tricuspid Annular Plane Systolic Excursion (TAPSE) &lt; 17mm or S’ &lt; 9cm/s. Changes between baseline and follow-up parameters were assessed using the paired t-test.

Results
A total of 46 patients were included. Average age was 77.28 ± 7.92 years and 30 were male (65.2%). Twelve patients were on NYHA class III (26.1%) and most had functional mitral insufficiency (25; 54.3%) and mild to moderate tricuspid insufficiency (36; 78.3%). All patients had severe mitral insufficiency (estimated regurgitant orifice area 41.28 ± 16.77mm; regurgitant volume 62 ± 28.96mL). Seventeen patients had diabetes (37.0%), 10 had coronary artery disease (21.7%), 23 had atrial fibrillation (50.0%) and 6 had chronic kidney disease (13.0%).
At 3 months, mean right ventricular/right atrial gradient (RV/RAgrad) was significantly lower (37.26 ± 9.66 mmHg vs 30.81 ± 17.36 mmHg; p 0.017) as well as MR (2.98 ± 0.15 vs 1.67 ± 0.63; p &lt; 0.001). There were no differences regarding severity of tricuspid regurgitation (TR) and RV and left ventricle (LV) function. At 1 year follow-up there was a marked improvement of RV/RAgrad (37.49 ± 10.87 mmHg vs 28.12 ± 10.13 mmHg; p 0.009), TAPSE (18.83 ± 4.22 mm vs 20.88 ± 3.08 mm; p 0.035), S’ (10.81 ± 4.00 cm/s vs 13.5 ± 1.97 cm/s, p 0.015) and MR severity (2.98 ± 0.15 vs 1.83 ± 0.71; p &lt;0.001). Number of heart failure readmissions was also lower at 1 year follow-up post TEER (0.35 ± 0.80 vs 0.81 ± 0.87; p 0.032). Over a mean follow-up time of 1.72 ± 1.16 years, only 8.7% of patients died and 17.4% were readmitted due to heart failure.

Conclusion
TEER has a positive impact on right ventricle function and pressures. This effect was more prominent at 1 year follow-up and suggests reverse remodelling continues even after 3 months. Overall, patients with TEER had low rates of death and heart failure readmissions.
In-hospital safety of catheter based left atrial appendage closure in Germany 2016 - 2020
Authors: Maier A , Kaier K , Heidt T , Westermann D , Grundmann S , Von Zur Meuhlen C 
Published: November 2023

Abstract

Background
New catheter based left atrial appendage (LAA) occlusion devices were introduced in the past decade. Catheter based LAA occlusion can be performed through a permanently implanted intracardiac LAA occlusion device or a loop stitch around the base of the LAA via an additional pericardial access. Knowledge about recent in-hospital safety trends and center volume dependent outcomes is limited.

Methods
Catheter based LAA closures in Germany were identified via ICD and OPS codes from 2016 - 2020. Adjusted risk differences for loop stitch procedures were calculated using an inverse probability weighting approach taking into account 17 predefined baseline characteristics. Center volume dependent outcomes were calculated using a risk adjusted logistics regression analysis taking into account the same predefined baseline characteristics.

Results
28 039 permanently intracardiac implanted LAA occlusion device procedures and 213 loop stitch LAA occlusions were performed from 2016 - 2020. Numbers of permanently implanted occlusion device procedures increased from 5 259 in 2016 to 5 917 in 2020 (p = 0.020) without a significant trend for in-hospital safety parameters. Risk adjusted logistic regression analysis of center volume depended MACCE and pericardial puncture for permanently implanted occlusion devices did not show a significant trend.
Patients receiving the loop stitch procedure were younger (76.17 +/- 8.16 vs. 73.16 +/- 8.99, p &lt; 0.001), had a lower comorbidity index (2.29 +/- 1.93 vs. 1.92 +/- 1.64, 0.005) and less previous myocardial infarctions (7.82 % vs. 3.29 %, p = 0.014) or cardiac surgeries (12.34 % vs. 6.57 %, p = 0.011). Adjusted risk difference of pericardial effusion (8.04 %; 95% CI: 3.01 % – 13.08 %; p = 0.002) and pericardial puncture (6.60 %; 95% CI: 3.85 % – 9.35 %; p &lt; 0.001) was higher for the LAA loop stitch procedure, while risk of bleeding (-1.85 %; 95% CI: -3.01 % to -0.69 %; p = 0.002), intracerebral bleeding (-0.37 %; 95% CI: -0.59 % to -0.15 %; p = 0.001) and shock (-1.41 %; 95% CI: -2.44 % to -0.39 %; p = 0.007) was lower. No significant difference was observed for in-hospital MACCE.

Conclusions
Permanently implanted occlusion devices were the major catheter based LAA closure procedure in Germany without improvements in in-hospital safety from 2016 – 2020. Center volumes did not influence in-hospital MACCE and pericardial puncture for the permanently implanted LAAC devices. LAA loop stitch occlusion was used much less frequently and was associated with a higher risk of pericardial effusion and pericardial puncture, a lower risk of bleeding and shock and no significant risk difference in MACCE.