bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of implantation depth and cusp-specific calcium score on the incidence of left bundle branch block and infranodal conduction delay after transcatheter aortic valve replacement
Authors: Serban T , Papa A , Isenegger C , Knecht S , Nestelberger T , Kaiser C , Leibundgut G , Sticherling C , Kuehne M , Badertscher P 
Published: November 2023

Abstract

Background
Conduction disorders and left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) are common. Risk factors, however, remain incompletely understood.

Purpose
To assess the impact of valve implantation depth and overall and cusp-specific aortic valve calcification on the incidence of LBBB and infranodal conduction delay post-TAVR.

Methods
In all patients undergoing TAVR between June 2020 and June 2021 the His-Ventricle (HV) interval was measured at least twice (pre-and post-valve deployment) and in the case of LBBB additionally one day after TAVR. Infranodal conduction delay was defined as HV &gt; 55ms. The implantation depth of the valve was defined as the distance between the lower edge of the valve frame and the aortic annulus level and examined by two independent raters. Aortic valve calcification was assessed using the Agatston calcium score: overall and for each aortic cusp separately. Patients with valve-in-valve procedures were excluded.

Results
A total of 101 patients (mean age 81±5.7 years, 47% women) were included. The mean implantation depth was 5±3.1 mm. The median calcium score was 1840 AU [IQR 632-2400]. The baseline median HV interval was 46ms [IQR 39-50] and 8 patients demonstrated LBBB at baseline. Post-valve deployment LBBB was observed in 52 patients (52%), in whom the median HV interval was 52 ms [IQR 44-57]. Infranodal conduction delay was noted in 27 of 101 patients (27%). There was no correlation of delta HV (pre- vs. post-TAVR) and implantation depth or calcium score (r=0.08 and r=0.01, respectively). Patients with LBBB and infranodal conduction delay had comparable valve implantation depths (p=0.5) and total calcium scores (p=0.19) compared to patients with no LBBB and no infranodal conduction delay. Left ventricular outflow tract calcification measured at non-coronary cusp (NCC) level was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (OR 1.62, 95% CI 1.06-2.69 per 100 AU increase, p=0.04) and in a quantile regression model (p=0.002, Figure). In all models, the implantation depth was unable to predict new conduction disorders.

Conclusion
While the implantation depth had no impact on the incidence of LBBB or infranodal conduction delay, preprocedural assessment of aortic valve calcification for the NCC may help identify patients at risk for conduction disorders after TAVR. Further studies are needed to confirm these findings.
Impact of platelet reactivity on subclinical valve thrombosis in patients treated with TAVR
Authors: Jimenez-Quevedo P , Espejo-Paeres C , Mcinerney A , Tirado-Conte G , Marroquin L , Spione F , Hennessey B , Gonzalo N , Fernandez-Ortiz A , Escaned J , Nunez-Gil I , Regueiro A , Gomez De Diego J J , Nombela-Franco L , Pozo E 
Published: November 2023

Abstract

Background and introduction
High residual platelet reactivity (HPR) in patients undergoing percutaneous coronary intervention with dual antiplatelet therapy (DAPT) is associated with an increased risk of thrombotic events. The relationship between HPR and the presence of subclinical valve thrombosis (SVT) following transcatheter aortic valve replacement (TAVR) is unknown.

Purpose
The aim of this study was to determine whether HPR is associated with the occurrence of SVT in patients undergoing TAVR treated with DAPT and to determine independent predictors of SVT.

Methods
This is a prospective, multicentre study. Patients with symptomatic aortic stenosis successfully treated with TAVR followed by DAPT (aspirin + clopidogrel) for 3 months were included. Patients with monotherapy, oral anticoagulation, or severe renal impairment were excluded. For the purpose of the study, platelet reactivity was measured either with Multiplate analyzer or VerifyNow point-of-care assay at baseline, at 1-2 days post, and 1-3 months post-TAVR. HPR was defined as ≥ 468AU, or ≥208PRU, respectively. The primary endpoint was the incidence of SVT measured by multi-slice CT at 3-months post TAVR in relation to HPR. Secondary objectives included the relationship between HPR following TAVR and the incidence of major adverse cardiac and cerebral clinical events (MACCE), to determine whether a pro-thrombotic inflammatory response is associated with the appearance of SVT and to evaluate factors associated with the occurrence of SVT.

Results
A total of 169 patients were included, the mean age was 81.5±5 and 51% were female. The overall rate of SVT was 22%. Patients with HPR demonstrated a similar incidence of SVT to those without (23,7% vs 33,6%: p=0,29). The overall bleeding rate was 4,9%. No differences in the rate of stroke at 1-year follow-up were observed (no SVT group 1.5% vs SVT group 2.6%: p=0.6). Independent predictors of SVT, were: dyslipemia OR 0,38 (0,15-0,96) p=0,039, creatinine clearance 0.98 (0.96.1.0, p=0.04), self-expandable valve OR 3,57 (1,40-9,06); p=0,006 and prosthesis size 0,78 (0,64-0,96): p=0,009. Patients with SVT expressed increased inflammatory parameters at 6 months compared to those without SVT CD14+ CD16-: 76,6±9,9 vs 70,7±13,9: p=0.02.

Conclusion
In contrast to coronary interventions, for the first time we have demonstrated that HPR does not appear to be associated with the development of SVT in TAVR patients treated with DAPT.
A novel hemodynamic index characterizing mitral regurgitation undergoing transcatheter edge to edge repair: the mitral pulse pressure fraction
Authors: Leone A M , Di Giusto F , Lucarelli K , Vicere A , Anastasia G , Galante D , Petrolati E , Burzotta F , Aurigemma C , Lombardo A , Locorotondo G , Graziani F , Casamassima V , Grimaldi M , Trani C 
Published: November 2023

Abstract

Objectives
Our study sought to investigate the role of invasive hemodynamic monitoring during Transcatheter Edge to Edge Repair (TEER) procedure on top of transesophageal echocardiographic (TEE) guidance.

Background
Direct hemodynamic impact of residual MR after TEER is not always univocally measured by TEE assessment alone. When analyzing TEER procedure result operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring.

Methods
We analyzed 78 patients with moderate-to-severe or severe mitral regurgitation (MR) who underwent TEER. Mitral pulse Pressure Fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. 23 patients with the same grade of MR not undergoing TEER were included as a control group.

Results
TEER had a significant impact reducing MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting (p &lt; 0.001) and control group (p = 0.004). MR reduction assessed by TEE guidance was not found to be correlated with improved clinical and functional status at follow-up as assessed by New York Heart Association (NYHA) classification (p = 0.424) and 12-items Kansas City Cardiomyopathy Questionnaire (KCCQ) (p = 0.1). On the contrary, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification (p = 0.003) and 12-items KCCQ (p&lt;0.001) during the follow-up period.

Conclusions
MPF provides an immediate estimate of the real hemodynamic impact of MR and can offer a prompt prediction of the functional improvement after TEER.
Investigating the impact of chronic heart failure on in-hospital outcomes following transcatheter mitral valve repair or replacement: a national inpatient sample study (2016-2020)
Authors: Nomigolzar S , Nomigolzar R , Vallabhaneni M , Hammammi A 
Published: November 2023

Abstract

Background
Chronic heart failure (CHF) is a global health problem and one of the primary causes of morbidity and mortality worldwide. Transcatheter mitral valve repair or replacement (TMVr or TMVR) is a procedure that has demonstrated improved outcomes in patients with severe mitral valve disease. However, the impact of CHF on in-hospital outcomes following TMVR or TMVr remains unclear.

Methods
In this retrospective cohort study, we utilized the United States National Inpatient Sample database from 2016 to 2020. We identified patients who underwent TMVR or TMVr using ICD-10 codes and stratified them based on the presence or absence of CHF diagnosis. We assessed in-hospital complications, length of stay, and cost of care as primary and secondary outcomes. We performed multivariate logistic regression analysis to control for potential confounders.

Results
Our study included 48,885 patients who underwent TMVR or TMVr, of which 16,132 (33%) had a diagnosis of CHF. The cohort was predominantly male (54%) with a mean age of 76 years. Compared to patients without CHF who underwent TMVR/TMVr, those with CHF had lower rates of in-hospital mortality, valvular complications, cardiogenic shock, vascular complications, bleeding, blood transfusions, respiratory failure, acute kidney injury, and acute myocardial infarction (see Figure 1). Additionally, patients with CHF had a reduced length of stay (coefficient -3.48; p &lt;0.001) and cost of care (coefficient -$58749.37; p &lt;0.001). However, there were no significant differences in rates of pericardial tamponade, intracranial hemorrhage, or ischemic strokes.

Conclusions
Our findings suggest that patients with chronic heart failure (CHF) who underwent transcatheter mitral valve repair or replacement (TMVr or TMVR) had better in-hospital outcomes compared to those without CHF. This may be due to a protective effect of the chronic disease, where compensatory mechanisms developed by the body may help patients with CHF better tolerate the procedure and have decreased in-hospital complications. These results highlight the importance of further investigating the role of CHF in TMVr/TMVR outcomes and tailoring patient selection for these procedures.
Preprocedural simulation of a mitral transcatheter edge-to-edge repair using computed tomography imaging
Authors: Miyata A , Miyamoto T , Imai M , Sato Y 
Published: November 2023

Abstract
Mitral transcatheter edge-to-edge repairs (TEERs) are a widespread treatment option for heart failure complicated with mitral regurgitation. Although we generally use trans-oesophageal echocardiography (TOE) to understand structural heart disease conditions, TOE does not provide a complete view of the heart and surrounding structures. As the TEER device moves in complex ways during the procedure, it is difficult to imagine the actual behavior of the device only from the images obtained from TOE because of its restricted angle of view. Contrast-enhanced CT, on the other hand, is a modality that can capture the image of the heart as a whole, as if looking at a bird’s eye view.
The purpose of our study was to create a TEER device simulator using ECG-gated computed tomography imaging.
As the first step, we created a virtual inferior vena cava and fossa ovalis model. We obtained 192 possible CT image patterns of the TEER device with this model, and they all were extracted into an STL file format. As the second step, the ECG-gated cardiac CT images of the patients were segmented into each cardiac structure and also extracted into STL files. Finally, both STL file images were fused by some 3D software, and we made a simulation of the TEER procedure preoperatively. By piling up each knob operation and rotation, we could reproduce the serial movement of the TEER device.
We could successfully reproduce the TEER device with each knob operation and rotation on a patient-specific cardiac CT image. The positional relationship between the heart and device were visualized, showing the entire trajectory of the device. It could also allow preoperative simulations to be tailored to each patient. Compared to some previous reports about TEER simulations using 3D printing models, our method could save time and cost 1)2). Another report demonstrated a simulator using a cardiac CT image, but that report did not mention how to obtain the device image 3). Our method would be more precise because our simulator was based on real TEER device images. We will apply this method for upcoming real cases and will then confirm whether a preoperative simulation of the ideal manipulation would enable optimal clipping.
We successfully created a prototype of a TEER simulator using ECG-gated computed tomography imaging.en face view of the mitral valve (TOE)en face view (simulator)
Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure
Authors: Guedeney P , Farjat-Pasos J I , Asslo G , Roule V , Hermida A , Huang F , Lattuca B , Leclercq F , Mesnier J , Abtan J , Rouanet S , Zeitouni M , Silvain J , Montalescot G , Rodes-Cabau J 
Published: November 2023

Abstract

Background
Temporary dual antiplatelet therapy (DAPT) is recommended following patent foramen ovale (PFO) percutaneous closure although its benefit, compared to single antiplatelet therapy (SAPT), has not been demonstrated in this setting.

Objective
We aimed at assessing outcomes following PFO closure according to the antiplatelet strategy at discharge.

Methods
The ambispective AIR-FORCE cohort included consecutive patients from 7 centers in France and Canada undergoing PFO closure and discharged without anticoagulation. Patients treated in French and Canadian centers were mostly discharged with DAPT and SAPT, respectively. The primary endpoint was the composite of death, stroke, transient ischemic attack, peripheral embolism, myocardial infarction, or BARC type ≥2 bleeding with up to 5 years of follow-up. The impact of the antiplatelet strategy on outcomes was evaluated with a marginal Cox model (cluster analyses per country) with inverse probability weighting according to propensity score.

Results
A total of 1,532 patients were included from 2001 to 2022, of whom 599 (39.1%) were discharged with SAPT and 933 (60.9%) with DAPT, for ≤3 months in 894/923 (96.9%) cases (Table 1). After a median follow-up of 2.4[1.1-4.4] years, a total of 58 events were observed. In the weighted analysis the rate of the primary endpoint up to 5 years was 7.8% in the SAPT strategy and 7.3% in the DAPT strategy (weighted hazard ratio 1.04, 95% confidence interval 0.59-1.83) (Figure 1). Results were consistent in a sensitivity analysis.

Conclusion
The strategy of antiplatelet strategy following PFO closure did not seem to impact clinical outcomes, thus challenging the current recommendations of temporary DAPT.Table 1.Baseline characteristicsFigure 1.Central illustration
Interventional left atrial appendage occlusion is effective and safe in high-risk patients with prior stroke: comprehensive insights from the multicenter German LAARGE registry
Authors: Fastner C , Brachmann J , Lewalter T , Zeymer U , Sievert H , Ledwoch J , Geist V , Hochadel M , Schneider S , Senges J , Akin I , Ansari U 
Published: November 2023

Abstract

Background
Interventional left atrial appendage occlusion (LAAO) is an alternative therapeutic strategy equivalent to non-vitamin K antagonist oral anticoagulation (OAC) in preventing thromboembolism (TE) for non-valvular atrial fibrillation (AF) patients with contraindications to OAC. However, patients with prior stroke are at relevant higher risk for TE than general patient populations. These patients are often prone to multimorbidity, are at high risk for bleeding, and may well benefit from LAAO.

Purpose
To investigate the performance of LAAO in secondary prevention after prior stroke versus patients without history of stroke and to reveal any potential differences in effectiveness and safety.

Methods
Data from multicenter German LAARGE was used, which is a prospective, non-randomized registry on clinical reality of LAAO with different standard commercial devices. Effectiveness was primarily assessed by the combined absence of all-cause death or non-fatal stroke within 365 days after the procedure, and secondarily by the absence of transient ischemic attack (TIA) or systemic embolism. Safety was assessed with data documenting adverse events during index hospitalization or follow-up.

Results
638 patients from 38 centers were consecutively included. 137 patients had a history of stroke (21.5%) and 501 patients had none. Stroke patients had a significantly pronounced cardiovascular comorbidity: CHA2DS2-VASc score 5.9+1.3 vs. 4.1+1.4 and HAS-BLED score 4.6+1.0 vs. 3.7+1.1, respectively (each p&lt;0.001). A high procedural success (98.5 vs. 97.4%, p=NS) was accompanied by low periprocedural MACCE or major complication rates (0% vs. 0.6 and 4.4 vs. 4.0%, respectively; each p=NS). Primary effectiveness outcome measure was not statistically different between both groups on follow-up (freedom from all-cause death or non-fatal stroke: 87.8 vs. 87.7%), while TIA (0 vs. 0.5%), systemic embolism (0.9 vs. 0%) as well as severe bleeding events (0 vs. 0.7%; each p=NS) were extremely rare.

Conclusions
Patients with history of stroke, though showing significantly pronounced multimorbidity, demonstrated a similar effectiveness and safety profile for LAAO as compared to patients without prior stroke. LAAO could serve as a feasible alternative to OAC in this selected group of high-risk AF patients with contraindications to standard care.All-cause death or non-fatal stroke (KM)
Left appendage closure after intracranial hemorrhage: safety, efficacy and timing
Authors: Laffond A , Gonzalez Calle D , Nunez Garcia J C , Blanco Fernandez F , Lopez Tejero S , Antunez Muinos P , Barreira De Sousa G , Rodriguez Collado J , Herrero Garibi J , Diego Nieto A , Martin Moreiras J , Sanchez Ledesma M , Sanchez Fernandez P L , Cruz Gonzalez I 
Published: November 2023

Abstract

Background
Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scare and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described.

Objective
To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2SVASc &gt;2) and to determine adequate timing of its performance.

Methods
The sample was obtained from a cohort of 397 patients with AF in which LAAO was performed between 2009 and 2020. In 115 of these patients, the indication for this procedure was ICH (29.8 %). Patients were divided into two groups: early occlusion (n=68; 59%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=47; 41%), after 90 days.

Results
Procedure success was 97% globally. Annual incidence of ischemic events was of 0,6%, with an absolute risk reduction of 5,9% and relative risk reduction of 90,3% compared to the predicted risk by CHA2DS2-VASC score. Regarding major hemorrhagic events, annual incidence was of 4%, with an absolute risk reduction of 3,4% and relative risk reduction of 45% compared to the predicted risk by HASBLED score.
There were no significant differences between the procedures performed in patients with history of intracranial bleeding and other indications for the procedure.
Early closure (first 90 days after the intracranial hemorrhage) was as safe as late closure, without an increase in in-hospital bleedings or complications. Furthermore, long-term follow-up demonstrated a significant reduction in all-cause mortality (11.76% versus 46.8%; HR 0.2, IC95% 0.07-0.55; p&lt;0.001). compared with late occlusion.

Conclusions
Left atrial appendage occlusion is an effective and safe treatment option to reduce the risk of ischemic stroke in selected patients with AF patients and history of ICH over mean follow-up of 3 years. Early occlusion seems to be at least as safe and effective as late occlusion and therefore could potentially reduce the rate of complications after ICH in selected patients.Survival and closure timingIschemic and bleeding risk reduction
The COVID-19 pandemic and reduced surgical site infection following cardiac surgery: time to take up the baton
Authors: Jameie M , Ilkhani S , Pashang M , Bagheri A , Jalali A , Barkhordari K H , Nosrati M , Boroumand M , Hosseini K , Masoudkabir F , Bagheri J 
Published: November 2023

Abstract

Background
Various hygienic measures have been reinforced or newly-adopted since the start of the COVID-19 pandemic. At the same time, studies have indicated a reduction in various types of hospital-acquired infections, including surgical site infections (SSI).

Purpose
This study investigated the association of the pandemic with SSI following cardiac surgeries.

Method
From 2014 to 2022, 26143 patients undergoing cardiac surgery were included and categorized into "pre-pandemic" (n= 22015) and "during-pandemic" (n=4128) groups. SSIs were classified into harvest-site, superficial sternal, and complex sternal infection. Logistic regression (univariate and multivariable) and inverse probability weighting (IPW) assessed the association of the pandemic with SSIs. For both analyses, various known SSI-related risk factors were taken into account as covariates.

Results
Among the study population, 793 SSIs occurred. The "during-pandemic" patients were significantly younger (61.87±10.58 vs. 65.64 ±11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of comorbidities/risk factors (expect for cigarette smoking). Total SSI rate significantly plummeted from 3.3% before COVID-19 to 1.8% afterward (P&lt;0.001) (Figure 1 and 2). IPW analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted-OR: 0.59, 95% confidence interval (CI):0.45-0.78), harvest-site (adjusted-OR: 0.36, 95%CI: 0.19-0.70), and superficial sternal infection (adjusted-OR: 0.60, 95%CI: 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted-OR: 1.05, 95% CI: 0.55-2.01). Multivariable regression recapitulated these findings (Figure 2).

Conclusions
The COVID-19 pandemic pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. To some extent, the drop in SSIs following the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending reinforcement of and adherence to these measurements into the post-COVID-19 era to maintain the status quo.