BACKGROUND AND AIMS:Radial access site for percutaneous coronary intervention (PCI) is recommended by clinical practice guidelines because of superior outcomes compared with femoral access site. Historically, the adoption of radial access site in the USA has lagged behind much of the rest of the world, but contemporary data on access site selection across the spectrum of clinical presentations and its association with outcomes are lacking. METHODS:A retrospective cohort study from the National Cardiovascular Data Registry's CathPCI Registry was conducted including PCIs performed between 1 January 2013 and 30 June 2022. The comparative safety of radial vs femoral access site for PCI was evaluated with instrumental variable analysis, a technique that can be used to support causal inference, exploiting operator variation in access site preferences as the instrumental variable. RESULTS:Overall, 6 658 479 PCI procedures were performed during the study period, of which 40.4% (n = 2 690 355) were performed via radial access site, increasing from 20.3% in 2013 to 57.5% in 2022. This increase was seen in all geographic regions and across the full spectrum of presentations, with the largest relative increase seen in patients with ST-elevation myocardial infarction. Overall, 2 420 805 PCIs met inclusion criteria for the comparative safety analysis. In instrumental variable analyses, radial access site was associated with lower in-hospital mortality [absolute risk difference (ARD) -.15%, 95% confidence interval (CI) -.20 to -.10], major access site bleeding (ARD -.64%, 95% CI -.68 to -.60), and other major vascular complications (ARD -.21%, 95% CI -.23 to -.18) but a higher risk of ischaemic stroke (ARD .05%, 95% CI .03-.08). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (ARD .00%, 95% CI -.03-.03). CONCLUSIONS:Over the past decade, use of radial access site for PCI has increased 2.8-fold in the USA and now represents the dominant form of access site across all procedural indications. Based on instrumental variable analyses, PCI with radial access site had lower rates of in-hospital mortality, major access site bleeding, and other major vascular complications compared with femoral access site but a slightly higher risk of ischaemic stroke in contemporary practice.
Tricuspid regurgitation (TR) is a highly morbid and often untreated valvular heart disease. New devices are under development to address this unmet need, necessitating valid models to test their efficacy. Aim of this study was to assess feasibility and reliability of pulmonary artery banding (PAB) as a pathological acute model of functional TR. Eight pigs underwent right thoracotomy, with an umbilical tape placed around the main pulmonary trunk, followed by controlled reduction of the pulmonary artery lumen via a tourniquet system. No animals died during the procedure. After PAB, right ventricular (RV) mean pressure, RV basal and mid-diameter and tricuspid septo-lateral diameter significantly increased (+ 97
Mitral valve (MV) regurgitation (MVR) is mainly associated with mitral valve leaflet prolapse. The leading cause of MV leaflet prolapse is degeneration of the mitral valve leaflets or functional MVR. Until recently, there has been a scarcity of surgical options for minimally invasive mitral valve repair in dogs. In contrast, humans often have forms of MVR that do not qualify for conventional heart surgery or existing minimally invasive mitral valve repair methods. Transapical Transcatheter Edge-to-Edge Repair (TEER) of the MV is an innovative new method that uses special clips that are inserted into the heart through apical punctures. This technique enables effective closure of the defective valve without necessitating a traditional thoracotomy or opening the heart. It is the first minimally invasive method for valve clamping in dogs and a new option available for humans suffering from severe MVR. In this article, we summarize the knowledge of TEER and its use in humans and dogs.
BACKGROUND:Cardiac conduction disturbances remain the most frequent complication of transcatheter aortic valve replacement (TAVR), but the clinical implications of new left bundle branch block (LBBB) after TAVR remain controversial. Here, we aim to assess the impact of new LBBB after TAVR on patient outcomes in a large, real-world registry. METHODS:The study population consisted of patients in the TVT registry (Society of Thoracic Surgery and American College of Cardiology Transcatheter Valve Therapy Registry) who underwent TAVR for aortic stenosis between 2016 and 2022 and were discharged alive from the index hospitalization. Key exclusion criteria included preexisting conduction defects and a permanent pacemaker before TAVR or during the index hospitalization. Clinical outcomes were compared between patients with and without new LBBB using Cox proportional hazards models adjusted for baseline demographic, clinical, and echocardiographic variables. RESULTS:Among 202 533 TAVR recipients, 32 933 (16.3%) developed new LBBB after TAVR. Over the study period, there was a significant decrease in the incidence of new LBBB from 19.9% in the first quarter of 2016 to 14.4% in the third quarter of 2022. Patients with new LBBB after TAVR, compared with those without LBBB, had significantly greater 1-year all-cause mortality (adjusted hazard ratio, 1.19 [95% CI, 1.13-1.25]; P<0.001), hospital readmission (adjusted hazard ratio, 1.23 [95% CI, 1.19-1.28]; P<0.001), and new pacemaker requirement (adjusted hazard ratio, 3.50 [95% CI, 3.26-3.76]; P<0.001). Patients with new LBBB also had lower Kansas City Cardiomyopathy Questionnaire Overall Summary scores (adjusted difference, -1.7 points [95% CI, -2.1 to -1.3]; P<0.001) and left ventricular ejection fraction (adjusted difference, -2.8% [95% CI, -3.4% to -2.2%]; P<0.001). CONCLUSIONS:New LBBB after TAVR is associated with worse 1-year outcomes, including death, rehospitalization, and permanent pacemaker, as well as worse health status and lower left ventricular ejection fraction. These findings suggest that continued efforts to limit the development of conduction disturbance after TAVR are warranted.
Background Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) is an established prognostic marker in tricuspid regurgitation (TR). Right ventricular free wall longitudinal strain (RVFWS)/PASP has been proposed as more sensitive prognostic markers than TAPSE/PASP in patients with TR, yet its role in patients undergoing transcatheter tricuspid valve repair (TTVr) remains unclear. The objective of the study was to evaluate and compare the prognostic value of RVFWS/PASP and TAPSE/PASP with two different vendors in symptomatic TTVr cohorts. Methods TTVr-treated patients across three centers (2017-2023) were included. RVFWS was assessed using two vendors (A = GE EchoPAC and B = Tomtec). The primary endpoint was a composite of all-cause mortality or the first heart failure hospitalization at 2-years. Prognostic performance was assessed using Cox regression, C-statistics, and Kaplan-Meier analysis. Results A total of 349 patients were included (137 vendor A and 212 vendor B). Patients in vendor B were older (83 vs. 80; p < 0.001), more symptomatic (New York Heart Association III/IV: 95.8 vs. 81.7%; p < 0.001), had lower 6-minute walk distance (218 vs. 282 m; p < 0.001), and greater right heart dilation, despite similar TR severity. RVFWS was higher in vendor B (23.0 vs. 18.0%, p < 0.001). RVFWS/PASP emerged as an independent predictor of the primary endpoint only in vendor A (hazard ratio per %/mmHg increase: 0.07, 95% CI: 0.01-0.46; p = 0.005), whereas TAPSE/PASP consistently showed independent prognostic association in both cohorts. Discrimination of both indices was not significantly different. Receiver operating characteristics-derived cutoffs identified patient subgroups with markedly different 2-year outcomes in both cohorts. Conclusions Both RVFWS/PASP and TAPSE/PASP provided modest prognostic value after TTVr, with TAPSE/PASP demonstrating consistent independent association across vendors.
