BACKGROUND:Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve. OBJECTIVES:This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads. METHODS:All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion. RESULTS:Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days. CONCLUSIONS:Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).
BACKGROUND:Dyspnea and fatigue represent common Long-COVID symptoms, but their presence is not always accompanied by lung function abnormalities. Aim of the study was to evaluate dyspnea and fatigue in relation to pulmonary function and exercise capacity. METHODS:Multicenter cohort study. Multivariable analyses were used to characterize, for both symptoms, functional phenotypes with and without pulmonary impairment according to the diffusing lung capacity for carbon monoxide (DLCO). Exercise capacity was assessed through the distance walked in 6 min (6MWD). RESULTS:Among 765 patients evaluated at a mean interval of six months from COVID-19, rates of dyspnea and fatigue were 41.3% and 41.6%, respectively. Roughly half of the patients with these two symptoms (51.6% and 54.7%, respectively) had normal pulmonary function at DLCO testing (≥80% of predicted). Low-DLCO (<80%) dyspnea was significantly associated with female sex, anxiety, duration of hospitalisation, use of corticosteroids and of monoclonal neutralizing antibodies, and its risk decreased at the increasing in time from acute infection. Normal-DLCO dyspnea was associated with younger age and obesity. Low-DLCO fatigue was associated with female sex, heart failure, anxiety and use of corticosteroids. Normal-DLCO fatigue was not associated with demographics, comorbidities, or COVID-19 severity. For both symptoms, the low-DLCO phenotypes had a significantly lower 6MWD. CONCLUSIONS:The clinical phenotypes of dyspnea and fatigue with normal pulmonary function should be further explored, possibly with additional tests that assess cardiorespiratory and cardiovascular function. DLCO testing should be included in the evaluation of patients who report dyspnea and/or fatigue as possible Long-COVID symptoms.
Ferrarini, Giovanni, Mattia Canevari, Valeria Azzini, Piergiuseppe Agostoni, Beatrice Pezzuto, and Carlo Vignati. Physiological responses to acute hypobaric and normobaric hypoxia: Differences in maximal exercise and clinical impact. High Alt Med Biol. 00:00-00, 2026.-Hypoxia, defined by inspired partial pressure of oxygen (PiO2) <150 mmHg, has been extensively studied in conditions of both reduced barometric pressure (hypobaric hypoxia, HH) and reduced inspired fraction of oxygen (FiO2) at sea level (normobaric hypoxia, NH). Traditionally considered interchangeable, mounting evidence indicates that HH and NH elicit distinct cardiovascular, ventilatory, and gas-exchange responses during physical effort, likely due to factors beyond PiO2, including air density, alveolar gas composition, exercise modality, and the age and sex of the individual performing the effort. A thorough understanding of how different hypoxic modalities affect exercise responses provides fundamental insights into human physiology and pathophysiology under extreme conditions, with practical implications for sports medicine and athletic training, as well as for patients with pathologies potentially influenced by hypoxia dealing with high altitude. This narrative review synthesizes current evidence on the differential effects of HH and NH on exercise responses, with an emphasis on maximal exercise capacity and underlying the physiological mechanisms regarding cardiovascular function, ventilatory adaptation, and gas-exchange responses, also outlining the implications for athletes, clinical populations (heart failure, chronic obstructive pulmonary disease, pulmonary hypertension), and altitude medicine.
Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the high prevalence of patients with diabetes and their increased susceptibility to renal injury, this study aimed to assess whether the renal-protective effect of AA infusion is maintained in this population. This post-hoc subgroup analysis examined patients with diabetes included in the multinational, double-blind, randomized, placebo-controlled PROTECTION trial. Participants were randomized to receive a continuous intravenous infusion of AA (2 g/kg of the ideal body weight per day; up to 72 h) or placebo during the perioperative period of cardiac surgery. Among 644 patients with diabetes (AA n = 309; placebo n = 335), the incidence of any-stage AKI was 43.3
Limited information exists regarding the effectiveness of oxygenated right ventricular assist devices (OxyRVAD) versus standard right ventricular assist device (RVAD) configurations in patients with acute right ventricular failure (aRVF). We analyzed 345 patients (n = 197 OxyRVAD; n = 148 RVAD) with aRVF from a multicenter registry (PLACE study). Propensity scores were estimated using generalized boosted models. Inverse probability of treatment weighting was applied to balance groups. The primary endpoint was 30 day mortality; secondary endpoints included in-hospital mortality, complications, and successful weaning. Subgroup and interaction analyses were conducted to assess effect modification, particularly by baseline PaO2. Oxygenated right ventricular assist device use was not associated with improved 30 day mortality (Hazard Ratio [HR]: 1.09, 95% confidence interval [CI]: 0.72-1.65) but was linked to higher risks of thromboembolism (Odds Ratio [OR]: 1.68, 95% CI: 1.04-2.71), bleeding (OR: 1.53, 95% CI: 1.01-2.39), and renal replacement therapy (OR: 1.61, 95% CI: 1.01-2.61). Subgroup analysis revealed a significant interaction between PaO2 and treatment group (p = 0.019), with a mortality benefit observed in patients with PaO2 of less than 60 mm Hg (HR: 0.67, 95% CI: 0.45-0.99). In non-hypoxemic aRVF patients, OxyRVAD use was associated with increased complications and no survival benefit. These findings support a physiologically stratified approach to temporary RV support and discourage unselected, patient phenotype-oriented OxyRVAD use in the presence of refractory aRVF.
