BACKGROUND AND AIMS:Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edge-to-edge repair (TEER) for AFMR has not been investigated. METHODS:Patients with AFMR who underwent TEER were selected from the OCEAN-Mitral registry, and medically managed controls were selected from the REVEAL-AFMR registry, using an identical AFMR definition. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. The secondary endpoint was all-cause mortality. RESULTS:A total of 1081 patients (mean age 80.1 ± 8.2 years, 60.5% female) with moderate or severe AFMR were included, of whom 441 underwent TEER and 640 remained on medical treatment. Overlap weighting based on the propensity score yielded well-balanced characteristics (n = 441 vs 640; all standardized mean differences <0.01), where TEER was associated with a lower incidence of the primary (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43-0.99, P = .044) and secondary endpoints (HR 0.58, 95% CI 0.35-0.99, P = .044). In an exploratory subgroup analysis, favourable outcomes might be pronounced in patients with ≤mild residual AFMR after TEER, while event rates in those with ≥ moderate residual AFMR were comparable with the medication group. As sensitivity analyses, inverse probability of treatment weighting (n = 158 vs 173), propensity score matching (n = 104 vs 104), and multivariable Cox regression (n = 441 vs. 640) all confirmed favourable associations of TEER with both endpoints. CONCLUSIONS:In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.
OBJECTIVE:In patients with chronic limb threatening ischaemia (CLTI), pedal artery angioplasty (PAA) is widely known to improve wound healing, but inframalleolar revascularisation may worsen arterial lesion morphology and lead to wound recurrence after healing. This retrospective cohort study aimed to clarify the effects of PAA on wound recurrence after wound healing. METHODS:Consecutive limbs with CLTI (n = 534) secondary to infrapopliteal and pedal artery disease that underwent endovascular therapy (EVT) and achieved complete wound healing at eight cardiovascular centres in Japan were analysed (March 2021 - December 2023). Limbs were divided into two groups according to whether PAA was performed (n = 89) or not (n = 445). RESULTS:Propensity score matching extracted 160 matched limbs that had no remarkable intergroup differences in patient and lesion characteristics. The wound recurrence rate at one year was statistically significantly higher in the PAA group than in the non-PAA group (51.4% vs. 23.5%; p < .001). Low serum albumin level, haemodialysis, good pedal artery type before EVT, and low small artery disease score showed significant interaction effects on wound recurrence, favouring non-PAA over PAA. Subanalysis of changes in plantar arch artery morphology before EVT and during repeat angiography at the time of wound recurrence showed statistically significantly more frequent deterioration of plantar arch artery morphology in the PAA group than in the non-PAA group (p = .020). CONCLUSION:This study showed a significantly greater wound recurrence rate and more frequent deterioration of plantar arch artery morphology after PAA than after a non-PAA treatment in patients with CLTI.
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidence regarding rotational atherectomy (RA) in 2020, which was updated in 2023. Because the revascularization strategy to severely calcified lesions has been the hottest topic in contemporary percutaneous coronary intervention (PCI), many literatures related to RA have been published since 2023. Latest advancements have been incorporated in this updated expert consensus document.
Background and Aims The association between periprocedural change in tricuspid regurgitation (TR) and outcomes in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER) is unclear. This study aimed to examine the prognostic value of TR before and after M-TEER.Methods Patients in the OCEAN-Mitral registry were divided into four groups according to baseline and post-procedure echocardiographic assessments: no TR/no TR (no TR), no TR/significant TR (new-onset TR), significant TR/no TR (normalized TR), and significant TR/significant TR (residual TR) (all represents before/after M-TEER). Tricuspid regurgitation >= moderate was defined as significant. The primary outcome was cardiovascular death or heart failure hospitalization. Tricuspid regurgitation pressure gradient was also evaluated.Results The numbers of patients in each group were 2103 (no TR), 201 (new-onset TR), 504 (normalized TR), and 858 (residual TR). Baseline assessment for TR and TR pressure gradient was not associated with outcomes after M-TEER. In contrast, patients with new-onset TR had the highest adjusted risk for the primary outcome, followed by those with residual TR [compared with no TR as a reference, hazard ratio 1.83 (95% confidence interval: 1.39-2.40) for new-onset TR, 1.45 (1.23-1.72) for residual TR, and 0.82 (0.65-1.04) for normalized TR]. Similarly, from baseline to post-procedure, TR pressure gradient changes were associated with subsequent outcomes after M-TEER. New-onset and residual TR incidence was commonly associated with dilated tricuspid annulus diameter and atrial fibrillation.Conclusions Post-procedural TR, but not baseline TR, was associated with outcomes after M-TEER. Careful TR assessment after the procedure would provide an optimal management for concomitant significant TR in patients undergoing M-TEER.
BACKGROUND:Paclitaxel-coated balloons (PCBs) are widely used for femoropopliteal artery (FPA) diseases. However, data on recurrence and recurrence patterns after PCB angioplasty are limited. This study investigated the association between recurrence patterns, baseline characteristics, and clinical outcomes in the cases following PCB angioplasty. METHODS:This multicenter, retrospective study included 1159 limbs in 1031 patients treated for de novo FPA lesions using PCBs. Patients were classified into three groups (patency, restenosis, and reocclusion) according to patency or recurrence patterns within 2 years after the index PCB angioplasty. The primary outcome was the incidence of target lesion revascularization (TLR), and the secondary outcome was the pattern of re-recurrence within 2 years following TLR using PCBs. RESULTS:When comparing the three groups, reocclusive cases were characterized by more complex lesions, including chronic total occlusion, at baseline. Following the index PCB angioplasty, approximately 70% of recurrent cases underwent TLR, which was performed more frequently in reocclusive than in restenotic cases (82.1% vs 63.7%). Conversely, a higher percentage of restenotic cases did not require TLR compared to reocclusive cases (10.3% vs 27.8%). In cases where TLR was performed using PCBs, the rate of re-recurrence with occlusive morphology was significantly higher in reocclusive than in restenotic cases (52.3% vs 24.3%). CONCLUSIONS:After PCB angioplasty for FPA lesions, symptomatic recurrence and requirement for TLR were more frequent in reocclusive cases. Even after TLR using PCBs, reocclusive cases tend to recur with occlusion.
