Outcomes of complex, high-risk percutaneous coronary intervention in patients with severe aortic stenosis: the ASCoP registry

EuroIntervention, Journal Year: 2025, Volume and Issue: 21(8), P. e426 - e436

Published: April 1, 2025

There is a lack of evidence to guide treatment patients with concomitant indication for transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI). We aimed assess different strategies PCI timing in this TAVI cohort. The ASCoP registry retrospectively included clinical both at least 1 criterion complex or PCI. primary endpoint was composite all-cause death unplanned rehospitalisation cardiovascular causes. secondary death, stroke, acute myocardial infarction, major bleeding, vascular complication revascularisation. Multivariable analysis used adjust possible confounders. A total 519 were included: 363 (69.9%) underwent staged procedures 156 (30.1%) After 441 (interquartile range 182-824) days, the occurred 151 (36.5%) cases, without any significant difference between 2 groups (p=0.98), while more frequently group (n=36 [25.8%] vs n=57 [17.4%]; p=0.014). In undergoing complex/high-risk PCI, strategy associated higher rate adverse events increased procedural risk. (ClinicalTrials.gov: NCT05750927).

Language: Английский

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Uncovering the treatable burden of severe aortic stenosis in the UK

Open Heart, Journal Year: 2022, Volume and Issue: 9(1), P. e001783 - e001783

Published: Jan. 1, 2022

Objective To estimate the population prevalence and treatable burden of severe aortic stenosis (AS) in UK. Methods We adapted a contemporary model profile symptomatic asymptomatic AS Europe North America to number people aged ≥55 years UK who might benefit from surgical valve replacement (SAVR) or transcatheter implantation (TAVI). Results With point 1.48%, we that 291 448 men women had 2019. Of these, 68.3% (199 059, 95% CI 1 77 201 221 355 people) would have been and, therefore, more readily treated according their risk profile; remaining 31.7% cases (92 389, 70 093 144 247) being asymptomatic. Based on historical patterns intervention, 58.4% (116 251, 106 895 25 606) 199 059 qualify for SAVR, with 7208 (95% 7091 7234) assessed as high, preoperative category. Among 41.6% (82 809, 73 453 92 164) potentially unsuitable an estimated 61.7% (51 093, 34 780 67 655) be suitable TAVI. 172 859 out prevalent (59.3%) will subsequently die within 5 without proactive management. Conclusions These data suggest high requiring intervention challenges ongoing capacity National Health Service meet needs those affected.

Language: Английский

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ACURATE neo2 versus SAPIEN 3 Ultra for transcatheter aortic valve implantation

EuroIntervention, Journal Year: 2023, Volume and Issue: 18(12), P. 987 - 995

Published: Jan. 1, 2023

No comparative data exist with the latest generation self-expanding ACURATE neo2 (Neo2) and balloon-expandable SAPIEN 3 Ultra (Ultra) transcatheter heart valves (THV).

Language: Английский

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Cerebral embolic protection during transcatheter heart interventions

EuroIntervention, Journal Year: 2023, Volume and Issue: 19(7), P. 549 - 570

Published: Sept. 1, 2023

Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during past decade. Embolic showers debris (calcium, atheroma, material, foreign material) are captured in majority patients who have TAVR using filter-based cerebral embolic protection device (CEPD). Additionally, systematic brain imaging studies, receiving exhibit new lesions. Mechanistic studies shown reductions volume lesions CEPDs, yet first randomised trial powered for periprocedural within 72 hours transfemoral failed to meet its primary endpoint showing superiority SENTINEL CEPD. The present review summarises clinicopathological rationale development evidence behind these devices date and emerging recognition embolisation many non-TAVR procedures. Given uniqueness each various CEPDs under development, specific trials tailored their designs will need be undertaken broaden CEPD field, addition evaluating role heart interventions. Importantly, cost-effectiveness require assessment adoption globally.

Language: Английский

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Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study

Circulation Cardiovascular Interventions, Journal Year: 2024, Volume and Issue: 17(3)

Published: March 1, 2024

BACKGROUND: Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth commissural alignment on redo-TAVR feasibility is unclear. We sought determine access after SAPIEN 3 (S3) TAVR stratified by alignment. METHODS: Consecutive patients with native stenosis were evaluated using multidetector computed tomography. S3 simulations done at depths, sizing per manufacturer recommendation assuming nominal expansion in all cases. Redo-TAVR was deemed unfeasible based valve-to-sinotubular junction distance valve-to-sinus height <2 mm, while neoskirt plane estimated feasibility. RESULTS: Overall, 1900 (mean age, 80.2±8 years; STS-PROM [Society Thoracic Surgeons Predicted Risk Operative Mortality], 3.4%) included. reduced significantly shallower depths (2.3% 80:20 versus 27.5% 100:0, P <0.001). Larger sizes feasibility, but only a 100:0 ( Commissural would render feasible patients, utilization leaflet modification techniques reduce height. Coronary following TAV-in-TAV affected both size. CONCLUSIONS: This study highlights critical depth, alignment, size predicting These findings highlight necessity for individualized preprocedural planning, considering immediate results long-term prospects reintervention as increasingly utilized younger stenosis.

Language: Английский

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