Comprehensive Cardiac Imaging Before and During Microaxial Flow Pump Support for Cardiogenic Shock.

The increasing use of microaxial flow pumps (mAFP) underpins the need for a comprehensive approach to manage critically ill patients in an effort to maximize the benefits of this temporary mechanical circulatory support (tMCS) while minimizing its potential complications. Multimodality cardiac imaging offers an irreplaceable array of tools to address device position, device-heart hemodynamic interaction, myocardial recovery assessment, and identification of complications. This review provides a comprehensive and pragmatic summary of the cardiovascular imaging modalities currently available throughout the pathway of care of mAFP-supported patients, from device insertion, to intensive cardiac care hemodynamic monitoring, weaning guidance, and myocardial recovery assessment.

Impact of Left Ventricular Outflow Tract Calcification on Early Outcome in Patient With Bicuspid Aortic Valve Undergoing Transcatheter Aortic Valve Implantation With Self-Expandable and Balloon-Expandable Valve.

The aim of this study was to assess the impact of left ventricular outflow (LVOT) calcification on early device outcomes in a contemporary patient cohort with bicuspid aortic valve undergoing transcatheter aortic valve implantation (TAVI), and to compare outcomes between balloon-expandable (BE) and self-expandable (SE) prostheses in this population. LVOT calcification is known to be associated with adverse outcomes after TAVI in patient with tricuspid anatomy. However, its impact on patients with bicuspid anatomy remains less explored.

Heart Valve Centre Approach to Severe Tricuspid Regurgitation: Real-World Data and Outcomes.

Background: Severe tricuspid regurgitation (TR) is associated with significant morbidity and mortality but remains markedly undertreated. Optimal management strategies and the timing of intervention are still unclear.

Methods: We retrospectively analysed 476 patients with isolated symptomatic severe TR treated at our heart valve centre from 2018 to 2023.

15-Year Outcomes of PFO Closure in Patients With Cryptogenic Embolism: Insights From the PROLONG Registry.

Background: Transcatheter patent foramen ovale (PFO) closure has become the gold-standard treatment for patients with cryptogenic embolism and PFO, but long-term outcomes data are limited.

Objectives: The aim of this study was to report the extended clinical outcomes of patients who underwent transcatheter PFO closure for cryptogenic embolism.

Methods: PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group) is an investigator-initiated, multicenter, retrospective registry that enrolled patients who underwent transcatheter PFO closure between 1999 and 2013 at 12 centers in Italy.

Chimney stenting for preventing coronary obstruction in redo-TAVI with balloon-expandable valves within self-expanding valves.

Background: Coronary obstruction (CO) is a major concern in redo-transcatheter aortic valve implantation (TAVI) for failing supra-annular self-expanding transcatheter aortic valves (TAVs).

Aims: This ex vivo study tested chimney stenting (ChS) for redo-TAVI in patients with high-risk anatomy for CO by evaluating stent outcomes and the feasibility of subsequent coronary access (CA) for percutaneous coronary intervention (PCI).

Methods: Patient-specific anatomical models were three-dimensionally printed from pre-TAVI computed tomography (CT) scans.

Even aortic insufficiency can be treated percutaneously: right?

Moderate or severe aortic insufficiency (AI) is a relatively rare condition but with significant clinical implications, especially in elderly patients at high surgical risk. Although surgical aortic valve replacement remains the gold standard for treatment, a significant proportion of patients are not eligible due to the high surgical risk. In recent years, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of aortic stenosis, but its application to AI has encountered significant challenges, mainly related to specific anatomical characteristics of this population.

Left Main Spontaneous Coronary Artery Dissection: Clinical Features, Management, and Outcomes.

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction (MI) and is associated with substantial adverse events. SCAD involving the left main coronary artery (LM) is a rare but potentially life-threatening condition. Currently, minimal data on LM SCAD have been reported.

Who Lives Longer, the Valve or the Patient? The Dilemma of TAVI Durability and How to Optimize Patient Outcomes.

Over the past few years, transcatheter aortic valve implantation (TAVI) imposed itself as the first-choice therapy for symptomatic aortic stenosis (AS) in elderly patients at surgical risk. There have been continuous technological advancements in the latest iterations of TAVI devices and implantation techniques, which have bolstered their adoption. Moreover, the favorable outcomes coming out from clinical trials represent an indisputable point of strength for TAVI.

Impact of leaflet splitting on coronary access after redo-TAVI for degenerated supra-annular self-expanding platforms.

Background: Coronary access (CA) is a major concern in redo-transcatheter aortic valve implantation (TAVI) for failing supra-annular self-expanding transcatheter aortic valves (TAVs).

Aims: This ex vivo study evaluated the benefit of leaflet splitting (LS) on subsequent CA after redo-TAVI in anatomies deemed at high risk of unfeasible CA.

Methods: Ex vivo, patient-specific models were printed three-dimensionally.

Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery.

Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support.

Predicting target lesion failure following percutaneous coronary intervention through machine learning risk assessment models.

Aims: Central to the practice of precision medicine in percutaneous coronary intervention (PCI) is a risk-stratification tool to predict outcomes following the procedure. This study is intended to assess machine learning (ML)-based risk models to predict clinically relevant outcomes in PCI and to support individualized clinical decision-making in this setting.

Methods And Results: Five different ML models [gradient boosting classifier (GBC), linear discrimination analysis, Naïve Bayes, logistic regression, and K-nearest neighbours algorithm) for the prediction of 1-year target lesion failure (TLF) were trained on an extensive data set of 35 389 patients undergoing PCI and enrolled in the global, all-comers e-ULTIMASTER registry.

Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valve Disease: Procedural Planning and Clinical Outcomes.

Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 1-2% and occurring in >20% of octogenarians referred for aortic valve replacement. However, BAV patients have been systematically excluded from pivotal randomized trials. Since TAVI indications are moving toward low-risk patients, an increase in the number of BAV patients who undergo TAVI is expected.

[Management of patients with myocardial ischemia/infarction with non-obstructive coronary artery disease in Italian catheterization laboratories: results of the SICI-GISE national survey promoted by the GISE Young Committee].

Background: Myocardial ischemia (INOCA) and acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) represent emerging entities in the landscape of interventional cardiology. These conditions have heterogeneous pathophysiological mechanisms and clinical presentations, complex diagnostics, and high prognostic significance.

Methods: This survey was carried out jointly by the GISE Young Committee with the support of the SICI-GISE Society and the ICOT group with the aim of evaluating the implementation of diagnostic-therapeutic pathways in cases of suspected/confirmed INOCA and MINOCA diseases.