José Ramón López-Mínguez

Background: Most evidence for transcatheter aortic valve replacement (TAVR) for valve‐in‐valve procedures comes from balloon‐expandable and supra‐annular self‐expanding valves. However, data on intra‐annular self‐expanding valves remain limited. The objectives of this registry were to evaluate the short‐ and midterm outcomes of ViV‐TAVR using the intra‐annular self‐expanding valve Navitor platform in a real‐world setting. Methods: The NAViV (Navitor Valve‐in‐Valve) registry is a retrospective, multicenter study that included 200 patients who underwent valve‐in‐valve TAVR with the Portico/Navitor systems. The primary end point was 30‐day device success. Secondary outcomes included intraprocedural technical success, early safety, and all‐cause death and major adverse events at 2 years. Results: The cohort had a high‐risk profile and a high prevalence of small surgical bioprostheses (internal diameter ≤21 mm in 86% of the patients). Technical success was achieved in 96%, with an in‐hospital mortality rate of 2% and early safety at 30 days of 84%. Mean residual gradients after TAVR were low (14 [interquartile range, 10–20] mm Hg), and residual significant aortic regurgitation was rare (1%). Device success was 73.5%, with high residual gradients (≥20 mm Hg) being the main reason for device failure. Two‐year survival and major adverse events were 85.6% and 69.8%, respectively; with low residual gradients and baseline significant AR being independently associated with higher survival. Conclusions: Valve‐in‐valve TAVR using the Portico/Navitor intra‐annular self‐expanding valve demonstrates a favorable procedural safety profile, sustained valve performance, and encouraging midterm survival in intermediate‐ and high‐risk populations. Larger and comparative studies are warranted to confirm these findings.

Background: Killip-Kimball classification has been used for estimating death risk in patients suffering acute myocardial infarction (AMI). Killip-Kimball stage IV corresponds to cardiogenic shock. However, the Society for Cardiovascular Angiography and Interventions (SCAI) classification provides a more precise tool to classify patients according to shock severity. The aim of this study was to apply this classification to a cohort of Killip IV patients and to analyze the differences in death risk estimation between the two classifications.Methods: A single-center retrospective cohort study of 100 consecutive patients hospitalized for “Killip IV AMI” between 2016 and 2023 was performed to reclassify patients according to SCAI stage.Results: Distribution of patients according to SCAI stages was B=4%, C=53%, D=27%, E=16%. Thirty-day mortality increased progressively according to these stages (B=0%, C=11.88%, D=55.56%, E=87.50%; P1.15 mg/dl and advanced SCAI stages (SCAI D and E) were independent predictors of 30-day mortality. Mechanical circulatory support use showed an almost significant benefit in advanced SCAI stages (D and E hazard ratio, 0.45; 95% confidence interval, 0.19–1.06; P=0.058).Conclusions: SCAI classification showed superior death risk estimation compared to Killip IV. Age, creatinine levels and advanced SCAI stages were independent predictors of 30-day mortality. Mechanical circulatory support could play a beneficial role in advanced SCAI stages.

Revista Española de Cardiología: Interventional Cardiology

Revista Española de Cardiología: Interventional Cardiology

Revista Española de Cardiología: Interventional Cardiology

Revista Española de Cardiología: Interventional Cardiology

Revista Española de Cardiología: Interventional Cardiology

Revista Española de Cardiología: Interventional Cardiology

Objective: To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI).Methods: A Markov model was developed to estimate, over 3‐month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality‐adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b‐4 and an average age of 72 years. The incidence of contrast‐induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all‐cause and state‐specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes.Results: The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice.Conclusions: The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b‐4 undergoing PCI in Spain.

Revista Española de Cardiología: Interventional Cardiology