Frank van der Kley

Background: The United Kingdom–British Cardiovascular Intervention Society complex high‐risk indicated percutaneous coronary intervention (UK‐BCIS CHIP) score was developed to identify patient‐ and procedural factors to predict short‐term adverse outcomes in patients undergoing high risk percutaneous coronary intervention (PCI). The performance of the UK‐BCIS CHIP score in a patient population treated with intravascular lithotripsy (IVL) for severe coronary calcification remains unknown. Aims: To evaluate the prognostic performance of the UK‐BCIS CHIP score in patients undergoing IVL‐assisted PCI for severe coronary calcification, and to assess procedural and 1‐year clinical outcomes across CHIP score categories. Methods: This international, multicenter, prospective study included consecutive patients undergoing IVL‐assisted PCI between May 2019 and December 2025 from the BENELUX‐IVL registry. Patients were stratified according to UK‐BCIS CHIP score categories (0, 1–2, 3–4, and ≥ 5). The primary endpoint was 1‐year major adverse cardiac events (MACE), defined as a composite of cardiovascular death, non‐fatal myocardial infarction, or clinically driven target vessel revascularization. Secondary endpoints included all‐cause mortality, procedural outcomes, and periprocedural complications. Discrimination of the UK‐BCIS CHIP score was assessed using the AUC for in‐hospital events and the Harrell's C‐index for 1‐year outcomes. Results: A total of 911 patients were included. Higher UK‐BCIS CHIP scores were associated with increased clinical comorbidity, lesion complexity, and procedural intensity. Procedural, device, and technical success rates were comparable across UK‐BCIS CHIP score categories (85.1%, 94.4%, and 85.7% overall; p = 0.850, p = 0.813, and p = 0.781, respectively). Complications requiring intervention occurred in 5.5% of patients and did not differ significantly across CHIP score categories ( p = 0.347). The 1‐year cumulative incidence of MACE, accounting for all‐cause death as a competing risk, did not differ significantly across UK‐BCIS CHIP score categories (Gray's test p = 0.53). Conclusion: In IVL‐assisted PCI, the UK‐BCIS CHIP score effectively identifies patients with increased clinical and procedural complexity but shows limited discrimination for mid‐term ischemic outcomes. IVL‐assisted PCI is safe and effective across the full spectrum of CHIP risk, while long‐term prognosis appears primarily driven by underlying comorbidity burden.

Background: Early discharge (ED) within 48 h after transcatheter aortic valve implantation (TAVI) seems feasible and safe. The POLESTAR study demonstrated good 30-day outcomes of ED after TAVI using the ACURATE valve but also identified patients requiring prolonged hospitalization. Long-term outcomes after ED or prolonged hospitalization remain unknown. Aims: To determine the long-term impact of successful ED and prolonged hospitalization. Methods: POLESTAR was a prospective, multicentre, observational trial enrolling patients deemed eligible for ED prior to transfemoral TAVI with ACURATE Neo/Neo2. One-year outcomes were determined and compared between those who achieved ED and those who did not. The primary endpoint was a landmark analysis of major adverse cardiovascular events (MACE), including all-cause mortality, stroke, myocardial infarction, and cardiac rehospitalization, occurring between 30 days and oneyear post-procedure. Results: Among 252 patients from 15 sites in four countries, ED was achieved in 173 (69%) patients, while 79 (31%) required prolonged hospital stay (non-ED). One-year survival was 97%. Landmark 30-day analysis showed MACE occurring in 4.7% of ED patients vs 11.7% of non-ED patients at 1 year (HR 0.38[0.15–0.98] P = .045). Rehospitalization was numerically lower in the ED group (HR 0.56[0.27–1.19]; P = .13). Kansas City Cardiomyopathy Questionnaire (KCCQ) scores improved significantly in the full cohort (18.5 improvement; 95%CI: 15.9–21.0, P < .01), with no statistically significant difference between ED and non-ED cohorts (P for interaction = .30). Conclusions: An ED strategy after TAVI with ACURATE Neo was safe in selected patients without compromising longer-term outcomes or health-related quality of life. Patients who did not achieve ED experienced more MACE after 30 days (NCT03910751).

Background: Partial cor triatriatum sinistrum is a rare congenital heart disease and is usually considered for surgery in symptomatic patients. We describe three cases of partial cor triatriatum sinistrum, two cases of successful percutaneous balloon dilatation, and one case of conservative treatment in a patient without symptoms. Case summary: The first case describes a female patient with progressive dyspnoea on exertion in which the membrane was dilated with a balloon to relieve symptoms. The second case is about a young patient with chronic congestion of the right lung because of a partial cor triatriatum sinistrum which was also treated with dilatation. The third case describes a male patient with an incidental finding of a cor triatriatum sinistrum who did not experience any symptoms and was treated conservatively. Discussion: Percutaneous balloon dilatation is a safe and effective alternative to surgery in selected cases of (partial) cor triatriatum.

Aims: In line with the contemporary European Society of Cardiology and American Heart Association/American College of Cardiology guidelines, the work-up for anomalous aortic origin of a coronary artery (AAOCA) should include anatomical and functional evaluation. Objective: This study aims to evaluate the impact of invasive functional testing vs. real-world non-invasive functional testing on the management strategy for adults with potentially malignant AAOCA. Methods and results: In this multicentre prospective study, all AAOCA patients, ≥16 years, with an interarterial or intraseptal course underwent diagnostic work-up, including anatomic and non-invasive functional evaluation. Invasive functional testing followed the MuSCAT protocol with fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR)/resting full-cycle ratio (RFR), and intravascular ultrasound (IVUS) at baseline and during pharmacological stress. Seventy-six patients [53% female, median age 53 (44–59) years] were included. Sixteen (21%) initially presented with cardiac chest pain. High-risk anatomy, e.g. acute take-off angle <30°, was present in 75 (99%) patients. Non-invasive functional testing was positive in 10 (13%), negative in 59 (78%) and inconclusive in 2 (3%). Invasive functional testing showed discrepant results compared with non-invasive testing in 21 (28%) patients. In 15 (20% of the overall cohort) patients, the treatment recommendation was altered based on the invasive functional testing results. Conclusion: This study in adult AAOCA patients revealed a 28% discrepancy between non-invasive and invasive functional testing, altering management recommendations for 20% of the overall cohort. Implementing optimal functional testing modalities may enhance risk stratification for ischaemic events and sudden cardiac death, enabling tailored treatment strategies for AAOCA patients. Further prospective research with long-term follow-up is needed to evaluate clinical outcomes. Registered in the Dutch Trial Register #NL8777; https://onderzoekmetmensen.nl/en.

Background: Intravascular lithotripsy (IVL) has emerged as a promising treatment for heavily calcified coronary lesions. However, evidence regarding its effectiveness in calcific bifurcation lesions remains limited. Objective: We aimed to evaluate the technical success and 1‐year clinical outcomes of IVL in calcified coronary bifurcation lesions. Methods: Patients undergoing PCI with the use of IVL from the ongoing prospective BENELUX‐IVL registry were included. Participants were stratified into bifurcation and non‐bifurcation groups. The primary technical endpoint was technical success, defined as successful crossing of the IVL catheter across the target lesion with a residual stenosis of < 30%. The primary safety endpoint was in‐hospital major adverse cardiac events (MACE). Results: Among 509 patients, 114 (22.4%) had coronary bifurcation lesions. Compared to the non‐bifurcation group, the bifurcation group had higher SYNTAX scores (25 [18–33] vs. 18 [10–29]; p < 0.01), longer procedural times (100 [75–129] min vs. 78 [59–107] min; p < 0.01), and greater contrast volume use (208 ± 8 mL vs. 176 ± 4 mL; p < 0.01). Abrupt side branch occlusion (1.8%) and bail‐out two‐stent techniques (3.6%) were infrequent. IVL achieved comparable technical success (91.2% vs. 90.0%, p = 0.71) and 1‐year MACE rates (9.6% vs. 5.8%, p = 0.20) in bifurcation versus non‐bifurcation lesions. Conclusion: IVL demonstrates excellent safety and efficacy in calcified coronary bifurcation PCI, achieving high technical success with low device‐dependent adverse event rates.

Background and Aims: Although women with severe symptomatic aortic stenosis have more complications than men when undergoing surgical valve replacement, they are under-represented in clinical trials. The Randomized researcH in womEn all comers wIth Aortic stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) vs. surgery in women. Methods: Women were randomized 1:1 to transfemoral TAVI with a balloon-expandable valve or surgery. The primary composite endpoint was death, stroke, or (valve, procedure or heart failure related) rehospitalization at 1 year. Non-inferiority testing with a pre-specified 6% margin and superiority testing were performed in the as-treated population. Results: At 48 European centres, 443 women underwent randomization, and 420 were treated as randomized. Mean age was 73 years, and the mean estimated surgical risk of death was 2.1% (Society of Thoracic Surgeons risk score). Kaplan–Meier estimates of the primary endpoint event rates at 1 year were 8.9% in the TAVI and 15.6% in the surgery group. This difference of −6.8% with an upper 95% confidence limit of −1.5% demonstrated the non-inferiority of TAVI (P < .001). The two-sided 95% confidence interval of −13.0% to −.5% further resulted in superiority (P = .034). The 1-year incidence of the primary endpoint components was: .9% with TAVI vs. 2.0% with surgery for death from any cause, 3.3% vs. 3.0% for stroke, and 5.8% vs. 11.4% for rehospitalization. Conclusions: Among women with severe aortic stenosis, the incidence of the composite of death, stroke, or rehospitalization at 1 year was lower with TAVI than with surgery. ClinicalTrials.gov number: NCT04160130.

Aims: This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI), and to investigate the prognostic value of cardiac damage stage evolution. Methods and results: Patients with severe aortic stenosis (AS) undergoing TAVI were retrospectively analysed. A five-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI. Multivariable Cox regression analyses were used to examine independent prognostic value of the changes in cardiac damage after TAVI. A total of 734 patients with severe AS (mean age, 79.8 ± 7.4 years; 55% male) were included. Before TAVI, 32 (4%) patients did not show any sign of extra-valvular cardiac damage (Stage 0), 85 (12%) had left ventricular damage (Stage 1), 220 (30%) left atrial and/or mitral valve damage (Stage 2), 227 (31%) pulmonary vasculature and/or tricuspid valve damage (Stage 3), and 170 (23%) right ventricular damage (Stage 4). Six months after TAVI, 39% of the patients improved at least one stage in cardiac damage. Staging of cardiac damage at 6 months after TAVI [hazard ratio (HR) per one-stage increase, 1.391; P = 0.035] as well as worsening in the stage of cardiac damage (HR, 3.729; P = 0.005) were independently associated with 2-year all-cause mortality. Conclusion: More than one-third of patients with severe AS showed an improvement in cardiac damage 6 months after TAVI. Staging cardiac damage at baseline and follow-up may improve risk stratification in patients undergoing TAVI.