Several novel interventional studies presented Oct. 14 during TCT 2020 were simultaneously published in JACC Journals. Research includes an automated algorithm for pre-PCI physiological results; an assessment of PCI patients in the work-up pre-TAVR; transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and mitral regurgitation (MR); early outcomes of the Cephea valve in patients with severe primary MR; assessment of accessory renal arteries (ARAs) as a target for renal denervation; and TAVR with the LOTUS Edge System.

According to a study simultaneously published in JACC: Cardiovascular Interventions, by Seung Hun Lee, MD, PhD, et al., an automated algorithm using pre-PCI fractional flow reserve (FFR) pullback curve may be able to predict post-PCI physiological results. "Incorporating an automated algorithm of dFFR(t)/dt might provide additional information to further refine proper target lesion selection in the pre-PCI phase," the authors conclude. Sebastian Völz, MD, PhD, and Elmir Omerovic, MD, PhD, note in a related editorial comment that "future studies designed for the assessment of relevant clinical endpoints are necessary to ultimately evaluate the feasibility and clinical benefit of pre-PCI physiological response assessment."

Research by Laurent Faroux, MD, et al., simultaneously published in JACC: Cardiovascular Interventions, looked at 1,197 patients who had PCI in the work-up pre-TAVR. Results showed that these patients "frequently exhibited complex coronary lesions and multivessel disease." After a median follow-up of two years, 444 patients (37.1%) presented a major adverse cardiovascular and cerebrovascular event, "with incomplete revascularization determining an increased risk." According to Cindy L. Grines, MD, FACC, and Pradyumna E. Tummala, MD, FACC, in a related editorial comment, "whether revascularization before TAVR is necessary is still uncertain."

A study by Richard G. Jung, BSc, et al., simultaneously published in JACC: Cardiovascular Interventions, evaluated the outcome of TMVr in 141 patients across 14 institutions with cardiogenic shock and moderate to severe, or severe MR. According to the authors "TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR." Philipp Lurz, MD, PhD, and Christian Besler, MD, note in a related editorial comment, "the findings by Jung et al., are encouraging and should stimulate more intense research in the field, but there is still a long way to go. Let’s hope TMVr finally finds a role in [cardiogenic shock] management, in the interest of our patients." 

Novel research by Alberto Alperi, MD, et al.,simultaneously published in JACC: Cardiovascular Interventions, found that "the transfemoral delivery of a purposely designed mitral prosthesis (Cephea valve) was safe and feasible in prohibitive risk patients." The researchers looked at three patients with severe primary MR (two women, mean age 79 ±3 years) at prohibitive surgical risk. Alperi et al., found that at 6-month follow-up, "valve performance was sustained, and clinical outcomes improved." Moving forward, they add that "the confirmation of these initial results, including a larger number of patients, could potentially open the door to a new therapeutic alternative in patients with severe MR, most likely including those with [mitral annular calcification] features."

Yu Sato, MD, et al., looked at 7,287 nerves from 14 ARAs and nine dominant renal arteries (DRAs) to assess the importance of ARA as a target for renal denervation. The research, simultaneously published in JACC: Cardiovascular Interventions, showed that ARAs showed a smaller number of nerves than DRAs, however, these results were dependent on the size of the ARA. "Ablation especially in large ARAs may allow for more complete denervation with the potential of further reducing blood pressure," the authors conclude.

A study on 286 patients undergoing TAVR with the LOTUS Edge System by Xavier Armario, MD, et al., was simultaneously published in JACC: Cardiovascular Interventions. Results showed that short-term safety and efficacy was "satisfactory," in additional to "favorable hemodynamic data, and very low rates of paravalvular leak in an anatomically complex cohort." The authors add that new permanent pacemaker implantation remained high – 25.9% among all patients and 30.8% among permanent pacemaker-naïve patients. Moving forward, the authors conclude that "Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of [permanent pacemaker] implantation."

For additional information on JACC Journals at TCT 2020, visit OnlineJACC.org/Events/TCT2020.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: TCT20, Transcatheter Cardiovascular Therapeutics, Mitral Valve Insufficiency, Shock, Cardiogenic, Renal Artery, Mitral Valve, Transcatheter Aortic Valve Replacement, Percutaneous Coronary Intervention, Blood Pressure, Fractional Flow Reserve, Myocardial, Hemodynamics

< Back to Listings