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Safety and efficacy of balloon angioplasty compared to stent-basedstrategies with pulmonary vein stenosis:A systematic review and meta-analysis

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World Journal of Cardiology 2023年第2期15卷 64-75页

作者： Pradyumna Agasthi Srilekha Sridhara Pattara Rattanawong Nithin Venepally Chieh-Ju Chao Hasan Ashraf Sai Harika Pujari Mohamed Allam Diana Almader-Douglas Yamini Alla Amit Kumar Farouk Mookadam Douglas L Packer david R Holmes Jr Donald J Hagler Floyd david fortuin Reza Arsanjani Department of Cardiovascular Diseases Mayo ClinicScottsdaleAZ 85259United States Department of Internal Medicine Banner Heart HospitalMesaAZ 85054United States Library Services Mayo ClinicPhoenixAZ 85054United States Department of Medicine Bronx Lebanon HospitalBronxNY 10457United States Department of Cardiovascular Diseases Mayo ClinicRochesterMN 55905United States

BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with *** We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for *** selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient *** adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were *** patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related *** metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical *** Eight observational studies treating 768 severe PVS in 487 patients met our inclusion *** age range of patients was 6 months to 70 years and 67%were *** primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI *** to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI *** were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line ther

关键词： Pulmonary veins Pulmonary vein stenosis Constriction Balloon angioplasty Stents Drugeluting stents

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Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement:The role of machine learning

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World Journal of Cardiology 2023年第3期15卷 95-105页

作者： Pradyumna Agasthi Hasan Ashraf Sai Harika Pujari Marlene Girardo Andrew Tseng Farouk Mookadam Nithin Venepally Matthew R Buras Bishoy Abraham Banveet K Khetarpal Mohamed Allam Siva K Mulpuru MD Mackram F Eleid Kevin L Greason Nirat Beohar John Sweeney david fortuin david R Jr Holmes Reza Arsanjani Department of Cardiology Mayo ClinicPhoenixAZ 85054United States Department of Internal Medicine The Brooklyn Hospital CenterBrooklynNY 11201United States Department of Biostatistics Mayo ClinicPhoenixAZ 85054United States Department of Cardiovascular Diseases Mayo ClinicRochesterMN 55905United States Department of Statistics Mayo ClinicPhoenixAZ 85054United States Department of Cardiovascular Surgery Mayo ClinicRochesterMN 55905United States Mount Sinai Medical Center Columbia UniversityMiami BeachFL 33138United States

BACKGROUND Atrioventricular block requiring permanent pacemaker(PPM)implantation is an important complication of transcatheter aortic valve replacement(TAVR).Application of machine learning could potentially be used to predict preprocedural risk for *** To apply machine learning to be used to predict pre-procedural risk for *** A retrospective study of 1200 patients who underwent TAVR(January 2014-December 2017)was performed.964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year *** the exclusion of variables with near-zero variance or≥50%missing data,167 variables were included in the random forest gradient boosting algorithm(GBM)optimized using 5-fold cross-validations repeated 10 *** receiver operator curve(ROC)for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 *** Of 964 patients included in the 30-d analysis without prior PPM,19.6%required PPM *** mean age of patients was 80.9±8.7 years.42.1%were *** 657 patients included in the 1-year analysis,the mean age of the patients was 80.7±*** those,42.6%of patients were female and 26.7%required PPM at 1-year *** area under ROC to predict 30-d and 1-year risk of PPM for the GBM model(0.66 and 0.72)was superior to that of the PPM risk score(0.55 and 0.54)with a P value<*** The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.

关键词： Transcatheter aortic valve replacement Permanent pacemaker implantation Machine learning

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