OpenSource Cardiology is a physician-led, open access, peer reviewed journal designed for physicians, authors, reviewers, and scientists.
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New in OpenSource Cardiology: the SENTINEL-BVF study.
Bioprosthetic valve fracture has changed what valve-in-valve TAVR can
deliver. By fracturing the surgical valve ring with a high-pressure
balloon inflation, BVF allows the transcatheter valve to expand fully — converting a
procedure that often left patients with a meaningful residual gradient
into one with durable hemodynamics.
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CHIP-BCIS3 demonstrated mechanical action without clinical protection. Low LVEF identifies vulnerability, not device responsiveness. Until a prospectively defined physiology-selected subgroup shows net benefit, planned Impella CP should not be routine in CHIP-BCIS3-like patients.
@ihtanboga @BrettSperryMD @jtsaxon
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The SENTINEL-BVF study
Captured debris was noted in all VIV-TAVR with BVF cases, with a higher number of small particles as compared with native valve TAVR. Whether these findings impact clinical stroke rates merits further evaluation.
@jtsaxon @chetanhuded @djc795
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OpenSource Cardiology retweeted
We have a plan for this. Take a look at @opensourcecards
Free publication, no APCs, rewards for peer review, no paywalls!
Hoy he entregado otra revisión por pares. Sin cobrar, como casi todos y sacándolo del tiempo personal.
Mañana hacen huelga, por primera vez en 200 años, quienes editan The Lancet
Algo está cambiando.
Unos y otros sostenemos la calidad de lo que se publica. Merecemos que se reconozca.
researchprofessionalnews.com…
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🆕 OpenSource: Cardiology — "Evaluation of Methods Used in Transitioning from Sodium Nitroprusside to Oral Vasodilators in Acute Heart Failure."
Bayan M. Alghafli @AboveandBayan and colleagues at Saint Luke's Mid America Heart Institute @MidAmericaHeart studied 136 patients with acute heart failure and reduced ejection fraction who were transitioned from sodium nitroprusside to oral vasodilators under pulmonary artery catheter guidance.
Forty-two (31%) came off the drip on a standardized rapid-titration order set — captopril or hydralazine-isosorbide dinitrate — and 94 (69%) on provider-directed dosing. Mean age 58.8 ± 14.0 years, 80.1% male, baseline EF 26% in both groups.
Protocol-guided vs provider-directed:
• Time to SNP discontinuation after oral vasodilator start: median 10.4 vs 13.7 hours (P = 0.271)
• SNP reinitiation: 7.1% vs 20.2%, OR 0.3 (95% CI 0.08–1.10), P = 0.055
• Hypotensive events: median 5.5 vs 4.0 (P = 0.554)
• ICU length of stay: median 5.3 vs 4.1 days (P = 0.230)
• Death in hospital or within 7 days of discharge: 11.9% vs 6.4% (P = 0.314); 8.1% overall
• Discharged on inotropes: 9.5% vs 16.0% (P = 0.317)
• Discharge ACEi/ARB/ARNi: 45.2% vs 61.7% (P = 0.073); beta-blocker 54.8% vs 52.1%; MRA 28.6% vs 36.2%
• Cardiac index and systemic vascular resistance at SNP discontinuation: no significant difference
Conclusion: protocol-guided transition of SNP to short acting PO vasodilators was feasible, with broadly similar short-term tolerance and clinical outcomes compared to a provider-directed approach.
@BrettSperryMD @jtsaxon @AndrewJSauer @maz_hanna @JavedButler1 @djc795
opensourcecardiology.org/doi…
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OpenSource Cardiology retweeted
Submit papers and review at @opensourcecards where open access research is free to publish and reviewers are paid!
@jtsaxon
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Hot topic!
Check out the trial summary by @ihtanboga here at OpenSource Cardiology
opensourcecardiology.org/doi…
@DrAmirKaki in debate of the century MCS for HRPCI - chip bcis3 recruited amongst the highest risk population for PCI in the literature - not reflecting population in real world, many were transferred back to non- pci hospitals on same day. 17 of 21 centres were new users of impella, no procedure support planning, in hospital mortality highest reported in Literature, could this relate to premature withdrawal of support- half met shock criteria ? See final slide
@mirvatalasnag @drptca @AlkashkariWail @crfheart @jgranadacrf @Hragy
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OpenSource Cardiology retweeted
At @opensourcecards, we are committed to free publication with no APCs for all primary research, authors retain copyright, and no paywalls - ever - for any publication. Our science is free to all, permanently.
@BrettSperryMD
.@JAMAInternalMed recently published a thoughtful piece on public access calling for NIH to assert its position regarding compliance with the NIH Public Access Policy.
NIH has the right to make the Author Accepted Manuscript, which has been supported by taxpayers, public in PubMed Central at time of publication; a right which is independent from any publisher agreement.
This is a free path to compliance for authors, helping us ensure rapid public access to NIH-supported research results.
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This is why we do what we do, Dr Tolis!
Send it our way. We will review in less than a week and let you know. Seamless, friction-free submission process.
@BrettSperryMD @jtsaxon @CMichaelGibson @DocSavageTJU
A multi-touchdown sequential LIMA to up to 3 LAD targets is perfect for this scenario, very underutilized and excellent LIMA to (some) LAD patency on repeat cath. Journals not interested in a series a few years ago, so have kept it to myself.
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🆕 New in OpenSource: Cardiology
"Routine Microaxial-Flow-Pump Support During High-Risk PCI: A Critical Appraisal of CHIP-BCIS3"
@ihtanboga on the trial testing whether planned Impella CP protects patients during complex PCI without shock.
Mechanical action ≠ protection. 🧵
Read it free @opensourcecards - link below
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6/ MORTALITY
47 deaths with planned support vs 33 (HR 1.54; 0.99–2.41).
CV death 36 vs 20 (HR 1.91; 1.11–3.30).
A signal of worsening survival.
And only 9/152 controls (5.9%) needed bailout.
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7/ CONCLUSION
Severe LV dysfunction + complex anatomy should not be an automatic indication for planned Impella CP without shock.
It doesn't refute bailout support, DanGer shock, or other pumps.
Low LVEF marks vulnerability, not device responsiveness.
opensourcecardiology.org/doi…
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OpenSource Cardiology retweeted
Check out the SENTINEL-BVF study, new in @opensourcecards
@akcmahi @djc795 @chetanhuded @tnazifMD @MichaelNassifMD @BrettSperryMD
New in OpenSource Cardiology: the SENTINEL-BVF study.
Bioprosthetic valve fracture has changed what valve-in-valve TAVR can
deliver. By fracturing the surgical valve ring with a high-pressure
balloon inflation, BVF allows the transcatheter valve to expand fully — converting a
procedure that often left patients with a meaningful residual gradient
into one with durable hemodynamics.
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OpenSource Cardiology retweeted
First original research paper published in @opensourcecards!
Congrats to @akcmahi @chetanhuded @jtsaxon @djc795 @HemalGada @tnazifMD @AlokeFinn @LizGrierMD et al on publishing this prospective study helping us better understand bioprosthetic valve fracture!
New in OpenSource Cardiology: the SENTINEL-BVF study.
Bioprosthetic valve fracture has changed what valve-in-valve TAVR can
deliver. By fracturing the surgical valve ring with a high-pressure
balloon inflation, BVF allows the transcatheter valve to expand fully — converting a
procedure that often left patients with a meaningful residual gradient
into one with durable hemodynamics.
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New in OpenSource Cardiology: the SENTINEL-BVF study.
Bioprosthetic valve fracture has changed what valve-in-valve TAVR can
deliver. By fracturing the surgical valve ring with a high-pressure
balloon inflation, BVF allows the transcatheter valve to expand fully — converting a
procedure that often left patients with a meaningful residual gradient
into one with durable hemodynamics.
1
6
17
7,434
SENTINEL-BVF (NCT05093764) enrolled 20 patients undergoing VIV-TAVR with
BVF at Saint Luke's Mid America Heart Institute, every one with SENTINEL
cerebral embolic protection in place. Each filter was sent for
histopathology, compared against 49 native-valve TAVR patients from the
SENTINEL Low-Intermediate Risk registry.
→ Debris was captured in 100% of cases — acute thrombus, organizing
thrombus, calcium, valve tissue, arterial wall, foreign material.
→ More particles were captured than in native-valve TAVR: 70.9 ± 32.9 vs 42.6 ± 40.7
particles ≥150 µm per patient (p<0.001).
→ The excess was almost entirely small particles, 150 to <500 µm. No
difference in intermediate or large particles.
→ Different composition, not just more of it: more organizing thrombus,
more foreign material, less valve tissue. The foreign material was mostly
gauze — an unexpected finding that points toward device preparation
rather than the fracture itself.
→ One in-hospital stroke (5%), no other major adverse cardiac events.
Comparable to the SENTINEL trial (5.6%) and the SENTINEL-LIR registry (4%).
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In summary: BVF liberates more debris, but it is small debris, and the large-particle burden is unchanged. This study replaces speculation about risks of BVF with measurement, and was performed by the group that developed the procedure.
Free to read, no paywall:
opensourcecardiology.org/doi…
Chhatriwalla, Huded, Saxon, Cohen, Nazif, Rinaldi, Gada, Seeger, Hart,
Grier, Finn, Virmani, Kawakami, Allen.
#TAVR #StructuralHeart #ValveInValve #CardioTwitter
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