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Funding Acknowledgements Type of funding sources: None. Aims Severe coronary calcification is a serious impediment to optimal stent expansion and can lead to stent failure and adverse outcomes. We hereby present Indian experience with intravascular lithotripsy(IVL) for the treatment of calcific lesions in acute and chronic coronary syndromes at our tertiary care center. Methods and results This is a single-center prospective study of all patients treated with intravascular lithotripsy (IVL) between June 2021 and June 2022. Patient demographics, procedural variables, and treatment outcomes and early MACE(30 days) were evaluated. During this period, there were 25 patients and 30 coronary lesions were treated with IVL-assisted percutaneous coronary intervention (PCI). The mean age of study population is 72.8±9.0 years. 96% of the study population were male. 88% of the study population were hypertensives and 68% were diabetics. Indications for PCI were acute coronary syndromes in 10 patients (40%), and chronic coronary syndrome in 13 patients (52 %). Optical Coherence Tomography (OCT) was used in 28% of the patients and Intravascular ultrasound(IVUS) was used in 12% of the patients. Rotablation was used in 12% of the patients. Upfront IVL usage was done in 32% of cases and rest of the cases (68%) IVL was done for suboptimal initial balloon pre dilatation or stent under expansion. Angiographic success ( Conclusions IVL appears to be a safe and effective modality in modifying coronary calcium to achieve optimal stent expansion with low early MACE(Major adverse cardiovascular events).

Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR), an integral component of cardiovascular disease (CVD) management in developed countries, is yet to become mainstream in India. With the prevailing gross mismatch between the need and the availability of CR services, an alternative model such as home-based CR may be the potential solution to challenges such as accessibility issues, transportation cost and lack of time. Purpose This study aimed to compare the efficacy of home-based versus centre-based CR in an Indian CVD population. Methods All CVD patients who participated in our centre-based and home-based CR programs between mid-2014 and mid-2022 were included in the study. Subjects who did not complete their post program evaluation (n=15) were excluded. Demographic data and data pertaining to CVD risk factors, nature of CVD, procedure undergone and details of CR program provided were documented for all subjects. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the CR program in-person or using telehealth platforms for the centre-based and home-based programs respectively. Subjects who attended some in-person and some home-based sessions were categorized based on the nature of the majority sessions. Results Age of the subjects (n=106) was 60±13 years, 94 (89%) were male and 22 (21%) were residing outside Chennai. While the risk factor and disease profiles were comparable, the home-based group was younger, had more out of Chennai participants and attended more sessions over a longer duration compared to the centre-based group (Table 1). The higher number of hybrid revascularization procedures in the home-based group corroborates with this being the preferred modality for acute coronary syndrome management during the pandemic-led lockdown. There was a significant improvement in body mass index, systolic blood pressure, 6-minute walk distance and left ventricular ejection fraction in those who completed the centre-based as well as home-based CR programs (Table 2). Conclusions Home-based CR is as efficacious as centre-based CR, is easier to deploy and helps overcome challenges inherent to centre-based CR such as transportation and time constraints. Home-based CR has potential to become the main mode of CR delivery in low-resource settings in the future.

Funding Acknowledgements Type of funding sources: None. Background We have witnessed a dramatic dip in adherence to cardiovascular health behaviors during the COVID-19 pandemic. Data from across the globe has shown that risk factors for cardiovascular disease (CVD) such as decreased physical activity, poor diet, and increased depression, loneliness, and stress have peaked during the pandemic. Having been badly affected by the pandemic and having had prolonged periods of countrywide lockdown, the at-risk and established CVD population has faced a major challenge in adhering to a healthy lifestyle in India. Purpose This study aimed to analyze the change in cardiovascular health behaviors brought about by a comprehensive lifestyle intervention program (CLIP) during the pandemic in India. Methods All at-risk and CVD patients who had participated in the CLIP from mid 2020 to mid 2022 and had completed the internally validated health behavior assessment questionnaire, pre and post-program, were included in this retrospective study. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the sessions online and/or in-person for the home-based and hybrid programs respectively. When a combination of online and in-person sessions were provided for a subject, it was called a hybrid program. The core components of the CLIP were exercise training, education on relevant health topics, nutritional guidance and psychosocial counseling. Results Age of the subjects (n=50) at enrolment was 54±13 years and 40 (80%) were male. The time between pre-program and post-program assessments was 110 (IQR 47) days. Number of at-risk and CVD patients attending home-based and hybrid programs are shown in the Figure. There were 4 couples in the study cohort; 21 (50%) of the remaining 42 subjects had at least 1 other family member attend the majority of sessions. There was a significant improvement in all the cardiovascular health behaviors, namely adequate daily intake of fruits, vegetables and whole grains, choice of heart-healthy foods between meals, sufficient weekly exercise and a reduction in self-reported chronic stress, upon completion of the CLIP (Table). Conclusions A comprehensive lifestyle intervention program that incorporates a multipronged approach to behavior modification is effective in improving cardiovascular health behaviors in individuals at-risk as well as with established cardiovascular disease in India. The ripple effect of behavior modification in the accompanying family members needs to be studied systematically.

AIM To evaluate healing response at strut-level and cross-section level after implanting an ultra-thin strut, everolimus-eluting stent with biodegradable polymer (Tetrilimus) using optical coherence tomography (OCT) at 3 and 6 months. METHODS This was prospective, multi-centre, single-arm, and investigator-initiated study performed at seven Indian sites between January, 2017 and September, 2018. OCT evaluations were performed in 57 patients who underwent Tetrilimus stent implantation. Follow-up OCT was scheduled at 3 months for first 16 patients and at 6 months for 41 patients. Primary outcomes included degree of strut coverage, malapposition and thickness of neointimal hyperplasia (NIH) over covered struts. RESULTS Sixty one Tetrilimus stents were implanted to treat 59 lesions in 57 patients. Paired (baseline and follow-up) OCT data was available for 12 patients and 30 patients at 3 and 6 months, respectively. At 3 months, rapid early healing was indicated by 95.48% covered struts per lesion with very low (0.11 ± 0.06 mm) NIH. At 6 months, NIH accumulation was greater (0.21 ± 0.07 mm) as compared to 3 months. 99.77% of struts per lesion were covered at 6 months. There was a very symmetrical healing as shown by very low eccentricity index. There was no difference in vascular healing between stents with small to moderate size vessels (≤3.00 mm) and large size vessels (>3.00 mm). CONCLUSION Present study demonstrated nearly complete endothelization and low NIH accumulation at 3 and 6 months following implantation of ultra-thin strut everolimus-eluting biodegradable polymer-coated Tetrilimus stent. Moreover, though being an ultra-thin strut stent, there was no difference in vascular healing and eccentricity after implantation of the Tetrilimus stents with smaller and larger diameters.

The transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS) at prohibitive risk for surgery. It is an alternative treatment to surgical aortic valve replacement in patients with AS at intermediate- and high-surgical risk. Although regulatory authorities extend the indications of TAVR to treat patients at low-surgical risk, the limitations of earlier-generation transcatheter heart valve (THV) systems accelerate the development of improved newer generation of THV systems. Myval™ THV (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) is a newer-generation, balloon-expandable TAVR system with features that facilitate accurate positioning of the bioprosthetic valve and favorable procedural and clinical outcomes. This review summarizes existing preclinical and clinical data on Myval THV for the intervention of symptomatic native AS and lays out the plan for future research program.

Aims The MeRes-1 trial sought to study the safety and effectiveness of a novel sirolimus-eluting bioresorbable vascular scaffold (MeRes100 BRS) in treating de novo native coronary artery lesions by clinical evaluation and using multiple imaging modalities. Methods and results The MeRes-1 first-in-human trial was a single-arm, prospective, multicentre study, which enrolled 108 patients with de novo coronary artery lesions (116 scaffolds were deployed to treat 116 lesions in 108 patients). At six months, quantitative coronary angiography revealed in-scaffold late lumen loss of 0.15±0.23 mm with 0% binary restenosis. Optical coherence tomography demonstrated minimum scaffold area (6.86±1.73 mm2) and percentage neointimal strut coverage (99.30%). Quantitative intravascular ultrasound analysis confirmed a 0.14±0.16 mm2 neointimal hyperplasia area. At one year, major adverse cardiac events, a composite of cardiac death, any myocardial infarction and ischaemia-driven target lesion revascularisation, occurred in only one patient (0.93%) and there was no scaffold thrombosis reported. At one year, computed tomography angiography demonstrated that all scaffolds were patent and in-scaffold mean percentage area stenosis was 11.33±26.57%. Conclusions The MeRes-1 trial demonstrated the safety and effectiveness of MeRes100 BRS. The favourable clinical outcomes and effective vascular responses have provided the basis for further studies in a larger patient population. The MeRes-1 trial is registered at the Clinical Trials Registry-India.

Background & aims Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. Methods and results A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists (‘Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. Conclusions Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS (‘Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature.

Transcatheter aortic valve replacement has revolutionised the treatment of aortic valve disease. The Myval™ device (Meril Life Sciences Pvt. Ltd., Gujarat, India) is a CE-marked, next-generation balloon-expandable transcatheter heart valve, designed for the treatment of severe aortic valve stenosis. This review illustrates the salient technical features of this transcatheter valve, pre-clinical studies and evidence from the first-in-human trial. We also provide a brief overview of planned clinical trials and registries.

MBBSObjectives: To study the clinical usefulness, cost benefit, and medium term outcome offractional flow reserve (FFR) based management of coronary artery disease of interme-diate severity. Background: In spite of the advantages of FFR there is paucity of datain Indian population who have frequent diffuse, small and multivessel disease where itwould probably be more beneficial in terms of cost and outcome. Methods: The treat-ing cardiologist’s management decision with both FFR and angiographic data wascompared with that of a reviewing cardiologist decision based on a retrospective anal-ysis of angiogram alone. Results: Eighty-one vessels with intermediate lesions in 59patients required 26 stents lesser when FFR data was added to the angiogram. Theconcordance of management decision was about 58% which means that >40% ofintermediate lesions would be misclassified as significant based on angiography alone.There were no major events at a mean follow up of 1165 months. The net cost benefitin favor of FFR based management was INR 8,57,600 (USD 15,600) in our centre. Con-clusion: Indians with more severe form of CAD benefit from a FFR based managementplan for intermediate lesions, both clinically and economically.

The EVER-OCT study aimed to evaluate the degree of strut coverage, malapposition, and vessel wall response after implantation of ultra-thin (60 μm), biodegradable-polymer coated Tetrilimus everolimus-eluting stents (Sahajan and Medical Technologies Pvt. Ltd., Surat, India) by means of serial

Recent technological developments have led to the development of Absorb™ bioresorbable vascular scaffold (BVS) [Abbott Vascular, Santa Clara, USA] for percutaneous treatment of coronary artery disease by percutaneous coronary intervention (PCI). The BVS is now approved for use in many countries but experience in bifurcation lesions is limited and largely unreported and concerns still exist about its use across major side branches. We report for the first time, the successful use of the “T and Protrusion” (TAP) technique of deploying BVS into the side branch (SB) through the struts of main branch (MB) BVS to salvage a suboptimal result and threatened closure of a SB in three cases when treating bifurcation lesions with a planned single BVS strategy. The TAP technique was successful in all cases and there were no complications. All patients continue to do well at short-term follow-up. This case report provides information regarding the feasibility as well as technical and procedural insights when using BVS for bifurcation lesions. © 2014 Wiley Periodicals, Inc.

Aim To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. Methods Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. Results Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7±8.2years and 19 (70.4%) were type B2/C lesions. The prevalence of parameters of suboptimal scaffold deployment were: underexpansion-22(61.1%), geographic miss-3(8.3%), tissue prolapse-7(25.9%), scaffold pattern irregularity-1(2.8%), longitudinal elongation-7(38.8%). Of the 7 overlaps imaged: excessive overlap was observed in 3 and scaffold gap in one. The median duration of follow up was 679days (range 193–963days). There were four events during this period. None were associated with suboptimal scaffold deployment. Conclusion OCT based parameters of suboptimal scaffold deployment are common in real world scenario and were not associated with adverse outcomes on long term follow up. These findings need to be confirmed in larger studies.

Background Calcific aortic stenosis and coronary artery disease share common risk factors. In some of the previous studies statins have been used to retard the progression of aortic stenosis, but the results were inconsistent. Methods One hundred and ten patients of CAS above the age of 40 years have undergone clinical, biochemical and echocardiographic evaluation. Coronary angiograms were done in 66% of them. Results Male to female ratio was 2:1. Patients of CAS with CAD showed higher prevalence of diabetes, hypertension, dyslipidemia, smoking and family history of CAD. Prevalence of obesity and bicuspid aortic valve by echocardiogram was high in those without CAD. Conclusions On comparison of prevalence of risk factor in those with and without associated CAD, there was higher prevalence of diabetes (65% vs 30%), hypertension (52% vs 43%), dyslipidemia (69% vs 52%), smoking (24% vs 18%) and family history of CAD (34% vs 16%) in those with associated CAD. The incidence of obesity was higher in those without CAD (20% vs 30%). The difference observed in diabetes alone was found to be statistically significant.