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Introduction: Clinically significant tricuspid regurgitation is common especially in patients with structural heart disease and is independently associated with poor outcomes. Several transcatheter interventions for tricuspid valve repair are under investigation. We aimed to illustrate and summarize the efficacy and safety of these interventions. Methods: We conducted a literature search for relevant clinical registries and trials published until April 2020. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL. We performed the analysis of continuous outcomes using the mean difference (MD) while used the risk ratio (RR) for analysis of dichotomous outcomes. We included the following outcomes: Tricuspid annular plane systolic excursion (TAPSE), Vena Contracta (VC), Tricuspid Annulus diameter (TAD), Tricuspid regurgitation volume (TRV), Left ventricular ejection fraction (LVEF), and mortality rates. The random-effects model was used for the analysis of heterogeneous data, while homogeneous data were analyzed under the fixed-effects model. Results: We obtained fifteen clinical registries/trials and included a total of 1329 patients. We found that tricuspid valve interventional devices improved LVEF (MD = 1.46%, 95% CI [0.45, 2.47], p=0.005), led to smaller VC (MD = -4.69, 95% CI [-5.50, -3.88], p=0.005), lower TRV (MD = -11.68, 95% CI [-21.25, -2.11], p=0.02), and smaller TAD (MD = -3.78mm, 95% CI [-5.09, -2.47], p Conclusions: Transcatheter tricuspid valve repair devices prove to be effective interventions in decreasing regurgitation and improving functional capacity in patients with clinically significant TR. Mortality (8% during mean 12 months follow up) seems to be related to underlying cardiovascular disease.

Summary Background Few studies have examined the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure compared with bare-metal stents (BMS) in patients undergoing stenting of de-novo SVG lesions. We assessed the risks and benefits of the use of DES versus BMS in de-novo SVG lesions. Methods Patients were recruited to our double-blind, randomised controlled trial from 25 US Department of Veterans Affairs centres. Eligible participants were aged at least 18 years and had at least one significant de-novo SVG lesion (50–99% stenosis of a 2·25–4·5 mm diameter SVG) requiring percutaneous coronary intervention with intent to use embolic protection devices. Enrolled patients were randomly assigned, in a 1:1 ratio, by phone randomisation system to receive a DES or BMS. Randomisation was stratified by presence or absence of diabetes and number of target SVG lesions requiring percutaneous coronary intervention (one or two or more) within each participating site by use of an adaptive scheme intended to balance the two stent type groups on marginal totals for the stratification factors. Patients, referring physicians, study coordinators, and outcome assessors were masked to group allocation. The primary endpoint was the 12-month incidence of target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation. The DIVA trial is registered with ClinicalTrials.gov, number NCT01121224. Findings Between Jan 1, 2012, and Dec 31, 2015, 599 patients were randomly assigned to the stent groups, and the data for 597 patients were used. The patients' mean age was 68·6 (SD 7·6) years, and 595 (>99%) patients were men. The two stent groups were similar for most baseline characteristics. At 12 months, the incidence of target vessel failure was 17% (51 of 292) in the DES group versus 19% (58 of 305) in the BMS group (adjusted hazard ratio 0·92, 95% CI 0·63–1·34, p=0·70). Between-group differences in the components of the primary endpoint, serious adverse events, or stent thrombosis were not significant. Enrolment was stopped before the revised target sample size of 762 patients was reached. Interpretation In patients undergoing stenting of de-novo SVG lesions, no significant differences in outcomes between those receiving DES and BMS during 12 months of follow-up were found. The study results have important economic implications in countries with high DES prices such as the USA, because they suggest that the lower-cost BMS can be used in SVG lesions without compromising either safety or efficacy. Funding US Department of Veterans Affairs Cooperative Studies Program.

Chronic kidney disease and in-hospital worsening renal function (WRF) are both associated with poor outcomes following transcatheter aortic valve replacement (TAVR). There are no data available on post-discharge WRF and outcomes. This was a single-center study evaluating all TAVR from June 1 2008

The present study determined the utility and needle control characteristics of highly controlled vascular syringes for image-guided pericardiocentesis.Vascular syringes have been integrated into invasive cardiovascular procedures with improved patient safety, but to date have not been used in pericardiocentesis. To address this issue, we determined the method of use of vascular syringes for pericardiocentesis.A vascular syringe with reciprocating plungers, the reciprocating procedure device (RPD syringe), replaced the corresponding 10 ml and 20 ml conventional syringes in a standard pericardiocentesis tray. The vascular syringe is controlled with one hand, and can either aspirate or inject by pushing the corresponding aspiration or injection plunger. Four hundred and thirty seven subjects underwent vascular syringe procedures. The linear displacement method was used to precisely measure control of the needle tip in millimeters (mm) in vascular syringes compared to conventional syringes in 20 individual operators.Relative to the corresponding 10 ml and 20 ml conventional syringes, vascular syringes significantly reduced unintended forward penetration of the needle tip by 44% (7.0 ± 4.3 mm; p0.0001) and 53% (10.1 ± 5.5 mm; p0.0001), respectively, and reduced unintended retraction of the needle by 56% (2.7 ± 2.2 mm; p0.001) and 60% (3.5 ± 2.5 mm; p0.001), respectively. During pericardiocentesis, the mechanical syringe permitted facile one-handed aspiration and maintained the operator's ability to clear the needle. In the 437 vascular syringe procedures, there were no complications, with an estimated cost savings of $10-65 per procedure.Vascular syringes improve needle control in pericardiocentesis, promote patient safety and permit one-handed aspiration and injection.