CHIP-BCIS3 randomized 300 patients with severe left-ventricular dysfunction and complex coronary anatomy, but without cardiogenic shock, to planned Impella CP support or standard care during PCI. The pump raised flow and pressure and spared inotropes, yet won no patient-important outcome — and this appraisal separates mechanical action from clinical protection, and marks where the evidence boundary now sits.
Background: Bioprosthetic valve fracture (BVF) improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement (VIV-TAVR), but it is unknown whether it increases the risk of embolic debris. This study aimed to characterize embolic debris liberated during VIV-TAVR with BVF. Methods: Between 3/2022 and 10/2024, we studied 20 patients who underwent VIV-TAVR with BVF using the SENTINEL cerebral embolic protection device (CEPD). Debris from the SENTINEL…
Researchers fund, write, review, and edit the scholarly literature, then pay to publish it or to read it. This Perspective describes that paradox and argues for a physician-led, open-access model that returns ownership and value to the research community.
