Structural Heart最新文献

英文中文

Outcomes of Left Atrial Appendage Occlusion in Patients With Cardiac Amyloidosis 心脏淀粉样变性患者左心耳闭塞的疗效

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-04-01 Epub Date: 2026-01-14 DOI: 10.1016/j.shj.2026.100795

Sonia Kshatri MD , David Lewandowski MD , Jake Luo PhD , Mohammad Assadi Shalmani , Marcie Berger MD , Jalaj Garg MBBS , Divyanshu Mohananey MBBS, MSc

引用次数: 0

Bench Testing of a New, Semirigid, Saddle-Shaped, Complete Mitral Annuloplasty Ring Designed to Circularize During Transcatheter Mitral Valve-in-Ring Procedures 新型半刚性鞍形完整二尖瓣环成形术环的台架试验，设计用于经导管二尖瓣环内手术。

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-04-01 Epub Date: 2025-12-30 DOI: 10.1016/j.shj.2025.100791

Keith B. Allen MD , Daniel J. Romary MD, MS , Elizabeth A. Grier MD , Chetan P. Huded MD , Duc T. Pham MD , Douglas R. Johnston MD , Panos N. Vardas MD , John R. Davis MD , Adnan K. Chhatriwalla MD

引用次数: 0

Ischemic vs. Nonischemic Cardiomyopathy in TAVR for Moderate Aortic Stenosis: A TAVR UNLOAD Sub Analysis 中度主动脉瓣狭窄TAVR患者缺血性与非缺血性心肌病：TAVR UNLOAD亚组分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-04-01 Epub Date: 2025-12-19 DOI: 10.1016/j.shj.2025.100787

Philipp von Stein MD , Henning Guthoff MD , Björn Redfors MD, PhD , Julia B. Thompson MS , Ernest Spitzer MD , Philippe Pibarot DVM, PhD , Jeroen J. Bax MD, PhD , Jan G.P. Tijssen PhD , Michael L. Chuang MD , Yukari Kobayashi MD , Arsalan Abu-Much MD , Nicole Cristell MD , Alexandra Popma MD , David J. Cohen MD, MSc , Sammy Elmariah MD, MPH , Martin B. Leon MD , Nicolas M. Van Mieghem MD, PhD , the TAVR UNLOAD trial study investigators

引用次数: 0

Finerenone in Patients Undergoing TAVR for Nonrheumatic Aortic Stenosis: Insights From a Real-World Cohort 非风湿性主动脉瓣狭窄患者接受TAVR的芬烯酮：来自现实世界队列的见解。

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-10-30 DOI: 10.1016/j.shj.2025.100751

Faysal Massad MD , Osamah Badwan MD , Akiva Rosenzveig MD , Fawzi Zghyer MD , Zaid Shahrori MD , Issam Motairek MD , Taha Hatab MD , Radwan Alkhatib MD , Samir Kapadia MD

引用次数: 0

Midterm Outcomes of Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation According to Anatomical Characteristics 经导管边缘对边缘修复先天性二尖瓣返流的中期结果分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-11-17 DOI: 10.1016/j.shj.2025.100763

Daryoush Samim MD , Caroline Chong-Nguyen MD , Yannick Hausammann B Med , Mischa Külling MD , Oliver Gaemperli MD , Roberto Corti MD , Joanna Bartkowiak MD , Daijiro Tomii MD , Domenico Angellotti MD , Nicolas Brugger MD , Thomas Pilgrim MD, MSc , Patric Biaggi MD , Fabien Praz MD , Peter Martin Wenaweser MD

Background

Mitral transcatheter edge-to-edge repair (M-TEER) is an established option for high-risk primary mitral regurgitation (PMR) patients, but data on the impact of anatomical complexity on prognosis are scarce and conflicting.

Objectives

The aims of this study were to characterize patients with severe PMR undergoing M-TEER, assess mid-term prognosis after M-TEER, and identify prognostic factors based on PMR mechanism.

Methods

Data from symptomatic PMR patients with severe PMR treated with M-TEER between July 2013 and October 2023 at two Swiss centers were collected retrospectively until 2017 and prospectively thereafter. Patients were categorized by lesion type: A2-P2 prolapse/flail vs. non-A2-P2 prolapse/flail. A subset was classified by mitral valve (MV) anatomical complexity (defined by the presence of ≥1 of the following: ≥moderate calcifications, Barlow’s disease, multiple prolapses, or commissural prolapses). Cox regression identified predictors of 1-year all-cause mortality.

Results

Among 315 patients (mean age 82.2 ± 6.3 years, 46.3% female, European System for Cardiac Operative Risk Evaluation II 5.1% ± 4.1%) followed for a median (interquartile range [IQR]) of 13 months (5-33), technical success was 93.0%. Compared with the non-A2-P2 prolapse/flail group (n = 186), the A2-P2 prolapse/flail group (n = 129) had better echocardiographic outcomes at discharge (residual mitral regurgitation [MR] ≤ 1+: 70.5 vs. 60.4%; p = 0.031) and superior symptomatic improvement at 1 year (New York Heart Association class ≤ II: 91.4 vs. 74.5%; p = 0.017) but similar 1-year all-cause mortality (15.1 vs. 18.8%; p = 0.492). Among patients classified by MV anatomical complexity (n = 143), patients with complex MV anatomy (n = 68) had a higher mortality at a median (IQR) follow-up of 22 months (9-36) compared to those with noncomplex MV anatomy (n = 75) (51.5 vs. 34.7%; p = 0.042). Multivariate analysis identified complex MV anatomy and severe renal failure as predictors of 1-year all-cause mortality.

Conclusions

MV anatomical characteristics have a significant influence on symptomatic improvement and all-cause mortality at 1 year and should be carefully considered during the selection of PMR patients for M-TEER.

二尖瓣经导管边缘到边缘修复（M-TEER）是高危原发性二尖瓣返流（PMR）患者的一种既定选择，但关于解剖复杂性对预后影响的数据很少且相互矛盾。目的本研究的目的是对重度PMR患者进行M-TEER，评估M-TEER后的中期预后，并根据PMR机制确定预后因素。方法回顾性收集2013年7月至2023年10月在瑞士两个中心接受M-TEER治疗的有症状的PMR患者的数据，直至2017年，并在此后进行前瞻性收集。患者按病变类型分类：A2-P2脱垂/连枷与非A2-P2脱垂/连枷。根据二尖瓣（MV）解剖复杂性进行分类（根据以下≥1项的存在来定义：≥中度钙化，Barlow病，多发性脱垂或合拢脱垂）。Cox回归确定了1年全因死亡率的预测因子。结果315例患者（平均年龄82.2±6.3岁，女性46.3%，欧洲心脏手术风险评估系统II 5.1%±4.1%）随访13个月（5-33），技术成功率为93.0%。与非A2-P2脱垂/连枷组（n = 186）相比，A2-P2脱垂/连枷组（n = 129）在出院时的超声心动图结果更好（残余二尖瓣返流[MR]≤1+:70.5 vs 60.4%; p = 0.031）， 1年后的症状改善也更好（纽约心脏协会分级≤II: 91.4 vs 74.5%; p = 0.017），但1年全因死亡率相似（15.1 vs 18.8%; p = 0.492）。在按中压解剖复杂性分类的患者（n = 143）中，中压解剖复杂的患者（n = 68）在中位（IQR）随访22个月（9-36）时的死亡率高于中压解剖不复杂的患者（n = 75）（51.5% vs. 34.7%; p = 0.042）。多变量分析发现复杂的中伏解剖和严重的肾功能衰竭是1年全因死亡率的预测因素。结论smv解剖特征对1年症状改善和全因死亡率有显著影响，在选择PMR患者进行M-TEER时应慎重考虑。

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引用次数: 0

Renal Response After Mitral Valve Repair: Clinically Meaningful Relationship 二尖瓣修复后肾脏反应：临床意义的关系

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-11-06 DOI: 10.1016/j.shj.2025.100757

Luis Nombela-Franco MD, PhD

引用次数: 0

Efficacy and Safety of Electrosurgical Balloon-Assisted Leaflet Modification to Prevent Coronary Obstruction During Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术中电球囊辅助小叶修饰预防冠状动脉阻塞的有效性和安全性

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.shj.2025.100790

Mostafa Naguib MD, Chantal Y. Asselin MSc, MD, Robert Kipperman MD, Leo Marcoff MD, Kostantinos P. Koulogiannis MD, Linda Gillam MD, MPH, Benjamin van Boxtel MD, John Brown III MD, Philippe Généreux MD, Gennaro Giustino MD

Background

Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) is a novel technique designed to prevent CO by performing electrosurgical leaflet traversal followed by intraleaflet valve implantation or complete leaflet laceration accomplished using noncompliant balloons. However, its efficacy and safety are not well established.

Methods

We retrospectively reviewed all patients who underwent UNICORN-assisted TAVR for both valve-in-valve and native valve procedures at a single high-volume center between September 2024 and September 2025. Patients were selected based on preprocedural cardiac computed tomography demonstrating high anatomic risk for CO. In all cases, the target leaflet was traversed using an electrified 0.014″ wire, followed by serial noncompliant balloon dilatations of the leaflet to either achieve complete leaflet laceration or to accommodate for intra-leaflet valve implantation. Balloon-expandable valves were used in all procedures.

Results

Fifteen patients underwent UNICORN-assisted TAVR. Twelve were valve-in-valve cases, and 3 involved native valves. The right coronary cusp was targeted in 11 procedures and the left in 6, including 2 requiring bileaflet modification. Technical success was achieved in all cases (100%). Procedural success was achieved in 93.3%. One patient developed acute CO due to skirt-related occlusion after a high implant in a degenerated self-expanding valve, requiring single-vessel coronary artery bypass surgery. No bailout coronary stenting was required. There were no in-hospital deaths or disabling strokes. All patients were alive at 30-day follow-up.

Conclusions

In this single-center experience, UNICORN appears technically reproducible, effective in preventing CO, and safe in TAVR patients at high-risk for CO.

背景：经导管主动脉瓣置换术（TAVR）中冠状动脉阻塞（CO）与显著的发病率和死亡率相关。UNICORN（利用射频针破坏医源性冠状动脉阻塞）是一种新技术，旨在通过电外科手术穿过小叶，然后在小叶内植入瓣膜或使用不合规的球囊完成完整的小叶撕裂来预防一氧化碳。然而，其有效性和安全性尚未得到很好的证实。方法回顾性分析2024年9月至2025年9月在单一大容量中心接受独角兽辅助TAVR（瓣中瓣和天然瓣）手术的所有患者。患者的选择基于术前心脏计算机断层扫描，显示出CO的高解剖风险。在所有病例中，使用通电的0.014″导线穿过目标小叶，随后对小叶进行一系列不合规的球囊扩张，以实现小叶完全撕裂或适应小叶内瓣膜植入。所有程序均采用球囊膨胀阀。结果15例患者行“独角兽”辅助TAVR。其中12例为阀中阀，3例为原生阀。11例手术的目标是右冠状动脉尖，6例是左冠状动脉尖，其中2例需要双侧小体修饰。所有病例均取得了技术上的成功（100%）。手术成功率93.3%。1例患者在高位植入退行性自扩张瓣膜后，由于裙部相关性闭塞发生急性一氧化碳，需要进行单支冠状动脉搭桥手术。无需紧急冠脉支架术。没有住院死亡或致残性中风。随访30天，所有患者均存活。结论在单中心实验中，UNICORN在技术上是可重复的，对CO高风险的TAVR患者预防CO有效，安全。

{"title":"Efficacy and Safety of Electrosurgical Balloon-Assisted Leaflet Modification to Prevent Coronary Obstruction During Transcatheter Aortic Valve Replacement","authors":"Mostafa Naguib MD, Chantal Y. Asselin MSc, MD, Robert Kipperman MD, Leo Marcoff MD, Kostantinos P. Koulogiannis MD, Linda Gillam MD, MPH, Benjamin van Boxtel MD, John Brown III MD, Philippe Généreux MD, Gennaro Giustino MD","doi":"10.1016/j.shj.2025.100790","DOIUrl":"10.1016/j.shj.2025.100790","url":null,"abstract":"<div><h3>Background</h3><div>Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) is a novel technique designed to prevent CO by performing electrosurgical leaflet traversal followed by intraleaflet valve implantation or complete leaflet laceration accomplished using noncompliant balloons. However, its efficacy and safety are not well established.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients who underwent UNICORN-assisted TAVR for both valve-in-valve and native valve procedures at a single high-volume center between September 2024 and September 2025. Patients were selected based on preprocedural cardiac computed tomography demonstrating high anatomic risk for CO. In all cases, the target leaflet was traversed using an electrified 0.014″ wire, followed by serial noncompliant balloon dilatations of the leaflet to either achieve complete leaflet laceration or to accommodate for intra-leaflet valve implantation. Balloon-expandable valves were used in all procedures.</div></div><div><h3>Results</h3><div>Fifteen patients underwent UNICORN-assisted TAVR. Twelve were valve-in-valve cases, and 3 involved native valves. The right coronary cusp was targeted in 11 procedures and the left in 6, including 2 requiring bileaflet modification. Technical success was achieved in all cases (100%). Procedural success was achieved in 93.3%. One patient developed acute CO due to skirt-related occlusion after a high implant in a degenerated self-expanding valve, requiring single-vessel coronary artery bypass surgery. No bailout coronary stenting was required. There were no in-hospital deaths or disabling strokes. All patients were alive at 30-day follow-up.</div></div><div><h3>Conclusions</h3><div>In this single-center experience, UNICORN appears technically reproducible, effective in preventing CO, and safe in TAVR patients at high-risk for CO.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 3","pages":"Article 100790"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Re-Examining Patient–Prosthesis Mismatch After Transcateter Aortic Valve Replacement: The Role of Flow, Remodeling, and Expansion Dynamics 重新检查经动脉主动脉瓣置换术后患者-假体不匹配：血流、重塑和扩张动力学的作用

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.shj.2025.100761

Ashish H. Shah MD, MD-Research (UK)

引用次数: 0

Transcatheter Aortic Valve Replacement for Severe Native Aortic Valve Regurgitation: A Multicenter and International Registry 经导管主动脉瓣置换术治疗严重原生主动脉瓣返流：多中心和国际注册。

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-11-15 DOI: 10.1016/j.shj.2025.100762

Sant Kumar MD , Ashish Pershad MD , David Elison MD , EiEi Thwe MD , Jacopo Farina MD , Ahmad Jabri MD , Ivan Hanson MD , Amr Abbas MD , Pedro A. Villablanca MD , Nezar Falluji MD , Simone Biscaglia MD , Carlo Tumscitz MD , Timothy Byrne DO , Francesco Saia MD , Soundos Moualla MD , Hursh Naik MD

引用次数: 0

Physiologic Markers of Mortality in Acute Valve Syndrome: An Ischemic Physiology Score Stratifies Patient Risk 急性瓣膜综合征死亡率的生理指标：缺血性生理评分对患者风险分层

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-03-01 Epub Date: 2025-11-20 DOI: 10.1016/j.shj.2025.100766

Omar Saleh BS , Nicholas J. Valle DO , Israa Saleh BA , Raymond Benza MD , Deepak R. Talreja MD , Matthew R. Summers MD

Background

Acute valve syndrome (AVS) represents a high-risk phenotype of advanced valvular disease with largely uncharacterized risk heterogeneity. We aimed to validate an expanded AVS definition and develop a physiology-dependent risk stratification tool using available clinical markers.

Methods

This retrospective study analyzed 2380 patients undergoing aortic valve replacement for severe aortic stenosis and classified them as AVS (n = 1556) or progressive valvular disease (n = 824). The primary outcome was 1-year all-cause mortality. An L2-regularized logistic regression model was developed to predict 1-year mortality using admission laboratory markers and comorbidity burden. Model performance was assessed using nested cross-validation with calibration metrics including the Brier score. The constituent risk factors were aggregated into an Ischemic Physiology Score.

Results

AVS patients (65.4%) showed higher comorbidity burden and higher 1-year mortality (11.6 vs. 4.7%; p < 0.001) than progressive valvular disease. The prediction model performed well (area under the receiver operating characteristic curve [AUC]: 0.765 ± 0.043, Brier Score: 0.094) during five-fold cross-validation. The Ischemic Physiology Score, incorporating renal dysfunction, hyperlactatemia, liver injury, elevated natriuretic peptides, high comorbidity burden, and preoperative vasoactive support, stratified patients into 3 risk groups with 1-year mortality of 1.9% (0 factors), 9.7% (1 factor), and 25.5% (≥2 factors) (p < 0.001 for trend). Multivariable analysis identified the Charlson Comorbidity Index, aspartate aminotransferase/alanine aminotransferase, lactate, N-Terminal pro-B type natriuretic peptide, and creatinine as independent predictors of 1-year mortality in our AVS cohort.

Conclusions

AVS is the predominant clinical phenotype within our cohort, appearing in over half of our patients undergoing aortic valve replacement. Complementing existing surgical risk scores to guide intervention optimization, a physiologic score based on admission data effectively stratifies patient risk.

背景：急性瓣膜综合征（AVS）是晚期瓣膜疾病的一种高风险表型，具有很大程度上未表征的风险异质性。我们的目的是验证扩大的AVS定义，并利用现有的临床标志物开发一种生理依赖的风险分层工具。方法回顾性分析2380例重度主动脉瓣狭窄行主动脉瓣置换术的患者，将其分为AVS （n = 1556）和进行性瓣膜病（n = 824）。主要终点为1年全因死亡率。建立了l2正则化逻辑回归模型，利用入院实验室标记物和合并症负担预测1年死亡率。模型性能评估使用嵌套交叉验证与校准指标，包括Brier评分。构成危险因素汇总成缺血生理评分。结果sav患者（65.4%）的合并症负担和1年死亡率（11.6% vs. 4.7%; p < 0.001）高于进展性瓣膜病。经五重交叉验证，预测模型效果良好（受试者工作特征曲线下面积[AUC]: 0.765±0.043，Brier评分：0.094）。缺血生理评分包括肾功能不全、高乳酸血症、肝损伤、利钠肽升高、高合并症负担和术前血管活性支持，将患者分为3个危险组，1年死亡率分别为1.9%（0因素）、9.7%（1因素）和25.5%（≥2因素）（趋势p <； 0.001）。多变量分析确定Charlson合并症指数、天冬氨酸转氨酶/丙氨酸转氨酶、乳酸、n端前b型利钠肽和肌酐是AVS队列1年死亡率的独立预测因子。结论savs是我们队列中主要的临床表型，出现在超过一半的主动脉瓣置换术患者中。与现有的外科风险评分相补充，基于入院数据的生理评分可以有效地对患者风险进行分层，以指导干预措施的优化。

{"title":"Physiologic Markers of Mortality in Acute Valve Syndrome: An Ischemic Physiology Score Stratifies Patient Risk","authors":"Omar Saleh BS , Nicholas J. Valle DO , Israa Saleh BA , Raymond Benza MD , Deepak R. Talreja MD , Matthew R. Summers MD","doi":"10.1016/j.shj.2025.100766","DOIUrl":"10.1016/j.shj.2025.100766","url":null,"abstract":"<div><h3>Background</h3><div>Acute valve syndrome (AVS) represents a high-risk phenotype of advanced valvular disease with largely uncharacterized risk heterogeneity. We aimed to validate an expanded AVS definition and develop a physiology-dependent risk stratification tool using available clinical markers.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 2380 patients undergoing aortic valve replacement for severe aortic stenosis and classified them as AVS (n = 1556) or progressive valvular disease (n = 824). The primary outcome was 1-year all-cause mortality. An L2-regularized logistic regression model was developed to predict 1-year mortality using admission laboratory markers and comorbidity burden. Model performance was assessed using nested cross-validation with calibration metrics including the Brier score. The constituent risk factors were aggregated into an Ischemic Physiology Score.</div></div><div><h3>Results</h3><div>AVS patients (65.4%) showed higher comorbidity burden and higher 1-year mortality (11.6 vs. 4.7%; <em>p</em> < 0.001) than progressive valvular disease. The prediction model performed well (area under the receiver operating characteristic curve [AUC]: 0.765 ± 0.043, Brier Score: 0.094) during five-fold cross-validation. The Ischemic Physiology Score, incorporating renal dysfunction, hyperlactatemia, liver injury, elevated natriuretic peptides, high comorbidity burden, and preoperative vasoactive support, stratified patients into 3 risk groups with 1-year mortality of 1.9% (0 factors), 9.7% (1 factor), and 25.5% (≥2 factors) (<em>p</em> < 0.001 for trend). Multivariable analysis identified the Charlson Comorbidity Index, aspartate aminotransferase/alanine aminotransferase, lactate, N-Terminal pro-B type natriuretic peptide, and creatinine as independent predictors of 1-year mortality in our AVS cohort.</div></div><div><h3>Conclusions</h3><div>AVS is the predominant clinical phenotype within our cohort, appearing in over half of our patients undergoing aortic valve replacement. Complementing existing surgical risk scores to guide intervention optimization, a physiologic score based on admission data effectively stratifies patient risk.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 3","pages":"Article 100766"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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