Pub Date : 2024-11-01DOI: 10.1016/j.shj.2024.100336
Nino Mihatov MD , Philippe Pibarot DVM, PhD
The clinical implications of severe aortic stenosis have been well established. Understanding of moderate aortic stenosis, however, continues to evolve. Athough moderate aortic stenosis may be less clinically impactful in patients with normal ventricular function, it may carry prognostic significance in those patients with a ventricle exhibiting signs of cardiac damage. Moderate aortic stenosis in the presence of cardiac damage or dysfunction may be prognostically comparable to that of severe aortic stenosis. Extravalvular risk parameters can inform aortic stenosis risk stratification. Three ongoing trials seek to evaluate transcatheter aortic valve assessment in patients with moderate aortic stenosis and signs of cardiac damage or left ventricular dysfunction.
{"title":"Moderate Aortic Stenosis With Cardiac Damage: A New Type of Severe Aortic Stenosis","authors":"Nino Mihatov MD , Philippe Pibarot DVM, PhD","doi":"10.1016/j.shj.2024.100336","DOIUrl":"10.1016/j.shj.2024.100336","url":null,"abstract":"<div><div>The clinical implications of severe aortic stenosis have been well established. Understanding of moderate aortic stenosis, however, continues to evolve. Athough moderate aortic stenosis may be less clinically impactful in patients with normal ventricular function, it may carry prognostic significance in those patients with a ventricle exhibiting signs of cardiac damage. Moderate aortic stenosis in the presence of cardiac damage or dysfunction may be prognostically comparable to that of severe aortic stenosis. Extravalvular risk parameters can inform aortic stenosis risk stratification. Three ongoing trials seek to evaluate transcatheter aortic valve assessment in patients with moderate aortic stenosis and signs of cardiac damage or left ventricular dysfunction.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100336"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.shj.2024.100366
Julie He MD, Jeanne E. Poole MD
{"title":"Prophylactic Pacemaker Implant in Patients Undergoing Transaortic Valve Replacement: Is Right Bundle Branch Block Enough?","authors":"Julie He MD, Jeanne E. Poole MD","doi":"10.1016/j.shj.2024.100366","DOIUrl":"10.1016/j.shj.2024.100366","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100366"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.shj.2024.100327
Abhinav Aggarwal MD , Sun-Joo Jang MD, PhD , Swarnima Vardhan MD , Fabricio Malaguez Webber MD , Md Mashiul Alam MD , Madhurima Vardhan PhD , Gilead I. Lancaster MD , Yousif Ahmad MD, PhD , Amit N. Vora MD, MPH , Stuart W. Zarich MD , Ignacio Inglessis-Azuaje MD , Sammy Elmariah MD, MPH , John K. Forrest MD , Carlos D. Davila MD
Background
Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis.
Methods
Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database. Propensity-score matched analysis was performed to compare the clinical characteristics, in-hospital, and 30-day outcomes between the two groups.
Results
Between 2016 and 2019, 4047 patients with cirrhosis underwent TAVR (n = 3298) or SAVR (n = 749). TAVR adoption sharply rose, doubling the number of cases performed during the study period. Following propensity matching among 718 patients, the TAVR group consistently exhibited significantly lower rates of in-hospital mortality (2.2 vs. 7.5%; p = 0.002), bleeding (14.5 vs. 52.9%; p < 0.001), vascular complications (1.4 vs. 5%; p = 0.011), hepatorenal syndrome (3.3 vs. 8.9%; p = 0.003), cardiogenic shock (2.8 vs. 7%; p = 0.015), mechanical circulatory support utilization (0.6 vs. 4.7%; p = 0.001), 30-day all-cause readmission rates (10.3 vs. 18.1%; p = 0.005), and 30-day unplanned readmission rates (10 vs. 16.6%; p = 0.015) compared to the SAVR group. The TAVR group had significantly shorter median hospital stays, lower non-home disposition rates, and reduced hospital costs.
Conclusions
TAVR is associated with significantly lower rates of in-hospital mortality, bleeding, vascular complications, hepatorenal syndrome, cardiogenic shock, mechanical circulatory support utilization, and 30-day readmission rates compared to SAVR and represents a safe therapeutic option for aortic valve replacement in patients with cirrhosis.
背景肝硬化是心脏手术患者围手术期发病率和死亡率较高的一个重要风险因素，但肝硬化并未被纳入手术风险预测模型。评估肝硬化患者接受经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）治疗效果的当代数据有限。结果2016年至2019年间，4047名肝硬化患者接受了TAVR（3298人）或SAVR（749人）。在研究期间，TAVR的采用率急剧上升，手术例数翻了一番。在对 718 名患者进行倾向匹配后，TAVR 组的院内死亡率（2.2 vs. 7.5%；p = 0.002）、出血率（14.5 vs. 52.9%；p < 0.001）、血管并发症（1.4 vs. 5%；p = 0.011）、肝肾综合征（3.3 vs. 8.9%; p = 0.003）、心源性休克（2.8 vs. 7%; p = 0.015）、使用机械循环支持（0.6 vs. 4.7%; p = 0.001）、30 天全因再入院率（10.3 vs. 18.1%; p = 0.005）和 30 天非计划再入院率（10 vs. 16.6%; p = 0.015）。结论与SAVR相比，TAVR的院内死亡率、出血率、血管并发症、肝肾综合征、心源性休克、机械循环支持使用率和30天再入院率均显著降低，是肝硬化患者主动脉瓣置换术的安全治疗选择。
{"title":"In-Hospital Outcomes and 30-Day Readmission Rate After Transcatheter and Surgical Aortic Valve Replacement in Liver Cirrhosis: A Contemporary Propensity-Matched Analysis","authors":"Abhinav Aggarwal MD , Sun-Joo Jang MD, PhD , Swarnima Vardhan MD , Fabricio Malaguez Webber MD , Md Mashiul Alam MD , Madhurima Vardhan PhD , Gilead I. Lancaster MD , Yousif Ahmad MD, PhD , Amit N. Vora MD, MPH , Stuart W. Zarich MD , Ignacio Inglessis-Azuaje MD , Sammy Elmariah MD, MPH , John K. Forrest MD , Carlos D. Davila MD","doi":"10.1016/j.shj.2024.100327","DOIUrl":"10.1016/j.shj.2024.100327","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis.</div></div><div><h3>Methods</h3><div>Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database. Propensity-score matched analysis was performed to compare the clinical characteristics, in-hospital, and 30-day outcomes between the two groups.</div></div><div><h3>Results</h3><div>Between 2016 and 2019, 4047 patients with cirrhosis underwent TAVR (n = 3298) or SAVR (n = 749). TAVR adoption sharply rose, doubling the number of cases performed during the study period. Following propensity matching among 718 patients, the TAVR group consistently exhibited significantly lower rates of in-hospital mortality (2.2 vs. 7.5%; <em>p</em> = 0.002), bleeding (14.5 vs. 52.9%; <em>p</em> < 0.001), vascular complications (1.4 vs. 5%; <em>p</em> = 0.011), hepatorenal syndrome (3.3 vs. 8.9%; <em>p</em> = 0.003), cardiogenic shock (2.8 vs. 7%; <em>p</em> = 0.015), mechanical circulatory support utilization (0.6 vs. 4.7%; <em>p</em> = 0.001), 30-day all-cause readmission rates (10.3 vs. 18.1%; <em>p</em> = 0.005), and 30-day unplanned readmission rates (10 vs. 16.6%; <em>p</em> = 0.015) compared to the SAVR group. The TAVR group had significantly shorter median hospital stays, lower non-home disposition rates, and reduced hospital costs.</div></div><div><h3>Conclusions</h3><div>TAVR is associated with significantly lower rates of in-hospital mortality, bleeding, vascular complications, hepatorenal syndrome, cardiogenic shock, mechanical circulatory support utilization, and 30-day readmission rates compared to SAVR and represents a safe therapeutic option for aortic valve replacement in patients with cirrhosis.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100327"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.shj.2024.100352
Jury Schewel MD, PhD , Ryan D. Madder MD , Dimitry Schewel MD, PhD
Background
Interventional echocardiography (IE) plays a critical role in guiding structural heart interventions. IE specialists face challenges including high radiation exposure and unfavorable ergonomics. To address these issues, a novel remote-control robotic (RCR) system for transesophageal echocardiography (TEE) control has been developed. This study aims to describe the novel RCR system and to assess its performance in bench tests and in vitro models in terms of functionality, image quality, and reproducibility.
Methods
Bench testing and in vitro testing were performed using the RCR system. All tests were performed using the GE 6VT-D TEE probe and the GE Vivid E95.
Results
Key findings include proof of concept through bench testing, remote control of all five degrees of freedom of the TEE probe, and reliable, fast, and accurate reproducibility using automated navigation. The ROB’E Base is securely attached to the operating table, optimizing the footprint in the operating room. The ROB’E Guide accurately performs the forward and backward motion of the flexible portion of the TEE probe, stabilizing the achieved positions and preventing twisting during rotation. The ROB'E RCR system can store and reproduce TEE probe positions and has demonstrated reliable and accurate automated reproducibility in both bench and in vitro tests.
Conclusions
The ROB'E RCR system for TEE overcomes the limitations of conventional IE by using a RCR approach that eliminates the need for the echocardiographer to be physically present in the operating room. Thus, it significantly reduces radiation exposure and demonstrates its capabilities to improve image quality, reproducibility, and overall safety in IE.
背景介入超声心动图（IE）在指导心脏结构性介入治疗方面发挥着至关重要的作用。介入超声心动图专家面临的挑战包括高辐射暴露和不利的人体工程学设计。为了解决这些问题，我们开发了一种用于经食道超声心动图（TEE）控制的新型遥控机器人（RCR）系统。本研究旨在描述新型 RCR 系统，并从功能、图像质量和可重复性方面评估其在台架试验和体外模型中的性能。所有测试均使用通用电气 6VT-D TEE 探头和通用电气 Vivid E95 进行。结果主要发现包括通过台架测试验证了概念，远程控制 TEE 探头的所有五个自由度，以及使用自动导航实现可靠、快速和准确的再现性。ROB'E 底座牢牢固定在手术台上，优化了手术室的占地面积。ROB'E 导轨可准确执行 TEE 探头柔性部分的前后运动，稳定已实现的位置并防止旋转过程中发生扭曲。用于 TEE 的 ROB'E RCR 系统可以存储和重现 TEE 探头的位置，并在工作台和体外测试中证明了其可靠、准确的自动重现性。结论用于 TEE 的 ROB'E RCR 系统克服了传统 IE 的局限性，它采用 RCR 方法，无需超声心动图医师亲临手术室。因此，它大大降低了辐射暴露，并证明了其在 IE 中提高图像质量、可重复性和整体安全性的能力。
{"title":"Concept, Design, and Preclinical Testing of a Remote-Control Robotic System for Transesophageal Echocardiography","authors":"Jury Schewel MD, PhD , Ryan D. Madder MD , Dimitry Schewel MD, PhD","doi":"10.1016/j.shj.2024.100352","DOIUrl":"10.1016/j.shj.2024.100352","url":null,"abstract":"<div><h3>Background</h3><div>Interventional echocardiography (IE) plays a critical role in guiding structural heart interventions. IE specialists face challenges including high radiation exposure and unfavorable ergonomics. To address these issues, a novel remote-control robotic (RCR) system for transesophageal echocardiography (TEE) control has been developed. This study aims to describe the novel RCR system and to assess its performance in bench tests and in vitro models in terms of functionality, image quality, and reproducibility.</div></div><div><h3>Methods</h3><div>Bench testing and in vitro testing were performed using the RCR system. All tests were performed using the GE 6VT-D TEE probe and the GE Vivid E95.</div></div><div><h3>Results</h3><div>Key findings include proof of concept through bench testing, remote control of all five degrees of freedom of the TEE probe, and reliable, fast, and accurate reproducibility using automated navigation. The ROB’E Base is securely attached to the operating table, optimizing the footprint in the operating room. The ROB’E Guide accurately performs the forward and backward motion of the flexible portion of the TEE probe, stabilizing the achieved positions and preventing twisting during rotation. The ROB'E RCR system can store and reproduce TEE probe positions and has demonstrated reliable and accurate automated reproducibility in both bench and in vitro tests.</div></div><div><h3>Conclusions</h3><div>The ROB'E RCR system for TEE overcomes the limitations of conventional IE by using a RCR approach that eliminates the need for the echocardiographer to be physically present in the operating room. Thus, it significantly reduces radiation exposure and demonstrates its capabilities to improve image quality, reproducibility, and overall safety in IE.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100352"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.shj.2024.100326
Mark Zorman BM BCh, MA , Paul Bamford MB ChB, MA, MSc , Marco Coronelli MBBS, BSc , Cara Barnes MBBS, MPhil , Christopher Saunderson MB ChB, MD , James Gamble MA, MD , Sam Dawkins BSc, DPhil , Rajesh K. Kharbanda BSc, MB ChB, PhD , James Newton MB ChB, MD , Adrian P. Banning MBBS, MD , Daniel J. Blackman MB ChB, MD , Thomas J. Cahill MBBS, DPhil
Background
Baseline right bundle branch block (RBBB) is an established predictor of permanent pacemaker (PPM) requirement after transcatheter aortic valve replacement (TAVR). There are limited data to support prophylactic PPM implantation in advance of TAVR. We aimed to evaluate the efficacy and safety of prophylactic PPM implantation in patients with RBBB prior to TAVR, and to identify the predictors of pacing dependence after TAVR.
Methods
This was a retrospective cohort study of patients undergoing prophylactic PPM implantation for baseline RBBB prior to TAVR at two high-volume UK centers between 2014 and 2022.
Results
Baseline RBBB was identified in 170/4580 (3.7%) patients undergoing TAVR during the study period. Of these, 106/170 (62.4%) underwent prophylactic PPM implantation. This group had a significantly shorter median length of hospital stay after TAVR compared to patients with RBBB undergoing TAVR without prophylactic PPM implantation (2 vs. 4 days, p = 0.028). Urgent PPM implantation after TAVR was required in 43/64 (67.2%) of patients with RBBB who underwent TAVR without a prophylactic PPM. Analysis of ventricular pacing over 12 months post-TAVR demonstrated a significant pacing requirement (ventricular pacing > 10%) in 50/79 (63%) of patients with a prophylactic PPM. Pacing requirement was independently predicted by baseline first-degree heart block (odds ratio 2.4, p = 0.03) and QRS duration >140 ms (odds ratio 4.3, p = 0.01).
Conclusions
In this retrospective two-center cohort study, prophylactic PPM implantation for patients with baseline RBBB was safe, effective, and reduced the length of hospital stay. First-degree atrioventricular block and broad RBBB (QRS > 140 ms) were independent baseline predictors of significant pacing requirements.
{"title":"Prophylactic Permanent Pacemaker Implantation for Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement: Clinical Efficacy, Safety, and Long-Term Pacing Requirement","authors":"Mark Zorman BM BCh, MA , Paul Bamford MB ChB, MA, MSc , Marco Coronelli MBBS, BSc , Cara Barnes MBBS, MPhil , Christopher Saunderson MB ChB, MD , James Gamble MA, MD , Sam Dawkins BSc, DPhil , Rajesh K. Kharbanda BSc, MB ChB, PhD , James Newton MB ChB, MD , Adrian P. Banning MBBS, MD , Daniel J. Blackman MB ChB, MD , Thomas J. Cahill MBBS, DPhil","doi":"10.1016/j.shj.2024.100326","DOIUrl":"10.1016/j.shj.2024.100326","url":null,"abstract":"<div><h3>Background</h3><div>Baseline right bundle branch block (RBBB) is an established predictor of permanent pacemaker (PPM) requirement after transcatheter aortic valve replacement (TAVR). There are limited data to support prophylactic PPM implantation in advance of TAVR. We aimed to evaluate the efficacy and safety of prophylactic PPM implantation in patients with RBBB prior to TAVR, and to identify the predictors of pacing dependence after TAVR.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients undergoing prophylactic PPM implantation for baseline RBBB prior to TAVR at two high-volume UK centers between 2014 and 2022.</div></div><div><h3>Results</h3><div>Baseline RBBB was identified in 170/4580 (3.7%) patients undergoing TAVR during the study period. Of these, 106/170 (62.4%) underwent prophylactic PPM implantation. This group had a significantly shorter median length of hospital stay after TAVR compared to patients with RBBB undergoing TAVR without prophylactic PPM implantation (2 vs. 4 days, <em>p</em> = 0.028). Urgent PPM implantation after TAVR was required in 43/64 (67.2%) of patients with RBBB who underwent TAVR without a prophylactic PPM. Analysis of ventricular pacing over 12 months post-TAVR demonstrated a significant pacing requirement (ventricular pacing > 10%) in 50/79 (63%) of patients with a prophylactic PPM. Pacing requirement was independently predicted by baseline first-degree heart block (odds ratio 2.4, <em>p</em> = 0.03) and QRS duration >140 ms (odds ratio 4.3, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>In this retrospective two-center cohort study, prophylactic PPM implantation for patients with baseline RBBB was safe, effective, and reduced the length of hospital stay. First-degree atrioventricular block and broad RBBB (QRS > 140 ms) were independent baseline predictors of significant pacing requirements.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100326"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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