Structural Heart最新文献

英文中文

Pushing the Limits of Transcatheter Edge-to-Edge Repair: How Small Can the Mitral Valve Area Go? 突破经导管边缘到边缘修复的极限：二尖瓣面积能缩小到多小？

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-02-01 DOI: 10.1016/j.shj.2025.100782

Gaspard Suc MD, PhD

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 : 2026-01-28 DOI: 10.1016/j.shj.2025.100761

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

引用次数: 0

Letter to the Editor Response 致编辑的信

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-01-20 DOI: 10.1016/j.shj.2025.100783

Revathy Sampath-Kumar MD, Ehtisham Mahmud MD

引用次数: 0

Aims & Scope 目标及范围

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-01-01 DOI: 10.1016/S2474-8706(26)00007-2

引用次数: 0

Impact of a Clinical Valve Coordinator on Hospital Length of Stay and Patient Outcomes: Results From the BENCHMARK Registry 临床瓣膜协调员对住院时间和患者预后的影响：来自基准登记的结果

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2026-01-01 DOI: 10.1016/j.shj.2025.100740

Sandra B. Lauck PhD , Francesco Saia MD , Eric Durand MD , Bettina Højberg Kirk MSN , Fiona Kelly RN , Douglas F. Muir MB, ChB , Gemma McCalmont MSc , Mark S. Spence MD , Mariuca Vasa-Nicotera MD , David Wood MD , Cristóbal A. Urbano Carrillo MD , Damien Bouchayer MD , Vlad Anton Iliescu MD , Christophe Saint Etienne MD , Nina Fauré RN , Céline Hee RN , Florence Leclercq MD , Vincent Auffret MD , Lluis Asmarats MD , Carlo Di Mario MD , Derk Frank MD

Background

Transcatheter aortic valve implantation (TAVI) treatment pathways can be supported by a dedicated clinical valve coordinator (CVC), enhancing their efficiency. We aimed to evaluate the impact of a CVC in managing the treatment pathway of patients undergoing TAVI across Europe before and after implementing 8 Benchmark best practices.

Methods

The BENCHMARK registry (ClinicalTrials NCT04579445) was a multicenter international study of patients with severe symptomatic aortic stenosis undergoing TAVI with balloon-expandable valves across 28 European centers. Primary outcomes were hospital and intensive care length of stay (LoS). The secondary outcome was 30-day patient safety.

Results

Of 2323 patients, 1262 were treated at centers without a pre-existing CVC and 1061 at centers with a pre-existing CVC; propensity matching resulted in 891 matched pairs. The total procedural time was significantly reduced in both groups (p < 0.001) after implementing Benchmark best practices. Hospital LoS was lower before Benchmark when a CVC was present and was significantly shorter in both groups following implementation (p < 0.001), as was the critical care LoS (p < 0.001). The presence of a CVC did not affect safety outcomes but was associated with a reduced risk of major vascular bleeding when combined with Benchmark best practices. Patient satisfaction was higher in centers with a pre-existing CVC (p < 0.001).

Conclusions

The addition of a CVC to the multidisciplinary team and their sustained contributions to processes of care align with the implementation of Benchmark practices, significantly decrease the health service requirements of TAVI patients, and are associated with improved patient-reported experiences.

背景经导管主动脉瓣植入术（TAVI）的治疗途径可以由专门的临床瓣膜协调员（CVC）支持，提高其效率。我们的目的是评估CVC在实施8个基准最佳实践之前和之后管理全欧洲TAVI患者治疗途径的影响。基准注册（ClinicalTrials NCT04579445）是一项多中心的国际研究，研究对象是28个欧洲中心的严重症状性主动脉狭窄患者，他们接受了带有球囊扩张瓣膜的TAVI。主要结局是住院时间和重症监护时间（LoS）。次要终点是患者30天的安全性。结果在2323例患者中，1262例在无CVC中心治疗，1061例在有CVC中心治疗；倾向匹配结果为891对。在实施Benchmark最佳实践后，两组的总程序时间都显著减少（p < 0.001）。当CVC存在时，医院LoS在Benchmark之前较低，并且在实施后两组的LoS明显较短（p < 0.001），重症监护LoS也是如此（p < 0.001）。CVC的存在不影响安全性结果，但与基准最佳实践相结合时，可降低大血管出血的风险。存在CVC的中心患者满意度较高（p < 0.001）。结论：在多学科团队中增加CVC及其对护理过程的持续贡献与基准实践的实施相一致，显著降低了TAVI患者的卫生服务需求，并与改善患者报告的体验相关。

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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 : 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。

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引用次数: 0

Patient Selection for Transcatheter Tricuspid Valve Intervention: Not Too Early, Not Too Late 经导管三尖瓣介入治疗的患者选择：不要太早，也不要太晚

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-19 DOI: 10.1016/j.shj.2025.100788

Jennifer von Stein MD , Philipp von Stein MD , Maria C. Alu MS , Andrea Scotti MD , Edwin C. Ho MD , Juan F. Granada MD , Azeem Latib MD

Tricuspid regurgitation (TR) is a common but frequently underrecognized condition associated with substantial morbidity and mortality. Long regarded as a mere bystander of left-sided heart disease, TR was often left untreated, contributing to late referrals and poor surgical outcomes. The emergence of transcatheter tricuspid valve interventions has broadened therapeutic options, particularly for high-risk or inoperable patients. However, procedural success and clinical benefit critically depend on appropriate patient selection and timely intervention. This review outlines the evolving landscape of TR management, emphasizing the importance of anatomical and clinical stage-adapted device selection. Key determinants of feasibility and prognosis include right ventricular function and dimensions, TR severity, tricuspid valve leaflet and annular remodeling, and hemodynamic congestion. Advanced imaging modalities and invasive hemodynamics provide incremental value for risk stratification. While tricuspid valve transcatheter edge-to-edge repair (T-TEER) and orthotopic valve replacement are the most widely adopted techniques, direct annuloplasty, heterotopic valve replacement, and coaptation enhancement devices may be more appropriate in anatomically advanced stages. Despite symptomatic improvement and reduced heart failure hospitalizations across different treatment modalities, a survival benefit has yet to be demonstrated. Delayed referral remains a challenge, often precluding repair or even replacement strategies. Dedicated risk models may improve prognostication and guide procedural decision-making. Ultimately, a multidisciplinary approach incorporating multiparametric assessment is essential to identify optimal candidates, guide timing, and personalize therapy. Ongoing trials and long-term outcome data are needed to refine treatment algorithms and clarify the role of early intervention in altering the natural course of severe TR.

三尖瓣反流（TR）是一种常见但常被忽视的疾病，与大量发病率和死亡率相关。长期以来，TR被视为左侧心脏病的旁观者，经常不治疗，导致转诊晚，手术效果差。经导管三尖瓣介入治疗的出现拓宽了治疗选择，特别是对高危或不能手术的患者。然而，手术的成功和临床效益关键取决于适当的患者选择和及时的干预。这篇综述概述了TR管理的发展前景，强调了解剖和临床阶段相适应的设备选择的重要性。可行性和预后的关键决定因素包括右心室功能和尺寸、TR严重程度、三尖瓣小叶和环重构以及血流动力学充血。先进的成像方式和侵入性血流动力学为风险分层提供了增加的价值。虽然三尖瓣经导管边缘到边缘修复（T-TEER）和原位瓣膜置换术是最广泛采用的技术，但直接环成形术、异位瓣膜置换术和配合增强装置可能更适合解剖晚期。尽管不同的治疗方式可以改善症状并减少心力衰竭住院治疗，但生存效益尚未得到证实。延迟转诊仍然是一个挑战，经常妨碍修复甚至更换策略。专门的风险模型可以改善预测和指导程序性决策。最终，结合多参数评估的多学科方法对于确定最佳候选人、指导时机和个性化治疗至关重要。需要正在进行的试验和长期结果数据来完善治疗算法，并阐明早期干预在改变严重TR自然病程中的作用。

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引用次数: 0

Impact of ICD-10-CM Z-Coded Social Determinants of Health on Transcatheter Aortic Valve Replacement–Related Outcomes ICD-10-CM z编码健康社会决定因素对经导管主动脉瓣置换术相关结果的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-19 DOI: 10.1016/j.shj.2025.100789

Ramzi Ibrahim MD , Matthew Romero BS , Hoang Nhat Pham MD , Ahmed K. Mahmoud MD , Kristen A. Sell-Dottin MD , John P. Sweeney MD , F. David Fortuin MD , Eugene Yang MD, MS , Kwan Lee MD , Said Alsidawi MD , Sadeer Al-Kindi MD , Chadi Ayoub MBBS, PhD , Reza Arsanjani 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 : 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

Radiation Realities: Radiation Safety Practices and Awareness Among Interventional Echocardiographers in the United States 辐射现实：介入超声心动图医师在美国的辐射安全实践和意识

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-15 DOI: 10.1016/j.shj.2025.100785

Priscilla Wessly MD , Enrique Garcia-Sayan MD , Nishath Quader MD , Stephen Little MD , Omar Khalique MD , Renuka Jain MD

Background

With the rise of structural heart interventions (SHIs), interventional echocardiographers (IEs) face significant radiation exposure in catheterization laboratories. However, US-specific radiation safety practices remain understudied. This study aims to address radiation safety practices and concerns among US IEs, focusing on occupational risks and sex-specific challenges.

Methods

A 21-item online survey was conducted from March to June 2025, targeting US IEs through a multifaceted recruitment strategy. It assessed demographics, SHI frequency, radiation monitoring, shielding practices, and reproductive health concerns. Descriptive statistics summarized responses, with sex-specific analyses for female IEs.

Results

Of 69 respondents (64% [n = 44] men, 36% [n = 25] women), 88% (n = 61) worked in tertiary care settings and 46% (n = 32) guided SHIs several times weekly. Key gaps were identified, including 18% (n = 17) not using dosimeters, 64% (n = 44) never receiving exposure notifications, and 80% (n = 55) lacking awareness of their personal annual radiation dose. In addition, 30% (n = 21) had no radiation safety training, and 75% (n = 52) reported insufficient radiation protection in their catheterization laboratory. Reproductive health concerns affected 71% (n = 49) of IEs. Among female IEs, 56% (n = 14) reported an influence on pregnancy planning, 32% (n = 8) noted career concerns owing to maternity, and 63% of those who had had a pregnancy (n = 12/19) performed SHIs during pregnancy, with 7% taking no additional precautions.

Conclusions

US IEs face critical radiation safety gaps, including inadequate monitoring, training, and shielding, with pronounced reproductive and career concerns among female IEs. Tailored protocols, enhanced shielding, and pregnancy-specific precautions are urgently needed to ensure the safety and well-being of IEs.

随着结构性心脏介入（SHIs）的兴起，介入超声心动图医师（IEs）在导管实验室面临着显著的辐射暴露。然而，美国特有的辐射安全措施仍未得到充分研究。本研究旨在解决美国工业工程师的辐射安全实践和担忧，重点关注职业风险和性别特异性挑战。方法于2025年3月至6月进行了一项21项的在线调查，通过多方面的招聘策略针对美国的工程师。它评估了人口统计、辐射辐射频率、辐射监测、屏蔽做法和生殖健康问题。描述性统计总结了调查结果，并对女性IEs进行了性别分析。结果69名受访者中（64% [n = 44]男性，36% [n = 25]女性），88% （n = 61）在三级保健机构工作，46% （n = 32）每周指导SHIs几次。已确定的主要差距包括18% （n = 17）未使用剂量计，64% （n = 44）从未收到照射通知，80% （n = 55）缺乏对个人年辐射剂量的认识。此外，30% （n = 21）的患者没有接受过辐射安全培训，75% （n = 52）的患者报告其导管室的辐射防护不足。生殖健康问题影响了71%的产妇（n = 49）。在女性IEs中，56% （n = 14）报告了对怀孕计划的影响，32% （n = 8）指出了因生育而引起的职业担忧，63%怀孕过的人（n = 12/19）在怀孕期间进行了SHIs， 7%没有采取额外的预防措施。结论美国放射学专业人员面临严重的辐射安全缺口，包括监测、培训和防护不足，女性放射学专业人员存在明显的生殖和职业担忧。为确保新生儿的安全和健康，迫切需要量身定制的方案、增强的防护和针对妊娠的预防措施。

{"title":"Radiation Realities: Radiation Safety Practices and Awareness Among Interventional Echocardiographers in the United States","authors":"Priscilla Wessly MD , Enrique Garcia-Sayan MD , Nishath Quader MD , Stephen Little MD , Omar Khalique MD , Renuka Jain MD","doi":"10.1016/j.shj.2025.100785","DOIUrl":"10.1016/j.shj.2025.100785","url":null,"abstract":"<div><h3>Background</h3><div>With the rise of structural heart interventions (SHIs), interventional echocardiographers (IEs) face significant radiation exposure in catheterization laboratories. However, US-specific radiation safety practices remain understudied. This study aims to address radiation safety practices and concerns among US IEs, focusing on occupational risks and sex-specific challenges.</div></div><div><h3>Methods</h3><div>A 21-item online survey was conducted from March to June 2025, targeting US IEs through a multifaceted recruitment strategy. It assessed demographics, SHI frequency, radiation monitoring, shielding practices, and reproductive health concerns. Descriptive statistics summarized responses, with sex-specific analyses for female IEs.</div></div><div><h3>Results</h3><div>Of 69 respondents (64% [n = 44] men, 36% [n = 25] women), 88% (n = 61) worked in tertiary care settings and 46% (n = 32) guided SHIs several times weekly. Key gaps were identified, including 18% (n = 17) not using dosimeters, 64% (n = 44) never receiving exposure notifications, and 80% (n = 55) lacking awareness of their personal annual radiation dose. In addition, 30% (n = 21) had no radiation safety training, and 75% (n = 52) reported insufficient radiation protection in their catheterization laboratory. Reproductive health concerns affected 71% (n = 49) of IEs. Among female IEs, 56% (n = 14) reported an influence on pregnancy planning, 32% (n = 8) noted career concerns owing to maternity, and 63% of those who had had a pregnancy (n = 12/19) performed SHIs during pregnancy, with 7% taking no additional precautions.</div></div><div><h3>Conclusions</h3><div>US IEs face critical radiation safety gaps, including inadequate monitoring, training, and shielding, with pronounced reproductive and career concerns among female IEs. Tailored protocols, enhanced shielding, and pregnancy-specific precautions are urgently needed to ensure the safety and well-being of IEs.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100785"},"PeriodicalIF":2.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927500","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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