Pub Date : 2025-02-01DOI: 10.1016/j.shj.2024.100357
Thijmen W. Hokken MD , Moniek P.M. de Maat MD, PhD , Nicolas M. Van Mieghem MD, PhD
{"title":"The Risk for Excessive Anticoagulation With Activated Clotting Time-Guided Monitoring in Patients Undergoing Transcatheter Aortic Valve Replacement","authors":"Thijmen W. Hokken MD , Moniek P.M. de Maat MD, PhD , Nicolas M. Van Mieghem MD, PhD","doi":"10.1016/j.shj.2024.100357","DOIUrl":"10.1016/j.shj.2024.100357","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100357"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529331","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 : 2025-02-01DOI: 10.1016/j.shj.2024.100306
Eliza Berman BSc , Arsalan Abu-Much MD , Mark Reisman MD , Nathan E. Matzko BSc , Jose M. Dizon MD , Bjӧrn Redfors MD, PhD , Maria C. Alu MS , Tamim M. Nazif MD , Martin B. Leon MD , Shmuel Chen MD, PhD
Transcatheter aortic valve replacement (TAVR) is a widely accepted treatment strategy for patients with severe aortic stenosis across all risk profiles. Pacing stimulation of the right ventricle (RV) is the conventional method used during TAVR for rapid pacing during balloon dilatation and transcatheter heart valve deployment and for the management of acute bradyarrhythmias. However, RV pacing requires additional venous access and carries a risk of RV perforation and cardiac tamponade. An alternate strategy of utilizing the stiff guidewire in the left ventricle for direct left ventricle pacing during valve deployment is increasingly being adopted, as it may reduce procedure cost, duration, and radiation exposure and potentially mitigate the risks associated with RV pacing. The current review aims to discuss contemporary rapid pacing techniques for TAVR, including their relative safety, efficiency, and outcomes.
{"title":"Contemporary Review of the Methods for Rapid Ventricular Pacing During Transcatheter Aortic Valve Replacement","authors":"Eliza Berman BSc , Arsalan Abu-Much MD , Mark Reisman MD , Nathan E. Matzko BSc , Jose M. Dizon MD , Bjӧrn Redfors MD, PhD , Maria C. Alu MS , Tamim M. Nazif MD , Martin B. Leon MD , Shmuel Chen MD, PhD","doi":"10.1016/j.shj.2024.100306","DOIUrl":"10.1016/j.shj.2024.100306","url":null,"abstract":"<div><div>Transcatheter aortic valve replacement (TAVR) is a widely accepted treatment strategy for patients with severe aortic stenosis across all risk profiles. Pacing stimulation of the right ventricle (RV) is the conventional method used during TAVR for rapid pacing during balloon dilatation and transcatheter heart valve deployment and for the management of acute bradyarrhythmias. However, RV pacing requires additional venous access and carries a risk of RV perforation and cardiac tamponade. An alternate strategy of utilizing the stiff guidewire in the left ventricle for direct left ventricle pacing during valve deployment is increasingly being adopted, as it may reduce procedure cost, duration, and radiation exposure and potentially mitigate the risks associated with RV pacing. The current review aims to discuss contemporary rapid pacing techniques for TAVR, including their relative safety, efficiency, and outcomes.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100306"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141389644","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100324
Ethan C. Korngold MD, Brandon M. Jones MD
{"title":"Redo-Transcatheter Aortic Valve Replacement with an Intra-Annular, Self-Expanding Prosthesis Within a Balloon Expandable Prosthesis: A Case Series","authors":"Ethan C. Korngold MD, Brandon M. Jones MD","doi":"10.1016/j.shj.2024.100324","DOIUrl":"10.1016/j.shj.2024.100324","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100324"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372551","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100375
Birgitte Carbuhn Larsen MD , Martin Christian Harmsen MD , Henrik Vase MD, PhD , Jens Erik Nielsen-Kudsk MD, DMSc , Asger Andersen MD, PhD
Background
A patent foramen ovale (PFO) has a complex anatomy, and evaluating the size before closure may be challenging. We aimed to investigate the correlation between preprocedural transesophageal echocardiography (TEE) and balloon sizing of PFO in patients undergoing percutaneous PFO closure.
Methods
A retrospective single-center study with analysis of 100 patients who, due to paradox thromboembolism in the left circulation, underwent percutaneous PFO closure. The PFO sizing was compared to measures attained by TEE and balloon sizing using linear regression analysis.
Results
PFO size measured by TEE occurred smaller than balloon sizing (2.19 mm [95% CI: 1.91 to 2.46] vs. 8.51 mm [95% CI: 8.02 to 9.00], p < 0.001). Additionally, neither the PFO channel length nor the atrial septal mobility measured by TEE correlated to the PFO size attained by balloon sizing, respectively (slope −0.018 [95% CI: −0.117 to 0.081], R = 0.036, p = 0.719) and (slope 0.049 [95% CI: ?0.043 to 0.141], R = 0.105, p = 0.297). Statistically significant difference in regression analysis but poor correlation was found between both TEE attained PFO and shunt size when compared to balloon sizing. Diverting patients according to the size of the PFO shunt was not statistically significant between PFO of moderate size compared, respectively, to a large and small PFO size. However, a difference was observed between a small and large PFO shunt size.
Conclusions
PFO defect and shunt size measured by TEE showed a poor correlation with balloon sizing. Neither PFO channel length nor septal mobility were correlated to the PFO size measured by balloon sizing.
{"title":"Comparison of Patent Foramen Ovale Sizing by Transesophageal Echocardiography and Balloon Sizing in Patients Undergoing Percutaneous Closure","authors":"Birgitte Carbuhn Larsen MD , Martin Christian Harmsen MD , Henrik Vase MD, PhD , Jens Erik Nielsen-Kudsk MD, DMSc , Asger Andersen MD, PhD","doi":"10.1016/j.shj.2024.100375","DOIUrl":"10.1016/j.shj.2024.100375","url":null,"abstract":"<div><h3>Background</h3><div>A patent foramen ovale (PFO) has a complex anatomy, and evaluating the size before closure may be challenging. We aimed to investigate the correlation between preprocedural transesophageal echocardiography (TEE) and balloon sizing of PFO in patients undergoing percutaneous PFO closure.</div></div><div><h3>Methods</h3><div>A retrospective single-center study with analysis of 100 patients who, due to paradox thromboembolism in the left circulation, underwent percutaneous PFO closure. The PFO sizing was compared to measures attained by TEE and balloon sizing using linear regression analysis.</div></div><div><h3>Results</h3><div>PFO size measured by TEE occurred smaller than balloon sizing (2.19 mm [95% CI: 1.91 to 2.46] vs. 8.51 mm [95% CI: 8.02 to 9.00], <em>p</em> < 0.001). Additionally, neither the PFO channel length nor the atrial septal mobility measured by TEE correlated to the PFO size attained by balloon sizing, respectively (slope <strong>−</strong>0.018 [95% CI: <strong>−</strong>0.117 to 0.081], R = 0.036, <em>p</em> = 0.719) and (slope 0.049 [95% CI: ?0.043 to 0.141], R = 0.105, <em>p</em> = 0.297). Statistically significant difference in regression analysis but poor correlation was found between both TEE attained PFO and shunt size when compared to balloon sizing. Diverting patients according to the size of the PFO shunt was not statistically significant between PFO of moderate size compared, respectively, to a large and small PFO size. However, a difference was observed between a small and large PFO shunt size.</div></div><div><h3>Conclusions</h3><div>PFO defect and shunt size measured by TEE showed a poor correlation with balloon sizing. Neither PFO channel length nor septal mobility were correlated to the PFO size measured by balloon sizing.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100375"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372554","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100367
Waseem Nosair MD, MPH , Morgana Mongraw-Chaffin PhD, MPH , William S. Weintraub MD
{"title":"Can Variation in Costs for Cardiovascular Procedures Be Attributed to Inefficiency in Care Delivery? Challenges in Causality, Data Availability, and the Need for Price Transparency","authors":"Waseem Nosair MD, MPH , Morgana Mongraw-Chaffin PhD, MPH , William S. Weintraub MD","doi":"10.1016/j.shj.2024.100367","DOIUrl":"10.1016/j.shj.2024.100367","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100367"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372047","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100396
Anthony DeMaria MD
{"title":"How Important Is Death?","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2024.100396","DOIUrl":"10.1016/j.shj.2024.100396","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100396"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372548","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100354
Grant W. Reed MD, MSc, Shady Nakhla MD, Rhonda Miyasaka MD, Serge Harb MD, Mohamed Kanj MD, Ousamma Wazni MD, Samir R. Kapadia MD, Amar Krishnaswamy MD
Percutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice. Recent data comparing the safety and efficacy of post-LAAO antiplatelet vs. antithrombotic therapy will be highlighted, with specific recommendations regarding which patients are best suited for each strategy. We will also address the safety and practical considerations provided by emerging trials on concomitant LAAO during other structural heart interventions such as transcatheter aortic valve replacement and mitral valve interventions, as well as electrophysiology procedures including catheter ablation for atrial fibrillation and pacemaker implantation. Practical considerations for the use of transesophageal echocardiography or intracardiac echocardiography for procedural guidance will also be discussed. As the evidence supporting LAAO continues to evolve, this review will serve as a primer on the recent and upcoming advances in device technology and management strategies positioned to further push LAAO forward into the future.
{"title":"Left Atrial Appendage Occlusion: Expanding Indications and New Developments","authors":"Grant W. Reed MD, MSc, Shady Nakhla MD, Rhonda Miyasaka MD, Serge Harb MD, Mohamed Kanj MD, Ousamma Wazni MD, Samir R. Kapadia MD, Amar Krishnaswamy MD","doi":"10.1016/j.shj.2024.100354","DOIUrl":"10.1016/j.shj.2024.100354","url":null,"abstract":"<div><div>Percutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice. Recent data comparing the safety and efficacy of post-LAAO antiplatelet vs. antithrombotic therapy will be highlighted, with specific recommendations regarding which patients are best suited for each strategy. We will also address the safety and practical considerations provided by emerging trials on concomitant LAAO during other structural heart interventions such as transcatheter aortic valve replacement and mitral valve interventions, as well as electrophysiology procedures including catheter ablation for atrial fibrillation and pacemaker implantation. Practical considerations for the use of transesophageal echocardiography or intracardiac echocardiography for procedural guidance will also be discussed. As the evidence supporting LAAO continues to evolve, this review will serve as a primer on the recent and upcoming advances in device technology and management strategies positioned to further push LAAO forward into the future.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100354"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372385","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100340
Serge C. Harb MD , Joshua A. Cohen MD , Amar Krishnaswamy MD , Samir R. Kapadia MD , Rhonda L. Miyasaka MD
{"title":"Targeting the Future: Three-Dimensional Imaging for Precise Guidance of the Transseptal Puncture","authors":"Serge C. Harb MD , Joshua A. Cohen MD , Amar Krishnaswamy MD , Samir R. Kapadia MD , Rhonda L. Miyasaka MD","doi":"10.1016/j.shj.2024.100340","DOIUrl":"10.1016/j.shj.2024.100340","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100340"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845120","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 : 2025-01-01DOI: 10.1016/j.shj.2024.100334
Michel Pompeu Sá MD, MSc, MHBA, PhD , Danial Ahmad MD, MPH , Yisi Wang MPH , Floyd Thoma BS , Amber Makani MD , Dustin Kliner MD , Catalin Toma MD , David West MD , Derek Serna-Gallegos MD , Ibrahim Sultan MD
Background
Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor).
Methods
Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM).
Results
We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; p = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm2/m2, p = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, p = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, p = 0.390). No statistically significant difference was observed in survival (log-rank p = 0.950) and stroke (p = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe.
Conclusions
IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.
{"title":"Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study","authors":"Michel Pompeu Sá MD, MSc, MHBA, PhD , Danial Ahmad MD, MPH , Yisi Wang MPH , Floyd Thoma BS , Amber Makani MD , Dustin Kliner MD , Catalin Toma MD , David West MD , Derek Serna-Gallegos MD , Ibrahim Sultan MD","doi":"10.1016/j.shj.2024.100334","DOIUrl":"10.1016/j.shj.2024.100334","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor).</div></div><div><h3>Methods</h3><div>Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM).</div></div><div><h3>Results</h3><div>We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; <em>p</em> = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm<sup>2</sup>/m<sup>2</sup>, <em>p</em> = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, <em>p</em> = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, <em>p</em> = 0.390). No statistically significant difference was observed in survival (log-rank <em>p</em> = 0.950) and stroke (<em>p</em> = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe.</div></div><div><h3>Conclusions</h3><div>IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100334"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711919","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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