Pub Date : 2025-12-13DOI: 10.1016/j.shj.2025.100786
Antonin Trimaille MD, PhD, Pablo Vidal-Cales MD, Carlos Giuliani MD, Juan Hernando Del Portillo MD, Jean-Michel Paradis MD, Siamak Mohammadi MD, Anthony Poulin MD, Frederic Beaupré MD, Eric Dumont MD, Jean Porterie MD, Erwan Salaun MD, Marisa Avvedimento MD, Josep Rodés-Cabau MD, PhD
Background
Vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have distinct biological properties that may differentially influence bioprosthetic valve durability following transcatheter aortic valve replacement. The aim of this study was to explore the effect of oral anticoagulation (OAC) class on bioprosthetic valve durability.
Methods
We analyzed the data of a prospective registry including 688 consecutive patients under OAC undergoing transcatheter aortic valve replacement between May 2007 and January 2024 who were alive at 1 year. The effect of OAC class was assessed using a propensity score-matched population (132 patients with VKA vs. 132 patients with DOAC). The primary endpoint was the occurrence of stage 2 or 3 hemodynamic valve deterioration according to Valve Academic Research Consortium-3 criteria.
Results
In the propensity score-matched population, treatment with DOACs was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration compared to VKAs (subdistribution hazard ratio [sHR] 0.89; 95% CI 0.35-2.29; p = 0.808) after a median follow-up of 4 years (interquartile range: 3-5). No significant differences were observed for the risk of bioprosthetic valve failure (sHR 1.62; 95% CI 0.53-4.96; p = 0.401) or aortic valve reintervention (sHR 0.97; 95% CI 0.14-6.82; p = 0.981). Long-term echocardiographic follow-up showed similar evolution of hemodynamic parameters over time.
Conclusions
No significant differences were observed between VKAs and DOACs on valve durability outcomes. Further studies with longer follow-up, larger population, and randomized designs are warranted to confirm these findings.
维生素K拮抗剂（VKAs）和直接口服抗凝剂（DOACs）具有不同的生物学特性，可能对经导管主动脉瓣置换术后生物假体瓣膜的耐久性产生不同的影响。本研究旨在探讨口服抗凝剂（OAC）对生物假体瓣膜耐久性的影响。方法：我们分析了一项前瞻性登记的数据，包括2007年5月至2024年1月期间连续688例经导管主动脉瓣置换术的OAC患者，这些患者存活1年。使用倾向评分匹配人群（132例VKA患者与132例DOAC患者）评估OAC类别的影响。主要终点是根据瓣膜学术研究协会-3标准发生的2期或3期血流动力学瓣膜恶化。结果在倾向评分匹配的人群中，与vka相比，doac治疗与2期或3期血流动力学瓣膜恶化的风险无关（亚分布风险比[sHR] 0.89; 95% CI 0.35-2.29; p = 0.808），中位随访4年（四分位数范围：3-5）。生物瓣膜失效的风险（sHR 1.62; 95% CI 0.53-4.96; p = 0.401）或主动脉瓣再介入（sHR 0.97; 95% CI 0.14-6.82; p = 0.981）无显著差异。长期超声心动图随访显示血流动力学参数随时间的变化相似。结论vka与doac在瓣膜耐久性方面无显著差异。进一步的随访时间更长、人群更大、随机设计的研究可以证实这些发现。
{"title":"Impact of Anticoagulant Class on Long-Term Bioprosthesis Durability Following Transcatheter Aortic Valve Replacement","authors":"Antonin Trimaille MD, PhD, Pablo Vidal-Cales MD, Carlos Giuliani MD, Juan Hernando Del Portillo MD, Jean-Michel Paradis MD, Siamak Mohammadi MD, Anthony Poulin MD, Frederic Beaupré MD, Eric Dumont MD, Jean Porterie MD, Erwan Salaun MD, Marisa Avvedimento MD, Josep Rodés-Cabau MD, PhD","doi":"10.1016/j.shj.2025.100786","DOIUrl":"10.1016/j.shj.2025.100786","url":null,"abstract":"<div><h3>Background</h3><div>Vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have distinct biological properties that may differentially influence bioprosthetic valve durability following transcatheter aortic valve replacement. The aim of this study was to explore the effect of oral anticoagulation (OAC) class on bioprosthetic valve durability.</div></div><div><h3>Methods</h3><div>We analyzed the data of a prospective registry including 688 consecutive patients under OAC undergoing transcatheter aortic valve replacement between May 2007 and January 2024 who were alive at 1 year. The effect of OAC class was assessed using a propensity score-matched population (132 patients with VKA vs. 132 patients with DOAC). The primary endpoint was the occurrence of stage 2 or 3 hemodynamic valve deterioration according to Valve Academic Research Consortium-3 criteria.</div></div><div><h3>Results</h3><div>In the propensity score-matched population, treatment with DOACs was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration compared to VKAs (subdistribution hazard ratio [sHR] 0.89; 95% CI 0.35-2.29; <em>p</em> = 0.808) after a median follow-up of 4 years (interquartile range: 3-5). No significant differences were observed for the risk of bioprosthetic valve failure (sHR 1.62; 95% CI 0.53-4.96; <em>p</em> = 0.401) or aortic valve reintervention (sHR 0.97; 95% CI 0.14-6.82; <em>p</em> = 0.981). Long-term echocardiographic follow-up showed similar evolution of hemodynamic parameters over time.</div></div><div><h3>Conclusions</h3><div>No significant differences were observed between VKAs and DOACs on valve durability outcomes. Further studies with longer follow-up, larger population, and randomized designs are warranted to confirm these findings.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100786"},"PeriodicalIF":2.8,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927495","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}
Pub Date : 2025-12-05DOI: 10.1016/j.shj.2025.100780
Lior Zornitzki MD , Ophir Freund MD , Inbal Greenberg MD PhD , Shir Frydman MD , Maayan Konigstein MD , Arie Steinvil MD , Israel Barbash MD , Ran Kornowski MD , Gabby G. Elbaz MD , Danny Dvir MD , Ariel Finkelstein MD , Yan Topilsky MD , Amir Halkin MD , Shmuel Banai MD , Jeremy Ben-Shoshan MD, PhD
Background
The estimated lifespan following transcatheter aortic valve replacement (TAVR) is the key in the decision-making process of lifelong management of patients with severe symptomatic aortic stenosis (AS). We aimed to assess the contemporary lifespan and associated factors in patients with severe AS undergoing TAVR.
Methods
We performed a retrospective cohort study of patients who underwent TAVR at the 4 largest centers in Israel between July 2008 and March 2023. Mortality predictors were assessed using multivariable Cox regression analysis.
Results
The cohort included 6191 patients (51% females; mean age 82.7 ± 5.4 years; median follow-up 5.9 years). The overall estimated 5- and 10-year survival was 70 and 42%, respectively. To assess temporal trends, patients were stratified to early (2008–2015; n = 2058) and late (2016–2023; n = 4133) eras. Patients in the early TAVR era had significantly lower survival probability, compared to the late era (hazard ratio 2.0 (95% confidence interval 1.8-2.2), p < 0.001], with an 8-year survival of 39 and 71%, respectively. Using an age threshold of ≥80 years, defined using spline analysis the 8-year survival in the early vs. late eras was 37 vs. 47% among older patients and 66 vs. 82% among younger patients.
Conclusions
Lifespan following successful TAVR has markedly improved over the past decade across age groups. Notably, patients younger than 80 years, at the time of TAVR exhibit an estimated survival exceeding 10 years. These findings should be integrated into Heart Team decision-making for optimal lifelong management of AS.
背景：经导管主动脉瓣置换术（TAVR）后的预估寿命是严重症状性主动脉瓣狭窄（AS）患者终身治疗决策的关键。我们的目的是评估严重AS患者接受TAVR的当代寿命和相关因素。方法：我们对2008年7月至2023年3月在以色列4个最大的中心接受TAVR的患者进行了回顾性队列研究。使用多变量Cox回归分析评估死亡率预测因子。结果纳入6191例患者，其中女性占51%，平均年龄82.7±5.4岁，中位随访5.9年。总体估计5年和10年生存率分别为70%和42%。为了评估时间趋势，将患者分层至早期（2008-2015年，n = 2058）和晚期（2016-2023年，n = 4133）。TAVR早期患者的生存率明显低于晚期患者（风险比2.0(95%可信区间1.8-2.2),p < 0.001）， 8年生存率分别为39%和71%。使用样条分析定义的年龄阈值≥80岁，老年患者早期和晚期的8年生存率分别为37 vs 47%，年轻患者为66 vs 82%。结论：在过去十年中，各年龄组TAVR成功后的寿命明显提高。值得注意的是，在TAVR时，年龄小于80岁的患者估计生存期超过10年。这些发现应纳入心脏团队决策，以实现最佳的AS终身管理。
{"title":"Contemporary Life Expectancy Following Transfemoral Transcatheter Aortic Valve Replacement—Data From a National Registry Perspective","authors":"Lior Zornitzki MD , Ophir Freund MD , Inbal Greenberg MD PhD , Shir Frydman MD , Maayan Konigstein MD , Arie Steinvil MD , Israel Barbash MD , Ran Kornowski MD , Gabby G. Elbaz MD , Danny Dvir MD , Ariel Finkelstein MD , Yan Topilsky MD , Amir Halkin MD , Shmuel Banai MD , Jeremy Ben-Shoshan MD, PhD","doi":"10.1016/j.shj.2025.100780","DOIUrl":"10.1016/j.shj.2025.100780","url":null,"abstract":"<div><h3>Background</h3><div>The estimated lifespan following transcatheter aortic valve replacement (TAVR) is the key in the decision-making process of lifelong management of patients with severe symptomatic aortic stenosis (AS). We aimed to assess the contemporary lifespan and associated factors in patients with severe AS undergoing TAVR.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients who underwent TAVR at the 4 largest centers in Israel between July 2008 and March 2023. Mortality predictors were assessed using multivariable Cox regression analysis.</div></div><div><h3>Results</h3><div>The cohort included 6191 patients (51% females; mean age 82.7 ± 5.4 years; median follow-up 5.9 years). The overall estimated 5- and 10-year survival was 70 and 42%, respectively. To assess temporal trends, patients were stratified to early (2008–2015; n = 2058) and late (2016–2023; n = 4133) eras. Patients in the early TAVR era had significantly lower survival probability, compared to the late era (hazard ratio 2.0 (95% confidence interval 1.8-2.2), <em>p</em> < 0.001], with an 8-year survival of 39 and 71%, respectively. Using an age threshold of ≥80 years, defined using spline analysis the 8-year survival in the early vs. late eras was 37 vs. 47% among older patients and 66 vs. 82% among younger patients.</div></div><div><h3>Conclusions</h3><div>Lifespan following successful TAVR has markedly improved over the past decade across age groups. Notably, patients younger than 80 years, at the time of TAVR exhibit an estimated survival exceeding 10 years. These findings should be integrated into Heart Team decision-making for optimal lifelong management of AS.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100780"},"PeriodicalIF":2.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022786","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}
Pub Date : 2025-12-05DOI: 10.1016/j.shj.2025.100779
Vyanne Hei-Tung Chan MBBS , Leo Kar Lok Lai MBChB , Kevin Ka-ho Kam MBChB , Kent Chak-yu So MBChB
{"title":"Heterotopic Implantation of an Embolized Valve During Transcatheter Mitral Valve Replacement","authors":"Vyanne Hei-Tung Chan MBBS , Leo Kar Lok Lai MBChB , Kevin Ka-ho Kam MBChB , Kent Chak-yu So MBChB","doi":"10.1016/j.shj.2025.100779","DOIUrl":"10.1016/j.shj.2025.100779","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100779"},"PeriodicalIF":2.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927494","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}
Pub Date : 2025-12-02DOI: 10.1016/j.shj.2025.100772
Chloe Kharsa MD, MSc , Yasser M. Sammour MD , Rasha Bazari MD , Alba Muñoz Estrella MD , Gal Sella MD , Sahar Samimi MD , Samarthkumar Thakkar MD , Mangesh Kritya MD , Taha Hatab MD , Rody G. Bou Chaaya MD , Syed Zaid MD , Joe Aoun MD , Sherif F. Nagueh MD , William A. Zoghbi MD , Marvin D. Atkins MD , Michael Reardon MD , Nadeen N. Faza MD , Stephen H. Little MD , Gerald Lawrie MD , Neal S. Kleiman MD , Sachin S. Goel MD
Background
A small baseline mitral valve area (MVA) raises concern for iatrogenic mitral stenosis due to increased transmitral pressure gradients (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Outcomes in patients with MVA <4.0 cm² remain limited, as this population has been largely excluded from clinical trials.
Methods
We retrospectively analyzed 305 consecutive patients who underwent M-TEER (2014-2022). Patients were stratified by baseline MVA (<4.0 cm2 vs. ≥4.0 cm2). The primary endpoint was 2-year all-cause mortality. Secondary endpoints included heart failure hospitalization (HFH), mitral regurgitation (MR) reduction, New York Heart Association functional class improvement, and postprocedural TMPG.
Results
Of 305 patients, 66 (21.6%) had MVA <4.0 cm². Women were more prevalent in the small MVA group (57.6% vs. 42.7%; p = 0.03). Patients with smaller MVA received fewer clips (1.3 ± 0.07 vs. 1.5 ± 0.04; p = 0.03). Procedural success and in-hospital outcomes were comparable. At discharge, residual MR (<moderate) and New York Heart Association class were similar, although TMPG was higher in the small group (3.9 ± 0.2 vs. 3.3 ± 0.1 mmHg; p = 0.006). At 30 days and 1 year, mortality, HFH, and residual MR rates remained similar. Two-year Kaplan–Meier analyses showed no differences in survival, HFH, or composite outcomes. In multivariable analysis, age, creatinine, and hemoglobin predicted mortality, while age, LVEF, and hemoglobin predicted the composite outcome. Indexed MVA did not predict mortality or elevated TMPG.
Conclusions
M-TEER can be safely and effectively performed in patients with baseline MVA <4.0 cm2 without adverse clinical outcomes through 2 years.
{"title":"Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Small Mitral Valve Area","authors":"Chloe Kharsa MD, MSc , Yasser M. Sammour MD , Rasha Bazari MD , Alba Muñoz Estrella MD , Gal Sella MD , Sahar Samimi MD , Samarthkumar Thakkar MD , Mangesh Kritya MD , Taha Hatab MD , Rody G. Bou Chaaya MD , Syed Zaid MD , Joe Aoun MD , Sherif F. Nagueh MD , William A. Zoghbi MD , Marvin D. Atkins MD , Michael Reardon MD , Nadeen N. Faza MD , Stephen H. Little MD , Gerald Lawrie MD , Neal S. Kleiman MD , Sachin S. Goel MD","doi":"10.1016/j.shj.2025.100772","DOIUrl":"10.1016/j.shj.2025.100772","url":null,"abstract":"<div><h3>Background</h3><div>A small baseline mitral valve area (MVA) raises concern for iatrogenic mitral stenosis due to increased transmitral pressure gradients (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Outcomes in patients with MVA <4.0 cm² remain limited, as this population has been largely excluded from clinical trials.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 305 consecutive patients who underwent M-TEER (2014-2022). Patients were stratified by baseline MVA (<4.0 cm<sup>2</sup> vs. ≥4.0 cm<sup>2</sup>). The primary endpoint was 2-year all-cause mortality. Secondary endpoints included heart failure hospitalization (HFH), mitral regurgitation (MR) reduction, New York Heart Association functional class improvement, and postprocedural TMPG.</div></div><div><h3>Results</h3><div>Of 305 patients, 66 (21.6%) had MVA <4.0 cm². Women were more prevalent in the small MVA group (57.6% vs. 42.7%; p = 0.03). Patients with smaller MVA received fewer clips (1.3 ± 0.07 vs. 1.5 ± 0.04; <em>p</em> = 0.03). Procedural success and in-hospital outcomes were comparable. At discharge, residual MR (<moderate) and New York Heart Association class were similar, although TMPG was higher in the small group (3.9 ± 0.2 vs. 3.3 ± 0.1 mmHg; <em>p</em> = 0.006). At 30 days and 1 year, mortality, HFH, and residual MR rates remained similar. Two-year Kaplan–Meier analyses showed no differences in survival, HFH, or composite outcomes. In multivariable analysis, age, creatinine, and hemoglobin predicted mortality, while age, LVEF, and hemoglobin predicted the composite outcome. Indexed MVA did not predict mortality or elevated TMPG.</div></div><div><h3>Conclusions</h3><div>M-TEER can be safely and effectively performed in patients with baseline MVA <4.0 cm<sup>2</sup> without adverse clinical outcomes through 2 years.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100772"},"PeriodicalIF":2.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927496","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}
Pub Date : 2025-12-01DOI: 10.1016/j.shj.2025.100752
Knut Qvale Søndenaa , Ola Alexander Schei , Rasmus Bach Sindre , Christian Engelsen Berg-Hansen MD , Barbara Rogge MD, PhD , Cecilie Linn Aas MD , Stig Urheim MD, PhD , Jon Herstad MD , Erik Packer MD, PhD , Vegard Tuseth MD, PhD , Dana Cramariuc MD, PhD
Background
More than mild residual mitral regurgitation (MR) is associated with reduced survival after transcatheter edge-to-edge mitral valve repair (M-TEER). However, whether the morphology of the residual MR (rMR) jet affects long-term clinical outcomes has not been reported. The purpose of the study was to assess the impact of eccentric rMR (erMR) at discharge on long-term mortality and heart failure hospitalizations after M-TEER.
Methods
We analyzed preprocedural, intraprocedural, and early postprocedural echocardiographic data (1-2 days post-TEER) in patients treated by M-TEER at our institution between 2012 and 2022. Eccentric rMR was defined as a nonsymmetric, wall-hugging MR jet.
Results
Among 125 patients with early residual jets, erMR was present in 30% and more commonly in those with medially placed devices and in severe rMR (p < 0.05). Eccentric jets were equally frequent in patients with originally functional or degenerative MR. During 49 (26-79) months follow-up, the median survival was 29 months in patients with erMR vs. 65 months in patients without erMR (p < 0.001). In Cox regression analysis, erMR predicted a 2.2-fold higher risk of death (95% CI 1.3-3.7, p < 0.05) after adjustment for MR severity, age, mean blood pressure, atrial fibrillation, left ventricular and left atrial size, and device position. Eccentric rMR also predicted a 1.8-fold (95% CI 1.1-3.1, p = 0.02) higher adjusted risk of heart failure hospitalization post-M-TEER.
Conclusions
Presence of erMR at discharge is associated with reduced long-term survival after M-TEER independent of the severity of rMR. Our findings shed light on the importance of preprocedural and intraprocedural planning to avoid eccentric jets and mitigate unfavorable long-term outcomes after M-TEER.
背景：轻度残留二尖瓣返流（MR）与经导管边缘到边缘二尖瓣修复（M-TEER）后存活率降低有关。然而，残留MR （rMR）射流的形态是否影响长期临床结果尚未报道。本研究的目的是评估出院时偏心rMR （erMR）对M-TEER术后长期死亡率和心力衰竭住院的影响。方法分析2012年至2022年在我院接受M-TEER治疗的患者术前、术中和术后早期超声心动图数据（teer后1-2天）。偏心磁流变被定义为非对称的抱壁磁流变射流。结果125例早期残留喷流患者中，erMR发生率为30%，其中放置器械者和严重rMR者发生率更高（p < 0.05）。在49（26-79）个月的随访中，erMR患者的中位生存期为29个月，而无erMR患者的中位生存期为65个月（p < 0.001）。在Cox回归分析中，在校正MR严重程度、年龄、平均血压、心房颤动、左室和左房大小以及装置位置后，erMR预测死亡风险高出2.2倍（95% CI 1.3-3.7, p < 0.05）。偏心rMR还预测m - teer后心力衰竭住院的调整风险增加1.8倍（95% CI 1.1-3.1, p = 0.02）。结论出院时erMR的存在与M-TEER术后长期生存率降低相关，与rMR的严重程度无关。我们的研究结果阐明了术前和术中规划的重要性，以避免偏心射流和减轻M-TEER术后不良的长期后果。
{"title":"Impact of Eccentric Residual Mitral Regurgitation on Long-Term Survival After Transcatheter Edge-to-Edge Mitral Valve Repair","authors":"Knut Qvale Søndenaa , Ola Alexander Schei , Rasmus Bach Sindre , Christian Engelsen Berg-Hansen MD , Barbara Rogge MD, PhD , Cecilie Linn Aas MD , Stig Urheim MD, PhD , Jon Herstad MD , Erik Packer MD, PhD , Vegard Tuseth MD, PhD , Dana Cramariuc MD, PhD","doi":"10.1016/j.shj.2025.100752","DOIUrl":"10.1016/j.shj.2025.100752","url":null,"abstract":"<div><h3>Background</h3><div>More than mild residual mitral regurgitation (MR) is associated with reduced survival after transcatheter edge-to-edge mitral valve repair (M-TEER). However, whether the morphology of the residual MR (rMR) jet affects long-term clinical outcomes has not been reported. The purpose of the study was to assess the impact of eccentric rMR (erMR) at discharge on long-term mortality and heart failure hospitalizations after M-TEER.</div></div><div><h3>Methods</h3><div>We analyzed preprocedural, intraprocedural, and early postprocedural echocardiographic data (1-2 days post-TEER) in patients treated by M-TEER at our institution between 2012 and 2022. Eccentric rMR was defined as a nonsymmetric, wall-hugging MR jet.</div></div><div><h3>Results</h3><div>Among 125 patients with early residual jets, erMR was present in 30% and more commonly in those with medially placed devices and in severe rMR (<em>p</em> < 0.05). Eccentric jets were equally frequent in patients with originally functional or degenerative MR. During 49 (26-79) months follow-up, the median survival was 29 months in patients with erMR vs. 65 months in patients without erMR (<em>p</em> < 0.001). In Cox regression analysis, erMR predicted a 2.2-fold higher risk of death (95% CI 1.3-3.7, <em>p</em> < 0.05) after adjustment for MR severity, age, mean blood pressure, atrial fibrillation, left ventricular and left atrial size, and device position. Eccentric rMR also predicted a 1.8-fold (95% CI 1.1-3.1, <em>p</em> = 0.02) higher adjusted risk of heart failure hospitalization post-M-TEER.</div></div><div><h3>Conclusions</h3><div>Presence of erMR at discharge is associated with reduced long-term survival after M-TEER independent of the severity of rMR. Our findings shed light on the importance of preprocedural and intraprocedural planning to avoid eccentric jets and mitigate unfavorable long-term outcomes after M-TEER.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100752"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615616","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}
Pub Date : 2025-12-01DOI: 10.1016/j.shj.2025.100754
Daryoush Samim MD , Matthias Siepe MD , Peter Jüni MD , Aakriti Gupta MD , Hasan Jilaihawi MD , Michael A. Borger MD-PhD , Raj R. Makkar MD , Martin B. Leon MD , Stephan Windecker MD
Bicuspid aortic valve (BAV) disease is the most common congenital heart abnormality, which affects up to 2% of the population and significantly increases the lifetime risk of aortic stenosis and the need for valve replacement. While surgical aortic valve replacement (SAVR) remains the standard of care in low surgical-risk patients, transcatheter aortic valve implantation (TAVI) is increasingly used as a treatment alternative with favorable outcomes in well-selected BAV patients. To date, randomized controlled trials comparing TAVI and SAVR have excluded patients with BAV, except the UK TAVI and the more recent The NOrdic Aortic Valve IntervenTION-2 trial. Of note, in The NOrdic Aortic Valve IntervenTION-2 trial, there was a numerical imbalance in the BAV subgroup, with more events observed in the TAVI group than in the SAVR group for the composite outcome (all-cause mortality, stroke, and rehospitalization) at 1- and 3-year follow-up, although the risk estimates were imprecise due to the limited number of events. The upcoming TraNscatheter Aortic Valve Implantation versus surGical AorTic valvE replacement in patients with Bicuspid aortic valve stenosis (NAVIGATE Bicuspid) and Bicuspid aortic valve replacement: EvaLuatIon of transcathetEr VERsus Surgery (BELIEVERS) trials will directly compare TAVI and SAVR in BAV populations. These trials are designed to provide robust, adequately powered estimates of the comparative safety and effectiveness of both interventions over extended follow-up and are expected to inform future guideline recommendations in the setting of BAV anatomy.
This review summarizes current data on the use of TAVI in patients with severe BAV stenosis, evaluates anatomical and procedural complexities, and outlines the design and rationale of upcoming randomized controlled trials addressing this critical knowledge gap.
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Pub Date : 2025-11-29DOI: 10.1016/j.shj.2025.100771
Cheuk Bong Ho MBBS, Hon Yeung Ko MBChB, Michael Chi Shing Chiang MBBS, Shing Fung Chui MBChB, Ka Chun Chan MBBS, Kam Tim Chan MBBS, Eric Chi Yuen Wong MBBS, Michael Kang Yin Lee MBBS
{"title":"Aortic Valve Trans-Leaflet Lithotripsy for Targeted Periannular Calcium Modification Prior to TAVI","authors":"Cheuk Bong Ho MBBS, Hon Yeung Ko MBChB, Michael Chi Shing Chiang MBBS, Shing Fung Chui MBChB, Ka Chun Chan MBBS, Kam Tim Chan MBBS, Eric Chi Yuen Wong MBBS, Michael Kang Yin Lee MBBS","doi":"10.1016/j.shj.2025.100771","DOIUrl":"10.1016/j.shj.2025.100771","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100771"},"PeriodicalIF":2.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792220","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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