Structural Heart最新文献_第2页

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。

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引用次数: 0

Impact of Anticoagulant Class on Long-Term Bioprosthesis Durability Following Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后抗凝类对生物假体长期耐久性的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-13 DOI: 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。

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引用次数: 0

Acceleration–Ejection Time Ratio in Patients With Severe Classic Low-Flow Low-Gradient Aortic Stenosis 典型重度低流量低梯度主动脉瓣狭窄患者的加速射血时间比

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-08 DOI: 10.1016/j.shj.2025.100781

Habib Layoun MD MSc, Tamari Lomaia MD, Besir Besir MD, Joseph Hajj MD, Judah Rajendran MD, Osamah Badwan MD, Grant W. Reed MD, Amar Krishnaswamy MD, Serge Harb MD, Samir Kapadia MD

引用次数: 0

Contemporary Life Expectancy Following Transfemoral Transcatheter Aortic Valve Replacement—Data From a National Registry Perspective 经股动脉导管主动脉瓣置换术后的当代预期寿命——来自国家登记的数据

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-05 DOI: 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。

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引用次数: 0

Heterotopic Implantation of an Embolized Valve During Transcatheter Mitral Valve Replacement 经导管二尖瓣置换术中栓塞瓣膜异位植入

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-05 DOI: 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

引用次数: 0

Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Small Mitral Valve Area 二尖瓣面积小的患者经导管边缘对边缘修复的疗效

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-02 DOI: 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.

背景：二尖瓣边缘修复（M-TEER）后，二尖瓣基线面积小（MVA）引起医源性二尖瓣狭窄的关注，因为二尖瓣边缘修复（M-TEER）后，二尖瓣压力梯度（TMPG）增加。MVA <；4.0 cm²患者的预后仍然有限，因为该人群在很大程度上被排除在临床试验之外。方法回顾性分析305例连续接受M-TEER治疗的患者（2014-2022年）。患者按基线MVA （<4.0 cm2 vs.≥4.0 cm2）分层。主要终点是2年全因死亡率。次要终点包括心力衰竭住院（HFH）、二尖瓣返流（MR）降低、纽约心脏协会功能分级改善和术后TMPG。结果305例患者中，MVA = 4.0 cm²66例（21.6%）。女性在小MVA组中更为普遍（57.6%比42.7%;p = 0.03）。MVA较小的患者使用的夹子较少（1.3±0.07比1.5±0.04;p = 0.03）。手术成功率和住院结果具有可比性。出院时，残余MR （<；中度）和纽约心脏协会分级相似，尽管TMPG在小组较高（3.9±0.2 vs 3.3±0.1 mmHg; p = 0.006）。在30天和1年时，死亡率、HFH和残留MR率保持相似。两年的Kaplan-Meier分析显示，生存率、HFH或综合结果没有差异。在多变量分析中，年龄、肌酐和血红蛋白预测死亡率，而年龄、LVEF和血红蛋白预测综合结果。索引MVA不能预测死亡率或TMPG升高。结论sm - teer对基线MVA和lt为4.0 cm2的患者可安全有效地进行2年，无不良临床结果。

{"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}

引用次数: 0

Aims & Scope 目标及范围

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-01 DOI: 10.1016/S2474-8706(25)00368-9

引用次数: 0

Impact of Eccentric Residual Mitral Regurgitation on Long-Term Survival After Transcatheter Edge-to-Edge Mitral Valve Repair 偏心二尖瓣残余返流对经导管二尖瓣边缘修复术后长期生存的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-01 DOI: 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。

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引用次数: 0

Transcatheter Treatment of Bicuspid Aortic Valve Stenosis: From Observational Studies to Randomized Clinical Trials 经导管治疗二尖瓣主动脉瓣狭窄：从观察性研究到随机临床试验

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-12-01 DOI: 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.

双尖瓣主动脉瓣（BAV）疾病是最常见的先天性心脏异常，影响高达2%的人口，并显著增加主动脉瓣狭窄的终生风险和瓣膜置换术的需要。虽然手术主动脉瓣置换术（SAVR）仍然是低手术风险患者的标准治疗方法，但经导管主动脉瓣植入术（TAVI）越来越多地作为一种治疗选择，在精心挑选的BAV患者中效果良好。迄今为止，比较TAVI和SAVR的随机对照试验都排除了BAV患者，除了英国TAVI和最近的北欧主动脉瓣介入-2试验。值得注意的是，在北欧主动脉瓣介入-2试验中，在BAV亚组中存在数值不平衡，在1年和3年随访中，TAVI组观察到的综合结局（全因死亡率、卒中和再住院）事件多于SAVR组，尽管由于事件数量有限，风险估计不精确。即将进行的经导管主动脉瓣植入术与手术主动脉瓣置换术对双尖瓣狭窄患者（导航双尖瓣）和双尖瓣主动脉瓣置换术：经导管与手术评估（BELIEVERS）试验将直接比较BAV人群的TAVI和SAVR。这些试验旨在通过长期随访对两种干预措施的相对安全性和有效性提供可靠、充分的估计，并有望为未来BAV解剖背景下的指南建议提供信息。这篇综述总结了目前在严重BAV狭窄患者中使用TAVI的数据，评估了解剖和程序的复杂性，并概述了即将进行的随机对照试验的设计和基本原理，以解决这一关键的知识空白。

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引用次数: 0