Structural Heart最新文献_第3页

Cardiac Damage in Aortic Regurgitation: Refining Risk Beyond Valve Severity 主动脉反流对心脏的损害：细化风险超出瓣膜严重程度

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-19 DOI: 10.1016/j.shj.2025.100765

Marisa Avvedimento MD

引用次数: 0

Midterm Outcomes of Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation According to Anatomical Characteristics 经导管边缘对边缘修复先天性二尖瓣返流的中期结果分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-17 DOI: 10.1016/j.shj.2025.100763

Daryoush Samim MD , Caroline Chong-Nguyen MD , Yannick Hausammann B Med , Mischa Külling MD , Oliver Gaemperli MD , Roberto Corti MD , Joanna Bartkowiak MD , Daijiro Tomii MD , Domenico Angellotti MD , Nicolas Brugger MD , Thomas Pilgrim MD, MSc , Patric Biaggi MD , Fabien Praz MD , Peter Martin Wenaweser MD

Background

Mitral transcatheter edge-to-edge repair (M-TEER) is an established option for high-risk primary mitral regurgitation (PMR) patients, but data on the impact of anatomical complexity on prognosis are scarce and conflicting.

Objectives

The aims of this study were to characterize patients with severe PMR undergoing M-TEER, assess mid-term prognosis after M-TEER, and identify prognostic factors based on PMR mechanism.

Methods

Data from symptomatic PMR patients with severe PMR treated with M-TEER between July 2013 and October 2023 at two Swiss centers were collected retrospectively until 2017 and prospectively thereafter. Patients were categorized by lesion type: A2-P2 prolapse/flail vs. non-A2-P2 prolapse/flail. A subset was classified by mitral valve (MV) anatomical complexity (defined by the presence of ≥1 of the following: ≥moderate calcifications, Barlow’s disease, multiple prolapses, or commissural prolapses). Cox regression identified predictors of 1-year all-cause mortality.

Results

Among 315 patients (mean age 82.2 ± 6.3 years, 46.3% female, European System for Cardiac Operative Risk Evaluation II 5.1% ± 4.1%) followed for a median (interquartile range [IQR]) of 13 months (5-33), technical success was 93.0%. Compared with the non-A2-P2 prolapse/flail group (n = 186), the A2-P2 prolapse/flail group (n = 129) had better echocardiographic outcomes at discharge (residual mitral regurgitation [MR] ≤ 1+: 70.5 vs. 60.4%; p = 0.031) and superior symptomatic improvement at 1 year (New York Heart Association class ≤ II: 91.4 vs. 74.5%; p = 0.017) but similar 1-year all-cause mortality (15.1 vs. 18.8%; p = 0.492). Among patients classified by MV anatomical complexity (n = 143), patients with complex MV anatomy (n = 68) had a higher mortality at a median (IQR) follow-up of 22 months (9-36) compared to those with noncomplex MV anatomy (n = 75) (51.5 vs. 34.7%; p = 0.042). Multivariate analysis identified complex MV anatomy and severe renal failure as predictors of 1-year all-cause mortality.

Conclusions

MV anatomical characteristics have a significant influence on symptomatic improvement and all-cause mortality at 1 year and should be carefully considered during the selection of PMR patients for M-TEER.

二尖瓣经导管边缘到边缘修复（M-TEER）是高危原发性二尖瓣返流（PMR）患者的一种既定选择，但关于解剖复杂性对预后影响的数据很少且相互矛盾。目的本研究的目的是对重度PMR患者进行M-TEER，评估M-TEER后的中期预后，并根据PMR机制确定预后因素。方法回顾性收集2013年7月至2023年10月在瑞士两个中心接受M-TEER治疗的有症状的PMR患者的数据，直至2017年，并在此后进行前瞻性收集。患者按病变类型分类：A2-P2脱垂/连枷与非A2-P2脱垂/连枷。根据二尖瓣（MV）解剖复杂性进行分类（根据以下≥1项的存在来定义：≥中度钙化，Barlow病，多发性脱垂或合拢脱垂）。Cox回归确定了1年全因死亡率的预测因子。结果315例患者（平均年龄82.2±6.3岁，女性46.3%，欧洲心脏手术风险评估系统II 5.1%±4.1%）随访13个月（5-33），技术成功率为93.0%。与非A2-P2脱垂/连枷组（n = 186）相比，A2-P2脱垂/连枷组（n = 129）在出院时的超声心动图结果更好（残余二尖瓣返流[MR]≤1+:70.5 vs 60.4%; p = 0.031）， 1年后的症状改善也更好（纽约心脏协会分级≤II: 91.4 vs 74.5%; p = 0.017），但1年全因死亡率相似（15.1 vs 18.8%; p = 0.492）。在按中压解剖复杂性分类的患者（n = 143）中，中压解剖复杂的患者（n = 68）在中位（IQR）随访22个月（9-36）时的死亡率高于中压解剖不复杂的患者（n = 75）（51.5% vs. 34.7%; p = 0.042）。多变量分析发现复杂的中伏解剖和严重的肾功能衰竭是1年全因死亡率的预测因素。结论smv解剖特征对1年症状改善和全因死亡率有显著影响，在选择PMR患者进行M-TEER时应慎重考虑。

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引用次数: 0

Impact of Different Transcatheter Edge-to-Edge Repair Systems on Tricuspid Annular Dimensions: A Three-Dimensional Imaging Analysis 不同经导管边缘对边缘修复系统对三尖瓣环形尺寸的影响：三维成像分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-16 DOI: 10.1016/j.shj.2025.100758

Jennifer von Stein MD , Nina C. Wunderlich MD , Maria Isabel Körber MD , Stephan Baldus MD , Juan F. Granada MD , Roman Pfister MD , Christos Iliadis MD , Philipp von Stein MD

引用次数: 0

Impact of Measured and Predicted Patient–Prosthesis Mismatch on Quality of Life Following Transcatheter Aortic Valve Implantation 测量和预测的患者-假体不匹配对经导管主动脉瓣植入术后生活质量的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-10 DOI: 10.1016/j.shj.2025.100759

Karim Al-Azizi MD , Mohamad Bader Abo Hajar MD , Taylor Pickering DO , Ghadi Moubarak MD , Cody W. Dorton DO , Kyle A. McCullough MD , Jonathan Ladner BS , Maya Elias BS , Colleen Parro BS , Shelby L. McCoy BS , Uzair Saeed MS , Tsung-Wei Ma PhD , Sarah Hale CRRC , Swapnil Gupta MPH , Katherine B. Harrington MD , Justin M. Schaffer MD , Asim Mohiuddin MD , William T. Brinkman MD , Amro Alsaid MD , Janaki Manne MD , Michael J. Mack MD

Background

While patient–prosthesis mismatch (PPM) after transcatheter aortic valve implantation (TAVI) has not been associated with increased mortality, its impact on quality of life (QoL) remains unclear.

Methods

We retrospectively analyzed 3013 patients undergoing TAVI (2012-2022) within a large health care system. Patients were stratified by effective orifice area indexed to body surface area (EOAi) into no (EOAi >0.85 cm²/m²), moderate (EOAi >0.65 cm²/m² or ≤0.85 cm²/m²), or severe (EOAi ≤0.65 cm²/m²) PPM, with lower cutoffs for obese patients (body mass index ≥30 kg/m²).

Results

The median age was 80.0 (73.0; 86.0) years, and 55.6% were female with a median Society of Thoracic Surgery risk score of 4.70% (2.66; 7.64). Overall, TAVI led to significant improvements in New York Heart Association and Kansas City Cardiomyopathy Questionnaire scores at 30 days and 1 year. Severe predicted and severe measured PPm was not associated with inferior QoL outcomes improvement (all p > 0.05).

Conclusion

In this large cohort, TAVI yielded substantial and durable QoL gains, regardless of PPM severity or valve type. These findings suggest that moderate or severe PPM does not diminish functional recovery and should not be a primary determinant in valve selection or procedural strategy at 1 year.

虽然经导管主动脉瓣植入术（TAVI）后患者-假体不匹配（PPM）与死亡率增加无关，但其对生活质量（QoL）的影响尚不清楚。方法回顾性分析某大型医疗系统内3013例TAVI患者（2012-2022）。根据有效孔口面积与体表面积（EOAi）指数将患者分为轻度（EOAi >0.85 cm2/m2）、中度（EOAi >；0.65 cm2/m2或≤0.85 cm2/m2）和重度（EOAi≤0.65 cm2/m2） PPM，其中肥胖患者（体重指数≥30 kg/m2）的下限较低。结果患者年龄中位数为80.0（73.0;86.0）岁，女性占55.6%，胸外科学会风险评分中位数为4.70%（2.66;7.64）。总体而言，TAVI在30天和1年内显著改善了纽约心脏协会和堪萨斯城心肌病问卷评分。严重的预测PPm和严重的测量PPm与较差的生活质量结果改善无关（均p >； 0.05）。结论：在这个大的队列中，TAVI产生了大量和持久的生活质量提高，无论PPM严重程度或瓣膜类型。这些研究结果表明，中度或重度PPM不会降低功能恢复，也不应成为1年后瓣膜选择或手术策略的主要决定因素。

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引用次数: 0

Renal Response After Mitral Valve Repair: Clinically Meaningful Relationship 二尖瓣修复后肾脏反应：临床意义的关系

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-06 DOI: 10.1016/j.shj.2025.100757

Luis Nombela-Franco MD, PhD

引用次数: 0

Comprehensive Unified Regimen for Eliminating Undiagnosed/Untreated Aortic Valve Stenosis: Algorithm Validation for Identifying Aortic Stenosis and Treatment Disparities 消除未确诊/未治疗的主动脉瓣狭窄的综合统一方案：识别主动脉瓣狭窄和治疗差异的算法验证

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-05 DOI: 10.1016/j.shj.2025.100755

Daniel Mitchell MD, Dhairya Patel MPH, Jesse Navarrette MPA, Raj Makkar MD, Susan Cheng MD, MPH, MS, Joseph E. Ebinger MD, MS

Background

Severe aortic stenosis (sAS) leads to high morbidity and mortality when left untreated. We sought to develop and validate an algorithm-based rules engine to identify patients with untreated sAS and to evaluate differences between those who did and did not subsequently receive guideline-concordant treatment with aortic valve replacement (AVR).

Methods

We curated discrete and nondiscrete data from our echocardiography system, then created a rules engine to identify and grade aortic stenosis. We assessed sensitivity and specificity of the rules engine to identify sAS using manual adjudication. We additionally conducted a retrospective cohort analysis to identify demographic and socioeconomic factors associated with receipt of guideline-concordant AVR treatment for sAS.

Results

The rules engine demonstrated 100% sensitivity and 95.4% specificity for identifying sAS across n = 2162 echocardiographic studies from unique patients. Univariate analyses revealed patients with untreated sAS were more likely to be older and female, with no appreciated differences by race, ethnicity, insurance status, or neighborhood-level socioeconomic scores. In multivariable analyses, older individuals, women, and those with Medicare/Medicare advantage were less likely to undergo AVR. Among treated patients, those who underwent surgical AVR were more likely to be younger, male, and have lower socioeconomic neighborhood scores.

Conclusions

Untreated sAS is prevalent but can be accurately identified at scale using an echocardiogram report-based rules engine. Disparities in the receipt of AVR persist, particularly among women, older adults, and patients with nonprivate insurance coverage. The systematic use of automated algorithmic protocols may facilitate valvular heart disease identification and reduction of treatment disparities.

背景：严重主动脉瓣狭窄（sAS）如果不及时治疗，会导致高发病率和死亡率。我们试图开发并验证一个基于算法的规则引擎，以识别未经治疗的sAS患者，并评估随后接受和未接受符合指南的主动脉瓣置换术（AVR）治疗的患者之间的差异。方法我们从超声心动图系统中收集离散和非离散数据，然后创建一个规则引擎来识别和分级主动脉瓣狭窄。我们评估了使用人工裁决来识别sa的规则引擎的敏感性和特异性。我们还进行了回顾性队列分析，以确定与接受符合指南的AVR治疗相关的人口统计学和社会经济因素。结果该规则引擎在n = 2162例特殊患者的超声心动图研究中识别sa的灵敏度为100%，特异性为95.4%。单变量分析显示，未经治疗的sa患者更可能是老年人和女性，没有明显的种族、民族、保险状况或社区社会经济评分差异。在多变量分析中，老年人、妇女和有医疗保险/医疗保险优势的人不太可能发生AVR。在接受治疗的患者中，接受外科AVR的患者更可能是年轻的男性，并且社会经济社区得分较低。结论未经治疗的sAS是普遍存在的，但可以使用基于超声心动图报告的规则引擎在规模上准确识别。接受AVR的差异仍然存在，特别是在妇女、老年人和非私人保险覆盖的患者中。系统地使用自动算法协议可以促进瓣膜性心脏病的识别和减少治疗差异。

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引用次数: 0

Midterm Outcomes of the Self-Expanding Navitor Transcatheter Heart Valve: A Systematic Review and Meta-Analysis 自扩张Navitor经导管心脏瓣膜的中期结果：系统回顾和meta分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-04 DOI: 10.1016/j.shj.2025.100750

Sahar Samimi MD , Chloe Kharsa MD, MSc , Mangesh Kritya MD , Joe Aoun MD , Syed Zaid MD , Nadeen N. Faza MD , Stephen H. Little MD , Neal S. Kleiman MD , Michael J. Reardon MD , Sachin S. Goel MD

引用次数: 0

Choosing Between Tricuspid Repair or Replacement: Decision Algorithms 三尖瓣修复或置换的选择：决策算法

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100732

Hannah Kempton MD , Lukas Stolz MD , Ludwug Weckbach MD , Thomas Stocker MD , Philipp Doldi MD , Michael Näbauer MD , Steffen Massberg MD , Fabien Praz MD , Jörg Hausleiter MD

Transcatheter tricuspid valve (TV) interventions have transformed the treatment of TV disease. Among available therapies, transcatheter tricuspid edge-to-edge repair has shown favorable safety, symptom relief, quality-of-life improvement, and reduction of heart failure hospitalizations in selected patients with severe tricuspid regurgitation (TR). In complex cases, repair may not result in optimal TR reduction, whereas transcatheter TV replacement (TTVR) offers TR elimination, irrespective of the valve anatomy. However, TTVR is less widely available, requires long-term anticoagulation, and can lead to periprocedural adverse events. As device options expand, careful procedural selection has become increasingly important and must be guided by a comprehensive, multidisciplinary assessment. Key factors include TV anatomy, right ventricular function, pulmonary pressures and resistance, right ventricular–pulmonary artery coupling, endocardial device leads, bleeding risk, imaging quality, and anticoagulation tolerance. Multimodal imaging, including echocardiography and cardiac computed tomography, along with right heart catheterization is an essential step for procedural planning. In addition, preprocedural optimization with diuresis, rhythm control, and collaboration with heart failure and electrophysiology specialists are essential to ensure optimal procedural outcomes. Transcatheter tricuspid edge-to-edge repair and TTVR should be viewed as complementary therapies that each play a role in tailoring transcatheter TV intervention to individual anatomical and clinical patient characteristics. This review presents a framework based on evidence and experience for procedural selection, highlighting the importance of individualized evaluation and multidisciplinary care. A stepwise algorithm is proposed to support decision-making in patients with severe TR.

经导管三尖瓣介入治疗已经改变了三尖瓣疾病的治疗方法。在现有的治疗方法中，经导管三尖瓣边缘到边缘修复显示出良好的安全性，症状缓解，生活质量改善，并减少严重三尖瓣反流（TR）患者的心力衰竭住院治疗。在复杂的情况下，修复可能无法达到最佳的TR减少效果，而经导管电视置换术（TTVR）可以消除TR，而不考虑瓣膜解剖。然而，TTVR的应用并不广泛，需要长期抗凝治疗，并可能导致围手术期不良事件。随着设备选择的扩大，谨慎的程序选择变得越来越重要，必须以全面的多学科评估为指导。关键因素包括电视解剖、右心室功能、肺动脉压力和阻力、右心室-肺动脉耦合、心内膜装置导联、出血风险、成像质量和抗凝耐受性。多模式成像，包括超声心动图和心脏计算机断层扫描，以及右心导管插入术是手术计划的重要步骤。此外，术前优化利尿、心律控制以及与心力衰竭和电生理学专家合作是确保最佳手术结果的关键。经导管三尖瓣边缘到边缘修复和TTVR应被视为互补疗法，它们各自在根据个体解剖和临床患者特征定制经导管电视干预方面发挥作用。这篇综述提出了一个基于证据和经验的程序选择框架，强调了个性化评估和多学科护理的重要性。提出了一种支持严重TR患者决策的逐步算法。

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引用次数: 0

Safety of Same-Day Discharge After Elective Transcatheter Aortic Valve Implantation With Balloon- and Self-Expanding Valves: A Prospective Single-Center UK Study 选择性经导管主动脉瓣球囊和自膨胀瓣膜植入术后当日出院的安全性：英国一项前瞻性单中心研究

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100728

Saif Memon MBBS , Muntaser Omari MBBS , Debbie Stewart BSc , Hong Hong Chong MBBS , Mohamed Ali MBBS , Richard Edwards MBBS , Rajiv Das MBBS , Tim Cartlidge MBBS , Azfar Zaman MBBS , Mohamed Farag MBBS , Mohammad Alkhalil DPhil

Background

In patients undergoing transcatheter aortic valve implantation (TAVI), it is unclear whether same-day discharge (SDD) while adopting a device-agnostic approach is a safe strategy compared to non-SDD. We aim to compare TAVI patients who underwent SDD and non-SDD according to a predefined protocol.

Methods

This is a prospective single-center study of consecutive patients who were scheduled for elective TAVI procedures. The primary endpoint was the composite of death, vascular access–related complications, any bleeding requiring hospitalization, all stroke (or transient ischemic attack), or new permanent pacemaker implantation at 30 days defined according to the Valve Academic Research Consortium 3 criteria.

Results

Out of 472 consecutive patients who underwent elective TAVI, 289 patients did not report procedural complications, of whom 60 (21%) were discharged on the same day. The mean age was 81 ± 7 years, with 60% of the cohort being male. There were no significant differences in clinical characteristics among patients according to their in-hospital SDD strategy. Pre-existing left or right bundle branch block was comparable between the 2 groups. The primary endpoint was reported in 2.8% of the entire cohort, with no significant difference between patients who underwent SDD TAVI and those who did not (1.7% vs. 3.1%, respectively, p = 0.56). Patients who had a self-expanding valve had a comparable primary endpoint to those who had a balloon-expandable valve, including readmission for a permanent pacemaker.

Conclusions

SDD TAVI is a safe and feasible approach in patients who underwent an elective uneventful procedure, including patients who received self-expanding valves. Future studies are required to support these findings.

背景：在接受经导管主动脉瓣植入术（TAVI）的患者中，与非SDD相比，采用与器械无关的方法进行当日出院（SDD）是否安全尚不清楚。我们的目的是根据预先确定的方案比较接受SDD和非SDD的TAVI患者。方法：这是一项前瞻性单中心研究，研究对象为计划择期TAVI手术的连续患者。主要终点是死亡、血管通路相关并发症、任何需要住院治疗的出血、所有中风（或短暂性脑缺血发作）或根据瓣膜学术研究联盟3标准定义的30天内新的永久性起搏器植入的综合结果。结果在连续472例选择性TAVI患者中，289例患者未报告手术并发症，其中60例（21%）当日出院。平均年龄81±7岁，60%为男性。不同住院SDD策略患者的临床特征无显著差异。两组间已存在的左束或右束分支阻滞具有可比性。整个队列中2.8%的患者报告了主要终点，接受SDD TAVI的患者与未接受SDD TAVI的患者之间无显著差异（分别为1.7%对3.1%,p = 0.56）。具有自扩张瓣膜的患者与具有球囊扩张瓣膜的患者具有相似的主要终点，包括永久性起搏器的再入院。结论ssdd TAVI是一种安全可行的方法，适用于接受选择性平稳手术的患者，包括接受自我扩张瓣膜的患者。需要进一步的研究来支持这些发现。

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引用次数: 0

Feasibility of Valve in Valve After Transcatheter Aortic Valve Replacement With SAPIEN 3 Valves and Surgical Aortic Valve Replacement 经导管主动脉瓣置换术与外科主动脉瓣置换术后瓣膜中的瓣膜的可行性

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100729

Tej Sheth MD , Warkaa Al-Shamkani MD , Ahmed Makhdoum MD , Jorge Chavarria Viquez MD , Muhammad Suleman MD , Alexander Dick MD , Janarthanan Sathananthan MD , David Wood MD , Neil Fam MD , Hatim AlRaddadi MD , Madhu K. Natarajan MD , James L. Velianou MD

Background

The feasibility of transcatheter intervention after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is important for the lifetime management of aortic stenosis.

Methods

A multicenter study was conducted of 4 patient groups: (1) TAVR using SAPIEN 3 at ≤90% implant depth, (2) TAVR using SAPIEN 3 at >90% implant depth, (3) SAVR, and (4) SAVR with aortic root enlargement (ARE) who underwent post-treatment computed tomography. Future TAVR was classified as challenging if the simulated neo-skirt was at or above the coronary ostia and <4 mm away from the coronary ostia and/or <2 mm from the sinotubular junction or aortic wall.

Results

A total of 245 patients were evaluated (n = 117 TAVR using SAPIEN 3 at ≤90% implant depth, n = 66 TAVR using SAPIEN 3 at >90% implant depth, n = 31 SAVR, n = 31 SAVR with ARE). The proportion of patients where the simulated neo-skirt was below both coronary arteries was the highest in TAVR with implantation depth ≤90% (47.0%), intermediate in TAVR using SAPIEN 3 at >90% implant depth (22.7%) and SAVR (12.9%), and the lowest in SAVR with ARE (0%), (p < 0.001). Challenging anatomy for future TAVR was identified in 9.8% of TAVR at ≤90% implant depth, 28.8% of TAVR at >90% implant depth, 22.6% of SAVR, and 29.0% of SAVR with ARE (p < 0.001).

Conclusions

Based on post-treatment computed tomography analysis, TAVR with SAPIEN 3 at implant depth ≤90% was the most repeatable initial intervention whereas SAVR with ARE did not improve the feasibility of future TAVR.

背景经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）后经导管介入治疗的可行性对主动脉瓣狭窄的终身治疗具有重要意义。方法对4组患者进行多中心研究：(1)在种植体深度≤90%时使用SAPIEN 3进行TAVR，(2)在种植体深度≤90%时使用SAPIEN 3进行TAVR， (3) SAVR,(4)治疗后行计算机断层扫描的主动脉根部扩大（ARE）的SAVR。如果模拟的新裙子位于或高于冠状动脉开口，距离冠状动脉开口4mm和/或距离窦管交界处或主动脉壁2mm，则未来TAVR被归类为具有挑战性。结果共评估245例患者（n = 117例在≤90%种植深度使用SAPIEN 3， n = 66例在≤90%种植深度使用SAPIEN 3， n = 31例SAVR， n = 31例使用ARE的SAVR）。在植入深度≤90%的TAVR中，模拟新裙子位于双冠状动脉以下的患者比例最高（47.0%），在植入深度≤90%的SAPIEN 3 TAVR中居中（22.7%）和SAVR(12.9%)，而在使用ARE的SAVR中最低（0%），（p < 0.001）。9.8%的TAVR（≤90%种植深度）、28.8%的TAVR（≤90%种植深度）、22.6%的SAVR和29.0%的SAVR （ARE）存在解剖学上的挑战（p < 0.001）。结论基于治疗后的计算机断层分析，SAPIEN 3在种植体深度≤90%时的TAVR是最可重复的初始干预，而ARE的SAVR并没有提高未来TAVR的可行性。

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引用次数: 0