Structural Heart最新文献

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Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100353

Shashank Shekhar MD, Amar Krishnaswamy MD, Grant Reed MD, MSc, James Yun MD, Rishi Puri MD, PhD, Samir Kapadia MD

Background

Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).

Methods

Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database. Stroke, major stroke, in-hospital mortality, and 30-day readmission rates were compared between the CPD and no-CPD cohorts in a propensity score matched analysis. Association of CPD use with adverse events was analyzed using multivariable logistic regression models.

Results

Of 100,928 eligible TAVR patients with AF, CPD was used in 6.9% of patients with a mean age of 80 years. CPD use was independently associated with lower overall stroke (1.7% vs. 2.2%; odds ratio [OR] 0.81 [95% CI 0.68-0.98]; p = 0.032), major stroke (1.2% vs. 1.8%; OR 0.69 [0.55-0.86]; p = 0.001), in-hospital mortality (0.9 vs. 1.5%; OR 0.56 [0.43-0.72]; p < 0.001), and lower 30-day readmission rates (12.7% vs. 14.7%; OR 0.87 [0.81-0.94]; p < 0.001). Reduction in adverse events with CPD was noted in high-volume but not in low-volume TAVR centers.

Conclusions

The present point towards clear benefits of CPD use among patients with AF undergoing TAVR. In anatomically eligible patients, the potential benefit of debris capture may be considered especially as younger and lower risk patients become eligible for TAVR. Data from future trials and registries are required to further corroborate our findings.

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引用次数: 0

A Review of “Access to Care” Issues in Aortic Stenosis Patients: A Negative Report Card

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100351

Adam M. Reisman MD , Sammy Elmariah MD, MPH

The identification and management of patients with aortic stenosis exist along a continuum that includes healthy living, latent progression, diagnosis, treatment, and posttreatment recovery. Barriers to the provision of appropriate care for these patients can occur at any stage along this continuum. Despite the presence of diagnostic echocardiograms, many patients with aortic stenosis are never clinically recognized, and the rate of mismanagement worsens among underrepresented minority groups and women. Regarding the treatment of clinically recognized aortic stenosis, only about half of patients with symptomatic severe aortic stenosis actually undergo aortic valve replacement within 2 years of diagnosis. Treatment rates are even lower among patients with symptomatic low-gradient severe aortic stenosis. Although several strategies have been raised by experts within the field to help and improve the diagnosis and treatment of patients with aortic valve disease, timely referral to a heart valve team specialist whenever aortic valve replacement is being considered likely remains the most pertinent intervention. Connecting these patients with fully informed aortic valve disease experts helps facilitate shared decision-making discussions, thus ensuring that patients have the opportunity to learn about and potentially receive the lifesaving interventions available to them.

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引用次数: 0

Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100376

Shivaraj Patil MD , Chaitanya Rojulpote MD , Abhijit Bhattaru BS , Avica Atri MD , Krishna Vamsi Rojulpote BS , Ola Khraisha MD , Viha Atri MD , William Frick MD , Tarek Nafee MD , Kishore Harjai MD , Sumeet Mainigi MD , Chien-Jung Lin PhD, MD

Background

The commercial use of percutaneous left atrial appendage occlusion with the Watchman device is increasing in the United States. The purpose of this study was to evaluate center-related variation in total hospital costs for Watchman device implantation and identify factors associated with high hospital costs at a national level.

Methods

All adults undergoing elective left atrial appendage occlusion with Watchman were identified in the 2016-2018 National Inpatient Database. Mixed models were used to evaluate the impact of center on total hospital costs, adjusting for patient and center characteristics and length of stay.

Results

A total of 30,175 patients underwent Watchman device implantation at a median cost of $24,500 and demonstrated significant variability across admissions (interdecile range, $13,900-37,000). Nearly 13% of the variability in patient-level costs was related to the center performing the procedure rather than patient factors. Higher-volume centers had lower total costs and demonstrated lesser total cost variation. Centers with low procedural volume, occurrence of procedural complications, congestive heart failure, and length of stay were independent predictors of a high-cost hospitalization. Though complications were associated with increased expenditure, they did not explain the observed cost variation related to the center.

Conclusions

A significant proportion of variation in total hospital cost was attributable to the center performing the procedure. Addressing variability of Watchman-related costs is necessary to achieve high-quality value-based care.

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引用次数: 0

Tricuspid Regurgitation in the Setting of Cardiac Implantable Electronic Devices 心脏植入式电子设备导致的三尖瓣反流

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100319

Omar M. Aldaas MD, Gary Ma MD, Quan Bui MD, Ryan R. Reeves MD, Ulrika Birgersdotter-Green MD

Cardiac implantable electronic devices (CIEDs) have been increasingly used in the management of various rhythm disorders amidst an aging population with more prevalent cardiovascular comorbidities. Although generally well-tolerated and safe, implantation of CIEDs may result in or worsen tricuspid regurgitation (TR), which is associated with a higher risk of morbidity and mortality. Several mechanisms of TR following device implantation have been proposed, and multiple diagnostic tests, percutaneous and surgical interventions, and alternative pacing methods have been developed to address this. CIED-related TR thus requires a multidisciplinary team of experts in cardiac imaging, interventional cardiology, electrophysiology, and cardiothoracic surgery with a comprehensive understanding of this multifaceted disease. The objective of this review is to summarize the epidemiology, clinical presentation, and management of CIED-related TR.

引用次数: 0

Single-Center Experience of Omitting Preprocedure Transesophageal Echo for MitraClip Patients

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100368

Ethan Korngold MD, Kateri J. Spinelli PhD, Michael P. Simanonok PhD, Hsin-Fang (Grace) Li PhD, Logan Vincent MD, Brandon Jones MD

引用次数: 0

Moderate Aortic Stenosis With Cardiac Damage: A New Type of Severe Aortic Stenosis 伴有心脏损伤的中度主动脉瓣狭窄：重度主动脉瓣狭窄的一种新类型

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-11-01 DOI: 10.1016/j.shj.2024.100336

Nino Mihatov MD , Philippe Pibarot DVM, PhD

The clinical implications of severe aortic stenosis have been well established. Understanding of moderate aortic stenosis, however, continues to evolve. Athough moderate aortic stenosis may be less clinically impactful in patients with normal ventricular function, it may carry prognostic significance in those patients with a ventricle exhibiting signs of cardiac damage. Moderate aortic stenosis in the presence of cardiac damage or dysfunction may be prognostically comparable to that of severe aortic stenosis. Extravalvular risk parameters can inform aortic stenosis risk stratification. Three ongoing trials seek to evaluate transcatheter aortic valve assessment in patients with moderate aortic stenosis and signs of cardiac damage or left ventricular dysfunction.

重度主动脉瓣狭窄的临床影响已得到充分证实。然而，人们对中度主动脉瓣狭窄的认识仍在不断发展。虽然中度主动脉瓣狭窄对心室功能正常的患者的临床影响较小，但对于心室有心脏损伤迹象的患者来说，中度主动脉瓣狭窄可能具有预后意义。存在心脏损伤或功能障碍的中度主动脉瓣狭窄在预后上可能与重度主动脉瓣狭窄相当。瓣外风险参数可为主动脉瓣狭窄风险分层提供参考。目前正在进行的三项试验旨在评估中度主动脉瓣狭窄和心脏损伤或左心室功能障碍患者的经导管主动脉瓣评估。

引用次数: 0

Aims & Scope 目标和范围

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-11-01 DOI: 10.1016/S2474-8706(24)00143-X

引用次数: 0

Right Bundle Branch Block Pre-Transcatheter Aortic Valve Replacement: Is a Pacemaker the Answer for Everyone? 经导管主动脉瓣置换术前的右束支传导阻滞：起搏器是每个人的选择吗？

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-11-01 DOI: 10.1016/j.shj.2024.100365

Lena Rivard MD, MSc

引用次数: 0

Clinical and Economic Consequences of Delayed Transcatheter Aortic Valve Replacement 延迟经导管主动脉瓣置换术的临床和经济后果

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-11-01 DOI: 10.1016/j.shj.2024.100325

William S. Weintraub MD

引用次数: 0

Prophylactic Pacemaker Implant in Patients Undergoing Transaortic Valve Replacement: Is Right Bundle Branch Block Enough? 主动脉瓣置换术患者的预防性起搏器植入：右束支传导阻滞是否足够？

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-11-01 DOI: 10.1016/j.shj.2024.100366

Julie He MD, Jeanne E. Poole MD

引用次数: 0

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