Pub Date : 2026-01-01DOI: 10.1016/j.shj.2025.100740
Sandra B. Lauck PhD , Francesco Saia MD , Eric Durand MD , Bettina Højberg Kirk MSN , Fiona Kelly RN , Douglas F. Muir MB, ChB , Gemma McCalmont MSc , Mark S. Spence MD , Mariuca Vasa-Nicotera MD , David Wood MD , Cristóbal A. Urbano Carrillo MD , Damien Bouchayer MD , Vlad Anton Iliescu MD , Christophe Saint Etienne MD , Nina Fauré RN , Céline Hee RN , Florence Leclercq MD , Vincent Auffret MD , Lluis Asmarats MD , Carlo Di Mario MD , Derk Frank MD
Background
Transcatheter aortic valve implantation (TAVI) treatment pathways can be supported by a dedicated clinical valve coordinator (CVC), enhancing their efficiency. We aimed to evaluate the impact of a CVC in managing the treatment pathway of patients undergoing TAVI across Europe before and after implementing 8 Benchmark best practices.
Methods
The BENCHMARK registry (ClinicalTrials NCT04579445) was a multicenter international study of patients with severe symptomatic aortic stenosis undergoing TAVI with balloon-expandable valves across 28 European centers. Primary outcomes were hospital and intensive care length of stay (LoS). The secondary outcome was 30-day patient safety.
Results
Of 2323 patients, 1262 were treated at centers without a pre-existing CVC and 1061 at centers with a pre-existing CVC; propensity matching resulted in 891 matched pairs. The total procedural time was significantly reduced in both groups (p < 0.001) after implementing Benchmark best practices. Hospital LoS was lower before Benchmark when a CVC was present and was significantly shorter in both groups following implementation (p < 0.001), as was the critical care LoS (p < 0.001). The presence of a CVC did not affect safety outcomes but was associated with a reduced risk of major vascular bleeding when combined with Benchmark best practices. Patient satisfaction was higher in centers with a pre-existing CVC (p < 0.001).
Conclusions
The addition of a CVC to the multidisciplinary team and their sustained contributions to processes of care align with the implementation of Benchmark practices, significantly decrease the health service requirements of TAVI patients, and are associated with improved patient-reported experiences.
{"title":"Impact of a Clinical Valve Coordinator on Hospital Length of Stay and Patient Outcomes: Results From the BENCHMARK Registry","authors":"Sandra B. Lauck PhD , Francesco Saia MD , Eric Durand MD , Bettina Højberg Kirk MSN , Fiona Kelly RN , Douglas F. Muir MB, ChB , Gemma McCalmont MSc , Mark S. Spence MD , Mariuca Vasa-Nicotera MD , David Wood MD , Cristóbal A. Urbano Carrillo MD , Damien Bouchayer MD , Vlad Anton Iliescu MD , Christophe Saint Etienne MD , Nina Fauré RN , Céline Hee RN , Florence Leclercq MD , Vincent Auffret MD , Lluis Asmarats MD , Carlo Di Mario MD , Derk Frank MD","doi":"10.1016/j.shj.2025.100740","DOIUrl":"10.1016/j.shj.2025.100740","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) treatment pathways can be supported by a dedicated clinical valve coordinator (CVC), enhancing their efficiency. We aimed to evaluate the impact of a CVC in managing the treatment pathway of patients undergoing TAVI across Europe before and after implementing 8 Benchmark best practices.</div></div><div><h3>Methods</h3><div>The BENCHMARK registry (ClinicalTrials NCT04579445) was a multicenter international study of patients with severe symptomatic aortic stenosis undergoing TAVI with balloon-expandable valves across 28 European centers. Primary outcomes were hospital and intensive care length of stay (LoS). The secondary outcome was 30-day patient safety.</div></div><div><h3>Results</h3><div>Of 2323 patients, 1262 were treated at centers without a pre-existing CVC and 1061 at centers with a pre-existing CVC; propensity matching resulted in 891 matched pairs. The total procedural time was significantly reduced in both groups (<em>p</em> < 0.001) after implementing Benchmark best practices. Hospital LoS was lower before Benchmark when a CVC was present and was significantly shorter in both groups following implementation (<em>p</em> < 0.001), as was the critical care LoS (<em>p</em> < 0.001). The presence of a CVC did not affect safety outcomes but was associated with a reduced risk of major vascular bleeding when combined with Benchmark best practices. Patient satisfaction was higher in centers with a pre-existing CVC (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The addition of a CVC to the multidisciplinary team and their sustained contributions to processes of care align with the implementation of Benchmark practices, significantly decrease the health service requirements of TAVI patients, and are associated with improved patient-reported experiences.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 1","pages":"Article 100740"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925054","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 : 2025-12-30DOI: 10.1016/j.shj.2025.100791
Keith B. Allen MD , Daniel J. Romary MD, MS , Elizabeth A. Grier MD , Chetan P. Huded MD , Duc T. Pham MD , Douglas R. Johnston MD , Panos N. Vardas MD , John R. Davis MD , Adnan K. Chhatriwalla MD
{"title":"Bench Testing of a New, Semirigid, Saddle-Shaped, Complete Mitral Annuloplasty Ring Designed to Circularize During Transcatheter Mitral Valve-in-Ring Procedures","authors":"Keith B. Allen MD , Daniel J. Romary MD, MS , Elizabeth A. Grier MD , Chetan P. Huded MD , Duc T. Pham MD , Douglas R. Johnston MD , Panos N. Vardas MD , John R. Davis MD , Adnan K. Chhatriwalla MD","doi":"10.1016/j.shj.2025.100791","DOIUrl":"10.1016/j.shj.2025.100791","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 4","pages":"Article 100791"},"PeriodicalIF":2.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168388","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 : 2025-12-26DOI: 10.1016/j.shj.2025.100790
Mostafa Naguib MD, Chantal Y. Asselin MSc, MD, Robert Kipperman MD, Leo Marcoff MD, Kostantinos P. Koulogiannis MD, Linda Gillam MD, MPH, Benjamin van Boxtel MD, John Brown III MD, Philippe Généreux MD, Gennaro Giustino MD
Background
Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) is a novel technique designed to prevent CO by performing electrosurgical leaflet traversal followed by intraleaflet valve implantation or complete leaflet laceration accomplished using noncompliant balloons. However, its efficacy and safety are not well established.
Methods
We retrospectively reviewed all patients who underwent UNICORN-assisted TAVR for both valve-in-valve and native valve procedures at a single high-volume center between September 2024 and September 2025. Patients were selected based on preprocedural cardiac computed tomography demonstrating high anatomic risk for CO. In all cases, the target leaflet was traversed using an electrified 0.014″ wire, followed by serial noncompliant balloon dilatations of the leaflet to either achieve complete leaflet laceration or to accommodate for intra-leaflet valve implantation. Balloon-expandable valves were used in all procedures.
Results
Fifteen patients underwent UNICORN-assisted TAVR. Twelve were valve-in-valve cases, and 3 involved native valves. The right coronary cusp was targeted in 11 procedures and the left in 6, including 2 requiring bileaflet modification. Technical success was achieved in all cases (100%). Procedural success was achieved in 93.3%. One patient developed acute CO due to skirt-related occlusion after a high implant in a degenerated self-expanding valve, requiring single-vessel coronary artery bypass surgery. No bailout coronary stenting was required. There were no in-hospital deaths or disabling strokes. All patients were alive at 30-day follow-up.
Conclusions
In this single-center experience, UNICORN appears technically reproducible, effective in preventing CO, and safe in TAVR patients at high-risk for CO.
{"title":"Efficacy and Safety of Electrosurgical Balloon-Assisted Leaflet Modification to Prevent Coronary Obstruction During Transcatheter Aortic Valve Replacement","authors":"Mostafa Naguib MD, Chantal Y. Asselin MSc, MD, Robert Kipperman MD, Leo Marcoff MD, Kostantinos P. Koulogiannis MD, Linda Gillam MD, MPH, Benjamin van Boxtel MD, John Brown III MD, Philippe Généreux MD, Gennaro Giustino MD","doi":"10.1016/j.shj.2025.100790","DOIUrl":"10.1016/j.shj.2025.100790","url":null,"abstract":"<div><h3>Background</h3><div>Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) is a novel technique designed to prevent CO by performing electrosurgical leaflet traversal followed by intraleaflet valve implantation or complete leaflet laceration accomplished using noncompliant balloons. However, its efficacy and safety are not well established.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients who underwent UNICORN-assisted TAVR for both valve-in-valve and native valve procedures at a single high-volume center between September 2024 and September 2025. Patients were selected based on preprocedural cardiac computed tomography demonstrating high anatomic risk for CO. In all cases, the target leaflet was traversed using an electrified 0.014″ wire, followed by serial noncompliant balloon dilatations of the leaflet to either achieve complete leaflet laceration or to accommodate for intra-leaflet valve implantation. Balloon-expandable valves were used in all procedures.</div></div><div><h3>Results</h3><div>Fifteen patients underwent UNICORN-assisted TAVR. Twelve were valve-in-valve cases, and 3 involved native valves. The right coronary cusp was targeted in 11 procedures and the left in 6, including 2 requiring bileaflet modification. Technical success was achieved in all cases (100%). Procedural success was achieved in 93.3%. One patient developed acute CO due to skirt-related occlusion after a high implant in a degenerated self-expanding valve, requiring single-vessel coronary artery bypass surgery. No bailout coronary stenting was required. There were no in-hospital deaths or disabling strokes. All patients were alive at 30-day follow-up.</div></div><div><h3>Conclusions</h3><div>In this single-center experience, UNICORN appears technically reproducible, effective in preventing CO, and safe in TAVR patients at high-risk for CO.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 3","pages":"Article 100790"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090677","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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