Pub Date : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.shj.2025.100788
Jennifer von Stein MD , Philipp von Stein MD , Maria C. Alu MS , Andrea Scotti MD , Edwin C. Ho MD , Juan F. Granada MD , Azeem Latib MD
Tricuspid regurgitation (TR) is a common but frequently underrecognized condition associated with substantial morbidity and mortality. Long regarded as a mere bystander of left-sided heart disease, TR was often left untreated, contributing to late referrals and poor surgical outcomes. The emergence of transcatheter tricuspid valve interventions has broadened therapeutic options, particularly for high-risk or inoperable patients. However, procedural success and clinical benefit critically depend on appropriate patient selection and timely intervention. This review outlines the evolving landscape of TR management, emphasizing the importance of anatomical and clinical stage-adapted device selection. Key determinants of feasibility and prognosis include right ventricular function and dimensions, TR severity, tricuspid valve leaflet and annular remodeling, and hemodynamic congestion. Advanced imaging modalities and invasive hemodynamics provide incremental value for risk stratification. While tricuspid valve transcatheter edge-to-edge repair (T-TEER) and orthotopic valve replacement are the most widely adopted techniques, direct annuloplasty, heterotopic valve replacement, and coaptation enhancement devices may be more appropriate in anatomically advanced stages. Despite symptomatic improvement and reduced heart failure hospitalizations across different treatment modalities, a survival benefit has yet to be demonstrated. Delayed referral remains a challenge, often precluding repair or even replacement strategies. Dedicated risk models may improve prognostication and guide procedural decision-making. Ultimately, a multidisciplinary approach incorporating multiparametric assessment is essential to identify optimal candidates, guide timing, and personalize therapy. Ongoing trials and long-term outcome data are needed to refine treatment algorithms and clarify the role of early intervention in altering the natural course of severe TR.
{"title":"Patient Selection for Transcatheter Tricuspid Valve Intervention: Not Too Early, Not Too Late","authors":"Jennifer von Stein MD , Philipp von Stein MD , Maria C. Alu MS , Andrea Scotti MD , Edwin C. Ho MD , Juan F. Granada MD , Azeem Latib MD","doi":"10.1016/j.shj.2025.100788","DOIUrl":"10.1016/j.shj.2025.100788","url":null,"abstract":"<div><div>Tricuspid regurgitation (TR) is a common but frequently underrecognized condition associated with substantial morbidity and mortality. Long regarded as a mere bystander of left-sided heart disease, TR was often left untreated, contributing to late referrals and poor surgical outcomes. The emergence of transcatheter tricuspid valve interventions has broadened therapeutic options, particularly for high-risk or inoperable patients. However, procedural success and clinical benefit critically depend on appropriate patient selection and timely intervention. This review outlines the evolving landscape of TR management, emphasizing the importance of anatomical and clinical stage-adapted device selection. Key determinants of feasibility and prognosis include right ventricular function and dimensions, TR severity, tricuspid valve leaflet and annular remodeling, and hemodynamic congestion. Advanced imaging modalities and invasive hemodynamics provide incremental value for risk stratification. While tricuspid valve transcatheter edge-to-edge repair (T-TEER) and orthotopic valve replacement are the most widely adopted techniques, direct annuloplasty, heterotopic valve replacement, and coaptation enhancement devices may be more appropriate in anatomically advanced stages. Despite symptomatic improvement and reduced heart failure hospitalizations across different treatment modalities, a survival benefit has yet to be demonstrated. Delayed referral remains a challenge, often precluding repair or even replacement strategies. Dedicated risk models may improve prognostication and guide procedural decision-making. Ultimately, a multidisciplinary approach incorporating multiparametric assessment is essential to identify optimal candidates, guide timing, and personalize therapy. Ongoing trials and long-term outcome data are needed to refine treatment algorithms and clarify the role of early intervention in altering the natural course of severe TR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100788"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927497","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 : 2026-02-01Epub Date: 2025-11-05DOI: 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.
{"title":"Comprehensive Unified Regimen for Eliminating Undiagnosed/Untreated Aortic Valve Stenosis: Algorithm Validation for Identifying Aortic Stenosis and Treatment Disparities","authors":"Daniel Mitchell MD, Dhairya Patel MPH, Jesse Navarrette MPA, Raj Makkar MD, Susan Cheng MD, MPH, MS, Joseph E. Ebinger MD, MS","doi":"10.1016/j.shj.2025.100755","DOIUrl":"10.1016/j.shj.2025.100755","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 2","pages":"Article 100755"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927499","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-01-01Epub Date: 2025-11-16DOI: 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
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