Structural Heart最新文献

英文中文

Femoral Arterial Calcification and Plug- vs. Suture-Based Closure Device Strategies Post-Transcatheter Aortic Valve Implantation: Insights From CHOICE-CLOSURE 经导管主动脉瓣植入术后股动脉钙化和塞子与缝合线闭合装置策略：CHOICE-CLOSURE 的启示

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100236

Sean Fitzgerald MD , Oliver Dumpies MD , Masafumi Shibata MD , Philipp Hartung MD , Danilo Obradovic MD , Peter Boekstegers MD , Marc Vorpahl MD , Johannes Rotta detto Loria MD , Philipp Kiefer MD , Steffen Desch MD , Holger Thiele MD , Mohamed Abdel-Wahab MD

Background

The location and severity of vascular calcification may influence closure device success in transfemoral transcatheter aortic valve implantation. The aim of this study was to analyze effects of vascular access-site calcification on vascular and bleeding outcomes post-transcatheter aortic valve implantation.

Methods

The Randomized Comparison of CatHeter-based Strategies fOr Interventional ACcess SitE CLOSURE during Transfemoral Transcatheter Aortic Valve Implantation (CHOICE-CLOSURE) trial assigned 516 patients to access site closure using a pure plug-based technique (MANTA, Teleflex) or a primary suture-based technique (ProGlide, Abbott Vascular). The principal finding of the overall study was that access-site or access-related complications were more common after the plug-based strategy compared to percutaneous closure with a suture-based strategy. In this predefined subgroup analysis, the overall cohort was split into patients with and without anterior calcification at the access site and divided by degree of calcification severity using the classification system developed in the MANTA vs. suture-based vascular closure after transcatHeter aortic valve replacement (MASH) trial. Differences in bleeding and vascular complications were compared. The primary endpoint consisted of access-site- or access-related major and minor vascular complications.

Results

There were more access-site-related major and minor vascular complications for patients with anterior wall vascular calcification and MASH severe calcification. No significant interaction with choice of closure technique in terms of access-site-related major and minor vascular complications was observed (odds ratio 1.70, 95% CI 0.77-3.78, p = 0.19 for the primary endpoint in plug- vs. suture-based strategy in patients with anterior calcification, odds ratio 1.78, 95% CI 0.56-5.65, p = 0.33 for primary endpoint in plug- vs. suture-based strategy with MASH severe calcification, p_int = 0.97 for anterior calcification, p_int = 0.95 for MASH severe calcification).

Conclusions

The total number of vascular complications was found to be greater in the presence of anterior and MASH severe calcification. Overall, the presence of anterior or severe calcification does not significantly modify the efficacy of the suture-based strategy compared to the plug-based strategy.

背景血管钙化的位置和严重程度可能会影响经胸主动脉瓣植入术中关闭装置的成功率。该研究旨在分析血管入路部位钙化对经导管主动脉瓣植入术后血管和出血预后的影响。方法 "经股动脉经导管主动脉瓣植入术中介入性入路部位闭合策略的随机比较"（CHOICE-CLOSURE）试验将 516 名患者分配到使用纯塞子技术（MANTA，Teleflex）或主要缝合技术（ProGlide，Abbott Vascular）进行入路部位闭合的患者中。整体研究的主要发现是，与采用缝合技术的经皮闭合术相比，采用塞子技术的闭合术更常见入路部位或与入路相关的并发症。在这项预定义的亚组分析中，研究人员将整个队列分成入路部位有和没有前方钙化的患者，并根据钙化严重程度，采用 MANTA 与经皮主动脉瓣置换术（MASH）后缝合式血管闭合试验中开发的分类系统进行划分。比较了出血和血管并发症的差异。结果前壁血管钙化和MASH严重钙化患者发生的与入路部位或入路相关的主要和次要血管并发症较多。在与入路相关的主要和次要血管并发症方面，未观察到与选择的闭合技术有明显的交互作用（前壁钙化患者中塞子与缝合策略的主要终点的几率比为 1.70，95% CI 为 0.77-3.78，P = 0.19；前壁钙化患者中塞子与缝合策略的主要终点的几率比为 1.78，95% CI 为 0.56-5.65，P = 0.33）。结论在前部钙化和 MASH 严重钙化的患者中，血管并发症的总数更多。总体而言，与塞子策略相比，前部钙化或严重钙化并不会显著改变缝合策略的疗效。

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引用次数: 0

Cardiac Structural and Functional Remodeling After Transcatheter Mitral Valve in Valve Implantation: Early Changes and Prognostic Significance 经导管二尖瓣瓣膜植入术后的心脏结构和功能重塑：早期变化和预后意义

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100264

Gloria Ayuba DO , Zhiying Meng MS , Abigail S. Baldridge PhD , Ansh Goyal MS , Blair Tilkens MD , Rishi Shrivastav MD , Taimur Safder MD , Chris S. Malaisrie MD , James Flaherty MD , Patrick M. McCarthy MD , James D. Thomas MD , Charles Davidson MD , Jyothy Puthumana MD , Akhil Narang MD

<div><h3>Background</h3><p>Transcatheter mitral valve-in-valve (MViV) replacement has emerged as an alternative to redo mitral valve (MV) surgery for the management of failed bioprosthetic MVs. The degree of cardiac remodeling assessed by echocardiography has been shown to have prognostic implications in degenerative mitral regurgitation patients undergoing MV surgery. The impact of transcatheter MViV in patients with degenerative bioprosthetic MV failure on cardiac remodeling and its associated prognosis remains undescribed.</p></div><div><h3>Objectives</h3><p>The aim of this study is to describe the early anatomic and functional changes of the left-sided chambers and right ventricle by echocardiography posttranscatheter MViV intervention and their impact on mortality outcomes. Additionally, we sought to analyze the outcome of heart failure in bioprosthetic MV failure patients undergoing transcatheter MViV replacement.</p></div><div><h3>Methods</h3><p>We analyzed consecutive patients undergoing MViV intervention for symptomatic bioprosthetic MV failure. Echocardiograms before intervention and within 100 days postintervention were analyzed. A chart review was performed to obtain baseline characteristics, follow-up visits, 30-day heart failure and 1-year all-cause mortality outcomes.</p></div><div><h3>Results</h3><p>A total of 62 patients (mean age 69 ± 13 years, 61% male) were included in the study. Most patients were undergoing MViV intervention for prosthetic mitral stenosis n = 48 (77.4%) and the rest for mitral regurgitation or mixed disease. Compared with baseline, significant reductions were observed in median left atrial volume (LAV; 103 [81–129] ml vs. 95.2 [74.5–117.5] ml, <em>p</em> < 0.01) and mean (SD) left atrial conduit strain (9.1% ± 5.2% vs. 10.8% ± 4.8%, <em>p</em> = 0.039) within 100 days postintervention. Early reduction in right ventricular free wall global longitudinal strain and fractional area change also occurred postintervention. No significant change in left ventricular chamber dimensions or ejection fraction was observed. During the 1-year follow up period, 5 (8%) patients died. While baseline LAV was not associated with 1-year all-cause mortality (OR 0.98 CI 0.95–1.01; <em>p</em> = 0.27), a change in LAV in the follow up period was associated with all-cause mortality at 1 year (OR 1.06 CI 1.01–1.12; <em>p</em> = 0.023). At 30 days postintervention, 65% of patients had an improvement in their New York Heart Association functional class.</p></div><div><h3>Conclusion</h3><p>In this retrospective study of patients undergoing transcatheter MViV intervention for failed bioprosthetic MVs, early reverse remodeling of the left atrium occurs within 100 days postintervention and reduction in LAV is associated with reduced all-cause mortality at 1 year. In addition, there is significant improvement in heart failure symptoms at 30 days following intervention but further investigation into the longitudinal remodeling changes and

背景导管二尖瓣瓣中置换术（MViV）已成为治疗失败的生物修复二尖瓣手术的替代方法。超声心动图评估的心脏重塑程度已被证明对接受二尖瓣手术的退行性二尖瓣反流患者的预后有影响。本研究旨在通过超声心动图描述经导管二尖瓣置换术后左心室和右心室的早期解剖和功能变化及其对死亡率结果的影响。此外，我们还试图分析接受经导管MViV置换术的生物假体MV衰竭患者的心衰结局。方法我们分析了因症状性生物假体MV衰竭而接受MViV介入治疗的连续患者。分析了介入前和介入后100天内的超声心动图。研究人员对病历进行了回顾，以了解基线特征、随访情况、30 天心衰和 1 年全因死亡率结果。大多数患者因人工二尖瓣狭窄而接受 MViV 干预治疗 n = 48（77.4%），其余患者因二尖瓣反流或混合性疾病而接受 MViV 干预治疗。与基线相比，干预后 100 天内观察到中位左心房容积（LAV；103 [81-129] ml vs. 95.2 [74.5-117.5] ml，p < 0.01）和平均（标清）左心房导管应变（9.1% ± 5.2% vs. 10.8% ± 4.8%，p = 0.039）明显降低。干预后，右心室游离壁整体纵向应变和分数面积变化也出现了早期降低。左心室室壁尺寸和射血分数没有明显变化。在 1 年的随访期间，有 5 名（8%）患者死亡。虽然基线 LAV 与 1 年的全因死亡率无关（OR 0.98 CI 0.95-1.01；P = 0.27），但随访期间 LAV 的变化与 1 年的全因死亡率有关（OR 1.06 CI 1.01-1.12；P = 0.023）。结论在这项针对因生物假体中房失败而接受经导管中房介入治疗的患者进行的回顾性研究中，左心房在介入治疗后 100 天内发生早期逆向重塑，LAV 的减少与 1 年后全因死亡率的降低有关。此外，干预后30天心衰症状明显改善，但纵向重塑变化和长期预后仍需进一步研究。

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引用次数: 0

Characteristics and Outcomes of Patients Ineligible for Tricuspid Transcatheter Edge-to-Edge Repair 不符合三尖瓣经导管边缘到边缘修补术患者的特征和疗效

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100235

Taha Hatab MD , Rody G. Bou Chaaya MD , Sahar Samimi MD , Fatima Qamar MD , Nadeen Faza MD , Stephen H. Little MD , Michael J. Reardon MD , Neal S. Kleiman MD , William A. Zoghbi MD , Ashrith Guha MD , Syed Zaid MD , Sachin S. Goel MD

引用次数: 0

Aims & Scope 目标和范围

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-03-01 DOI: 10.1016/S2474-8706(24)00016-2

引用次数: 0

Utilization of 3-Dimensional Print Technology and 4-Dimensional Intracardiac Echocardiography (ICE) Imaging to Manage Left Atrial Appendage Occlusion Peridevice Leak 利用三维打印技术和四维心内超声心动图 (ICE) 成像处理左心房阑尾闭塞周漏

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100263

Kifah Hussain MD, Christopher Ding MD, Jose Nazari MD, Mark Metzl MD, Amit Pursnani MD, Jonathan R. Rosenberg MD

引用次数: 0

Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms 双尖瓣主动脉瓣疾病：分类、治疗和新兴的经导管范例

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-01-01 DOI: 10.1016/j.shj.2023.100227

Ankur Kalra MD , Rajiv Das MB ChB, MD , Mohammad Alkhalil MD, DPhil , Iryna Dykun MD , Alessandro Candreva MD , Omar Jarral MBBS, PhD , Syed M. Rehman MBBS , Monil Majmundar MD , Kunal N. Patel MD, MPH , Josep Rodes-Cabau MD, PhD , Michael J. Reardon MD , Rishi Puri MBBS, PhD

Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.

主动脉瓣二尖瓣（BAV）是一种常见的先天性瓣膜畸形，可能导致早期主动脉瓣病变和二尖瓣相关性主动脉病变。最近提出了一种新的 BAV 分类系统，同时经导管主动脉瓣置换术越来越多地被有症状的年轻 BAV 患者所考虑，并取得了良好的临床效果，但却没有随机试验的证据。与接受经导管主动脉瓣置换术的三尖瓣主动脉瓣狭窄患者相比，BAV 患者的手术技术和临床效果都有了显著改善。本综述总结了新的 BAV 分类系统，并研究了当代的手术和经导管方法。

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引用次数: 0

FAcilitating Safe Trans-femoral ACCESS for Transcatheter Aortic Valve Replacement in High Body Mass Index Patients—The FAST-ACCESS Cohort Study 促进高体重指数患者经导管主动脉瓣置换术的安全经股动脉入路--FAST-ACCESS 队列研究

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-01-01 DOI: 10.1016/j.shj.2023.100232

Sarosh Khan MBBS , Rohan Jagathesan MD , Olivia M.T. Frost BSc , Iveta Crawford BSc , Sheila Smith BSc , Swamy Gedela MBBS , Samer Fawaz BMBS , Rupert Simpson MBChB , Arvind Singh MBBS , Grigoris V. Karamasis MD , Thomas R. Keeble MD , John R. Davies PhD , Alamgir Kabir PhD , Rajesh Aggarwal MD , Christopher M. Cook PhD

引用次数: 0

Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后血压控制目标对心外膜冠脉流量的不同影响

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-01-01 DOI: 10.1016/j.shj.2023.100230

Brennan J. Vogl BS , Alejandra Chavez-Ponce MD , Adam Wentworth MS , Eric Erie AAS , Pradeep Yadav MD , Vinod H. Thourani MD , Lakshmi Prasad Dasi PhD , Brian Lindman MD, MSc , Mohamad Alkhouli MD , Hoda Hatoum PhD

Background

The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion.

Methods

The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an in vitro left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia.

Results

As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (p ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91.

Conclusions

Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.

背景主动脉瓣置换术（AVR）后心血管死亡率增加与血压（BP）降低之间的关联原因尚不清楚。本研究旨在评估在右冠状动脉病变的情况下，主动脉瓣置换术后心外膜冠状动脉血流（ECF）是如何随着血压水平的变化而变化的。方法在体外左心模拟器中，在收缩压（SBP）和舒张压（DBP）变化的范围内，评估了3D打印主动脉根部模型的血流动力学。计算了 ECF 和流量比率指数。结果随着 SBP 的降低，平均 ECF 降至低于 120 mmHg 时的生理冠状动脉最小值。随着 DBP 的降低，平均 ECF 仍保持在生理最小值以上。当 SBP ≥130 mmHg 时，血流比率指数为 0.9。然而，当 SBP 为 120 mmHg 时，流量比率为 0.63（p ≤ 0.0055）。结论在有冠状动脉疾病的情况下，将血压降低到 AVR 后为普通人群指定的当前推荐水平可能需要重新考虑血压水平和治疗的优先次序。需要进行更多的研究，以充分了解存在和不存在冠状动脉疾病的情况下进行房室反流术后心 ECF 动态的变化。

{"title":"Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement","authors":"Brennan J. Vogl BS , Alejandra Chavez-Ponce MD , Adam Wentworth MS , Eric Erie AAS , Pradeep Yadav MD , Vinod H. Thourani MD , Lakshmi Prasad Dasi PhD , Brian Lindman MD, MSc , Mohamad Alkhouli MD , Hoda Hatoum PhD","doi":"10.1016/j.shj.2023.100230","DOIUrl":"10.1016/j.shj.2023.100230","url":null,"abstract":"<div><h3>Background</h3><p>The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion.</p></div><div><h3>Methods</h3><p>The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an <em>in vitro</em> left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia.</p></div><div><h3>Results</h3><p>As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (<em>p</em> ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91.</p></div><div><h3>Conclusions</h3><p>Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 1","pages":"Article 100230"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623001240/pdfft?md5=f196d452263fee2a8a6454519e119567&pid=1-s2.0-S2474870623001240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135714264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editor’s Page: What Ever Happened to the Physical Examination? 编辑专页：体格检查怎么了？

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-01-01 DOI: 10.1016/j.shj.2023.100265

Anthony DeMaria MD

引用次数: 0

Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后的舒张功能障碍和健康状况结果

Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2024-01-01 DOI: 10.1016/j.shj.2023.100225

Rayan S. El-Zein DO , Ali O. Malik MD, MSc , David J. Cohen MD, MSc , John A. Spertus MD, MPH , John T. Saxon MD , Philippe Pibarot DVM, PhD , Rebecca T. Hahn MD , Maria C. Alu MS , Kan Shang PhD , Susheel K. Kodali MD , Vinod H. Thourani MD , Martin B. Leon MD , Michael J. Mack MD , Adnan K. Chhatriwalla MD

Background

Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR.

Methods

Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS.

Results

Of 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007).

Conclusions

Change in LVDD grade was associated with change in health status 1 year following TAVR.

背景在接受经导管主动脉瓣置换术（TAVR）的重度主动脉瓣狭窄患者中，基线左室舒张功能障碍（LVDD）与健康状况不良有关，但TAVR术后健康状况的改善似乎与所有等级的LVDD相似。方法分析在 PARTNER（主动脉经导管瓣膜置入）2 SAPIEN 3 登记和 PARTNER 3 试验中接受 TAVR 且在基线和 1 年时 LVDD 均可评估的患者。LVDD 等级采用超声心动图核心实验室数据和美国超声心动图学会指南的改编定义进行评估。健康状况采用堪萨斯城心肌病问卷调查总体总结（KCCQ-OS）评分进行评估。结果 1100 名患者中，基线 LVDD 为 0/1、2 和 3 级的分别有 724 人（65.8%）、283 人（25.7%）和 93 人（8.5%）。1 年后，790 名患者（71.8%）的 LVDD 严重程度保持不变，189 名患者（17.2%）的 LVDD 严重程度有所改善，121 名患者（11.0%）的 LVDD 严重程度有所恶化。在基线 LVDD 为 2 级或 3 级的 376 名患者中，50.3% 的患者 LVDD 有所改善。在整个队列中，KCCQ-OS评分在1年后提高了21.9分。结论 LVDD等级的变化与TAVR术后1年的健康状况变化有关。

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