Structural Heart最新文献

{"title":"Indirect Annuloplasty for Functional Mitral Regurgitation: CINCH or CLIP?","authors":"Mi Chen MD, PhD, Lian Krivoshei MD, Maurizio Taramasso MD, PhD","doi":"10.1016/j.shj.2025.100749","DOIUrl":"10.1016/j.shj.2025.100749","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100749"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570583","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}

{"title":"Managing Hostile Aortic Anatomies Using an Extended-Length Introducer Sheath During Transfemoral Transcatheter Aortic Valve Replacement: Rationale and Clinical Outcomes","authors":"Yusuke Kobari MD, PhD ,&nbsp;Davorka Lulic MD ,&nbsp;Arif A. Khokhar BM, BCh, MA ,&nbsp;Yinghao Lim MD ,&nbsp;Tau Sarra Hartikainen MD ,&nbsp;Laurence Campens MD, PhD ,&nbsp;Yannick Willemen MD, PhD ,&nbsp;Gintautas Bieliauskas MD ,&nbsp;Ole De Backer MD, PhD","doi":"10.1016/j.shj.2025.100737","DOIUrl":"10.1016/j.shj.2025.100737","url":null,"abstract":"<div><h3>Background</h3><div>Transfemoral (TF) access is the safest and guideline-recommended approach for transcatheter aortic valve replacement (TAVR). However, in patients with hostile aortic anatomies, the procedure may carry increased risks of vascular or cerebrovascular complications. The objective of this article is, therefore, to evaluate the safety and efficacy of using the extended-length DrySeal Flex introducer sheath (Gore, USA) for TF-TAVR in high-risk patients with challenging aortic anatomies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center cohort study including all consecutive patients who underwent TF-TAVR with the 65-cm DrySeal sheath between 2021 and 2025. We analyzed the indications for sheath use and the following clinical outcomes: all-cause mortality, stroke, and major vascular complications as defined by Valve Academic Research Consortium-3 criteria.</div></div><div><h3>Results</h3><div>The 65-cm DrySeal sheath was used in 200 patients (median age 80 years; median Society of Thoracic Surgeons score 5.4%) out of 2430 (8.2%) TF-TAVR procedures performed. This approach was selected to address challenges posed by aortic arch calcification (28%), heavily atheromatous or shaggy aorta (20%), acute aortic angulation (26%), tortuosity (36%), and aortic coarctation (8%). In this high-risk cohort, all-cause mortality was 0.5%, stroke occurred in 1.5% (including 0.5% with disabling stroke), and major vascular complications were observed in 1.0%. These outcomes were comparable to those seen in lower-risk patients undergoing TF-TAVR using conventional approaches.</div></div><div><h3>Conclusions</h3><div>In patients with hostile aortic anatomies, the extended-length DrySeal Flex introducer sheath facilitated safe and effective TAV delivery and was associated with a low rate of periprocedural complications, including cerebrovascular events. Its use may help mitigate the risks traditionally associated with hostile aortic anatomies.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100737"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521268","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}

{"title":"Aims & Scope","authors":"","doi":"10.1016/S2474-8706(25)00368-9","DOIUrl":"10.1016/S2474-8706(25)00368-9","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100776"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789676","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}

{"title":"Long-Term Outcomes of Indirect Annuloplasty for Functional Mitral Regurgitation: Interim Results From the CINCH Registry","authors":"Stephan Fichtlscherer MD ,&nbsp;Sergiu Hicea MD ,&nbsp;Fabian Barbieri MD ,&nbsp;Murat Yildiz MD ,&nbsp;Elvis Ypi MD ,&nbsp;Humam Al-Kadah MD ,&nbsp;Dietrich Pfeiffer MD ,&nbsp;Steven L. Goldberg MD ,&nbsp;Klaus K. Witte MD ,&nbsp;Horst Sievert MD ,&nbsp;CINCH Investigators","doi":"10.1016/j.shj.2025.100738","DOIUrl":"10.1016/j.shj.2025.100738","url":null,"abstract":"<div><h3>Background</h3><div>Functional mitral regurgitation (FMR) has limited effective treatment options. As a transcatheter indirect annuloplasty, the Carillon Mitral Contour System reduces FMR and improves symptoms, but long-term safety and effectiveness are incompletely characterized.</div></div><div><h3>Methods</h3><div>This prospective, multicenter CINCH registry enrolled heart failure patients with FMR treated with the Carillon Mitral Contour System across 22 centers in Germany. Main outcomes included change in New York Heart Association (NYHA) class and MR severity, heart failure hospitalization (HFH), all-cause mortality rates, and device- or procedure-related serious adverse events at 1 year. Median follow-up was 2.0 years (range, 0-5 years).</div></div><div><h3>Results</h3><div>Among 228 patients (age 78 ± 8 years; 51% female; 51% with left ventricular ejection fraction ≥50%), Carillon implantation improved clinical and echocardiographic variables. The rate of NYHA class III or IV symptoms decreased from 81 to 29% at 1 year, and the rate of moderate-to-severe MR (grade 3+/4+) decreased from 84 to 9% at 1 year, with ≥92% showing stable or improved NYHA class and ≥97% showing stable or improved MR grade over 5 years. Decreases in MR grade were associated with improvements in NYHA class (<em>p</em> = 0.048). Kaplan–Meier estimates over 5 years were 54.0% for HFH, 46.9% for all-cause mortality, and 68.3% for the composite of HFH or death. The proportion of patients experiencing any serious device- or procedure-related serious adverse event at 1 year was 1.8%.</div></div><div><h3>Conclusions</h3><div>The CINCH registry provides real-world evidence supporting the long-term safety, effectiveness, and durability of the Carillon Mitral Contour System in treating FMR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100738"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570580","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}

{"title":"Impact of Eccentric Residual Mitral Regurgitation on Long-Term Survival After Transcatheter Edge-to-Edge Mitral Valve Repair","authors":"Knut Qvale Søndenaa ,&nbsp;Ola Alexander Schei ,&nbsp;Rasmus Bach Sindre ,&nbsp;Christian Engelsen Berg-Hansen MD ,&nbsp;Barbara Rogge MD, PhD ,&nbsp;Cecilie Linn Aas MD ,&nbsp;Stig Urheim MD, PhD ,&nbsp;Jon Herstad MD ,&nbsp;Erik Packer MD, PhD ,&nbsp;Vegard Tuseth MD, PhD ,&nbsp;Dana Cramariuc MD, PhD","doi":"10.1016/j.shj.2025.100752","DOIUrl":"10.1016/j.shj.2025.100752","url":null,"abstract":"<div><h3>Background</h3><div>More than mild residual mitral regurgitation (MR) is associated with reduced survival after transcatheter edge-to-edge mitral valve repair (M-TEER). However, whether the morphology of the residual MR (rMR) jet affects long-term clinical outcomes has not been reported. The purpose of the study was to assess the impact of eccentric rMR (erMR) at discharge on long-term mortality and heart failure hospitalizations after M-TEER.</div></div><div><h3>Methods</h3><div>We analyzed preprocedural, intraprocedural, and early postprocedural echocardiographic data (1-2 days post-TEER) in patients treated by M-TEER at our institution between 2012 and 2022. Eccentric rMR was defined as a nonsymmetric, wall-hugging MR jet.</div></div><div><h3>Results</h3><div>Among 125 patients with early residual jets, erMR was present in 30% and more commonly in those with medially placed devices and in severe rMR (<em>p</em> &lt; 0.05). Eccentric jets were equally frequent in patients with originally functional or degenerative MR. During 49 (26-79) months follow-up, the median survival was 29 months in patients with erMR vs. 65 months in patients without erMR (<em>p</em> &lt; 0.001). In Cox regression analysis, erMR predicted a 2.2-fold higher risk of death (95% CI 1.3-3.7, <em>p</em> &lt; 0.05) after adjustment for MR severity, age, mean blood pressure, atrial fibrillation, left ventricular and left atrial size, and device position. Eccentric rMR also predicted a 1.8-fold (95% CI 1.1-3.1, <em>p</em> = 0.02) higher adjusted risk of heart failure hospitalization post-M-TEER.</div></div><div><h3>Conclusions</h3><div>Presence of erMR at discharge is associated with reduced long-term survival after M-TEER independent of the severity of rMR. Our findings shed light on the importance of preprocedural and intraprocedural planning to avoid eccentric jets and mitigate unfavorable long-term outcomes after M-TEER.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100752"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615616","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}

{"title":"Transcatheter Treatment of Bicuspid Aortic Valve Stenosis: From Observational Studies to Randomized Clinical Trials","authors":"Daryoush Samim MD ,&nbsp;Matthias Siepe MD ,&nbsp;Peter Jüni MD ,&nbsp;Aakriti Gupta MD ,&nbsp;Hasan Jilaihawi MD ,&nbsp;Michael A. Borger MD-PhD ,&nbsp;Raj R. Makkar MD ,&nbsp;Martin B. Leon MD ,&nbsp;Stephan Windecker MD","doi":"10.1016/j.shj.2025.100754","DOIUrl":"10.1016/j.shj.2025.100754","url":null,"abstract":"<div><div>Bicuspid aortic valve (BAV) disease is the most common congenital heart abnormality, which affects up to 2% of the population and significantly increases the lifetime risk of aortic stenosis and the need for valve replacement. While surgical aortic valve replacement (SAVR) remains the standard of care in low surgical-risk patients, transcatheter aortic valve implantation (TAVI) is increasingly used as a treatment alternative with favorable outcomes in well-selected BAV patients. To date, randomized controlled trials comparing TAVI and SAVR have excluded patients with BAV, except the UK TAVI and the more recent The NOrdic Aortic Valve IntervenTION-2 trial. Of note, in The NOrdic Aortic Valve IntervenTION-2 trial, there was a numerical imbalance in the BAV subgroup, with more events observed in the TAVI group than in the SAVR group for the composite outcome (all-cause mortality, stroke, and rehospitalization) at 1- and 3-year follow-up, although the risk estimates were imprecise due to the limited number of events. The upcoming TraNscatheter Aortic Valve Implantation versus surGical AorTic valvE replacement in patients with Bicuspid aortic valve stenosis (NAVIGATE Bicuspid) and Bicuspid aortic valve replacement: EvaLuatIon of transcathetEr VERsus Surgery (BELIEVERS) trials will directly compare TAVI and SAVR in BAV populations. These trials are designed to provide robust, adequately powered estimates of the comparative safety and effectiveness of both interventions over extended follow-up and are expected to inform future guideline recommendations in the setting of BAV anatomy.</div><div>This review summarizes current data on the use of TAVI in patients with severe BAV stenosis, evaluates anatomical and procedural complexities, and outlines the design and rationale of upcoming randomized controlled trials addressing this critical knowledge gap.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100754"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615615","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}

{"title":"Impact of Central vs. Noncentral Predominant Jet Location on Clinical Outcomes: Results From the EXPANDed Studies","authors":"Jason H. Rogers MD ,&nbsp;Matthew J. Price MD ,&nbsp;Gagan D. Singh MD ,&nbsp;Paul Mahoney MD ,&nbsp;Mathew Williams MD ,&nbsp;Paolo Denti MD ,&nbsp;Anita Asgar MD ,&nbsp;Janani Aiyer MS ,&nbsp;Rong Huang MS ,&nbsp;Jose Luis Zamorano MD ,&nbsp;Federico M. Asch MD ,&nbsp;Francesco Maisano MD ,&nbsp;Saibal Kar MD ,&nbsp;Ralph Stephan von Bardeleben MD ,&nbsp;Evelio Rodriguez MD","doi":"10.1016/j.shj.2025.100743","DOIUrl":"10.1016/j.shj.2025.100743","url":null,"abstract":"<div><h3>Background</h3><div>Mitral transcatheter edge-to-edge repair (M-TEER) is a treatment option for patients with severe mitral regurgitation (MR) at a high surgical risk. Although most MR involves central A2P2 jets, a subset present with noncentral jets, which may introduce procedural complexity and influence outcomes. The objective of the study was to evaluate the impact of main MR jet location (central [A2P2] versus noncentral [A1/P1 or A3/P3]) on procedural success and clinical outcomes following M-TEER.</div></div><div><h3>Methods</h3><div>This analysis used the EXPANDed data set, which included patients undergoing M-TEER with MitraClip G3/G4 systems and echocardiographic core laboratory-assessed main MR jet location. One-year clinical, echocardiographic, and functional outcomes were assessed.</div></div><div><h3>Results</h3><div>A total of 1785 patients had main jets at A2P2 and 81 at A1P1 or A3P3 (non-A2P2). Non-A2P2 patients more frequently had degenerative MR, prior mitral valve procedures, and better left ventricular function. Procedural success was high and comparable (A2P2: 95.9%, non-A2P2: 92.5%; <em>p</em> = 0.15), with low 30-day major adverse event rates in both (A2P2: 4.2%, non-A2P2: 7.4%; <em>p</em> = 0.16). MR ≤ 1+ was achieved in both groups at 1 year (A2P2: 91%, non-A2P2: 84%, <em>p</em> = 0.11). New York Heart Association class ≤ II improved through 1 year in both groups (A2P2: 81%, non-A2P2: 88%). Kansas City Cardiomyopathy Questionnaire overall summary improved significantly with no difference between groups at 1 year (A2P2: Δ13 points, non-A2P2: Δ20 points). One-year all-cause mortality was similar (10.7 vs. 13.7%; <em>p</em> = 0.47).</div></div><div><h3>Conclusions</h3><div>In this largest analysis to date of patients with severe MR, main MR jet location did not affect the safety or effectiveness of the MitraClip system. These findings support the use of M-TEER across a range of anatomical presentations, including non-A2P2 MR jets.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100743"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570581","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}

{"title":"Mission M-Possible: Mitral Transcatheter Edge-to-Edge Repair in Mitral Annular Calcification Using the Crab-Walk Technique","authors":"John Abdelmalek MD ,&nbsp;Muhammad Qudrat-Ullah MD ,&nbsp;Ahmed Souka MD ,&nbsp;Sibi Thomas DO ,&nbsp;Ralph Matar MD ,&nbsp;Lee Hafen MD ,&nbsp;Karim Al-Azizi MD","doi":"10.1016/j.shj.2025.100736","DOIUrl":"10.1016/j.shj.2025.100736","url":null,"abstract":"<div><h3>Background</h3><div>Mitral annular calcification (MAC) complicates transcatheter interventions for degenerative mitral regurgitation (DMR), particularly with small mitral valve orifice areas (MVOAs).</div></div><div><h3>Case Summary</h3><div>An 83-year-old woman with severe DMR, severe MAC, and MVOA of 3.8 cm² presented post-heart failure hospitalization with declining function. High surgical risk and unfavorable transcatheter mitral valve replacement anatomy (neo-LVOT 0.30 cm²) limited options to transcatheter edge-to-edge repair (TEER). Using the Edwards PASCAL precision system and the “Crab-Walk” technique (independent leaflet clasp manipulation for MAC-related challenges), TEER reduced mitral regurgitation to mild (1+), with a 2 mmHg gradient at 3 months. The patient was weaned off oxygen and remains asymptomatic at 1 year.</div></div><div><h3>Discussion</h3><div>This first reported mitral TEER case in DMR with significant MAC and small MVOA highlights the “Crab-Walk” technique’s innovation.</div></div><div><h3>Take-Home Messages</h3><div>TEER with novel techniques is viable for DMR with MAC when transcatheter mitral valve replacement is prohibitive.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100736"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570579","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}

{"title":"Left Atrial Appendage Occlusion Using the Amplatzer Amulet Device in High-Risk Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Intervention: A Randomized Pilot Study","authors":"Philipp Jakob MD ,&nbsp;Priska Heinz MSc ,&nbsp;Yiqi Gong MD ,&nbsp;Mi Chen MD ,&nbsp;Ronald K. Binder MD ,&nbsp;Ulrike Held PhD ,&nbsp;Maurizio Taramasso MD, PhD ,&nbsp;Francesco Paneni MD, PhD ,&nbsp;Philipp Schuetz MD, MPH ,&nbsp;Philipp K. Haager MD ,&nbsp;Markus Kasel MD ,&nbsp;Giovanni Pedrazzini MD ,&nbsp;Stephan Windecker MD ,&nbsp;Marco Moccetti MD ,&nbsp;Thomas Pilgrim MD, MSc ,&nbsp;Thomas F. Lüscher MD, PhD ,&nbsp;Barbara E. Stähli MD, MPH ,&nbsp;Fabian Nietlispach MD, PhD ,&nbsp;TAVI-LAAO Investigators","doi":"10.1016/j.shj.2025.100735","DOIUrl":"10.1016/j.shj.2025.100735","url":null,"abstract":"<div><h3>Background</h3><div>Patients with severe aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve intervention (TAVI) are at increased risk of bleeding and cerebrovascular events. This investigator-initiated, randomized, multicenter, open-label pilot study assessed left atrial appendage occlusion (LAAO) in patients with AF undergoing TAVI.</div></div><div><h3>Methods</h3><div>Patients were randomly assigned to LAAO (TAVI + LAAO) or standard medical therapy (SMT) (TAVI + SMT). The primary endpoint was a composite of cerebrovascular events, peripheral embolism, life-threatening/disabling/major bleeding, or cardiovascular mortality at 1 year. A sensitivity analysis was performed in the per-protocol population.</div></div><div><h3>Results</h3><div>Eighty-one patients (Society of Thoracic Surgeons score: 9.0% ± 5.4%) were enrolled. The primary endpoint occurred in 13 patients (33%) in the TAVI + LAAO group and in 15 patients (37%) in the TAVI + SMT group (adjusted odds ratio [OR], 0.87; 95% CI: 0.32-2.29, <em>p</em> = 0.77). Bleeding rates were comparable between TAVI + LAAO (13%) and TAVI + SMT (17%), with absent nonprocedural bleeding in the TAVI + LAAO group and 5 gastrointestinal bleedings in TAVI + SMT, and cerebrovascular events did not significantly differ between groups (10% in TAVI + LAAO vs. 2.4% in TAVI + SMT). In the per-protocol analysis, occurrence of the primary endpoint was comparable between groups (adjusted OR, 0.55; 95% CI: 0.18-1.56, <em>p</em> = 0.27) with cerebrovascular events in 5.6% and 2.4%, and bleeding events in 8.3% and 17% for TAVI + LAAO and TAVI + SMT, respectively.</div></div><div><h3>Conclusions</h3><div>This pilot study suggests that among high-risk patients with AF undergoing TAVI, a strategy of a combined procedure with LAAO and early cessation of oral anticoagulation overall showed similar rates of the primary end point as compared to a single TAVI procedure (NCT03088098).</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100735"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521267","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}

{"title":"Transcatheter Versus Surgical Aortic Valve Replacement in Women of Childbearing Age in the United States","authors":"Mahmoud Ismayl MBBS ,&nbsp;Hasaan Ahmed MD ,&nbsp;Andrew M. Goldsweig MD, MS ,&nbsp;Mayra Guerrero MD","doi":"10.1016/j.shj.2025.100746","DOIUrl":"10.1016/j.shj.2025.100746","url":null,"abstract":"<div><h3>Background</h3><div>Women of childbearing age occasionally require aortic valve replacement (AVR), sometimes performed with transcatheter AVR (TAVR). Outcomes of TAVR versus surgical AVR (SAVR) in women of childbearing age have not been evaluated. We aimed to evaluate the contemporary use and outcomes of TAVR versus SAVR in women of childbearing age in the United States.</div></div><div><h3>Methods</h3><div>Women aged 18-50 years hospitalized for isolated AVR were identified in the Nationwide Readmissions Database (2016-2022). In-hospital outcomes of TAVR versus SAVR were compared using propensity-score matching. Readmissions were compared using the Cox proportional hazards regression model.</div></div><div><h3>Results</h3><div>Of 6926 weighted hospitalizations for isolated AVR in women aged 18-50 years, 897 (13.0%) included TAVR, and 6029 (87.0%) included SAVR. From 2016-2022, the proportion of AVR performed using TAVR increased from 7.4% to 16.3% in women aged 18-50 years (p_trend&lt;0.001). Compared with SAVR, TAVR was associated with lower in-hospital mortality (&lt;1.4 vs. 3.5%, <em>p</em> = 0.03), acute kidney injury (9.0 vs. 16.8%, <em>p</em> = 0.002), and need for blood transfusion (7.1 vs. 19.1%, <em>p</em> ​&lt; ​0.001), but higher heart block (23.5 vs. 9.7%, <em>p</em> ​&lt; ​0.001) and vascular complications (5.0 vs. 2.1%, <em>p</em> = 0.03). Length of stay was shorter (2 vs. 7 days, <em>p</em> ​&lt; ​0.001) and nonhome discharges were lower (16.2 vs. 56.7%, <em>p</em> ​&lt; ​0.001) with TAVR compared with SAVR. Ninety-day all-cause readmissions were similar between TAVR and SAVR (12.6 vs. 13.3%, <em>p</em> = 0.78).</div></div><div><h3>Conclusions</h3><div>This nationwide observational analysis found that TAVR is increasingly performed among women aged 18-50 years with lower in-hospital mortality and resource utilization and similar readmissions compared with SAVR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 12","pages":"Article 100746"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570582","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}