Pub Date : 2025-09-01DOI: 10.1016/j.shj.2025.100727
Ali J. Ebrahimi MD, Mustafa Alkhawam MD, Mustafa I. Ahmed MD
We report the case of a 48-year-old male with a history of multiple mitral valve replacements and an interrupted inferior vena cava who presented with severe anteroseptal mitral paravalvular leak (PVL). Due to his complex anatomy, standard transfemoral access was not feasible. A right internal jugular vein approach was used to perform a transseptal puncture and successfully deliver five Amplatzer Vascular Plug II devices for PVL closure. The procedure was guided by transesophageal echocardiography and fluoroscopy. Postprocedural imaging confirmed reduced regurgitation and preserved valve function. This case highlights the feasibility and advantages of using the right internal jugular approach for transcatheter PVL closure in patients with challenging venous anatomy.
{"title":"Internal Jugular Approach for Percutaneous Mitral Paravalvular Leak Closure in a Patient With Interrupted Inferior Vena Cava","authors":"Ali J. Ebrahimi MD, Mustafa Alkhawam MD, Mustafa I. Ahmed MD","doi":"10.1016/j.shj.2025.100727","DOIUrl":"10.1016/j.shj.2025.100727","url":null,"abstract":"<div><div>We report the case of a 48-year-old male with a history of multiple mitral valve replacements and an interrupted inferior vena cava who presented with severe anteroseptal mitral paravalvular leak (PVL). Due to his complex anatomy, standard transfemoral access was not feasible. A right internal jugular vein approach was used to perform a transseptal puncture and successfully deliver five Amplatzer Vascular Plug II devices for PVL closure. The procedure was guided by transesophageal echocardiography and fluoroscopy. Postprocedural imaging confirmed reduced regurgitation and preserved valve function. This case highlights the feasibility and advantages of using the right internal jugular approach for transcatheter PVL closure in patients with challenging venous anatomy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 11","pages":"Article 100727"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222156","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 : 2025-09-01DOI: 10.1016/j.shj.2025.100722
Josep Rodés-Cabau MD, PhD
{"title":"Structural Heart: The Journal of the Heart Team - Starting a New Era","authors":"Josep Rodés-Cabau MD, PhD","doi":"10.1016/j.shj.2025.100722","DOIUrl":"10.1016/j.shj.2025.100722","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100722"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319485","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 : 2025-09-01DOI: 10.1016/j.shj.2025.100725
Raviteja R. Guddeti MD , Nadia El-Hangouche MD , Geoffrey Answini MD , Dean Kereiakes MD , Santiago Garcia MD
Untreated clinically significant aortic regurgitation (AR) is frequently seen in the general population and is associated with worse outcomes, including higher mortality. Surgical aortic valve replacement is currently the treatment of choice for severe AR. However, a significant proportion of these patients are not good surgical candidates due to advanced age, frailty, and underlying comorbidities, prompting the need for transcatheter options. Current guidelines do not recommend transcatheter aortic valve replacement (TAVR) for severe AR with commercially available transcatheter heart valves (THVs). Off-label use of commercial TAVR devices has been associated with lower procedural success, increased complications, mainly valve embolization and residual AR, and poor clinical outcomes. The suboptimal results of TAVR with the current generation THVs are attributed to anatomical factors such as a lack of annular calcium, a large aortic annulus, and a dilated aortic root, posing challenges for device anchoring. TAVR with dedicated devices for AR, such as the JenaValve and the J-Valve, is rapidly evolving, with preliminary evidence suggesting higher procedural success rates and improved clinical outcomes during short-term follow-up. There is a significant unmet need for the development of transcatheter therapies with dedicated THVs for severe AR, and both the JenaValve and J-Valve systems are undergoing rigorous clinical trial testing before regulatory approval in the United States.
{"title":"Transcatheter Aortic Valve Replacement for Treating Native Aortic Regurgitation: Ready for Prime Time?","authors":"Raviteja R. Guddeti MD , Nadia El-Hangouche MD , Geoffrey Answini MD , Dean Kereiakes MD , Santiago Garcia MD","doi":"10.1016/j.shj.2025.100725","DOIUrl":"10.1016/j.shj.2025.100725","url":null,"abstract":"<div><div>Untreated clinically significant aortic regurgitation (AR) is frequently seen in the general population and is associated with worse outcomes, including higher mortality. Surgical aortic valve replacement is currently the treatment of choice for severe AR. However, a significant proportion of these patients are not good surgical candidates due to advanced age, frailty, and underlying comorbidities, prompting the need for transcatheter options. Current guidelines do not recommend transcatheter aortic valve replacement (TAVR) for severe AR with commercially available transcatheter heart valves (THVs). Off-label use of commercial TAVR devices has been associated with lower procedural success, increased complications, mainly valve embolization and residual AR, and poor clinical outcomes. The suboptimal results of TAVR with the current generation THVs are attributed to anatomical factors such as a lack of annular calcium, a large aortic annulus, and a dilated aortic root, posing challenges for device anchoring. TAVR with dedicated devices for AR, such as the JenaValve and the J-Valve, is rapidly evolving, with preliminary evidence suggesting higher procedural success rates and improved clinical outcomes during short-term follow-up. There is a significant unmet need for the development of transcatheter therapies with dedicated THVs for severe AR, and both the JenaValve and J-Valve systems are undergoing rigorous clinical trial testing before regulatory approval in the United States.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100725"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045135","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 : 2025-08-27DOI: 10.1016/j.shj.2025.100482
Atefeh Ghorbanzadeh MD , Conor Lane MBBCh , Abdullah Al-Abcha MD , Alan Ortega-Macias MD , Mackram Eleid MD , Dee Dee Wang MD , Isaac George MD , Susheel Kodali MD , Carl L. Tommaso MD , Philip Krause MD , Ronald Berger MD , Igor Palacios MD , Raj Makkar MD , Lowell Satler MD , Tatiana Kaptzan PhD , Brad Lewis MS , Jeremy Thaden MD , Jae Oh MD , Rebecca T. Hahn MD , Chet Rihal MD , Mayra Guerrero MD
Background
The long-term hemodynamic consequences of iatrogenic atrial septum defect (iASD) after transseptal (TS) transcatheter mitral valve replacement (TMVR) are unknown. The objective of this study was to compare the clinical outcomes of patients who underwent iASD closure after TS TMVR in the MITRAL (Mitral Implantation of TRAnscatheter vaLves) trial.
Methods
The MITRAL trial enrolled high-surgical-risk patients with severe mitral annular calcification treated with valve-in-mitral annular calcification (ViMAC), failed surgical repair with annuloplasty ring treated with mitral valve-in-ring (MViR), or failed surgical mitral bioprosthesis treated with mitral valve-in-valve (MViV).
Results
Ninety-one patients were prospectively enrolled between February 2015 and December 2017, at 13 US sites (MViV = 30, MViR = 30, ViMAC = 31). Seventy-five of them were treated with TS access (MViV = 30, MViR = 30, and ViMAC = 15), of which 16 patients underwent iASD closure during or after the index procedure (MViV = 3, MViR = 7, ViMAC = 6). Closure of the iASDs was left to the operator's discretion, and the reason in most patients was the presence of large left-to-right shunt. Patients who underwent closure of iASD were a sicker population at baseline with more severe symptoms (87.5% with New York Heart Association functional class III-IV, compared to 81.4% in non-iASD closure group, p = 0.02), higher rate of recent heart failure hospitalization (68.8% vs. 30.5%; p = 0.01) and lower 6-minute walk test distance (110 m vs. 214 m; p = 0.002). These patients also had longer length of stay after TMVR compared with patients who did not undergo iASD closure (8 vs. 4 days, p < 0.001). Despite these differences at baseline and requiring longer hospital stays, there was no significant difference in mortality, New York Heart Association class, 6-minute walk test distance, or heart failure hospitalization at 5 years.
Conclusions
Patients who underwent iASD closure were more symptomatic at baseline, had decreased functional exercise capacity and required longer length of stay after TMVR. Despite these differences at baseline, 5-year outcomes were similar between groups.
{"title":"Outcomes of Iatrogenic Atrial Septal Defect Closure After Transseptal Transcatheter Mitral Valve Replacement in the Mitral Implantation of Transcatheter Valves (MITRAL) Trial","authors":"Atefeh Ghorbanzadeh MD , Conor Lane MBBCh , Abdullah Al-Abcha MD , Alan Ortega-Macias MD , Mackram Eleid MD , Dee Dee Wang MD , Isaac George MD , Susheel Kodali MD , Carl L. Tommaso MD , Philip Krause MD , Ronald Berger MD , Igor Palacios MD , Raj Makkar MD , Lowell Satler MD , Tatiana Kaptzan PhD , Brad Lewis MS , Jeremy Thaden MD , Jae Oh MD , Rebecca T. Hahn MD , Chet Rihal MD , Mayra Guerrero MD","doi":"10.1016/j.shj.2025.100482","DOIUrl":"10.1016/j.shj.2025.100482","url":null,"abstract":"<div><h3>Background</h3><div>The long-term hemodynamic consequences of iatrogenic atrial septum defect (iASD) after transseptal (TS) transcatheter mitral valve replacement (TMVR) are unknown. The objective of this study was to compare the clinical outcomes of patients who underwent iASD closure after TS TMVR in the MITRAL (Mitral Implantation of TRAnscatheter vaLves) trial.</div></div><div><h3>Methods</h3><div>The MITRAL trial enrolled high-surgical-risk patients with severe mitral annular calcification treated with valve-in-mitral annular calcification (ViMAC), failed surgical repair with annuloplasty ring treated with mitral valve-in-ring (MViR), or failed surgical mitral bioprosthesis treated with mitral valve-in-valve (MViV).</div></div><div><h3>Results</h3><div>Ninety-one patients were prospectively enrolled between February 2015 and December 2017, at 13 US sites (MViV = 30, MViR = 30, ViMAC = 31). Seventy-five of them were treated with TS access (MViV = 30, MViR = 30, and ViMAC = 15), of which 16 patients underwent iASD closure during or after the index procedure (MViV = 3, MViR = 7, ViMAC = 6). Closure of the iASDs was left to the operator's discretion, and the reason in most patients was the presence of large left-to-right shunt. Patients who underwent closure of iASD were a sicker population at baseline with more severe symptoms (87.5% with New York Heart Association functional class III-IV, compared to 81.4% in non-iASD closure group, <em>p</em> = 0.02), higher rate of recent heart failure hospitalization (68.8% vs. 30.5%; <em>p</em> = 0.01) and lower 6-minute walk test distance (110 m vs. 214 m; <em>p</em> = 0.002). These patients also had longer length of stay after TMVR compared with patients who did not undergo iASD closure (8 vs. 4 days, <em>p</em> < 0.001). Despite these differences at baseline and requiring longer hospital stays, there was no significant difference in mortality, New York Heart Association class, 6-minute walk test distance, or heart failure hospitalization at 5 years.</div></div><div><h3>Conclusions</h3><div>Patients who underwent iASD closure were more symptomatic at baseline, had decreased functional exercise capacity and required longer length of stay after TMVR. Despite these differences at baseline, 5-year outcomes were similar between groups.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100482"},"PeriodicalIF":2.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020975","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 : 2025-08-25DOI: 10.1016/j.shj.2025.100726
Justin T. Tretter MD , Mackram F. Eleid MD , Francesco Bedogni MD , Josep Rodés-Cabau MD, PhD , Ander Regueiro MD, PhD , Luca Testa MD, PhD , Shmuel Chen MD, PhD , Attilio Galhardo MD, MSc , Kenneth A. Ellenbogen MD , Martin B. Leon MD , Shlomo Ben-Haim MD, DSc
Background
Need for permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR) remains a common complication. We aimed to assess computed tomography (CT)-based anatomical and electrocardiogram (ECG)-based parameters in a predictive model for PPI following TAVR.
Methods
We assessed CT-based parameters, including the predicted course of the conduction axis from atrioventricular node to left bundle branch origin relative to the aortic virtual basal ring. Electrophysiological variables were combined in assessing a model to predict post-TAVR PPI.
Results
Among 433 patients (mean age 82.0 [9.0] years, 54.0% female), 90 (21.0%) required PPI. Multiple binary logistic modeling demonstrated a shallower position of the membranous septum inferior margin midpoint increased the odds of PPI by 20% for every 1 mm (adjusted odds ratio [aOR]: 1.20) adjusted for the CT assessment phase. Increasing aortic root rotational angle associated with lower PPI odds (odds ratio [OR]: 0.98; 95% CI [0.95-1.00]), while an angle between the membranous septum midpoint and noncoronary leaflet nadir associated with increased PPI odds (OR: 1.04; 95% CI [1.01-1.08]). Preprocedural right bundle branch block and first-degree atrioventricular block associated with increased odds for PPI (OR: 3.76; 95% CI [1.71-8.21]; and OR: 1.84; 95% CI [1.06-3.18], respectively). The model had an area under the curve of 0.73 (95% CI [0.67-0.79]), sensitivity of 0.74 (95% CI [0.47-0.93]), and specificity of 0.65 (95% CI [0.40-0.87]) for predicting PPI requirement.
Conclusions
A predictive model for determining the risk of PPI following TAVR is reported, combining comprehensive conduction-specific anatomical measurements relative to the aortic root and electrical measurements with clinical parameters. This model requires prospective application to understand its performance in the real-world.
{"title":"Preprocedural CT and ECG Markers for Predicting Post-TAVR Pacemaker Requirement in High-Risk Patients","authors":"Justin T. Tretter MD , Mackram F. Eleid MD , Francesco Bedogni MD , Josep Rodés-Cabau MD, PhD , Ander Regueiro MD, PhD , Luca Testa MD, PhD , Shmuel Chen MD, PhD , Attilio Galhardo MD, MSc , Kenneth A. Ellenbogen MD , Martin B. Leon MD , Shlomo Ben-Haim MD, DSc","doi":"10.1016/j.shj.2025.100726","DOIUrl":"10.1016/j.shj.2025.100726","url":null,"abstract":"<div><h3>Background</h3><div>Need for permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR) remains a common complication. We aimed to assess computed tomography (CT)-based anatomical and electrocardiogram (ECG)-based parameters in a predictive model for PPI following TAVR.</div></div><div><h3>Methods</h3><div>We assessed CT-based parameters, including the predicted course of the conduction axis from atrioventricular node to left bundle branch origin relative to the aortic virtual basal ring. Electrophysiological variables were combined in assessing a model to predict post-TAVR PPI.</div></div><div><h3>Results</h3><div>Among 433 patients (mean age 82.0 [9.0] years, 54.0% female), 90 (21.0%) required PPI. Multiple binary logistic modeling demonstrated a shallower position of the membranous septum inferior margin midpoint increased the odds of PPI by 20% for every 1 mm (adjusted odds ratio [aOR]: 1.20) adjusted for the CT assessment phase. Increasing aortic root rotational angle associated with lower PPI odds (odds ratio [OR]: 0.98; 95% CI [0.95-1.00]), while an angle between the membranous septum midpoint and noncoronary leaflet nadir associated with increased PPI odds (OR: 1.04; 95% CI [1.01-1.08]). Preprocedural right bundle branch block and first-degree atrioventricular block associated with increased odds for PPI (OR: 3.76; 95% CI [1.71-8.21]; and OR: 1.84; 95% CI [1.06-3.18], respectively). The model had an area under the curve of 0.73 (95% CI [0.67-0.79]), sensitivity of 0.74 (95% CI [0.47-0.93]), and specificity of 0.65 (95% CI [0.40-0.87]) for predicting PPI requirement.</div></div><div><h3>Conclusions</h3><div>A predictive model for determining the risk of PPI following TAVR is reported, combining comprehensive conduction-specific anatomical measurements relative to the aortic root and electrical measurements with clinical parameters. This model requires prospective application to understand its performance in the real-world.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 11","pages":"Article 100726"},"PeriodicalIF":2.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222155","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 : 2025-08-13DOI: 10.1016/j.shj.2025.100724
Antonio H. Frangieh MD, MPH , Mark W. Abdelnour MD , Siddharth Vad MS , Scott Chadderdon MD , Jin Kyung Kim MD, PhD , Firas Zahr MD
As transcatheter tricuspid valve replacement with the EVOQUE system gains wider clinical adoption, growing experience has highlighted key anatomical considerations that influence procedural success. While right transfemoral (TF) access is the standard approach, it can be technically challenging in patients with complex right heart anatomy, such as low right atrium (RA) height or a large inferior vena cava–tricuspid valve annulus (IVC-TVA) offset. These factors may lead to suboptimal trajectory, impaired coaxiality, and difficult valve deployment. Left TF access offers a potential alternative by providing additional RA height and a more favorable lateral trajectory, allowing improved alignment with the tricuspid valve annulus (TVA). This approach is particularly useful in patients with large short-axis (SAX) offsets (>20 mm) or steep long-axis angles where right TF access may not achieve perpendicular orientation despite secondary catheter flexion. Using a preprocedural cardiac computed tomography angiography (CCTA) scan, anatomical factors such as RAH, leaflet tethering height, RV depth, and papillary muscle location can be evaluated to guide access planning. While left TF access introduces its own technical considerations, including venous tortuosity, excessive unwanted RA height, and increased need for primary flex, it may expand procedural feasibility in anatomically challenging cases. This review outlines real-world scenarios where left-sided access was favored, supporting its use as a safe and effective strategy in selected patients. Further studies are warranted to assess long-term outcomes and to inform the design of next-generation delivery systems capable of accommodating broader anatomical variation.
{"title":"When Right Isn’t Right: Left Femoral Access for EVOQUE Transcatheter Tricuspid Valve Replacement System","authors":"Antonio H. Frangieh MD, MPH , Mark W. Abdelnour MD , Siddharth Vad MS , Scott Chadderdon MD , Jin Kyung Kim MD, PhD , Firas Zahr MD","doi":"10.1016/j.shj.2025.100724","DOIUrl":"10.1016/j.shj.2025.100724","url":null,"abstract":"<div><div>As transcatheter tricuspid valve replacement with the EVOQUE system gains wider clinical adoption, growing experience has highlighted key anatomical considerations that influence procedural success. While right transfemoral (TF) access is the standard approach, it can be technically challenging in patients with complex right heart anatomy, such as low right atrium (RA) height or a large inferior vena cava–tricuspid valve annulus (IVC-TVA) offset. These factors may lead to suboptimal trajectory, impaired coaxiality, and difficult valve deployment. Left TF access offers a potential alternative by providing additional RA height and a more favorable lateral trajectory, allowing improved alignment with the tricuspid valve annulus (TVA). This approach is particularly useful in patients with large short-axis (SAX) offsets (>20 mm) or steep long-axis angles where right TF access may not achieve perpendicular orientation despite secondary catheter flexion. Using a preprocedural cardiac computed tomography angiography (CCTA) scan, anatomical factors such as RAH, leaflet tethering height, RV depth, and papillary muscle location can be evaluated to guide access planning. While left TF access introduces its own technical considerations, including venous tortuosity, excessive unwanted RA height, and increased need for primary flex, it may expand procedural feasibility in anatomically challenging cases. This review outlines real-world scenarios where left-sided access was favored, supporting its use as a safe and effective strategy in selected patients. Further studies are warranted to assess long-term outcomes and to inform the design of next-generation delivery systems capable of accommodating broader anatomical variation.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 11","pages":"Article 100724"},"PeriodicalIF":2.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159763","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 : 2025-08-12DOI: 10.1016/j.shj.2025.100723
Luai Madanat MD, Rohit Chandra MD, Samia Mazumder MD, Richard Bloomingdale MD, Ahmad Jabri MD, Vishal Birk MD, Brian Renard MD, Rohit Vyas MD, Marina Maraskine MD, Ivan D. Hanson MD, Amr E. Abbas MD
{"title":"Concomitant Percutaneous Coronary Intervention and Mitral Transcatheter Edge-to-Edge Repair for Acute Ischemic Mitral Regurgitation From Papillary Muscle Rupture","authors":"Luai Madanat MD, Rohit Chandra MD, Samia Mazumder MD, Richard Bloomingdale MD, Ahmad Jabri MD, Vishal Birk MD, Brian Renard MD, Rohit Vyas MD, Marina Maraskine MD, Ivan D. Hanson MD, Amr E. Abbas MD","doi":"10.1016/j.shj.2025.100723","DOIUrl":"10.1016/j.shj.2025.100723","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100723"},"PeriodicalIF":2.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011256","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}
Tricuspid regurgitation (TR) is associated with substantial morbidity and mortality, yet it remains an undertreated entity. Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising therapeutic option, with multiple novel systems demonstrating early safety and efficacy. The objective of this study is to systematically review and synthesize the clinical outcomes of transcatheter heart valve systems.
Methods
A systematic search of PubMed, Embase, and Cochrane databases was conducted from database inception through March 31, 2025. Eligible studies included adult patients undergoing TTVR for severe or torrential TR, reporting at least one clinical outcome. Pooled event rates were calculated using a random-effects model. Subgroup analyses were performed by valve type, and meta-regression explored potential sources of heterogeneity.
Results
Twenty studies comprising 1017 patients were included. The mean age was 73 ± 9 years, and 71.2% were female. The weighted in-hospital and 30-day mortality were 1.37 and 2.49%, respectively. New permanent pacemaker implantation occurred in 7.98%, with highest rates observed in EVOQUE recipients (11.64%). Only 3% of patients had greater than or equal to severe TR at follow-up, and only 12% remained in New York Heart Association functional class III/IV. Subgroup analysis revealed lower in-hospital and 30-day mortality with EVOQUE but higher permanent pacemaker implantation compared to other valves.
Conclusions
TTVR is a feasible and safe intervention for patients with severe TR, providing significant functional improvement and TR reduction. Robust, longer-term randomized controlled trials with standardized outcome reporting and clinical endpoints are urgently needed to define durable clinical benefit and guide optimal device selection for patients with severe TR.
{"title":"Clinical Outcomes Following Transcatheter Tricuspid Valve Replacement – A Meta-Analysis","authors":"Taha Hatab MD , Osamah Badwan MD , Radwan Alkhatib MD , Akiva Rosenzveig MD , Mangesh Kritya MD , Faysal Massad MD , Saeid Mirzai DO , Serge Harb MD , Grant Reed MD, MSc , Amar Krishnaswamy MD , Rishi Puri MD, PhD , Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100721","DOIUrl":"10.1016/j.shj.2025.100721","url":null,"abstract":"<div><h3>Background</h3><div>Tricuspid regurgitation (TR) is associated with substantial morbidity and mortality, yet it remains an undertreated entity. Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising therapeutic option, with multiple novel systems demonstrating early safety and efficacy. The objective of this study is to systematically review and synthesize the clinical outcomes of transcatheter heart valve systems.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and Cochrane databases was conducted from database inception through March 31, 2025. Eligible studies included adult patients undergoing TTVR for severe or torrential TR, reporting at least one clinical outcome. Pooled event rates were calculated using a random-effects model. Subgroup analyses were performed by valve type, and meta-regression explored potential sources of heterogeneity.</div></div><div><h3>Results</h3><div>Twenty studies comprising 1017 patients were included. The mean age was 73 ± 9 years, and 71.2% were female. The weighted in-hospital and 30-day mortality were 1.37 and 2.49%, respectively. New permanent pacemaker implantation occurred in 7.98%, with highest rates observed in EVOQUE recipients (11.64%). Only 3% of patients had greater than or equal to severe TR at follow-up, and only 12% remained in New York Heart Association functional class III/IV. Subgroup analysis revealed lower in-hospital and 30-day mortality with EVOQUE but higher permanent pacemaker implantation compared to other valves.</div></div><div><h3>Conclusions</h3><div>TTVR is a feasible and safe intervention for patients with severe TR, providing significant functional improvement and TR reduction. Robust, longer-term randomized controlled trials with standardized outcome reporting and clinical endpoints are urgently needed to define durable clinical benefit and guide optimal device selection for patients with severe TR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 11","pages":"Article 100721"},"PeriodicalIF":2.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325288","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 : 2025-08-05DOI: 10.1016/j.shj.2025.100710
Andreas Hain MD , Ben N. Schmermund MD , Steffen D. Kriechbaum MD , Claudia Unbehaun MD , Theresa Lampert MD , Samuel T. Sossalla MD , Tim Seidler MD, MHBA
The recent development and approval of a transcatheter tricuspid valve represent a significant breakthrough in the management of patients with tricuspid regurgitation who are not suitable for existing invasive or interventional therapies. Despite promising outcomes, pacemaker dependency is a common consequence of transcatheter tricuspid valve replacement (TTVR). In the pivotal TRISCEND II randomized trial, conduction disorders requiring pacemaker implantation were the most frequent major adverse event at 30 days. Managing bradycardia following valve implantation in the tricuspid position requires specialized knowledge and tailored approaches for both temporary and permanent pacing. This necessity is driven by the specific design features of the valves and the evolving choices of valve-sparing pacing strategies. Our aim is to summarize these unique challenges to support both heart team members and nonelectrophysiology health care professionals performing TTVR, as well as intensive care unit and bradycardia specialists who may be unfamiliar with the distinctive characteristics of TTVR. Bradycardia due to atrioventricular (AV) conduction delay, requiring new pacemaker implantation, affects approximately 1 in 4 patients receiving the bioprosthetic EVOQUE valve and is also common with other TTVR devices. This review summarizes current knowledge on TTVR-associated bradycardia and a management algorithm for both acute and long-term settings, highlighting specialized considerations for patients undergoing TTVR.
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