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.
{"title":"Managing Bradycardia in Patients After Transcatheter Tricuspid Valve Replacement","authors":"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","doi":"10.1016/j.shj.2025.100710","DOIUrl":"10.1016/j.shj.2025.100710","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100710"},"PeriodicalIF":2.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107134","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.2025.100720
Pedro Cepas-Guillén MD, PhD , Mathieu Robichaud MS , Gilles O`Hara MD, Jean-Michel Paradis MD, Jean Champagne MD, Hugo Delarochelliere MD, Erwan Salaun MD, Pierre-Olivier Sirois MS, Melanie Coté MSc, Josep Rodés-Cabau MD, PhD
Background
Left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation and contraindications to oral anticoagulation. The potential role of early prothrombotic status assessment in evaluating device-related thrombus (DRT) risk following LAAC remains unclear.
Methods
The study included 147 patients undergoing LAAC with oral anticoagulation contraindication. Coagulation activation markers—prothrombin fragment 1 + 2 and thrombin antithrombin III—were measured at baseline and 7 days postprocedure. Based on the 50th percentile of delta (%) changes, patients were classified into low or high prothrombotic status. Specific delta % thresholds were assessed, which could serve as noninvasive cutoffs to rule out DRT.
Results
A total of 53 patients (36.1%) were classified as having high prothrombotic status. DRT occurred in 9 patients (6.1%), with a significantly higher incidence in the high prothrombotic group (15.1 vs. 1.1%, p < 0.001). Multivariable analysis identified elevated post-LAAC coagulation activation markers as independent predictors of DRT (adjusted odds ratio: 13.84 [1.65-115.89], p = 0.015). Proposed thresholds for prothrombin fragment 1 + 2 (74.11%) and thrombin antithrombin III (120.74%) demonstrated negative predictive values of 98.9%. Using these thresholds, 75.5% of patients were classified as low risk for DRT. No clinical differences were observed at follow-up between the low- and high-risk DRT groups.
Conclusions
Early evaluation of coagulation markers provides valuable insight into DRT risk after LAAC. The proposed thresholds demonstrate a high negative predictive value, effectively identifying patients at low risk for DRT and supporting their use as noninvasive tools to safely rule out DRT. These markers could enable early antithrombotic de-escalation and reduce the need for repeat imaging. Further studies are warranted.
{"title":"Role of Early Prothrombotic Evaluation in Device-Related Thrombus Risk Stratification After Left Atrial Appendage Closure","authors":"Pedro Cepas-Guillén MD, PhD , Mathieu Robichaud MS , Gilles O`Hara MD, Jean-Michel Paradis MD, Jean Champagne MD, Hugo Delarochelliere MD, Erwan Salaun MD, Pierre-Olivier Sirois MS, Melanie Coté MSc, Josep Rodés-Cabau MD, PhD","doi":"10.1016/j.shj.2025.100720","DOIUrl":"10.1016/j.shj.2025.100720","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation and contraindications to oral anticoagulation. The potential role of early prothrombotic status assessment in evaluating device-related thrombus (DRT) risk following LAAC remains unclear.</div></div><div><h3>Methods</h3><div>The study included 147 patients undergoing LAAC with oral anticoagulation contraindication. Coagulation activation markers—prothrombin fragment 1 + 2 and thrombin antithrombin III—were measured at baseline and 7 days postprocedure. Based on the 50th percentile of delta (%) changes, patients were classified into low or high prothrombotic status. Specific delta % thresholds were assessed, which could serve as noninvasive cutoffs to rule out DRT.</div></div><div><h3>Results</h3><div>A total of 53 patients (36.1%) were classified as having high prothrombotic status. DRT occurred in 9 patients (6.1%), with a significantly higher incidence in the high prothrombotic group (15.1 vs. 1.1%, <em>p</em> < 0.001). Multivariable analysis identified elevated post-LAAC coagulation activation markers as independent predictors of DRT (adjusted odds ratio: 13.84 [1.65-115.89], <em>p</em> = 0.015). Proposed thresholds for prothrombin fragment 1 + 2 (74.11%) and thrombin antithrombin III (120.74%) demonstrated negative predictive values of 98.9%. Using these thresholds, 75.5% of patients were classified as low risk for DRT. No clinical differences were observed at follow-up between the low- and high-risk DRT groups.</div></div><div><h3>Conclusions</h3><div>Early evaluation of coagulation markers provides valuable insight into DRT risk after LAAC. The proposed thresholds demonstrate a high negative predictive value, effectively identifying patients at low risk for DRT and supporting their use as noninvasive tools to safely rule out DRT. These markers could enable early antithrombotic de-escalation and reduce the need for repeat imaging. Further studies are warranted.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100720"},"PeriodicalIF":2.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158983","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 : 2025-08-01DOI: 10.1016/j.shj.2025.100422
Maren Weferling MD , Julia Treiber MD , Christoph Liebetrau MD , Andreas Rolf MD , Yeong-Hoon Choi MD , Efstratios I. Charitos MD , Damini Dey PhD , Samuel Sossalla MD , Won-Keun Kim MD
Background
Mitral annular calcification (MAC) is a common finding in the elderly that is associated with worse outcomes. It is postulated that MAC is a different form of atherosclerosis. Epicardial fat tissue (EFT) is in close contact with different heart structures and is especially pronounced in the atrioventricular grooves and the area surrounding the atrioventricular valve apparatus. The amount of EFT is associated with the extent of coronary artery disease, including plaque burden and coronary calcification. The aim of this study was to investigate whether EFT is also associated with the extent of MAC.
Methods
In this retrospective analysis of n = 543 (53.6% female) consecutive patients with high-grade aortic stenosis, EFT volume and MAC were assessed in the pre-transcatheter aortic valve implantation computed tomography scans. Patients with no/mild MAC and moderate/severe MAC were compared in terms of EFT volume and baseline, procedural, and postprocedural characteristics. Univariate and multivariable regression analyses were performed with MAC as dependent variable.
Results
Over one-quarter (n = 154; 28.4%) of the patients had moderate or severe MAC. The EFT volume between those with moderate/severe MAC and those with little or no MAC did not differ significantly: 130 (interquartile range 94-164) cm3 vs. 133 (interquartile range 95-176) cm3; p = 0.704. Accordingly, EFT volume did not predict increased MAC. Female sex, atrial fibrillation, and prior pacemaker implantation were independent predictors of moderate/severe MAC.
Conclusions
Increased EFT is not a predictor of MAC, and thus its unfavorable proinflammatory properties do not seem to play a significant role in the development of MAC.
{"title":"Increased Amounts of Epicardial Fat Tissue Are Not Associated With Mitral Annular Calcification in Patients With Severe Aortic Stenosis Planned for Transcatheter Aortic Valve Implantation","authors":"Maren Weferling MD , Julia Treiber MD , Christoph Liebetrau MD , Andreas Rolf MD , Yeong-Hoon Choi MD , Efstratios I. Charitos MD , Damini Dey PhD , Samuel Sossalla MD , Won-Keun Kim MD","doi":"10.1016/j.shj.2025.100422","DOIUrl":"10.1016/j.shj.2025.100422","url":null,"abstract":"<div><h3>Background</h3><div>Mitral annular calcification (MAC) is a common finding in the elderly that is associated with worse outcomes. It is postulated that MAC is a different form of atherosclerosis. Epicardial fat tissue (EFT) is in close contact with different heart structures and is especially pronounced in the atrioventricular grooves and the area surrounding the atrioventricular valve apparatus. The amount of EFT is associated with the extent of coronary artery disease, including plaque burden and coronary calcification. The aim of this study was to investigate whether EFT is also associated with the extent of MAC.</div></div><div><h3>Methods</h3><div>In this retrospective analysis of n = 543 (53.6% female) consecutive patients with high-grade aortic stenosis, EFT volume and MAC were assessed in the pre-transcatheter aortic valve implantation computed tomography scans. Patients with no/mild MAC and moderate/severe MAC were compared in terms of EFT volume and baseline, procedural, and postprocedural characteristics. Univariate and multivariable regression analyses were performed with MAC as dependent variable.</div></div><div><h3>Results</h3><div>Over one-quarter (n = 154; 28.4%) of the patients had moderate or severe MAC. The EFT volume between those with moderate/severe MAC and those with little or no MAC did not differ significantly: 130 (interquartile range 94-164) cm<sup>3</sup> vs. 133 (interquartile range 95-176) cm<sup>3</sup>; <em>p</em> = 0.704. Accordingly, EFT volume did not predict increased MAC. Female sex, atrial fibrillation, and prior pacemaker implantation were independent predictors of moderate/severe MAC.</div></div><div><h3>Conclusions</h3><div>Increased EFT is not a predictor of MAC, and thus its unfavorable proinflammatory properties do not seem to play a significant role in the development of MAC.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100422"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878125","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 : 2025-08-01DOI: 10.1016/j.shj.2025.100699
Pablo Vidal-Calés MD , Laura Llull MD , Sylvain Lanthier MD , Juan H. del Portillo MD , Laurent Desjardins MD , Christine Houde MD , Pierre-Olivier Sirois , Xavier Freixa MD, PhD , Ángel Chamorro MD, PhD , Josep Rodés-Cabau MD, PhD
Stroke is a major cause of morbidity and mortality worldwide, with recurrence risk increasing with age. In patients over 60 years of age with cryptogenic stroke, paradoxical embolism through a patent foramen ovale may be an important pathophysiology contributor, particularly when high-risk anatomical features (e.g., large shunt, atrial septal aneurysm) are present. Although patent foramen ovale closure has become a standard therapy in younger cryptogenic stroke patients, its benefit in older adults remains uncertain due to limited evidence and the need to exclude highly prevalent alternative causes like atrial fibrillation or carotid disease. A multidisciplinary heart-brain team is critical for accurate diagnosis, patient selection, and shared decision-making. Current guidelines vary and highlight the need for more robust data in this population. Recent observational studies suggest that patent foramen ovale closure in older patients may be safe and potentially reduce stroke recurrence compared to antithrombotic therapy alone. Ongoing randomized controlled trials are expected to provide definitive evidence on the efficacy and safety of patent foramen ovale closure in this age group, guiding future clinical decisions.
{"title":"Patent Foramen Ovale Closure in Older Patients With Cryptogenic Stroke: Current Evidence and Next Steps","authors":"Pablo Vidal-Calés MD , Laura Llull MD , Sylvain Lanthier MD , Juan H. del Portillo MD , Laurent Desjardins MD , Christine Houde MD , Pierre-Olivier Sirois , Xavier Freixa MD, PhD , Ángel Chamorro MD, PhD , Josep Rodés-Cabau MD, PhD","doi":"10.1016/j.shj.2025.100699","DOIUrl":"10.1016/j.shj.2025.100699","url":null,"abstract":"<div><div>Stroke is a major cause of morbidity and mortality worldwide, with recurrence risk increasing with age. In patients over 60 years of age with cryptogenic stroke, paradoxical embolism through a patent foramen ovale may be an important pathophysiology contributor, particularly when high-risk anatomical features (e.g., large shunt, atrial septal aneurysm) are present. Although patent foramen ovale closure has become a standard therapy in younger cryptogenic stroke patients, its benefit in older adults remains uncertain due to limited evidence and the need to exclude highly prevalent alternative causes like atrial fibrillation or carotid disease. A multidisciplinary heart-brain team is critical for accurate diagnosis, patient selection, and shared decision-making. Current guidelines vary and highlight the need for more robust data in this population. Recent observational studies suggest that patent foramen ovale closure in older patients may be safe and potentially reduce stroke recurrence compared to antithrombotic therapy alone. Ongoing randomized controlled trials are expected to provide definitive evidence on the efficacy and safety of patent foramen ovale closure in this age group, guiding future clinical decisions.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100699"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878868","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 : 2025-08-01DOI: 10.1016/j.shj.2025.100704
Alexander M. Spring MD , Andrea Scotti MD , Julio Echarte-Morales MD , Matteo Sturla MD , Manaf Assafin MD , Guillaume Bonnet MD , Lorenzo D’Angelo MD , Juan Torrado MD , Sandhya Murthy MD , Juan F. Granada MD , Edwin Ho MD , Leandro Slipczuk MD, PhD , Ulrich P. Jorde MD , Jozef Bartunek MD, PhD , Azeem Latib MD
Despite a plethora of pharmacological therapies for heart failure (HF), reducing the symptomatic burden in patients with advanced HF remains an unmet clinical need. Over the past decade, atrial shunting has emerged as a novel therapy for those with symptomatic HF despite optimal guideline-directed medical therapy. Initially thought of as a therapy reserved for those with diastolic HF, the field now spans the entire HF spectrum. In this review, we explore the physiology, devices, and trials that have shaped the field of atrial shunting. We detail how device-based interatrial shunts, no-implant interatrial shunts, and coronary sinus shunts aim to provide clinical benefit in specific patient populations and the limitations associated with their use.
{"title":"Atrial Shunting for Heart Failure","authors":"Alexander M. Spring MD , Andrea Scotti MD , Julio Echarte-Morales MD , Matteo Sturla MD , Manaf Assafin MD , Guillaume Bonnet MD , Lorenzo D’Angelo MD , Juan Torrado MD , Sandhya Murthy MD , Juan F. Granada MD , Edwin Ho MD , Leandro Slipczuk MD, PhD , Ulrich P. Jorde MD , Jozef Bartunek MD, PhD , Azeem Latib MD","doi":"10.1016/j.shj.2025.100704","DOIUrl":"10.1016/j.shj.2025.100704","url":null,"abstract":"<div><div>Despite a plethora of pharmacological therapies for heart failure (HF), reducing the symptomatic burden in patients with advanced HF remains an unmet clinical need. Over the past decade, atrial shunting has emerged as a novel therapy for those with symptomatic HF despite optimal guideline-directed medical therapy. Initially thought of as a therapy reserved for those with diastolic HF, the field now spans the entire HF spectrum. In this review, we explore the physiology, devices, and trials that have shaped the field of atrial shunting. We detail how device-based interatrial shunts, no-implant interatrial shunts, and coronary sinus shunts aim to provide clinical benefit in specific patient populations and the limitations associated with their use.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100704"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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