Structural Heart最新文献

英文中文

Role of Early Prothrombotic Evaluation in Device-Related Thrombus Risk Stratification After Left Atrial Appendage Closure 早期血栓形成前评估在左心耳关闭后器械相关血栓风险分层中的作用

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-05 DOI: 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.

背景左心房附件关闭术（LAAC）越来越多地用于预防非瓣膜性心房颤动和口服抗凝禁忌症患者的脑卒中。LAAC术后早期血栓前状态评估在评估器械相关血栓（DRT）风险中的潜在作用尚不清楚。方法纳入147例有口服抗凝禁忌症的LAAC患者。凝血激活标志物-凝血酶原片段1 + 2和凝血酶抗凝血酶iii -在基线和术后7天测量。根据delta（%）变化的第50个百分位数，将患者分为低或高血栓前状态。评估特定的δ %阈值，可以作为排除DRT的非侵入性截止值。结果53例（36.1%）患者被归为高血栓前状态。DRT发生在9例患者中（6.1%），其中高血栓原组的发生率明显更高（15.1比1.1%,p < 0.001）。多变量分析发现laac后凝血激活标志物升高是DRT的独立预测因子（校正优势比：13.84 [1.65-115.89],p = 0.015）。建议的凝血酶原片段1 + 2（74.11%）和凝血酶抗凝血酶III（120.74%）阈值为98.9%的阴性预测值。使用这些阈值，75.5%的患者被归为DRT低风险。在随访中，低风险和高风险DRT组之间没有观察到临床差异。结论早期评价凝血指标对LAAC术后DRT风险有重要意义。所提出的阈值具有很高的阴性预测值，可有效识别DRT风险低的患者，并支持将其作为非侵入性工具安全地排除DRT。这些标记物可以实现早期抗血栓降级，减少重复成像的需要。进一步的研究是必要的。

{"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}

引用次数: 0

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 经导管主动脉瓣置入术中严重主动脉狭窄患者心外膜脂肪组织增加与二尖瓣环钙化无关

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 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.

背景：二尖瓣环钙化（MAC）在老年人中很常见，且预后较差。假设MAC是一种不同形式的动脉粥样硬化。心外膜脂肪组织（EFT）与不同的心脏结构密切接触，在房室沟和房室瓣膜周围区域尤为明显。EFT的量与冠状动脉疾病的程度有关，包括斑块负荷和冠状动脉钙化。方法回顾性分析n = 543例（53.6%为女性）连续高级别主动脉瓣狭窄患者，在经导管主动脉瓣置入术前计算机断层扫描中评估EFT容量和MAC。比较无/轻度MAC和中度/重度MAC患者的EFT容量、基线、手术和术后特征。以MAC为因变量进行单变量和多变量回归分析。结果超过四分之一（n = 154, 28.4%）的患者有中度或重度MAC。中度/重度MAC患者与轻度或无MAC患者的EFT体积差异无统计学意义：130 (94-164)cm3 vs 133 (95-176) cm3；P = 0.704。因此，EFT容量不能预测MAC的增加。女性、房颤和是否植入过起搏器是中度/重度MAC的独立预测因素。结论EFT的增加不是MAC的预测因素，因此其不利的促炎特性似乎在MAC的发展中没有显著作用。

{"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}

引用次数: 0

Patent Foramen Ovale Closure in Older Patients With Cryptogenic Stroke: Current Evidence and Next Steps 老年隐源性卒中患者卵圆孔未闭：目前的证据和下一步

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 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.

中风是世界范围内发病率和死亡率的主要原因，其复发风险随着年龄的增长而增加。在60岁以上的隐源性卒中患者中，通过卵圆孔未闭的矛盾栓塞可能是一个重要的病理生理因素，特别是当存在高风险解剖特征（如大分流、房间隔动脉瘤）时。尽管卵圆孔未闭已成为年轻隐源性卒中患者的标准治疗方法，但由于证据有限，且需要排除房颤或颈动脉疾病等高度流行的其他原因，其在老年人中的益处仍不确定。一个多学科的心脑团队对于准确诊断、患者选择和共同决策至关重要。目前的指南各不相同，并强调需要在这一人群中获得更可靠的数据。最近的观察性研究表明，与单独抗血栓治疗相比，老年患者卵圆孔未闭闭合可能是安全的，并有可能减少卒中复发。正在进行的随机对照试验有望为该年龄组卵圆孔未闭闭合的有效性和安全性提供明确的证据，指导未来的临床决策。

{"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}

引用次数: 0

Coronary Cannulation Following Transcatheter Aortic Valve Replacement With Self-Expanding Evolut FX+ System: The CANNULATE TAVR II Study 自扩张Evolut FX+系统经导管主动脉瓣置换术后冠状动脉插管：插管TAVR II研究

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100483

Rafey Feroze MD , Marco Frazzetto MD , Lakshmi Prasad Dasi PhD , Taylor Becker BS , Luis Augusto Palma Dallan MD, PhD , Anene Ukaigwe MD , Steven J. Filby MD , Gregory Rushing MD , Guilherme F. Attizzani MD

引用次数: 0

Comparison of Experienced and Inexperienced Raters Using Automated Deep Learning Computed Tomography Analysis to Evaluate Tricuspid Valve and Right Heart Morphology 有经验和没有经验的评分者使用自动深度学习计算机断层扫描分析评估三尖瓣和右心形态的比较

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100488

Isabel Mattig MD , Maximilian Eichenberg MD , Elena Romero Dorta MD , Cheng-Ying Chiu MD , Nanike Bühring MD , Ann-Christine Stahl MD , Georg Böning MD , Lars-Arne Schaafs MD , Marc Dewey MD , Henryk Dreger MD

引用次数: 0

Atrial Shunting for Heart Failure 心房分流治疗心力衰竭

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 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.

尽管对心力衰竭（HF）有大量的药物治疗，但减轻晚期心力衰竭患者的症状负担仍然是一个未满足的临床需求。在过去的十年里，心房分流术已经成为一种治疗症状性心衰的新方法，尽管有最佳的指导药物治疗。最初被认为是为舒张性心衰患者保留的一种治疗方法，现在该领域涵盖了整个心衰频谱。在这篇综述中，我们探讨了形成心房分流领域的生理学、设备和试验。我们详细介绍了基于装置的房间分流、无植入物的房间分流和冠状动脉窦分流是如何在特定患者群体中提供临床益处的，以及它们使用的局限性。

引用次数: 0

Incomplete Left Atrial Appendage Closure: How to Address the (Knowledge) Gap? 不完全左心耳闭合：如何解决（知识）差距？

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100466

Yannick Willemen MD, PhD, Ole De Backer MD, PhD

引用次数: 0

Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR Procedures 提高经导管主动脉瓣置换术的效率：1000例TAVR手术的经验

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100467

Mohammed Quader MD , Neha Shah MPH , Rebecca Deitch BS , Barbara Lawson MD , Delia Endicott NP , Zachary Gertz MD

Background

Since Food and Drug Administration approval of transcatheter aortic valve replacement (TAVR) in 2011, advancements in technology and procedural refinements have improved efficiency and safety. By systematically eliminating steps in the original TAVR protocol, we achieved reductions in procedural time, contrast volume, and fluoroscopy time without compromising outcomes.

Methods

Institutional TAVR data (November 2012 to September 2023) were analyzed, focusing on procedural times, contrast volume, radiation exposure, and outcomes. Four protocol modifications were compared: traditional protocol (2012 to 2016), elimination of rotational angiogram (2017 to 2020), elimination of balloon valvuloplasty (2020 to 2022), and elimination of femoral angiogram (2022 to 2023).

Results

Among 1095 TAVR procedures, 88.5% were femoral access, and 86.0% were done under conscious sedation. The mean age of patients was 79.0 ± 8.7 years, with 59% males. Most patients were classified in the Society of Thoracic Surgeons intermediate-risk category (38.4%), followed by prohibitive risk (30.0%), high risk (23.9%), and low risk (7.4%). Average procedural time, contrast volume, and fluoroscopy time were 88.4 ± 38.0 minutes, 73.0 ± 38.8 mL, and 13.8 ± 7.9 minutes, respectively. Adverse events occurred in 15%, with vascular complications (3.7%) being the most common. Mortality was 1.5%, highest in transapical (15%) and lowest in femoral (0.3%). Protocol modifications were associated with significant reductions in procedural time (59.99 ± 15.2 vs. 97.8 ± 33.9 minutes), contrast use (40.1 ± 26.6 vs. 92.9 ± 38.1 mL), fluoroscopy time (8.6 ± 7.4 vs. 18.5 ± 8.5 minutes), and complications (5.5 vs. 25.6%), all p < 0.001.

Conclusions

Systematic elimination of procedural steps was associated with reduced procedural time, contrast use, and fluoroscopy time, without compromising patient safety. These refinements may enhance procedural efficiency and patient outcomes.

自2011年美国食品和药物管理局批准经导管主动脉瓣置换术（TAVR）以来，技术的进步和程序的改进提高了效率和安全性。通过系统地消除原始TAVR方案中的步骤，我们在不影响结果的情况下减少了手术时间、造影剂体积和透视时间。方法分析2012年11月至2023年9月的TAVR数据，重点分析手术时间、造影剂体积、辐射暴露和结果。比较了四种方案修改：传统方案（2012年至2016年）、取消旋转血管造影（2017年至2020年）、取消球囊瓣膜成形术（2020年至2022年）和取消股动脉血管造影（2022年至2023年）。结果1095例TAVR手术中，88.5%为股骨通路，86.0%为清醒镇静。患者平均年龄79.0±8.7岁，男性占59%。大多数患者被胸外科学会分类为中危（38.4%），其次是禁忌性（30.0%）、高风险（23.9%）和低危（7.4%）。平均手术时间、造影剂体积、透视时间分别为88.4±38.0 min、73.0±38.8 mL、13.8±7.9 min。不良事件发生率为15%，其中血管并发症（3.7%）最为常见。死亡率为1.5%，经根尖最高（15%），股骨最低（0.3%）。方案修改与手术时间（59.99±15.2 vs 97.8±33.9分钟）、造影剂使用（40.1±26.6 vs 92.9±38.1 mL）、透视时间（8.6±7.4 vs 18.5±8.5分钟）和并发症（5.5 vs 25.6%）的显著减少相关，均p <； 0.001。系统地取消手术步骤与减少手术时间、造影剂使用和透视时间相关，且不影响患者安全。这些改进可以提高手术效率和患者预后。

{"title":"Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR Procedures","authors":"Mohammed Quader MD , Neha Shah MPH , Rebecca Deitch BS , Barbara Lawson MD , Delia Endicott NP , Zachary Gertz MD","doi":"10.1016/j.shj.2025.100467","DOIUrl":"10.1016/j.shj.2025.100467","url":null,"abstract":"<div><h3>Background</h3><div>Since Food and Drug Administration approval of transcatheter aortic valve replacement (TAVR) in 2011, advancements in technology and procedural refinements have improved efficiency and safety. By systematically eliminating steps in the original TAVR protocol, we achieved reductions in procedural time, contrast volume, and fluoroscopy time without compromising outcomes.</div></div><div><h3>Methods</h3><div>Institutional TAVR data (November 2012 to September 2023) were analyzed, focusing on procedural times, contrast volume, radiation exposure, and outcomes. Four protocol modifications were compared: traditional protocol (2012 to 2016), elimination of rotational angiogram (2017 to 2020), elimination of balloon valvuloplasty (2020 to 2022), and elimination of femoral angiogram (2022 to 2023).</div></div><div><h3>Results</h3><div>Among 1095 TAVR procedures, 88.5% were femoral access, and 86.0% were done under conscious sedation. The mean age of patients was 79.0 ± 8.7 years, with 59% males. Most patients were classified in the Society of Thoracic Surgeons intermediate-risk category (38.4%), followed by prohibitive risk (30.0%), high risk (23.9%), and low risk (7.4%). Average procedural time, contrast volume, and fluoroscopy time were 88.4 ± 38.0 minutes, 73.0 ± 38.8 mL, and 13.8 ± 7.9 minutes, respectively. Adverse events occurred in 15%, with vascular complications (3.7%) being the most common. Mortality was 1.5%, highest in transapical (15%) and lowest in femoral (0.3%). Protocol modifications were associated with significant reductions in procedural time (59.99 ± 15.2 vs. 97.8 ± 33.9 minutes), contrast use (40.1 ± 26.6 vs. 92.9 ± 38.1 mL), fluoroscopy time (8.6 ± 7.4 vs. 18.5 ± 8.5 minutes), and complications (5.5 vs. 25.6%), all <em>p</em> < 0.001.</div></div><div><h3>Conclusions</h3><div>Systematic elimination of procedural steps was associated with reduced procedural time, contrast use, and fluoroscopy time, without compromising patient safety. These refinements may enhance procedural efficiency and patient outcomes.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100467"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878865","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}

引用次数: 0

Feasibility, Efficacy, and Safety of the Mitral Annulo-TRIpsy in eXtreme Risk Patients 二尖瓣环治疗极端危险患者的可行性、有效性和安全性

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100683

Gennaro Giustino MD , Chantal Y. Asselin MSc, MD , Mostafa Naguib MD , Ahmad Jabri MD , Leo Kar Lok Lai MD , Robert Kipperman MD , Kostantinos P. Koulogiannis MD , Leo Marcoff MD , Amr Abbas MD , Pedro Villablanca MD , Philippe Généreux MD

Background

Severe calcific mitral stenosis is common and therapeutically challenging. Intravascular lithotripsy (IVL) can facilitate percutaneous balloon mitral valvuloplasty in patients not amenable to conventional therapies. We describe a modified technique using larger IVL balloons to ensure maximal annular contact and delivery of ultrasonic shockwaves to restore mitral leaflet pliability and reduce transvalvular gradients without the need for noncompliant valvuloplasty balloons.

Methods

Seven patients underwent the Mitral Annulo-TRIpsy in eXtreme risk patients (MATRIX) procedure at 3 tertiary structural heart disease centers in the United States. Transcatheter mitral valve replacement was contraindicated due to prohibitive risk of left ventricular outflow tract obstruction or insufficient annular calcification for anchoring of a balloon-expandable valve. IVL balloons were delivered using a large-bore transseptal sheath over three 0.014 wires. Runs of delivery of IVL therapy were repeated until satisfactory results in terms of mean mitral gradient (mMG) reduction were achieved.

Results

Median age was 78 years, and 14.3% were female. All patients presented with progressive New York Heart Association class III-IV symptoms and functional limitations. Pre-MATRIX mMG was 9.0 mmHg. The final mMG was 3.0 mmHg (absolute difference 6.3 mmHg; 95% CI 2.6-10.1 mmHg; p <0.01). No conventional valvuloplasty balloons were used after IVL. All patients successfully underwent MATRIX. No major periprocedural complications were observed including death, stroke, major bleeding, or reintervention. No patients experienced worsening mitral regurgitation. All patients were discharged alive.

Conclusions

This small multicenter series demonstrates that IVL of calcified mitral stenosis using the MATRIX technique is feasible and safe and associated with effective reductions in mMG.

背景：严重的钙化性二尖瓣狭窄是常见的，治疗上具有挑战性。血管内碎石术（IVL）可以促进经皮球囊二尖瓣成形术患者不适合常规治疗。我们描述了一种改进的技术，使用更大的IVL球囊来确保最大的环接触和超声冲击波的传递，以恢复二尖瓣小叶的柔韧性和减少跨瓣梯度，而不需要不符合的瓣膜成形术球囊。方法在美国3个三级结构性心脏病中心，7例患者接受了极端危险患者（MATRIX）二尖瓣环术。经导管二尖瓣置换术是禁忌的，因为左心室流出道梗阻或球囊膨胀性瓣膜锚定不充分的环形钙化。IVL气球通过三根0.014金属丝通过大口径跨隔膜鞘输送。IVL治疗反复进行，直到在平均二尖瓣梯度（mMG）降低方面取得满意的结果。结果中位年龄为78岁，女性占14.3%。所有患者均表现为进行性纽约心脏协会III-IV级症状和功能限制。Pre-MATRIX mMG为9.0 mmHg。最终mMG为3.0 mmHg（绝对差6.3 mmHg; 95% CI 2.6-10.1 mmHg; p <0.01）。IVL后未使用常规瓣膜成形术球囊。所有患者均成功接受MATRIX治疗。未观察到重大围手术期并发症，包括死亡、卒中、大出血或再干预。没有患者出现二尖瓣返流恶化。所有患者出院时均存活。结论这个小的多中心研究表明，使用MATRIX技术进行钙化二尖瓣狭窄的IVL是可行和安全的，并且与mMG的有效降低有关。

{"title":"Feasibility, Efficacy, and Safety of the Mitral Annulo-TRIpsy in eXtreme Risk Patients","authors":"Gennaro Giustino MD , Chantal Y. Asselin MSc, MD , Mostafa Naguib MD , Ahmad Jabri MD , Leo Kar Lok Lai MD , Robert Kipperman MD , Kostantinos P. Koulogiannis MD , Leo Marcoff MD , Amr Abbas MD , Pedro Villablanca MD , Philippe Généreux MD","doi":"10.1016/j.shj.2025.100683","DOIUrl":"10.1016/j.shj.2025.100683","url":null,"abstract":"<div><h3>Background</h3><div>Severe calcific mitral stenosis is common and therapeutically challenging. Intravascular lithotripsy (IVL) can facilitate percutaneous balloon mitral valvuloplasty in patients not amenable to conventional therapies. We describe a modified technique using larger IVL balloons to ensure maximal annular contact and delivery of ultrasonic shockwaves to restore mitral leaflet pliability and reduce transvalvular gradients without the need for noncompliant valvuloplasty balloons.</div></div><div><h3>Methods</h3><div>Seven patients underwent the Mitral Annulo-TRIpsy in eXtreme risk patients (MATRIX) procedure at 3 tertiary structural heart disease centers in the United States. Transcatheter mitral valve replacement was contraindicated due to prohibitive risk of left ventricular outflow tract obstruction or insufficient annular calcification for anchoring of a balloon-expandable valve. IVL balloons were delivered using a large-bore transseptal sheath over three 0.014 wires. Runs of delivery of IVL therapy were repeated until satisfactory results in terms of mean mitral gradient (mMG) reduction were achieved.</div></div><div><h3>Results</h3><div>Median age was 78 years, and 14.3% were female. All patients presented with progressive New York Heart Association class III-IV symptoms and functional limitations. Pre-MATRIX mMG was 9.0 mmHg. The final mMG was 3.0 mmHg (absolute difference 6.3 mmHg; 95% CI 2.6-10.1 mmHg; <em>p</em> <0.01). No conventional valvuloplasty balloons were used after IVL. All patients successfully underwent MATRIX. No major periprocedural complications were observed including death, stroke, major bleeding, or reintervention. No patients experienced worsening mitral regurgitation. All patients were discharged alive.</div></div><div><h3>Conclusions</h3><div>This small multicenter series demonstrates that IVL of calcified mitral stenosis using the MATRIX technique is feasible and safe and associated with effective reductions in mMG.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100683"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878841","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}

引用次数: 0

Intravascular Lithotripsy in Mitral Annulus Calcification-Related Mitral Stenosis: Hope or Hype? 血管内碎石治疗二尖瓣钙化相关狭窄：希望还是炒作？

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100703

Marina Urena MD, PhD

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Structural Heart

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀