Structural Heart最新文献_第8页

Aims & Scope 目标及范围

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/S2474-8706(25)00305-7

引用次数: 0

Outcomes of Patients With a Small and Large Aortic Annulus Following Balloon-Expandable Transcatheter Aortic Valve Replacement Across Flow-Gradient Patterns 经导管球囊扩张主动脉瓣置换术后小主动脉环和大主动脉环患者血流梯度模式的结果

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100456

Besir Besir MD , Shivabalan Kathavarayan Ramu MD , Tamari Lomaia MD , Maryam Muhammad Ali Majeed-Saidan MD , Judah Rajendran MD , Issam Motairek MD , Serge C. Harb MD , Rhonda Miyasaka MD , Grant W. Reed MD , Rishi Puri MD , James J.Y. Yun MD , Amar Krishnaswamy MD , Samir R. Kapadia MD

Background

Patients with small annuli are at risk for worse hemodynamic performance after transcatheter aortic valve replacement (TAVR). It is debatable whether a small annulus confers worse outcomes. This study explored the clinical outcomes following TAVR for patients with small and large annuli across flow-gradient subgroups of aortic stenosis (AS).

Methods

This is a retrospective cohort of patients >18 years who underwent TAVR at Cleveland Clinic between 2016 and 2020. Patients were classified into 2 groups according to annular size: small (area ≤430 mm²) and large (area >430 mm²). Patients undergoing TAVR with self-expanding valves and those with annular sizing using transesophageal echocardiography were excluded. Each group was subclassified into classical low-flow low-gradient (LFLG) AS, paradoxical LFLG AS, normal-flow low-gradient AS, and high-gradient AS. Clinical outcomes included mortality and heart failure rehospitalization.

Results

The study included 1866 patients, of which 709 (38%) had small annuli. There was no difference in heart failure rehospitalization and mortality between the groups in any of the 4 flow-gradient patterns: hazard ratio (HR) = 0.93 (95% confidence interval [CI]: 0.51-1.69) for patients with classical LFLG AS, HR = 0.95, CI (0.62-1.47) for patients with paradoxical LFLG AS, HR = 1.16, CI (0.49-2.74) for patients with normal-flow low-gradient AS, and HR = 0.73, CI (0.50-1.07) for patients with high-gradient AS, using large annulus as a reference. Patients with small annuli had higher mean gradients, lower dimensionless valve index, and a higher incidence of hypoattenuated leaflet thickening and structural valve deterioration post-TAVR.

Conclusions

Patients with small and large annuli have similar intermediate-term clinical outcomes post-TAVR across all flow-gradient patterns treated with balloon-expandable valve.

背景：小环空患者在经导管主动脉瓣置换术（TAVR）后血流动力学表现更差的风险。小环是否会带来更糟糕的结果尚存争议。本研究探讨了主动脉狭窄（AS）小环和大环患者经血流梯度亚组TAVR后的临床结果。方法：这是一项回顾性队列研究，纳入了2016年至2020年在克利夫兰诊所接受TAVR治疗的18岁患者。根据环的大小将患者分为小组（面积≤430 mm2）和大组（面积>；430 mm2）。排除了经食管超声心动图显示瓣膜自扩张的TAVR患者和经食管超声心动图显示瓣膜环形缩小的患者。每组又分为经典低流量低梯度AS、矛盾低流量低梯度AS、正常流量低梯度AS和高梯度AS。临床结果包括死亡率和心力衰竭再住院。结果纳入1866例患者，其中小环空709例（38%）。在4种血流梯度模式下，两组心力衰竭再住院和死亡率均无差异：经典LFLG AS患者的风险比(HR) = 0.93(95%可信区间[CI]: 0.51-1.69)，矛盾LFLG AS患者的风险比(HR) = 0.95， CI(0.62-1.47)，正常血流低梯度AS患者的风险比(HR) = 1.16， CI(0.49-2.74)，高梯度AS患者的风险比(HR) = 0.73， CI(0.50-1.07)，以大环为参考。环空较小的患者tavr后平均梯度较高，无量纲瓣膜指数较低，低减薄小叶增厚和瓣膜结构恶化的发生率较高。结论小环空和大环空的tavr患者在所有血流梯度模式下均具有相似的中期临床结果。

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引用次数: 0

Postoperative Transesophageal Echocardiographic Evaluation of Surgical Left Atrial Appendage Exclusion: Characterization and Predictors of Success 术后经食管超声心动图评价手术左心耳排除：特征和成功的预测因素

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100469

Karl M. Richardson MD , Karanpreet K. Dhaliwal MD , Sebastian S. Hernandez BS , Rohesh J. Fernando MD , Matthew J. Singleton MS, MD , Prashant D. Bhave MS, MD

Background

Mounting evidence suggests surgical left atrial appendage (LAA) exclusion reduces stroke risk in patients with atrial fibrillation. Prior older research suggests that LAA exclusion is often incomplete, but few transesophageal echocardiogram (TEE) data exist evaluating LAA remnants.

Methods

We analyzed 121 patients with an available postoperative TEE who underwent LAA exclusion by surgical excision (SE), AtriClip occlusion (AO), or Tiger Paw occlusion (TO). TEE images were assessed for LAA remnant depths, presence of flow into remnant, and visible suture, thrombus, or pectinate. Successful LAA exclusion was defined as a remnant with depth past LAA ostium <1 cm in all available imaging angles.

Results

Left atrial appendage exclusion was successful in 99/121 (82%) patients. Success varied numerically but not statistically by technique; 73/85 (86%), 22/29 (76%), 4/7 (57%) in the SE, AO, and TO groups, respectively. SE group had similar mean and max (cm) remnant depths (0.56 ± 0.32 and 0.65 ± 0.38) compared to the AO group (0.68 ± 0.38 and 0.81 ± 0.49) and TO group (0.69 ± 0.30 and 0.83 ± 0.40). Flow into LAA remnant was seen in 4.4% (SE), 15.0% (AO), and 20.0% (TO). Residual pectinate was seen in 18.8% (SE), 13.8% (AO), and 14.3% (TO); 8% in SE group had visible suture. Thrombus was seen in 2 cases within the SE group. In multivariable models, diabetes and heart failure predicted max LAA depth.

Conclusions

Postoperative TEE examination of LAA remnants revealed a relatively high failure rate by current standards. More data are needed to evaluate the clinical relevance of LAA remnant characteristics.

背景：越来越多的证据表明，手术左心房附件（LAA）排除可降低房颤患者的卒中风险。先前较早的研究表明LAA排除通常是不完整的，但很少有经食管超声心动图（TEE）数据存在评估LAA残余。方法我们分析了121例可用的术后TEE患者，这些患者通过手术切除（SE）、唇裂闭塞（AO）或虎爪闭塞（TO）来排除LAA。TEE图像评估LAA残留深度、残留血流、可见缝合线、血栓或果胶。LAA排除成功定义为在所有可用成像角度深度超过LAA开口1 cm的残余。结果左心耳排除成功率为99/121（82%）。成功率在数字上有所不同，但在统计上与技术无关；SE、AO、TO组分别为73/85（86%）、22/29（76%）、4/7（57%）。与AO组（0.68±0.38和0.81±0.49）和to组（0.69±0.30和0.83±0.40）相比，SE组的平均和最大（cm）残余深度（0.56±0.32和0.65±0.38）相近。LAA残余血流率分别为4.4% （SE）、15.0% （AO）和20.0% （TO）。果胶残留率分别为18.8% （SE）、13.8% （AO）和14.3% (TO)；SE组8%可见缝线。SE组2例出现血栓。在多变量模型中，糖尿病和心力衰竭预测最大LAA深度。结论手术后TEE检查LAA残体按现行标准失败率较高。需要更多的数据来评估LAA残余特征的临床相关性。

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引用次数: 0

Trends in Isolated and Combined Aortic Valve Replacement for Severe Aortic Stenosis in Patients Younger Than 65 Years 年龄小于65岁的严重主动脉瓣狭窄患者单独和联合主动脉瓣置换术的趋势

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100684

Tanush Gupta MD , James T. DeVries MD , Hsiang-Ching Huang MS , Cathy S. Ross MS , David Butzel MD , James M. Flynn MD , Michael N. Young MD , Rony N. Lahoud MD , Frank Ittleman MD , Ansar Hassan MD , Harold L. Dauerman MD

Background

Recent data demonstrate near equalization in the use of transcatheter aortic valve replacement (TAVR) and isolated bioprosthetic surgical aortic valve replacement (SAVR) in patients aged <65 years for treatment of isolated aortic stenosis (AS). Whether these trends are also seen across the entire spectrum of aortic valve replacement (AVR) procedures (including mechanical SAVR and concomitant procedures) is unknown.

Methods

This retrospective study included patients aged <65 years who underwent AVR for severe AS in the multicenter Northern New England Cardiovascular Disease Group registry between 2015 and 2023. Patients were stratified by approach: TAVR, isolated SAVR, and combined SAVR (SAVR with concomitant procedures).

Results

Of 1254 patients younger than 65 years who underwent AVR, 21.9% underwent TAVR, 39.7% underwent isolated SAVR, and 38.4% underwent combined SAVR. TAVR utilization more than doubled during the study period, with near equalization of TAVR and isolated bioprosthetic SAVR (28.3% and 30.8% of all AVR in 2021-2023, respectively). However, when including mechanical AVR and combined SAVR, TAVR only comprised approximately one-fourth of all AVR procedures. TAVR patients had a significantly higher burden of comorbidities compared with patients receiving isolated or combined SAVR.

Conclusions

In this multicenter study, there is a consistent increase in TAVR use in patients <65 years old with preferential TAVR utilization in patients with higher comorbidities and risk. While approximately 50% of younger patients with isolated AS are receiving TAVR in recent study years, the overall utilization of TAVR in the broader group of patients with both isolated and combined AS remains approximately 25% of the overall AVR cohort.

背景：最近的数据显示，在65岁的孤立性主动脉瓣狭窄（AS）患者中，经导管主动脉瓣置换术（TAVR）和孤立性生物假体外科主动脉瓣置换术（SAVR）的使用几乎相等。这些趋势是否也在主动脉瓣置换术（AVR）手术（包括机械SAVR和伴随手术）的整个范围内出现尚不清楚。方法：本回顾性研究纳入了2015年至2023年在新英格兰北部多中心心血管疾病组登记的65岁因严重AS接受AVR的患者。患者按方法进行分层：TAVR、孤立SAVR和联合SAVR （SAVR伴行手术）。结果1254例年龄小于65岁的AVR患者中，21.9%为TAVR， 39.7%为单独SAVR， 38.4%为联合SAVR。在研究期间，TAVR的利用率增加了一倍以上，TAVR和分离的生物假体SAVR几乎相等（分别占2021-2023年所有AVR的28.3%和30.8%）。然而，当包括机械AVR和联合SAVR时，TAVR仅占所有AVR手术的约四分之一。与接受单独或联合SAVR的患者相比，TAVR患者的合并症负担明显更高。结论在这项多中心研究中，65岁以上患者TAVR的使用持续增加，并且在合并症和风险较高的患者中优先使用TAVR。在最近的研究中，大约50%的年轻孤立性AS患者正在接受TAVR治疗，而在更广泛的孤立性和合并性AS患者群体中，TAVR的总体利用率仍约占整个AVR队列的25%。

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引用次数: 0

Outcomes After Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries: The Impact of Frailty and Social Vulnerability 医疗保险受益人经导管主动脉瓣置换术后的结果：虚弱和社会脆弱性的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-08-01 DOI: 10.1016/j.shj.2025.100685

Gregory P. Fontana MD , Harun Kundi MD, MMSc , Steven V. Manoukian MD , Bruce Bowers MD , Todd M. Dewey MD , Charles T. Klodell MD , V. Seenu Reddy MD , John A. Riddick MD , Jorge A. Alvarez MD , Michael S. Chenier MD , Mark A. Groh MD , Marcos A. Nores MD , Pranav Loyalka MD , Francis J. Zidar MD , Julia B. Thompson MS , Maria C. Alu MS , David J. Cohen MD, MSc , Juan F. Granada MD , Martin B. Leon MD , Jeffrey J. Popma MD , Saibal Kar MD

Background

Transcatheter aortic valve replacement (TAVR) is an accepted alternative to surgery in many patients with severe aortic stenosis. Clinical trials have evaluated early and late outcomes in selected TAVR patients, but predictors of late mortality have been less well studied in a broadly inclusive, national patient cohort undergoing TAVR. We sought to characterize 5-year outcomes after TAVR in Medicare beneficiaries and to evaluate the incremental predictive value of demographics, comorbidities, procedural factors, frailty, and social vulnerability in determining late mortality risk.

Methods

We studied the fee-for-service Centers for Medicare & Medicaid Services MedPAR database that includes patients aged ≥65 years undergoing TAVR between 2017 and 2022. The primary endpoint was 5-year mortality. Sequential multivariable Cox models were constructed, incrementally adjusting for demographics, comorbidities, procedural and hospital characteristics, and frailty and social vulnerability. Model performance was assessed using C-statistics and integrated discrimination improvement (IDI).

Results

A total of 371,248 TAVR patients were included in the analysis. The baseline model, including only demographic factors (age, sex, and race), yielded modest model performance (C = 0.589). Inclusion of comorbidities improved the model discrimination substantially (C = 0.684; IDI +6.9%, p < 0.001), and adding hospital and procedural characteristics yielded additional gains (C = 0.695; IDI +0.9%, p < 0.001). The final model integrated frailty and social vulnerability and achieved the highest predictive accuracy (C = 0.705; IDI +1.0%, p < 0.001).

Conclusions

In this large national cohort, frailty and social vulnerability significantly improved risk prediction for long-term mortality after TAVR. We conclude that sociodemographic and frailty-related factors are important components for prediction of 5-year mortality after TAVR.

背景：经导管主动脉瓣置换术（TAVR）是许多严重主动脉瓣狭窄患者接受的手术替代方法。临床试验已经评估了选定TAVR患者的早期和晚期结局，但在广泛包容的全国TAVR患者队列中，晚期死亡率的预测因素尚未得到很好的研究。我们试图描述医疗保险受益人TAVR后的5年预后，并评估人口统计学、合并症、程序因素、虚弱和社会脆弱性在确定晚期死亡风险方面的增量预测价值。方法我们研究了医疗保险和医疗补助服务收费中心MedPAR数据库，该数据库包括2017年至2022年期间接受TAVR的年龄≥65岁的患者。主要终点为5年死亡率。构建序列多变量Cox模型，逐步调整人口统计学、合并症、手术和医院特征、虚弱和社会脆弱性。采用c统计和综合判别改进（IDI）对模型性能进行评估。结果共纳入TAVR患者371248例。仅包括人口统计学因素（年龄、性别和种族）的基线模型产生了适度的模型性能（C = 0.589）。纳入合并症大大提高了模型的辨别性（C = 0.684; IDI +6.9%, p < 0.001），增加医院和程序特征获得了额外的收益（C = 0.695; IDI +0.9%, p < 0.001）。最终模型综合了脆弱性和社会脆弱性，预测准确率最高（C = 0.705; IDI +1.0%, p < 0.001）。结论在这个庞大的国家队列中，虚弱和社会脆弱性显著提高了TAVR术后长期死亡率的风险预测。我们得出结论，社会人口学和虚弱相关因素是预测TAVR后5年死亡率的重要组成部分。

{"title":"Outcomes After Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries: The Impact of Frailty and Social Vulnerability","authors":"Gregory P. Fontana MD , Harun Kundi MD, MMSc , Steven V. Manoukian MD , Bruce Bowers MD , Todd M. Dewey MD , Charles T. Klodell MD , V. Seenu Reddy MD , John A. Riddick MD , Jorge A. Alvarez MD , Michael S. Chenier MD , Mark A. Groh MD , Marcos A. Nores MD , Pranav Loyalka MD , Francis J. Zidar MD , Julia B. Thompson MS , Maria C. Alu MS , David J. Cohen MD, MSc , Juan F. Granada MD , Martin B. Leon MD , Jeffrey J. Popma MD , Saibal Kar MD","doi":"10.1016/j.shj.2025.100685","DOIUrl":"10.1016/j.shj.2025.100685","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) is an accepted alternative to surgery in many patients with severe aortic stenosis. Clinical trials have evaluated early and late outcomes in selected TAVR patients, but predictors of late mortality have been less well studied in a broadly inclusive, national patient cohort undergoing TAVR. We sought to characterize 5-year outcomes after TAVR in Medicare beneficiaries and to evaluate the incremental predictive value of demographics, comorbidities, procedural factors, frailty, and social vulnerability in determining late mortality risk.</div></div><div><h3>Methods</h3><div>We studied the fee-for-service Centers for Medicare & Medicaid Services MedPAR database that includes patients aged ≥65 years undergoing TAVR between 2017 and 2022. The primary endpoint was 5-year mortality. Sequential multivariable Cox models were constructed, incrementally adjusting for demographics, comorbidities, procedural and hospital characteristics, and frailty and social vulnerability. Model performance was assessed using C-statistics and integrated discrimination improvement (IDI).</div></div><div><h3>Results</h3><div>A total of 371,248 TAVR patients were included in the analysis. The baseline model, including only demographic factors (age, sex, and race), yielded modest model performance (C = 0.589). Inclusion of comorbidities improved the model discrimination substantially (C = 0.684; IDI +6.9%, <em>p</em> < 0.001), and adding hospital and procedural characteristics yielded additional gains (C = 0.695; IDI +0.9%, <em>p</em> < 0.001). The final model integrated frailty and social vulnerability and achieved the highest predictive accuracy (C = 0.705; IDI +1.0%, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>In this large national cohort, frailty and social vulnerability significantly improved risk prediction for long-term mortality after TAVR. We conclude that sociodemographic and frailty-related factors are important components for prediction of 5-year mortality after TAVR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100685"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878940","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

Outcomes of Transcatheter or Surgical Treatment of Severe Aortic Stenosis in Patients With Coronary Artery Disease 冠状动脉疾病患者重度主动脉狭窄经导管或手术治疗的结果

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-29 DOI: 10.1016/j.shj.2025.100709

Joseph Kassab MD, MS , Joseph Hajj MD , Rishi Puri MD, PhD , James Yun MD , Grant Reed MD , Amar Krishnaswamy MD , Serge C. Harb MD , Samir R. Kapadia MD

引用次数: 0

Uniform Safety and Excellent Performance of Pressure-Regulated Deployment of Transcatheter Aortic Valves 经导管主动脉瓣调压部署的均匀安全性和优异性能

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-29 DOI: 10.1016/j.shj.2025.100708

Afik Snir MBBS, BE , Michael K. Wilson MBBS , Bianca Coelho BSc , Andrew Moussad MBBS , Christopher Naoum MBBS, PhD , Stephen G. Worthley MBBS, PhD , Michael J. Reardon MD , David S. Celermajer MBBS, PhD , Martin K. Ng MBBS, PhD

引用次数: 0

Cardiac Implantable Electronic Devices and Transcatheter Tricuspid Valve Replacement With the EVOQUE System: A Case-Review Series Highlighting Procedural and Management Considerations 心脏植入式电子装置和经导管三尖瓣置换术与EVOQUE系统：一个案例回顾系列强调程序和管理方面的考虑

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-26 DOI: 10.1016/j.shj.2025.100707

Raviteja R. Guddeti MD, Puvi Seshiah MD, Richard Bae MD, Nadia El-Hangouche MD, Alex Costea MD, Edward Schloss MD, Mehmet Yildiz MD, Santiago Garcia MD

Severe, untreated tricuspid regurgitation is associated with worse clinical outcomes. While isolated tricuspid valve (TV) surgery has been linked to poor long-term outcomes, transcatheter TV therapies, including edge-to-edge repair and transcatheter tricuspid valve replacement (TTVR), have emerged as effective alternatives and have been shown to improve outcomes, leading to their regulatory approval in the United States. Conduction system abnormalities are commonly seen among patients undergoing TTVR due to the close proximity of the atrioventricular node and the His bundle to the TV annulus. In the TRISCEND II (Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device) trial, 38% of the patients had prior cardiac implantable electronic devices (CIEDs), while 25% of patients developed new conduction abnormalities necessitating implantation of new CIEDs. Concerns exist regarding trapping existing CIED leads during TTVR. Similarly, transvenous permanent pacemaker implantation post-TTVR has been reported to be associated with valve dysfunction. In this case-based narrative review, we describe case examples of patients with prior CIEDs undergoing TTVR and conduction abnormalities post-TTVR needing a new permanent pacemaker and discuss potential periprocedural strategies for optimal outcomes. Electrophysiologists specializing in periprocedural management of CIEDs, including lead extraction and post-TTVR device management, play a crucial role and should be part of a comprehensive heart team approach for optimal outcomes.

严重的、未经治疗的三尖瓣反流与较差的临床结果相关。虽然孤立三尖瓣（TV）手术与不良的长期预后有关，但经导管TV治疗，包括边缘到边缘修复和经导管三尖瓣置换术（TTVR），已成为有效的替代方案，并已被证明可以改善预后，从而在美国获得监管部门的批准。传导系统异常常见于接受TTVR的患者，因为房室结和His束离电视环很近。在TRISCEND II（经导管三尖瓣置换术：使用新型装置安全性和临床疗效的关键临床研究）试验中，38%的患者先前有心脏植入式电子装置（cied），而25%的患者出现新的传导异常，需要植入新的cied。在TTVR期间，存在捕获现有CIED引线的问题。同样，经静脉永久起搏器植入后ttvr已被报道与瓣膜功能障碍有关。在这篇基于病例的叙述性综述中，我们描述了之前患有cied的患者进行TTVR和TTVR后的传导异常需要新的永久性起搏器的病例示例，并讨论了可能的围手术期策略以获得最佳结果。专门从事cied围手术期管理的电生理学家，包括铅拔出和ttvr后设备管理，发挥着至关重要的作用，应该成为全面的心脏团队方法的一部分，以获得最佳结果。

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引用次数: 0

A Novel Management to Severe Hypoattenuation Leaflet Thickening Following Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后严重低衰减小叶增厚的新处理方法

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-26 DOI: 10.1016/j.shj.2025.100706

Himax Patel MD , John Lester BS , Amr Essa MBCHB , Robert Summers MD , Dania Al Jabri MD , Jarren Ypil BS , Kimberly Atianzar MD , Musa Sharkawi MBBCH

引用次数: 0

Transcatheter Mitral Valve Replacement Using Contemporary Dedicated Devices: A Systematic Review and Meta-Analysis 经导管二尖瓣置换术使用现代专用装置：系统回顾和荟萃分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-15 DOI: 10.1016/j.shj.2025.100702

Mark J. Zorman BM BCh , Katerina Dangas BM BCh , Jonathan Vibhishanan MB BChir , James Castle MBChB , Kate Eastwick-Jones BM BCh , Marco Coronelli MBBS , Mohamad S. Alabdaljabar MD , Kaleb Foster MD , Danuzia Silva MD, MPH , Parth Patel MD , Emma Johns MD , Palina Piankova MB BCh BAO, MSc , José Ordóñez-Mena MSc, Dr. sc. hum. , Sam Dawkins MBBS, DPhil , James Newton MB ChB, MD , Mackram F. Eleid MD , Mayra E. Guerrero MD , Thomas J. Cahill MBBS, DPhil

Background

Dedicated transcatheter mitral valve replacement (TMVR) devices have emerged as a promising strategy for treating mitral regurgitation (MR) in high-risk patients with complex native valve anatomy. Early experience spans multiple devices utilizing both transapical and transseptal access. The aim of this study was to evaluate procedural, 30-day, and midterm outcomes of TMVR with contemporary dedicated mitral devices in patients with native MR.

Methods

A systematic search of Medline, Embase, and Cochrane Library (January 2010-January 2025) was conducted. Pooled outcome estimates were derived using random-effects models, excluding legacy devices and cases of mitral stenosis.

Results

Thirteen studies (914 patients) were included in the analysis. The mean age was 75.4 years, and 69.8% had functional or mixed MR. Technical success was 96.3%. Residual MR was mild or less in 99% of patients at 30 days and 98% at 1 year. All-cause mortality was 11.0% at 30 days and 26.4% at 1 year. Over a mean follow-up of 12.1 months, rates of heart failure (HF) hospitalizations, cerebrovascular events, and valve reinterventions were 26.2, 5.6, and 6.0 events per 100 patient-years, respectively. Compared with transseptal access, transapical showed higher 30-day major bleeding (19.2% vs. 10.4%, p = 0.03) and all-cause mortality at 30 days (14.0% vs. 4.7%, p <0.001) and 1 year (27.7% vs. 13.1%, p = 0.005). Midterm rates of HF readmissions, major bleeding, and valve reinterventions were comparable between access routes.

Conclusions

Contemporary dedicated TMVR devices demonstrate high technical success and sustained MR reduction. Transseptal access is associated with lower morbidity and mortality. Further research is needed to improve longer-term mortality and HF hospitalizations following TMVR with dedicated mitral devices.

背景：专用经导管二尖瓣置换术（TMVR）装置已成为治疗先天性瓣膜解剖复杂的高危患者二尖瓣返流（MR）的一种有前景的策略。早期的经验跨越多个设备，利用经根尖和经隔膜接入。本研究的目的是评估采用现代专用二尖瓣装置TMVR治疗先天性mr患者的手术、30天和中期结果。方法系统检索Medline、Embase和Cochrane图书馆（2010年1月- 2025年1月）。使用随机效应模型得出汇总结果估计，排除遗留装置和二尖瓣狭窄病例。结果13项研究（914例患者）纳入分析。平均年龄75.4岁，69.8%有功能性或混合性mr，技术成功率为96.3%。99%的患者在30天和98%的患者在1年的剩余MR轻度或更少。30天全因死亡率11.0%，1年全因死亡率26.4%。在平均12.1个月的随访中，心力衰竭（HF）住院率、脑血管事件率和瓣膜再干预率分别为每100患者年26.2、5.6和6.0次。与经间隔入路相比，经根尖入路30天大出血（19.2%比10.4%,p = 0.03）和30天（14.0%比4.7%,p <0.001）和1年（27.7%比13.1%,p = 0.005）的全因死亡率更高。中期心衰再入院率、大出血率和瓣膜再介入率在两种通路之间具有可比性。结论：当代专用TMVR装置具有很高的技术成功率和持续的MR降低。经隔膜入路与较低的发病率和死亡率有关。需要进一步的研究来改善使用专用二尖瓣装置TMVR后的长期死亡率和HF住院率。

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引用次数: 0