Pub Date : 2025-10-01Epub Date: 2025-05-29DOI: 10.1016/j.shj.2025.100486
Yusuke Kobari MD, PhD , Arif A. Khokhar BM, BCh, MA , Davorka Lulic MD , Klaus Fuglsang Kofoed MD, PhD , Andreas Fuchs MD, PhD , Gintautas Bieliauskas MD , Sahil Khera MD, MPH , Gilbert HL. Tang MD, MSc, MBA , Ole De Backer MD, PhD
Background
Redo-transcatheter aortic valve replacement (TAVR) may be unfeasible due to the risk of coronary flow compromise by the pinned-back leaflets of the index transcatheter aortic valve (TAV). This study aimed to evaluate the feasibility of redo-TAVR using a balloon-expandable SAPIEN 3 (S3, Edwards Lifesciences, USA) implanted within the intra-annular self-expanding Navitor TAV (Abbott, USA).
Methods
A total of 106 post-TAVR computed tomography scans of patients who underwent Navitor implantation were analyzed. Redo-TAVR using an S3 was simulated in 2 positions: S3 outflow to node 2 of the Navitor (low implant) and S3 outflow to the base of the Navitor commissural posts (high implant). The overall coronary risk, determined by the risk of coronary flow compromise and coronary inaccessibility, was determined by the height of the neoskirt plane and the valve-to-aorta distances.
Results
At a low S3 implant position, the overall coronary risk was high for only 1% of patients, but this increased to 39% with a high S3 implant position. If the high S3 implant was combined with a high index Navitor implant depth, 73% of patients were deemed high coronary risk, which could be reduced to 28% in case of an index Navitor implant depth >5 mm. At both S3 implant depths, redo-TAVR in Navitor was associated with a lower coronary risk compared to redo-TAVR in supra-annular self-expanding valves.
Conclusions
The feasibility of redo-TAVR following S3-in-self-expanding valve depends on the type and implant depth of the index TAV as well as the implant depth of the second TAV.
{"title":"Computed Tomography-Based Evaluation of Redo-Transcatheter Aortic Valve Replacement Feasibility for Self-Expanding Valves","authors":"Yusuke Kobari MD, PhD , Arif A. Khokhar BM, BCh, MA , Davorka Lulic MD , Klaus Fuglsang Kofoed MD, PhD , Andreas Fuchs MD, PhD , Gintautas Bieliauskas MD , Sahil Khera MD, MPH , Gilbert HL. Tang MD, MSc, MBA , Ole De Backer MD, PhD","doi":"10.1016/j.shj.2025.100486","DOIUrl":"10.1016/j.shj.2025.100486","url":null,"abstract":"<div><h3>Background</h3><div>Redo-transcatheter aortic valve replacement (TAVR) may be unfeasible due to the risk of coronary flow compromise by the pinned-back leaflets of the index transcatheter aortic valve (TAV). This study aimed to evaluate the feasibility of redo-TAVR using a balloon-expandable SAPIEN 3 (S3, Edwards Lifesciences, USA) implanted within the intra-annular self-expanding Navitor TAV (Abbott, USA).</div></div><div><h3>Methods</h3><div>A total of 106 post-TAVR computed tomography scans of patients who underwent Navitor implantation were analyzed. Redo-TAVR using an S3 was simulated in 2 positions: S3 outflow to node 2 of the Navitor (low implant) and S3 outflow to the base of the Navitor commissural posts (high implant). The overall coronary risk, determined by the risk of coronary flow compromise and coronary inaccessibility, was determined by the height of the neoskirt plane and the valve-to-aorta distances.</div></div><div><h3>Results</h3><div>At a low S3 implant position, the overall coronary risk was high for only 1% of patients, but this increased to 39% with a high S3 implant position. If the high S3 implant was combined with a high index Navitor implant depth, 73% of patients were deemed high coronary risk, which could be reduced to 28% in case of an index Navitor implant depth >5 mm. At both S3 implant depths, redo-TAVR in Navitor was associated with a lower coronary risk compared to redo-TAVR in supra-annular self-expanding valves.</div></div><div><h3>Conclusions</h3><div>The feasibility of redo-TAVR following S3-in-self-expanding valve depends on the type and implant depth of the index TAV as well as the implant depth of the second TAV.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100486"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020971","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 : 2025-10-01Epub Date: 2025-05-12DOI: 10.1016/j.shj.2025.100645
Besir Besir MD , Maryam Muhammad Ali Majeed-Saidan MD , Shivabalan Kathavarayan Ramu MD , Tamari Lomaia MD , Judah Rajendran MD , Odette Iskandar MD , Issam Motairek MD , Serge C. Harb MD , Rhonda Miyasaka MD , James Yun MD PhD , Rishi Puri MD, PhD , Grant W. Reed MD, MSc , Amar Krishnaswamy MD , Samir R. Kapadia MD
Background
Flow is known to typically improve after transcatheter aortic valve replacement (TAVR); however, the characteristics correlating with improvement are still unclear. This study sought to explore the outcomes of patients with low-flow low-gradient aortic stenosis (LFLG AS) and flow improvement following TAVR compared to those without flow improvement, in addition to the predictors of flow improvement.
Methods
This is a retrospective cohort of patients >18 years of age who underwent TAVR at Cleveland Clinic between 2016 and 2020. Only patients with aortic valve area <1 cm2, aortic valve mean gradient <40 mmHg, and stroke volume index (SVI) <35 mL/m2 were included. Patients were classified into 2 groups according to whether SVI improved by 20% or more at the 30-day follow-up. Patients who underwent valve-in-valve TAVR were excluded. Binary logistic regression was used to evaluate the predictors of flow improvement.
Results
A total of 633 patients had LFLG AS. Two hundred twenty-eight patients (36%) had SVI improvement by 20% or more. Male sex, left ventricular ejection fraction (LVEF) improvement by 10% or more 30 days post-TAVR, lower baseline SVI and paradoxical LFLG AS predicted flow improvement. There was no difference in mortality and heart failure rehospitalization between patients with and without flow improvement.
Conclusions
One-third of patients with LFLG AS show an improvement in flow post-TAVR. Paradoxical LFLG AS, male sex, lower baseline SVI, and improvement in LVEF correlated with flow improvement, whereas baseline LVEF did not. There was no difference in clinical outcomes between patients with and without flow improvement post-TAVR.
{"title":"Outcomes and Predictors of Flow Improvement After Transcatheter Aortic Valve Replacement in Patients With Low-Flow Low-Gradient Aortic Stenosis","authors":"Besir Besir MD , Maryam Muhammad Ali Majeed-Saidan MD , Shivabalan Kathavarayan Ramu MD , Tamari Lomaia MD , Judah Rajendran MD , Odette Iskandar MD , Issam Motairek MD , Serge C. Harb MD , Rhonda Miyasaka MD , James Yun MD PhD , Rishi Puri MD, PhD , Grant W. Reed MD, MSc , Amar Krishnaswamy MD , Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100645","DOIUrl":"10.1016/j.shj.2025.100645","url":null,"abstract":"<div><h3>Background</h3><div>Flow is known to typically improve after transcatheter aortic valve replacement (TAVR); however, the characteristics correlating with improvement are still unclear. This study sought to explore the outcomes of patients with low-flow low-gradient aortic stenosis (LFLG AS) and flow improvement following TAVR compared to those without flow improvement, in addition to the predictors of flow improvement.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort of patients >18 years of age who underwent TAVR at Cleveland Clinic between 2016 and 2020. Only patients with aortic valve area <1 cm<sup>2</sup>, aortic valve mean gradient <40 mmHg, and stroke volume index (SVI) <35 mL/m<sup>2</sup> were included. Patients were classified into 2 groups according to whether SVI improved by 20% or more at the 30-day follow-up. Patients who underwent valve-in-valve TAVR were excluded. Binary logistic regression was used to evaluate the predictors of flow improvement.</div></div><div><h3>Results</h3><div>A total of 633 patients had LFLG AS. Two hundred twenty-eight patients (36%) had SVI improvement by 20% or more. Male sex, left ventricular ejection fraction (LVEF) improvement by 10% or more 30 days post-TAVR, lower baseline SVI and paradoxical LFLG AS predicted flow improvement. There was no difference in mortality and heart failure rehospitalization between patients with and without flow improvement.</div></div><div><h3>Conclusions</h3><div>One-third of patients with LFLG AS show an improvement in flow post-TAVR. Paradoxical LFLG AS, male sex, lower baseline SVI, and improvement in LVEF correlated with flow improvement, whereas baseline LVEF did not. There was no difference in clinical outcomes between patients with and without flow improvement post-TAVR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100645"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020972","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 : 2025-10-01Epub Date: 2025-06-11DOI: 10.1016/j.shj.2025.100679
Pranav Chandrashekar MD , Anas Zaqut MD , Raluca McCallum MD , Chara Rydzak MD, PhD , En-Ha Wu MD , Firas Zahr MD , Scott M. Chadderdon MD
Background
Treatment options for severe tricuspid regurgitation (TR) require a multimodal analysis of the tricuspid annulus (TA). Cardiac computed tomography (CT) is currently considered the gold standard for annular perimeter measurements, though three-dimensional transesophageal echocardiography (3D TEE) can yield similar results. As such, we sought to determine the accuracy and precision of 3D TEE imaging of the TA perimeter compared to CT imaging in outpatients with severe TR.
Methods
Fifty-five patients were referred for multimodality workup for severe TR that included CT and 3D TEE. The 3D TEE imaging was performed in the mid-esophageal (ME) and transgastric views. A semiautomated software program was used to identify and measure the TA with additional manual optimization by the reader. These 3D TEE measurements were compared to cardiac CT imaging.
Results
Out of 55 patients, 3 were excluded for hiatal hernias and 1 was excluded for severe kidney disease. Fifty-one studied patients had an average age of 76 ± 10 years with 59% female. The 3D TEE analysis of the TA perimeter demonstrated an excellent correlation with CT from the ME view, R = 0.88, and from the TG view, R = 0.86, with an average difference of approximately 8.5% when compared to CT. TEE inter-reader variability was approximately 6%, whereas CT variability was 1.4%
Conclusions
The 3D TEE TA perimeter measurements are accurate when compared to CT with a variability of 8.5%. While CT remains more precise, 3D TEE imaging for TA sizing should be considered a near-equivalent modality to CT.
{"title":"Tricuspid Annulus Measurements in Severe Tricuspid Regurgitation: Comparative Analysis of Cardiac-Gated Computed Tomography Versus Three-Dimensional Transesophageal Echocardiography","authors":"Pranav Chandrashekar MD , Anas Zaqut MD , Raluca McCallum MD , Chara Rydzak MD, PhD , En-Ha Wu MD , Firas Zahr MD , Scott M. Chadderdon MD","doi":"10.1016/j.shj.2025.100679","DOIUrl":"10.1016/j.shj.2025.100679","url":null,"abstract":"<div><h3>Background</h3><div>Treatment options for severe tricuspid regurgitation (TR) require a multimodal analysis of the tricuspid annulus (TA). Cardiac computed tomography (CT) is currently considered the gold standard for annular perimeter measurements, though three-dimensional transesophageal echocardiography (3D TEE) can yield similar results. As such, we sought to determine the accuracy and precision of 3D TEE imaging of the TA perimeter compared to CT imaging in outpatients with severe TR.</div></div><div><h3>Methods</h3><div>Fifty-five patients were referred for multimodality workup for severe TR that included CT and 3D TEE. The 3D TEE imaging was performed in the mid-esophageal (ME) and transgastric views. A semiautomated software program was used to identify and measure the TA with additional manual optimization by the reader. These 3D TEE measurements were compared to cardiac CT imaging.</div></div><div><h3>Results</h3><div>Out of 55 patients, 3 were excluded for hiatal hernias and 1 was excluded for severe kidney disease. Fifty-one studied patients had an average age of 76 ± 10 years with 59% female. The 3D TEE analysis of the TA perimeter demonstrated an excellent correlation with CT from the ME view, R = 0.88, and from the TG view, R = 0.86, with an average difference of approximately 8.5% when compared to CT. TEE inter-reader variability was approximately 6%, whereas CT variability was 1.4%</div></div><div><h3>Conclusions</h3><div>The 3D TEE TA perimeter measurements are accurate when compared to CT with a variability of 8.5%. While CT remains more precise, 3D TEE imaging for TA sizing should be considered a near-equivalent modality to CT.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100679"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020974","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 : 2025-10-01Epub 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":"2025-10-01","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}
Pub Date : 2025-10-01Epub 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":"2025-10-01","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 : 2025-10-01Epub 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":"2025-10-01","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 : 2025-09-01Epub Date: 2025-07-15DOI: 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.
{"title":"Transcatheter Mitral Valve Replacement Using Contemporary Dedicated Devices: A Systematic Review and Meta-Analysis","authors":"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","doi":"10.1016/j.shj.2025.100702","DOIUrl":"10.1016/j.shj.2025.100702","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%, <em>p</em> = 0.03) and all-cause mortality at 30 days (14.0% vs. 4.7%, <em>p</em> <0.001) and 1 year (27.7% vs. 13.1%, <em>p</em> = 0.005). Midterm rates of HF readmissions, major bleeding, and valve reinterventions were comparable between access routes.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100702"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826623","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 : 2025-09-01Epub Date: 2025-10-13DOI: 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}
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