Pub Date : 2025-07-01DOI: 10.1016/j.shj.2025.100669
Rebecca T. Hahn MD
Transcatheter tricuspid valve interventions may offer patients less invasive treatment alternatives to surgery. This review evaluates the use of echocardiography to determine anatomic suitability and guide the 2 most common classes of device currently used worldwide to treat tricuspid regurgitation, tricuspid transcatheter edge-to-edge repair, and orthotopic transcatheter tricuspid valve replacement. This review outlines the intraprocedural echocardiographic imaging required for these 2 devices.
{"title":"Echocardiographic Imaging to Guide Tricuspid Interventions","authors":"Rebecca T. Hahn MD","doi":"10.1016/j.shj.2025.100669","DOIUrl":"10.1016/j.shj.2025.100669","url":null,"abstract":"<div><div>Transcatheter tricuspid valve interventions may offer patients less invasive treatment alternatives to surgery. This review evaluates the use of echocardiography to determine anatomic suitability and guide the 2 most common classes of device currently used worldwide to treat tricuspid regurgitation, tricuspid transcatheter edge-to-edge repair, and orthotopic transcatheter tricuspid valve replacement. This review outlines the intraprocedural echocardiographic imaging required for these 2 devices.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100669"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605620","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 : 2025-07-01DOI: 10.1016/j.shj.2025.100666
Giulia Masiero MD , Anna Franzone MD, PhD , Valeria Paradies MD , Nicole Karam MD, PhD , Chiara Fraccaro MD, PhD , Chiara De Biase MD , Mirvat Alasnag MD , Giulia Botti MD , Angelicarosa Cascone MD , Ana Belen Cid-Alvarez MD, PhD , Tanja K. Rudolph MD, PhD , Marta Kaluzna-Oleksy MD, PhD , Stephane Manzo-Silberman MD, PhD , Julinda Mehilli MD, PhD , Barbara E. Stähli MD, PhD , Julia Grapsa MD, PhD , Kyriakos Panaou MD , Barbara Bellini MD , Joanna J. Wykrzykowska MD, PhD , Sabine Bleiziffer MD, PhD , Alaide Chieffo MD, PhD
The impact of sex on the baseline characteristics, morphology, and clinical presentation of degenerative aortic stenosis (AS) is well-documented but remains poorly understood. Unlike valve surgery, for which patients have been predominantly male, percutaneous treatment of AS has shown balanced representation of both sexes, with women demonstrating greater benefit from transfemoral aortic valve replacement compared to surgical treatment. This review explores sex-specific differences in the epidemiology, pathophysiology, diagnostic challenges, treatment approaches, and clinical outcomes of degenerative AS. Furthermore, it addresses technical, sex-specific considerations in transfemoral aortic valve replacement, including preprocedural screening, device selection, implantation strategy, and postprocedural management.
Pub Date : 2025-07-01DOI: 10.1016/j.shj.2024.100360
Francesca Maria Di Muro MD , Birgit Vogel MD , Angelo Oliva MD , Benjamin Bay MD , Mauro Gitto MD , George D. Dangas MD, PhD , Roxana Mehran MD
Over the past 2 decades, structural heart interventions–including procedures like transcatheter aortic valve replacement, transcatheter mitral or tricuspid valve replacement, and transcatheter edge-to-edge mitral or tricuspid valve repair–have emerged as feasible alternatives to traditional surgery for treating valvular heart diseases. Antithrombotic treatment represents a critical aspect of postoperative care, aiming to balance the thromboembolic risk due to the incorporation of prosthetic materials and the consequently altered hemodynamics within the cardiac chambers with the bleeding risk depending on patients’ and procedural factors. This continuously evolving interplay underscores the importance of personalized, evidence-based approaches to ensure optimal outcomes. This review provides a comprehensive examination of the current knowledge on antithrombotic therapies after structural interventions, offering insights into the evolving field and emphasizing the importance of tailored strategies.
{"title":"Pharmacology in Structural Intervention for Valvular Heart Disease: Current Practice and Future Perspectives","authors":"Francesca Maria Di Muro MD , Birgit Vogel MD , Angelo Oliva MD , Benjamin Bay MD , Mauro Gitto MD , George D. Dangas MD, PhD , Roxana Mehran MD","doi":"10.1016/j.shj.2024.100360","DOIUrl":"10.1016/j.shj.2024.100360","url":null,"abstract":"<div><div>Over the past 2 decades, structural heart interventions–including procedures like transcatheter aortic valve replacement, transcatheter mitral or tricuspid valve replacement, and transcatheter edge-to-edge mitral or tricuspid valve repair–have emerged as feasible alternatives to traditional surgery for treating valvular heart diseases. Antithrombotic treatment represents a critical aspect of postoperative care, aiming to balance the thromboembolic risk due to the incorporation of prosthetic materials and the consequently altered hemodynamics within the cardiac chambers with the bleeding risk depending on patients’ and procedural factors. This continuously evolving interplay underscores the importance of personalized, evidence-based approaches to ensure optimal outcomes. This review provides a comprehensive examination of the current knowledge on antithrombotic therapies after structural interventions, offering insights into the evolving field and emphasizing the importance of tailored strategies.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100360"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605624","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}
Mitral annular calcification (MAC) is a degenerative process that causes calcium deposits along the mitral annulus. The pathophysiological mechanisms contributing to the development of MAC are not fully understood. The main risk factors for MAC are advanced age, female gender, chronic kidney disease, and conditions predisposing to left ventricular hypertrophy, which increases mitral annulus tension and subsequent annular degeneration. The prevalence of MAC varies widely among studies, from 5% to 42%, depending on the characteristics of the study population and the imaging modality used to make the diagnosis, and it is increasing over time. MAC is independently associated with all-cause mortality, cardiovascular mortality, and the occurrence of cardiovascular disease such as atrial fibrillation, conduction abnormalities, or stroke. MAC can progress and involve the mitral valve leaflets, causing mitral stenosis, mitral regurgitation, or both. Patients who develop symptomatic mitral valve dysfunction associated with significant MAC have lower survival when mitral valve intervention is not performed. However, the surgical risk of these patients is often high, precluding surgery in many. Therefore, transcatheter mitral valve implantation is emerging as an alternative in patients with severe MAC and associated symptomatic mitral valve dysfunction. This manuscript summarizes a description of the disease process in MAC and its treatment options.
{"title":"Mitral Annular Calcification: Understanding the Disease and Treatment Options","authors":"Marina Urena MD, PhD , John Kikoïne MD , Mayra Guerrero MD","doi":"10.1016/j.shj.2025.100668","DOIUrl":"10.1016/j.shj.2025.100668","url":null,"abstract":"<div><div>Mitral annular calcification (MAC) is a degenerative process that causes calcium deposits along the mitral annulus. The pathophysiological mechanisms contributing to the development of MAC are not fully understood. The main risk factors for MAC are advanced age, female gender, chronic kidney disease, and conditions predisposing to left ventricular hypertrophy, which increases mitral annulus tension and subsequent annular degeneration. The prevalence of MAC varies widely among studies, from 5% to 42%, depending on the characteristics of the study population and the imaging modality used to make the diagnosis, and it is increasing over time. MAC is independently associated with all-cause mortality, cardiovascular mortality, and the occurrence of cardiovascular disease such as atrial fibrillation, conduction abnormalities, or stroke. MAC can progress and involve the mitral valve leaflets, causing mitral stenosis, mitral regurgitation, or both. Patients who develop symptomatic mitral valve dysfunction associated with significant MAC have lower survival when mitral valve intervention is not performed. However, the surgical risk of these patients is often high, precluding surgery in many. Therefore, transcatheter mitral valve implantation is emerging as an alternative in patients with severe MAC and associated symptomatic mitral valve dysfunction. This manuscript summarizes a description of the disease process in MAC and its treatment options.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100668"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605619","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}
Secondary mitral regurgitation (SMR), classified as ventricular or atrial SMR, is associated with excess mortality, heart failure (HF) hospitalization, and worsening quality of life. Therapy is directed toward the underlying cardiomyopathy first with use of neurohormonal antagonism, cardiac resynchronization therapy and arrhythmia reduction, which can reduce MR severity and improve outcomes, followed by transcatheter therapies. Multimodality imaging in the evaluation of MR is critical to determine the mechanism, severity, and options for intervention. Transcatheter treatment of severe SMR provides a percutaneous option for patients who remain symptomatic despite optimal medical management, and there have been significant advances in the procedural capabilities and devices available for treatment. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure trial demonstrated improvement in morbidity and mortality with use of mitral transcatheter edge-to-edge repair (mTEER). The results of this trial suggest that greater proportionate MR, in which the magnitude of MR is accompanied proportionately with a high degree of LV dilation, confers less clinical benefit. A window of opportunity exists during which time mTEER may improve symptoms and prognosis in HF patients as guided by Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure criteria in stage C HF. This review describes our current understanding of the pathophysiology and treatment of SMR. Additionally, it explores several questions as to the optimal timing of transcatheter intervention, the role of mTEER in moderate MR, our understanding of exercise-induced MR, implications for mitral valvular and ventricular remodeling, and whether mTEER may facilitate optimization of medical therapy.
{"title":"Functional Mitral Regurgitation and the Role of Transcatheter Repair","authors":"Richa Gupta MD, MPH , Holly Gonzales MD , Stacy Tsai MD , Angela Lowenstern MD , JoAnn Lindenfeld MD","doi":"10.1016/j.shj.2024.100347","DOIUrl":"10.1016/j.shj.2024.100347","url":null,"abstract":"<div><div>Secondary mitral regurgitation (SMR), classified as ventricular or atrial SMR, is associated with excess mortality, heart failure (HF) hospitalization, and worsening quality of life. Therapy is directed toward the underlying cardiomyopathy first with use of neurohormonal antagonism, cardiac resynchronization therapy and arrhythmia reduction, which can reduce MR severity and improve outcomes, followed by transcatheter therapies. Multimodality imaging in the evaluation of MR is critical to determine the mechanism, severity, and options for intervention. Transcatheter treatment of severe SMR provides a percutaneous option for patients who remain symptomatic despite optimal medical management, and there have been significant advances in the procedural capabilities and devices available for treatment. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure trial demonstrated improvement in morbidity and mortality with use of mitral transcatheter edge-to-edge repair (mTEER). The results of this trial suggest that greater proportionate MR, in which the magnitude of MR is accompanied proportionately with a high degree of LV dilation, confers less clinical benefit. A window of opportunity exists during which time mTEER may improve symptoms and prognosis in HF patients as guided by Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure criteria in stage C HF. This review describes our current understanding of the pathophysiology and treatment of SMR. Additionally, it explores several questions as to the optimal timing of transcatheter intervention, the role of mTEER in moderate MR, our understanding of exercise-induced MR, implications for mitral valvular and ventricular remodeling, and whether mTEER may facilitate optimization of medical therapy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100347"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605623","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 : 2025-07-01DOI: 10.1016/j.shj.2025.100670
Anita W. Asgar MD
{"title":"The Vital Contribution of Women in Structural Heart Disease — Shaping the Future Through Innovation, Imaging, and Insight","authors":"Anita W. Asgar MD","doi":"10.1016/j.shj.2025.100670","DOIUrl":"10.1016/j.shj.2025.100670","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100670"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605622","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 : 2025-07-01DOI: 10.1016/j.shj.2025.100424
Linda D. Gillam MD, MPH, Philippe Généreux MD
Staging based on extra-valvular cardiac damage is an intuitive approach to categorizing patients with aortic stenosis (AS) that is easily applied using widely available echocardiographic tools. As discussed in this review, it has been shown to be a powerful tool for risk stratification that complements conventional approaches. The original and most widely used framework identifies stage 0 when there is AS without additional cardiac damage; stage 1 when there is left ventricular damage (hypertrophy, systolic or diastolic dysfunction with evidence of elevated filling pressures); stage 2 when there is mitral dysfunction (moderate or greater mitral regurgitation, typically secondary) or left atrial abnormalities (left atrial enlargement or atrial fibrillation); stage 3 when there is pulmonary hypertension and/or moderate or greater tricuspid regurgitation (typically secondary); and stage 4 when there is moderate or greater right ventricular dysfunction. In a series of studies that have collectively evaluated damage before and after aortic valve replacement in patients with moderate and severe AS, as well as with and without symptoms, cardiac damage has been shown to predict all-cause and cardiovascular mortality and other outcomes. These observations support the design of trials to reevaluate thresholds for aortic valve replacement in AS and approaches that consider cardiac damage stage in clinical decision-making for individual patients (valve replacement vs. medical therapy).
{"title":"Staging Aortic Stenosis Based on Cardiac Damage: A New Tool for Risk Prediction, Clinical Decision-Making, and Trial Design","authors":"Linda D. Gillam MD, MPH, Philippe Généreux MD","doi":"10.1016/j.shj.2025.100424","DOIUrl":"10.1016/j.shj.2025.100424","url":null,"abstract":"<div><div>Staging based on extra-valvular cardiac damage is an intuitive approach to categorizing patients with aortic stenosis (AS) that is easily applied using widely available echocardiographic tools. As discussed in this review, it has been shown to be a powerful tool for risk stratification that complements conventional approaches. The original and most widely used framework identifies stage 0 when there is AS without additional cardiac damage; stage 1 when there is left ventricular damage (hypertrophy, systolic or diastolic dysfunction with evidence of elevated filling pressures); stage 2 when there is mitral dysfunction (moderate or greater mitral regurgitation, typically secondary) or left atrial abnormalities (left atrial enlargement or atrial fibrillation); stage 3 when there is pulmonary hypertension and/or moderate or greater tricuspid regurgitation (typically secondary); and stage 4 when there is moderate or greater right ventricular dysfunction. In a series of studies that have collectively evaluated damage before and after aortic valve replacement in patients with moderate and severe AS, as well as with and without symptoms, cardiac damage has been shown to predict all-cause and cardiovascular mortality and other outcomes. These observations support the design of trials to reevaluate thresholds for aortic valve replacement in AS and approaches that consider cardiac damage stage in clinical decision-making for individual patients (valve replacement vs. medical therapy).</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100424"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605625","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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