Structural Heart最新文献

{"title":"Incomplete Left Atrial Appendage Closure: How to Address the (Knowledge) Gap?","authors":"Yannick Willemen MD, PhD, Ole De Backer MD, PhD","doi":"10.1016/j.shj.2025.100466","DOIUrl":"10.1016/j.shj.2025.100466","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100466"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878117","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}

{"title":"Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR Procedures","authors":"Mohammed Quader MD ,&nbsp;Neha Shah MPH ,&nbsp;Rebecca Deitch BS ,&nbsp;Barbara Lawson MD ,&nbsp;Delia Endicott NP ,&nbsp;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> ​&lt; ​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}

{"title":"Feasibility, Efficacy, and Safety of the Mitral Annulo-TRIpsy in eXtreme Risk Patients","authors":"Gennaro Giustino MD ,&nbsp;Chantal Y. Asselin MSc, MD ,&nbsp;Mostafa Naguib MD ,&nbsp;Ahmad Jabri MD ,&nbsp;Leo Kar Lok Lai MD ,&nbsp;Robert Kipperman MD ,&nbsp;Kostantinos P. Koulogiannis MD ,&nbsp;Leo Marcoff MD ,&nbsp;Amr Abbas MD ,&nbsp;Pedro Villablanca MD ,&nbsp;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> &lt;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}

{"title":"Intravascular Lithotripsy in Mitral Annulus Calcification-Related Mitral Stenosis: Hope or Hype?","authors":"Marina Urena MD, PhD","doi":"10.1016/j.shj.2025.100703","DOIUrl":"10.1016/j.shj.2025.100703","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100703"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878842","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}

{"title":"Aims & Scope","authors":"","doi":"10.1016/S2474-8706(25)00305-7","DOIUrl":"10.1016/S2474-8706(25)00305-7","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100713"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878119","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}

{"title":"Outcomes of Patients With a Small and Large Aortic Annulus Following Balloon-Expandable Transcatheter Aortic Valve Replacement Across Flow-Gradient Patterns","authors":"Besir Besir MD ,&nbsp;Shivabalan Kathavarayan Ramu MD ,&nbsp;Tamari Lomaia MD ,&nbsp;Maryam Muhammad Ali Majeed-Saidan MD ,&nbsp;Judah Rajendran MD ,&nbsp;Issam Motairek MD ,&nbsp;Serge C. Harb MD ,&nbsp;Rhonda Miyasaka MD ,&nbsp;Grant W. Reed MD ,&nbsp;Rishi Puri MD ,&nbsp;James J.Y. Yun MD ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100456","DOIUrl":"10.1016/j.shj.2025.100456","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>This is a retrospective cohort of patients &gt;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 &gt;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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>Patients with small and large annuli have similar intermediate-term clinical outcomes post-TAVR across all flow-gradient patterns treated with balloon-expandable valve.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100456"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878154","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}

{"title":"Postoperative Transesophageal Echocardiographic Evaluation of Surgical Left Atrial Appendage Exclusion: Characterization and Predictors of Success","authors":"Karl M. Richardson MD ,&nbsp;Karanpreet K. Dhaliwal MD ,&nbsp;Sebastian S. Hernandez BS ,&nbsp;Rohesh J. Fernando MD ,&nbsp;Matthew J. Singleton MS, MD ,&nbsp;Prashant D. Bhave MS, MD","doi":"10.1016/j.shj.2025.100469","DOIUrl":"10.1016/j.shj.2025.100469","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 &lt;1 cm in all available imaging angles.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100469"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878124","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}

{"title":"Trends in Isolated and Combined Aortic Valve Replacement for Severe Aortic Stenosis in Patients Younger Than 65 Years","authors":"Tanush Gupta MD ,&nbsp;James T. DeVries MD ,&nbsp;Hsiang-Ching Huang MS ,&nbsp;Cathy S. Ross MS ,&nbsp;David Butzel MD ,&nbsp;James M. Flynn MD ,&nbsp;Michael N. Young MD ,&nbsp;Rony N. Lahoud MD ,&nbsp;Frank Ittleman MD ,&nbsp;Ansar Hassan MD ,&nbsp;Harold L. Dauerman MD","doi":"10.1016/j.shj.2025.100684","DOIUrl":"10.1016/j.shj.2025.100684","url":null,"abstract":"<div><h3>Background</h3><div>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 &lt;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.</div></div><div><h3>Methods</h3><div>This retrospective study included patients aged &lt;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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>In this multicenter study, there is a consistent increase in TAVR use in patients &lt;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.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100684"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878935","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}

{"title":"Outcomes After Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries: The Impact of Frailty and Social Vulnerability","authors":"Gregory P. Fontana MD ,&nbsp;Harun Kundi MD, MMSc ,&nbsp;Steven V. Manoukian MD ,&nbsp;Bruce Bowers MD ,&nbsp;Todd M. Dewey MD ,&nbsp;Charles T. Klodell MD ,&nbsp;V. Seenu Reddy MD ,&nbsp;John A. Riddick MD ,&nbsp;Jorge A. Alvarez MD ,&nbsp;Michael S. Chenier MD ,&nbsp;Mark A. Groh MD ,&nbsp;Marcos A. Nores MD ,&nbsp;Pranav Loyalka MD ,&nbsp;Francis J. Zidar MD ,&nbsp;Julia B. Thompson MS ,&nbsp;Maria C. Alu MS ,&nbsp;David J. Cohen MD, MSc ,&nbsp;Juan F. Granada MD ,&nbsp;Martin B. Leon MD ,&nbsp;Jeffrey J. Popma MD ,&nbsp;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 &amp; 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> &lt; 0.001), and adding hospital and procedural characteristics yielded additional gains (C = 0.695; IDI +0.9%, <em>p</em> &lt; 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> &lt; 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}

{"title":"Outcomes of Transcatheter or Surgical Treatment of Severe Aortic Stenosis in Patients With Coronary Artery Disease","authors":"Joseph Kassab MD, MS ,&nbsp;Joseph Hajj MD ,&nbsp;Rishi Puri MD, PhD ,&nbsp;James Yun MD ,&nbsp;Grant Reed MD ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Serge C. Harb MD ,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100709","DOIUrl":"10.1016/j.shj.2025.100709","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100709"},"PeriodicalIF":2.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907280","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}