Structural Heart最新文献

{"title":"Repeat Interventions After Transcatheter Aortic Valve Replacement: Considerations for Lifetime Management—The First Cut Is the Deepest","authors":"Sachin S. Goel MD , Benjamin Z. Galper MD, MPH","doi":"10.1016/j.shj.2025.100426","DOIUrl":"10.1016/j.shj.2025.100426","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100426"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168744","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":"Real-World Clinical Outcomes and Health Care Utilization in Patients With Severe Tricuspid Regurgitation","authors":"Mahesh V. Madhavan MD, MS ,&nbsp;Colin M. Barker MD ,&nbsp;Lisa S. Kemp PhD ,&nbsp;Sarah Mollenkopf MPH ,&nbsp;Michael Ryan MS ,&nbsp;Candace Gunnarsson EdD, MA ,&nbsp;David J. Cohen MD, MSc","doi":"10.1016/j.shj.2025.100463","DOIUrl":"10.1016/j.shj.2025.100463","url":null,"abstract":"<div><h3>Background</h3><div>Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Data on long-term clinical outcomes and health care resource utilization for this population are limited.</div></div><div><h3>Methods</h3><div>We used the Optum Market Clarity database from 2016 to 2022 to identify patients with severe TR based on a combination of physician documentation, claims for severe TR, and echocardiography within 3 months of the diagnosis. Event rates through 3-year follow-up were calculated using Kaplan-Meier methodology, and health care resource use and expenditures were calculated using the Bang and Tsiatis censoring method. Secondary analyses were performed among patients with severe, symptomatic TR, which required additional physician documentation of prespecified signs or symptoms.</div></div><div><h3>Results</h3><div>We identified 1190 patients with severe TR and no previous tricuspid valve surgery between 2016 and 2022. The mean age was 72 years, and 67% were female. Baseline comorbidities were common, with a mean Elixhauser score of 9.4 ± 4.0 (range, 0-31). Of patients with detailed echocardiographic data available (N = 322), 46% had normal left ventricular ejection fraction. Three-year rates of all-cause mortality, stroke, and any tricuspid valve surgery were 47.9, 19.1, and 7.5%, respectively. Health care–related resource utilization was high, with cumulative 3-year costs of approximately $127,000/patient.</div></div><div><h3>Conclusions</h3><div>Over 3 years of follow-up, patients with severe TR had high rates of death and adverse clinical events and incurred substantial health care costs. Longer-term data regarding the impact of transcatheter interventions for severe TR on clinical outcomes and costs are needed to better understand the value of these novel therapies.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100463"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168746","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)00065-X","DOIUrl":"10.1016/S2474-8706(25)00065-X","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100473"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168741","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":"Tenacity","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2025.100470","DOIUrl":"10.1016/j.shj.2025.100470","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100470"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168742","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":"Conduction Disorders After Transcatheter Aortic Valve Implantation: Evolution Over Time and Association With Long-Term Outcomes","authors":"Aileen Paula Chua MD ,&nbsp;Rinchyenkhand Myagmardorj MD ,&nbsp;Takeru Nabeta MD ,&nbsp;Jurrien H. Kuneman MD ,&nbsp;Frank van der Kley MD, PhD ,&nbsp;Jeroen J. Bax MD, PhD ,&nbsp;Nina Ajmone Marsan MD, PhD","doi":"10.1016/j.shj.2025.100428","DOIUrl":"10.1016/j.shj.2025.100428","url":null,"abstract":"<div><h3>Background</h3><div>Expanding indications for transcatheter aortic valve implantation (TAVI) highlighted the importance of complications such as new left bundle branch block (LBBB) or permanent pacemaker (PPM) implantation. However, studies on the long-term outcomes of these conduction abnormalities (CA) are limited. This study aims to examine the progression of CA within the first year after TAVI and their long-term prognostic value.</div></div><div><h3>Methods</h3><div>TAVI patients were divided into 1) PPM implantation within the first year, 2) post-TAVI LBBB persisting until 1 year (permanent LBBB), and 3) no-CA. Endpoint was all-cause mortality after 1 year.</div></div><div><h3>Results</h3><div>Among 794 patients initially included, 30% developed new LBBB, which persisted in 17% until discharge; 12% received a PPM during the hospitalization. One-year follow-up was available in 502 patients: 11% were classified as permanent LBBB (n = 56), 18% as PPM (n = 89), and the rest as no-CA (n = 357). Baseline characteristics were comparable, except for valve type, with self-expanding more common among the PPM group. At 1-year follow-up, lower left ventricular ejection fraction and global longitudinal strain were observed in the PPM and permanent LBBB groups compared to the no-CA group (55% ± 9% and 15% ± ​4% vs. 54% ± 11% and 15% ± 4% vs. 58% ± 9% and 17% ± ​4%, respectively, <em>p</em> ​&lt; 0.001). At long-term follow-up (median: 4 [interquartile range: 3-6] years), higher mortality was observed in the PPM group (ꭓ² = 10.168, <em>p</em> = 0.006). In addition, PPM implantation (hazard ratio: 1.654, <em>p</em> = 0.011) and global longitudinal strain at 1 year (hazard ratio: 0.950, <em>p</em> = 0.027), as well as pre-TAVI EuroSCORE II and New York Heart Association III-IV at 1 year, were independently associated with the outcome.</div></div><div><h3>Conclusions</h3><div>Post-TAVI CAs are dynamic within the first year. Patients who needed PPM implantation did not show significant improvement in left ventricular function after TAVI and had higher long-term mortality.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100428"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168745","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":"Simulation for Procedural Planning and Intracardiac Echo for Enhancing Precision in Cardiac Interventions With a Focus on Left Atrial Appendage Closure","authors":"Jaya Chandrasekhar MBBS, MS, PhD ,&nbsp;Jacqueline Saw MD","doi":"10.1016/j.shj.2025.100427","DOIUrl":"10.1016/j.shj.2025.100427","url":null,"abstract":"<div><div>In recent years, structural interventions have explored three-dimensional printing and computer simulation technologies to facilitate optimal device selections for more efficient procedures with fewer patient complications. Cardiovascular procedures, both structural interventions and electrophysiological procedures, have examined the utility of intracardiac echocardiography. In this review, we will discuss the growth of these technologies and highlight recent studies with a key focus on left atrial appendage closure.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100427"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168749","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":"Grading Mitral Regurgitation: To Severe and Beyond!","authors":"Amar Krishnaswamy MD ,&nbsp;Rhonda Miyasaka MD","doi":"10.1016/j.shj.2025.100425","DOIUrl":"10.1016/j.shj.2025.100425","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100425"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168740","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":"Percutaneous Paravalvular Leak Closure of the EVOQUE Transcatheter Tricuspid Valve Replacement System","authors":"Gennaro Giustino MD,&nbsp;James C. Lee MD,&nbsp;Brian P. O’Neill MD,&nbsp;Jonathan X. Fang MBBS,&nbsp;Bryan Zweig MD,&nbsp;Ahmad Jabri MD,&nbsp;Tiberio M. Frisoli MD,&nbsp;Pedro Engel MD,&nbsp;William W. O’Neill MD,&nbsp;Pedro A. Villablanca MD","doi":"10.1016/j.shj.2025.100421","DOIUrl":"10.1016/j.shj.2025.100421","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100421"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168739","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":"Transcatheter Aortic Valve Implantation in Very Low-Gradient Aortic Stenosis","authors":"Connor Raikar BA ,&nbsp;Abigail S. Baldridge DrPH ,&nbsp;Zhiying Meng MS ,&nbsp;Akhil Narang MD ,&nbsp;Charles J. Davidson MD ,&nbsp;James D. Flaherty MD ,&nbsp;Duc Thinh Pham MD ,&nbsp;Ranya Sweis MD ,&nbsp;Laura Davidson MD ,&nbsp;Andrei Churyla MD ,&nbsp;Christopher Mehta MD ,&nbsp;S. Chris Malaisrie MD","doi":"10.1016/j.shj.2025.100457","DOIUrl":"10.1016/j.shj.2025.100457","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) is beneficial in low-flow, low-gradient aortic stenosis (LGAS) (mean pressure gradient [MPG] ​&lt;40 mmHg). The benefit and outcomes of TAVI in very low-gradient aortic stenosis (VLGAS) patients (MPG &lt;25 mmHg) are under-reported.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 1173 patients with severe native valve aortic stenosis who underwent TAVI at a tertiary-care center between July 2012 and December 2021. Patients were divided into VLGAS (≤25 mmHg), LGAS (25 mmHg to 40 mmHg), and high-gradient aortic stenosis (≥40 mmHg) using MPG from transthoracic echocardiography. VLGAS and LGAS were subdivided into classical low-flow, paradoxical low-flow, and normal flow subgroups. The primary outcomes were symptom improvement (measured by New York Heart Association class improvement), quality-of-life improvement (measured by Kansas City Cardiomyopathy Questionnaire Summary Score increase), rehospitalization, and mortality. Outcomes were measured at 30 days and 1 year postimplant.</div></div><div><h3>Results</h3><div>Most patients with VLGAS had symptom and quality-of-life improvement after TAVI. Fewer patients with VLGAS had symptom improvement at 1 ​year (<em>p</em> ​&lt; ​0.01). One-year rehospitalization was the highest in VLGAS patients (<em>p</em> ​&lt; ​0.01). All other primary outcomes were similar between groups. In subset analyses, 1-year symptom improvement only differed between normal flow subgroups, while rehospitalization and mortality only differed between low-flow subgroups.</div></div><div><h3>Conclusions</h3><div>Trascatheter aortic valve implantation improves symptoms and quality of life in LGAS, including those with VLGAS. A lower degree of symptom improvement was observed in VLGAS at 1 ​year, primarily driven by those with normal flow states. Differences in mortality and rehospitalization were observed only in classical low-flow states.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100457"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168747","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":"Repeat Interventions After Transcatheter Aortic Valve Replacement: Clinical Characteristics and Outcomes of Redo Transcatheter Aortic Valve Replacement and Surgical Explants","authors":"Gustavo Mendez-Hirata MD,&nbsp;Christian W. Schmidt MS,&nbsp;Geoffrey A. Answini MD,&nbsp;J. Michael Smith MD,&nbsp;Saad Hasan MD,&nbsp;Jeffrey Griffin MD,&nbsp;Robert Dowling MD,&nbsp;Dean J. Kereiakes MD,&nbsp;Puvi Seshiah MD,&nbsp;Joseph Choo MD,&nbsp;Zaid Alirhayim MD,&nbsp;Santiago Garcia MD","doi":"10.1016/j.shj.2024.100393","DOIUrl":"10.1016/j.shj.2024.100393","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valves (TAVs) are subject to degeneration and repeat intervention. TAVs are increasingly used in clinical practice, but there is a paucity of data regarding repeat interventions.</div></div><div><h3>Methods</h3><div>We sought to describe and compare clinical characteristics and outcomes of TAV in TAV procedures vs. surgical explant procedures after an index transcatheter aortic valve replacement (TAVR) at The Christ Hospital Health Network (Cincinnati, OH) from January 2015 to August 2023.</div></div><div><h3>Results</h3><div>A total of 1314 patients underwent TAVR procedures during the study period. Of these patients, 31 (2.3%) underwent repeat interventions (25 TAV in TAV and 6 surgical explants) and were included. The median [interquartile range] time from index TAVR to a repeat intervention was 5.02 years [1.01-7.12] for TAV in TAV and 2.55 years [1.36-3.20] for surgical explants (<em>p</em> = 0.386). Patients undergoing TAV in TAV were more likely to have structural valve deterioration (60%), whereas patients undergoing surgical explants were more likely to present with infective endocarditis (50%). Major adverse cardiovascular event rates were similar at discharge (20 vs. 17%, <em>p</em> = 1.00). No mortality events were presented in TAVR explant patients. Two strokes presented in TAVR explant patients, 1 at discharge and 1 at 30 days.</div></div><div><h3>Conclusions</h3><div>Repeat interventions are uncommon in the first decade after TAVR. In clinical practice, the mechanism of failure of the TAVR valve is an important determinant of subsequent treatment; most patients with structural valve deterioration receive a TAV in TAV procedure, whereas surgical explants are usually reserved for infective endocarditis.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 5","pages":"Article 100393"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168743","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}