Structural Heart最新文献

Redo-Transcatheter Aortic Valve Replacement with an Intra-Annular, Self-Expanding Prosthesis Within a Balloon Expandable Prosthesis: A Case Series

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100324

Ethan C. Korngold MD, Brandon M. Jones MD

引用次数: 0

Comparison of Patent Foramen Ovale Sizing by Transesophageal Echocardiography and Balloon Sizing in Patients Undergoing Percutaneous Closure

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100375

Birgitte Carbuhn Larsen MD , Martin Christian Harmsen MD , Henrik Vase MD, PhD , Jens Erik Nielsen-Kudsk MD, DMSc , Asger Andersen MD, PhD

{"title":"Comparison of Patent Foramen Ovale Sizing by Transesophageal Echocardiography and Balloon Sizing in Patients Undergoing Percutaneous Closure","authors":"Birgitte Carbuhn Larsen MD , Martin Christian Harmsen MD , Henrik Vase MD, PhD , Jens Erik Nielsen-Kudsk MD, DMSc , Asger Andersen MD, PhD","doi":"10.1016/j.shj.2024.100375","DOIUrl":"10.1016/j.shj.2024.100375","url":null,"abstract":"<div><h3>Background</h3><div>A patent foramen ovale (PFO) has a complex anatomy, and evaluating the size before closure may be challenging. We aimed to investigate the correlation between preprocedural transesophageal echocardiography (TEE) and balloon sizing of PFO in patients undergoing percutaneous PFO closure.</div></div><div><h3>Methods</h3><div>A retrospective single-center study with analysis of 100 patients who, due to paradox thromboembolism in the left circulation, underwent percutaneous PFO closure. The PFO sizing was compared to measures attained by TEE and balloon sizing using linear regression analysis.</div></div><div><h3>Results</h3><div>PFO size measured by TEE occurred smaller than balloon sizing (2.19 mm [95% CI: 1.91 to 2.46] vs. 8.51 mm [95% CI: 8.02 to 9.00], <em>p</em> < 0.001). Additionally, neither the PFO channel length nor the atrial septal mobility measured by TEE correlated to the PFO size attained by balloon sizing, respectively (slope <strong>−</strong>0.018 [95% CI: <strong>−</strong>0.117 to 0.081], R = 0.036, <em>p</em> = 0.719) and (slope 0.049 [95% CI: ?0.043 to 0.141], R = 0.105, <em>p</em> = 0.297). Statistically significant difference in regression analysis but poor correlation was found between both TEE attained PFO and shunt size when compared to balloon sizing. Diverting patients according to the size of the PFO shunt was not statistically significant between PFO of moderate size compared, respectively, to a large and small PFO size. However, a difference was observed between a small and large PFO shunt size.</div></div><div><h3>Conclusions</h3><div>PFO defect and shunt size measured by TEE showed a poor correlation with balloon sizing. Neither PFO channel length nor septal mobility were correlated to the PFO size measured by balloon sizing.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100375"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Can Variation in Costs for Cardiovascular Procedures Be Attributed to Inefficiency in Care Delivery? Challenges in Causality, Data Availability, and the Need for Price Transparency

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100367

Waseem Nosair MD, MPH , Morgana Mongraw-Chaffin PhD, MPH , William S. Weintraub MD

引用次数: 0

How Important Is Death?

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100396

Anthony DeMaria MD

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Left Atrial Appendage Occlusion: Expanding Indications and New Developments

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100354

Grant W. Reed MD, MSc, Shady Nakhla MD, Rhonda Miyasaka MD, Serge Harb MD, Mohamed Kanj MD, Ousamma Wazni MD, Samir R. Kapadia MD, Amar Krishnaswamy MD

{"title":"Left Atrial Appendage Occlusion: Expanding Indications and New Developments","authors":"Grant W. Reed MD, MSc, Shady Nakhla MD, Rhonda Miyasaka MD, Serge Harb MD, Mohamed Kanj MD, Ousamma Wazni MD, Samir R. Kapadia MD, Amar Krishnaswamy MD","doi":"10.1016/j.shj.2024.100354","DOIUrl":"10.1016/j.shj.2024.100354","url":null,"abstract":"<div><div>Percutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice. Recent data comparing the safety and efficacy of post-LAAO antiplatelet vs. antithrombotic therapy will be highlighted, with specific recommendations regarding which patients are best suited for each strategy. We will also address the safety and practical considerations provided by emerging trials on concomitant LAAO during other structural heart interventions such as transcatheter aortic valve replacement and mitral valve interventions, as well as electrophysiology procedures including catheter ablation for atrial fibrillation and pacemaker implantation. Practical considerations for the use of transesophageal echocardiography or intracardiac echocardiography for procedural guidance will also be discussed. As the evidence supporting LAAO continues to evolve, this review will serve as a primer on the recent and upcoming advances in device technology and management strategies positioned to further push LAAO forward into the future.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100354"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Targeting the Future: Three-Dimensional Imaging for Precise Guidance of the Transseptal Puncture 瞄准未来：三维成像为经窦穿刺提供精确引导

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100340

Serge C. Harb MD , Joshua A. Cohen MD , Amar Krishnaswamy MD , Samir R. Kapadia MD , Rhonda L. Miyasaka MD

引用次数: 0

Aims & Scope

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/S2474-8706(24)00161-1

引用次数: 0

Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study 小主动脉瓣环上与瓣环内自扩张瓣膜：倾向评分匹配研究

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100334

Michel Pompeu Sá MD, MSc, MHBA, PhD , Danial Ahmad MD, MPH , Yisi Wang MPH , Floyd Thoma BS , Amber Makani MD , Dustin Kliner MD , Catalin Toma MD , David West MD , Derek Serna-Gallegos MD , Ibrahim Sultan MD

{"title":"Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study","authors":"Michel Pompeu Sá MD, MSc, MHBA, PhD , Danial Ahmad MD, MPH , Yisi Wang MPH , Floyd Thoma BS , Amber Makani MD , Dustin Kliner MD , Catalin Toma MD , David West MD , Derek Serna-Gallegos MD , Ibrahim Sultan MD","doi":"10.1016/j.shj.2024.100334","DOIUrl":"10.1016/j.shj.2024.100334","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor).</div></div><div><h3>Methods</h3><div>Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM).</div></div><div><h3>Results</h3><div>We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; <em>p</em> = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm<sup>2</sup>/m<sup>2</sup>, <em>p</em> = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, <em>p</em> = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, <em>p</em> = 0.390). No statistically significant difference was observed in survival (log-rank <em>p</em> = 0.950) and stroke (<em>p</em> = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe.</div></div><div><h3>Conclusions</h3><div>IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100334"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100353

Shashank Shekhar MD, Amar Krishnaswamy MD, Grant Reed MD, MSc, James Yun MD, Rishi Puri MD, PhD, Samir Kapadia MD

{"title":"Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation","authors":"Shashank Shekhar MD, Amar Krishnaswamy MD, Grant Reed MD, MSc, James Yun MD, Rishi Puri MD, PhD, Samir Kapadia MD","doi":"10.1016/j.shj.2024.100353","DOIUrl":"10.1016/j.shj.2024.100353","url":null,"abstract":"<div><h3>Background</h3><div>Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).</div></div><div><h3>Methods</h3><div>Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database. Stroke, major stroke, in-hospital mortality, and 30-day readmission rates were compared between the CPD and no-CPD cohorts in a propensity score matched analysis. Association of CPD use with adverse events was analyzed using multivariable logistic regression models.</div></div><div><h3>Results</h3><div>Of 100,928 eligible TAVR patients with AF, CPD was used in 6.9% of patients with a mean age of 80 years. CPD use was independently associated with lower overall stroke (1.7% vs. 2.2%; odds ratio [OR] 0.81 [95% CI 0.68-0.98]; <em>p</em> = 0.032), major stroke (1.2% vs. 1.8%; OR 0.69 [0.55-0.86]; <em>p</em> = 0.001), in-hospital mortality (0.9 vs. 1.5%; OR 0.56 [0.43-0.72]; <em>p</em> < 0.001), and lower 30-day readmission rates (12.7% vs. 14.7%; OR 0.87 [0.81-0.94]; <em>p</em> < 0.001). Reduction in adverse events with CPD was noted in high-volume but not in low-volume TAVR centers.</div></div><div><h3>Conclusions</h3><div>The present point towards clear benefits of CPD use among patients with AF undergoing TAVR. In anatomically eligible patients, the potential benefit of debris capture may be considered especially as younger and lower risk patients become eligible for TAVR. Data from future trials and registries are required to further corroborate our findings.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100353"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Review of “Access to Care” Issues in Aortic Stenosis Patients: A Negative Report Card

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100351

Adam M. Reisman MD , Sammy Elmariah MD, MPH

{"title":"A Review of “Access to Care” Issues in Aortic Stenosis Patients: A Negative Report Card","authors":"Adam M. Reisman MD , Sammy Elmariah MD, MPH","doi":"10.1016/j.shj.2024.100351","DOIUrl":"10.1016/j.shj.2024.100351","url":null,"abstract":"<div><div>The identification and management of patients with aortic stenosis exist along a continuum that includes healthy living, latent progression, diagnosis, treatment, and posttreatment recovery. Barriers to the provision of appropriate care for these patients can occur at any stage along this continuum. Despite the presence of diagnostic echocardiograms, many patients with aortic stenosis are never clinically recognized, and the rate of mismanagement worsens among underrepresented minority groups and women. Regarding the treatment of clinically recognized aortic stenosis, only about half of patients with symptomatic severe aortic stenosis actually undergo aortic valve replacement within 2 years of diagnosis. Treatment rates are even lower among patients with symptomatic low-gradient severe aortic stenosis. Although several strategies have been raised by experts within the field to help and improve the diagnosis and treatment of patients with aortic valve disease, timely referral to a heart valve team specialist whenever aortic valve replacement is being considered likely remains the most pertinent intervention. Connecting these patients with fully informed aortic valve disease experts helps facilitate shared decision-making discussions, thus ensuring that patients have the opportunity to learn about and potentially receive the lifesaving interventions available to them.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100351"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0