Structural Heart最新文献

{"title":"The Crack and the Light: Revisiting the Female Paradox After Transcatheter Aortic Valve Replacement","authors":"Ovidio De Filippo MD, Antonio Dalu MD, Fabrizio D’Ascenzo MD, Federico Conrotto MD","doi":"10.1016/j.shj.2026.101107","DOIUrl":"10.1016/j.shj.2026.101107","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101107"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148854804","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}

{"title":"Impact of Early Nonfatal Complications After Transcatheter Aortic Valve Implantation on 1-Year Mortality and Quality of Life: Insights From the LANDMARK Trial","authors":"Akihiro Tobe MD,&nbsp;Yoshinobu Onuma MD, PhD,&nbsp;Niels van Royen MD, PhD,&nbsp;Ignacio J. Amat-Santos MD, PhD,&nbsp;Martin Hudec MD, PhD,&nbsp;Matjaz Bunc MD, PhD,&nbsp;Ben J.L. van den Branden MD,&nbsp;Peep Laanmets MD,&nbsp;Daniel Unic MD, PhD,&nbsp;Bela Merkely MD, PhD,&nbsp;Renicus S. Hermanides MD, PhD,&nbsp;Vlasis Ninios MD,&nbsp;Marcin Protasiewicz MD, PhD,&nbsp;Benno J.W.M. Rensing MD, PhD,&nbsp;Pedro L. Martin MD, PhD,&nbsp;Fausto Feres MD,&nbsp;Manuel de Sousa Almeida MD, PhD,&nbsp;Eric Van Belle MD, PhD,&nbsp;Axel Linke MD,&nbsp;Alfonso Ielasi MD,&nbsp;Patick W. Serruys MD, PhD","doi":"10.1016/j.shj.2026.101101","DOIUrl":"10.1016/j.shj.2026.101101","url":null,"abstract":"<div><h3>Background</h3><div>The impact of early nonfatal complications on subsequent mortality and quality of life (QOL) after contemporary transcatheter aortic valve implantation (TAVI) remains unclear.</div></div><div><h3>Methods</h3><div>This post-hoc substudy of the LANDMARK trial included patients with severe aortic stenosis randomized to the Myval transcatheter heart valve (THV) series or to contemporary THV (Sapien or Evolut) series. Early nonfatal complications were defined as events occurring within 30 days after TAVI in patients surviving the first 30 days and included stroke, type 3 bleeding, major vascular complications, acute kidney injury stages 2-4, moderate or severe aortic regurgitation, new permanent pacemaker implantation, or reintervention according to the VARC-3 early safety endpoint. The primary endpoint was all-cause mortality from 30 to 365 days. QOL was assessed using the Short Form-12 at baseline, 30 days, and 1 year.</div></div><div><h3>Results</h3><div>Of the 768 randomized patients, 742 were alive at 30 days. Of these, 177 (23.9%) experienced at least 1 early nonfatal complication, whereas 565 (76.1%) did not. Age (80 ± 5 years vs. 80 ± 6 years, <em>p</em> = 0.67) and Society of Thoracic Surgeons score (median 2.6 [interquartile range: 1.6-3.9] vs. 2.6 [1.7-3.9], <em>p</em> = 0.76) were similar between groups. Patients with early nonfatal complications had higher mortality between 30 and 365 days (8.0% vs. 3.9%, <em>p</em> = 0.03). Early nonfatal complications were independently associated with increased 1-year mortality (hazard ratio = 2.14; 95% CI, 1.07-4.27; <em>p</em> = 0.03). One-year QOL did not differ between groups.</div></div><div><h3>Conclusions</h3><div>In this post-hoc, hypothesis-generating analysis, early nonfatal complications after TAVI were associated with increased 1-year mortality, whereas 1-year QOL was comparable among survivors; findings should be interpreted with caution due to potential survivor bias.</div></div><div><h3>Trial registration number</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, NCT04275726.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101101"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148854805","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}

{"title":"Sex-Specific Differences in Clinical Outcomes After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Reconstructed Individual Patient Survival Data","authors":"Ali M. Abdelaziz MD,&nbsp;Mohamedhen Vall Nounou MD,&nbsp;Ahmad Al Othman MD,&nbsp;Mirvat Alasnag MD,&nbsp;Alaide Chieffo MD, PhD,&nbsp;J. Dawn Abbott MD,&nbsp;Abubaker Al-Allawee,&nbsp;Sofian Zreigh,&nbsp;Mohammed Benhammou,&nbsp;Muhiddin Dervis,&nbsp;Walid Guerguer MD,&nbsp;Ashraf Haidarah,&nbsp;Rafeek Elmezayen,&nbsp;Mohammad Alzu’bi,&nbsp;Serag Almzainy,&nbsp;Saber Khalid,&nbsp;Qasim Shawesh MD,&nbsp;Maram Abuajamieh,&nbsp;Muhammed Elhadi MD, MSc,&nbsp;Rodrigo Bagur MD, PhD,&nbsp;Mamas A. Mamas MD, PhD","doi":"10.1016/j.shj.2026.101100","DOIUrl":"10.1016/j.shj.2026.101100","url":null,"abstract":"<div><h3>Background</h3><div>Females with severe aortic stenosis present with distinct anatomical and clinical characteristics compared to males, which may influence outcomes following transcatheter aortic valve replacement (TAVR). We sought to investigate the prognostic impact of sex-specific differences on short- and long-term outcomes following TAVR.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Scopus, and Web of Science were searched through August 2025 for randomized and observational studies reporting sex-specific outcomes after TAVR. Reconstructed individual patient data from published Kaplan–Meier (KM) curves were used to estimate long-term survival outcomes.</div></div><div><h3>Results</h3><div>Overall, 71 studies involving 481,353 patients were included. Compared with males, females demonstrated a higher short-term risk of adverse outcomes, including 30-day all-cause mortality (hazard ratio [HR]: 1.064, 95% CI: 1.005–1.127; <em>p</em> = 0.033) and stroke/transient ischemic attack (HR: 1.511, 95% CI: 1.317–1.734; <em>p</em> &lt; 0.001). Females were also more likely to experience life-threatening bleeding (risk ratio [RR]: 1.29, 95% CI: 1.03–1.62; <em>p</em> = 0.028), major bleeding (RR: 1.26, 95% CI: 1.13–1.41; <em>p</em> &lt; 0.001), and major vascular complications (RR: 1.66, 95% CI: 1.53–1.81; <em>p</em> &lt; 0.001). Despite these higher periprocedural risks, females demonstrated superior long-term outcomes, with lower all-cause mortality (HR: 0.812, 95% CI: 0.794–0.831; <em>p</em> &lt; 0.001) and cardiovascular mortality (HR: 0.837, 95% CI: 0.784–0.893; <em>p</em> &lt; 0.001) during follow-up extending to 10 years, whereas risks of stroke/transient ischemic attack and myocardial infarction were comparable between sexes.</div></div><div><h3>Conclusions</h3><div>Females undergoing TAVR experience higher early risks of mortality, stroke, bleeding, and vascular complications, but exhibit a sustained long-term survival advantage compared with males, highlighting the need for sex-centered periprocedural management strategies.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101100"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148854806","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}

{"title":"Pacemaker Implantation in Patients With Pre-Existing Bundle Branch Block Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement","authors":"Judah Rajendran MD,&nbsp;Shivabalan Kathavarayan Ramu MD,&nbsp;Carl Ammoury MD,&nbsp;Besir Besir MD,&nbsp;Akhilesh Khuttan MD,&nbsp;Odette Iskander MD,&nbsp;Tamari Lomaia MD,&nbsp;Ankit Agrawal MD,&nbsp;Alexander Egoavil BA,&nbsp;James Yun MD,&nbsp;Grant Reed MD,&nbsp;Rishi Puri MD,&nbsp;Serge Harb MD,&nbsp;Oussama Wazni MD,&nbsp;Amar Krishnaswamy MD,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.shj.2026.101052","DOIUrl":"10.1016/j.shj.2026.101052","url":null,"abstract":"<div><h3>Background</h3><div>The primary objective of this study was to compare permanent pacemaker (PPM) implantation rates following balloon-expandable transcatheter aortic valve replacement (TAVR) between patients with pre-existing right bundle branch block (RBBB) versus left bundle branch block (LBBB). Secondary objectives were to assess long-term clinical outcomes according to baseline conduction status and post-TAVR PPM implantation and identify independent predictors of PPM implantation.</div></div><div><h3>Methods</h3><div>This retrospective study included 380 patients with pre-existing RBBB (n = 269) and LBBB (n = 111) who underwent balloon-expandable TAVR between 2016 and 2020, excluding those with prior pacemakers or implantable cardioverter defibrillators.</div></div><div><h3>Results</h3><div>Within 30 days following TAVR, PPM implantation was significantly more frequent in patients with preexisting RBBB compared with LBBB (18.59 vs. 7.21%, <em>p</em> = 0.003), whereas early mortality remained low and similar between groups. Patients with RBBB exhibited larger annular dimensions, greater annular calcium burden, and a narrower membranous septum angle. Over long-term 2-year follow-up, there were no significant differences in all-cause mortality or heart failure hospitalization between RBBB and LBBB patients, irrespective of post-TAVR PPM implantation status. On multivariable logistic regression, baseline RBBB (odds ratio [OR] 3.56; 95% CI 1.01–12.58) and prior atrial fibrillation/flutter (OR 4.13; 95% CI 1.63–10.45) were independently associated with increased 30-day PPM risk, whereas deeper right-sided membranous septum implantation depth was associated with lower PPM risk (OR 0.90; 95% CI 0.81–0.99).</div></div><div><h3>Conclusions</h3><div>Patients with preexisting RBBB undergoing balloon-expandable TAVR had a significantly higher and earlier rate of PPM implantation compared to LBBB patients, with no differences in outcomes irrespective of BBB and PPM implantation status. Atrial fibrillation/flutter and RBBB were associated with an increased risk of 30-day PPM implantation, although the risk is acceptable with higher valve implantation.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 101052"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148642444","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}

{"title":"Prediction of Underexpansion Following Transcatheter Aortic Valve Implantation and Efficacy of Balloon Postdilatation","authors":"Mariama Akodad MD, PhD,&nbsp;Sri Krishna Sivakumar PhD,&nbsp;Joshua Yoon MD,&nbsp;Courtney Ream BSc,&nbsp;David A. Wood MD,&nbsp;Jonathon A. Leipsic MD,&nbsp;Philipp Blanke MD,&nbsp;John G. Webb MD,&nbsp;Lakshmi Prasad Dasi PhD,&nbsp;David Meier MD,&nbsp;Stephanie L. Sellers MSc, PhD","doi":"10.1016/j.shj.2026.100850","DOIUrl":"10.1016/j.shj.2026.100850","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter heart valve (THV) underexpansion following transcatheter aortic valve implantation (TAVI) is associated with elevated gradients, paravalvular leak, and/or risk of hypoattenuating leaflet thickening. We aimed to simulate TAVI using pre-TAVI computed tomography (CT) images to predict the extent of THV underexpansion and the effect of staged balloon postdilatation on THV expansion.</div></div><div><h3>Methods</h3><div>Patients who underwent balloon postdilatation as a staged procedure for symptomatic THV dysfunction following native or valve-in-valve TAVI with available pre-TAVI, post-TAVI, and post–balloon aortic valvuloplasty CT between 2016 and 2023 were analyzed. TAVI and postdilatation were simulated computationally in patient-specific models using finite element analysis. Simulations were performed in blinded fashion without information of index procedure. THV expansion was defined as the percentage of THV area achieved by THV in CT or modeling when compared to nominal area defined by THV manufacturer.</div></div><div><h3>Results</h3><div>Among patients with balloon-expandable THVs following TAVI, the differences in expansion between CT and simulation measurements were −0.88% ± 3.27% (<em>p</em> = 0.75), −3.11% ± 4.65% (<em>p</em> = 0.26), and −3.27% ± 4.67% (<em>p</em> = 0.03) at the inflow, mid, and outflow regions, respectively. Following postdilatation, the differences in expansion between CT and simulation measurements were −0.60% ± 4.7% (<em>p</em> = 0.71), −1.64% ± 6.0% (<em>p</em> = 0.99), and −1.13% ± 4.2% (<em>p</em> = 0.55), respectively. Among patients with self-expandable THVs following TAVI, the percentage difference between CT and simulation measurements were 6.2% ± 4.2% (<em>p</em> = 0.99) and 9.3% ± 2.7% (<em>p</em> = 0.99) at the inflow and mid regions, respectively. Following postdilatation, the differences in expansion between CT and simulation measurements were 9.0% ± 3.2% and 8.9% ± 3.4%, respectively.</div></div><div><h3>Conclusions</h3><div>Patient-specific computational modeling can predict THV underexpansion during the index procedure and the effect of postdilatation on THV expansion.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100850"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731368","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}

{"title":"Aims & Scope","authors":"","doi":"10.1016/S2474-8706(26)00319-2","DOIUrl":"10.1016/S2474-8706(26)00319-2","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 101110"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731369","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}

{"title":"Gradient Is Not Enough: Stroke Volume Index as the True Arbiter of Risk in Advanced Aortic Stenosis","authors":"Ashish H. Shah MD, MD","doi":"10.1016/j.shj.2026.100844","DOIUrl":"10.1016/j.shj.2026.100844","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100844"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731365","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}

{"title":"Beyond Gradient, Beyond Flow: Rethinking Risk Stratification in Aortic Stenosis","authors":"Kimberley I. Hemelrijk MD,&nbsp;Hugo M. Aarts MD,&nbsp;Gijs M. Broeze MSc,&nbsp;Astrid C. van Nieuwkerk MD, PhD,&nbsp;Ronak Delewi MD, PhD","doi":"10.1016/j.shj.2026.101047","DOIUrl":"10.1016/j.shj.2026.101047","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 101047"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731366","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}

{"title":"Complete Versus Incomplete Revascularization in Patients With Severe Aortic Stenosis Undergoing Complex, High-Risk PCI: Insights From the ASCoP Registry","authors":"Francesco Tartaglia MD,&nbsp;Antonio Mangieri MD,&nbsp;Andrea R. Munafò MD,&nbsp;Damiano Regazzoli MD,&nbsp;Giuseppe Esposito MD, PhD,&nbsp;Francesco Soriano MD,&nbsp;Ketina Arslani MD,&nbsp;Stephanie Brunner MD,&nbsp;Sarah Verhemel MD,&nbsp;Andrea Buono MD,&nbsp;Mattia Squillace MD,&nbsp;José Luis Díez Gil MD,&nbsp;Andrea Scotti MD,&nbsp;Alessandro Mandurino-Mirizzi MD,&nbsp;David Bauer MD,&nbsp;Pablo Codner MD,&nbsp;Kerstin Piayda MD,&nbsp;Italo Porto MD, PhD,&nbsp;Stefano Nava MD,&nbsp;Matteo Maurina MD,&nbsp;Claudio Montalto MD","doi":"10.1016/j.shj.2026.100824","DOIUrl":"10.1016/j.shj.2026.100824","url":null,"abstract":"<div><h3>Background</h3><div>Complex coronary artery disease frequently coexists with severe aortic stenosis. The prognostic impact of complete revascularization (CR) versus incomplete revascularization (IR) in patients undergoing complex and/or high-risk indicated percutaneous coronary intervention (CHIP) and transcatheter aortic valve implantation (TAVI) remains unclear.</div></div><div><h3>Methods</h3><div>We analyzed 550 patients who underwent CHIP and transfemoral TAVI between 2013 and 2023 at 14 international centers. Patients were stratified by completeness of revascularization. The primary endpoint was a composite of all-cause death and unplanned cardiovascular (CV) hospitalization at 1 year.</div></div><div><h3>Results</h3><div>CR was achieved in 299 patients (54.4%). Patients with IR more frequently had three-vessel disease, bifurcation lesions, left main disease, and need for mechanical support. Balloon-expandable valves were more frequently implanted in the CR cohort. Short-term outcomes were similar in the two groups. At 1 year, the incidence of the primary endpoint did not differ significantly between CR and IR groups (20.1 vs. 27.3%, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.49-1.07). CV rehospitalizations were significantly reduced in the CR group (14.8 vs. 22.8%, HR 0.61, 95% CI 0.38-0.97) even after multivariable adjustment and excluding hospitalizations for repeat revascularization.</div></div><div><h3>Conclusions</h3><div>In patients undergoing CHIP and TAVI, CR was associated with a reduction in CV hospitalizations. Further studies are needed to confirm this finding.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100824"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731367","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}

{"title":"Real-World Outcomes and Trends From a Prospective Japanese Transcatheter Aortic Valve Replacement Registry","authors":"Santiago Garcia MD","doi":"10.1016/j.shj.2026.100854","DOIUrl":"10.1016/j.shj.2026.100854","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100854"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731370","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}