Structural Heart最新文献

{"title":"Predicting Treatment of Bioprosthetic Aortic Valve Failure in the United States: A Proposed Model","authors":"Philippe Généreux MD , Martin B. Leon MD , Roy D. Dar PhD , Rishi Puri MD, PhD , Yoseph Rozenman MD , Molly Szerlip MD , Pradeep K. Yadav MD , Vinod H. Thourani MD , Philippe Pibarot DVM, PhD , Danny Dvir MD","doi":"10.1016/j.shj.2024.100339","DOIUrl":"10.1016/j.shj.2024.100339","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100339"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704495","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":"Role of Ultrasound-Based Therapies in Cardiovascular Diseases","authors":"Amit Bansal MBBS, PGDip, MPhil, GCert ,&nbsp;Bernard Bulwer MD ,&nbsp;Ricarda von Krüchten Priv.-Doz., Dr. M. ,&nbsp;Jagkirat Singh MD ,&nbsp;Rajan Rehan MBBS, MPH ,&nbsp;Ata Doost MD, MPhil","doi":"10.1016/j.shj.2024.100349","DOIUrl":"10.1016/j.shj.2024.100349","url":null,"abstract":"<div><div>Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality globally, placing an immense burden on health care costs worldwide. The emergence of therapeutic ultrasound-based therapies in the CVD management represents a promising innovative strategy beyond current established approaches. This paper explores three distinct modalities of ultrasound-based therapies—high-intensity focused ultrasound, extracorporeal shock wave therapy, and low-intensity pulsed ultrasound—each characterized by unique acoustic parameters and mechanisms of action tailored to specific therapeutic outcomes. High-intensity focused ultrasound was shown to be beneficial as an adjunct in the treatment of myocardial infarction and arrhythmias. It has also been investigated for the <em>in vivo</em> treatment of resistant hypertension, symptomatic aortic valve stenosis, arterial stenosis, tumors, hypertrophic cardiomyopathy, and external cardiac pacing. Extracorporeal shock wave therapy was shown to be beneficial in the treatment of chronic refractory angina pectoris, while low-intensity pulsed ultrasound was shown to be beneficial in dissolving blood clots and improving blood flow in the treatment of acute pulmonary embolism, despite its association with an increased risk of bleeding. Ultrasound-based therapies are, therefore, a potential adjunct and comparatively safe adjuncts for managing challenging CVD cases. Further investigations are essential to validate their long-term effectiveness and safety, particularly for high-risk individuals susceptible to postprocedural complications.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100349"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844108","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":"Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020","authors":"Abdul Rahman Akkawi MD ,&nbsp;Syed Zaid MD ,&nbsp;Taha Hatab MD ,&nbsp;Rody G. Bou Chaaya MD ,&nbsp;Emmanuel Oundo MD ,&nbsp;Nadeen Faza MD ,&nbsp;Stephen H. Little MD ,&nbsp;Marvin D. Atkins MD ,&nbsp;Michael J. Reardon MD ,&nbsp;William A. Zoghbi MD ,&nbsp;Neal S. Kleiman MD ,&nbsp;Sachin S. Goel MD","doi":"10.1016/j.shj.2024.100350","DOIUrl":"10.1016/j.shj.2024.100350","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100350"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849807","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":"Evaluation of Expanded Mitral Regurgitation Grading in Patients Undergoing Transcatheter Edge-to-Edge Repair","authors":"Andrew Gustafson MD,&nbsp;O’Neil R. Mason MD,&nbsp;Blair Tilkens DO,&nbsp;Rishi Shrivastav MD,&nbsp;Kifah Hussain MD,&nbsp;Kevin Lin MD,&nbsp;Jyothy J. Puthumana MD,&nbsp;Akhil Narang MD","doi":"10.1016/j.shj.2024.100369","DOIUrl":"10.1016/j.shj.2024.100369","url":null,"abstract":"<div><h3>Background</h3><div>An expanded tricuspid regurgitation scale has been shown to be incrementally useful in understanding the response to transcatheter therapies. A similar approach to mitral regurgitation (MR) has not been evaluated. The purpose of this study was to investigate how an expanded MR grading system that includes categories of massive and torrential would regrade patients undergoing transcatheter edge-to-edge repair (TEER) for MR and evaluate procedural outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively identified 142 consecutive patients with severe MR who underwent TEER. Transesophageal echocardiography was used to assess the quantitative severity of MR and reclassify regurgitation into severe, massive, and torrential grades. Similarly, residual MR was assessed postprocedurally.</div></div><div><h3>Results</h3><div>In the expanded scale, 59% of patients were regraded as severe, 23% as massive, and 18% as torrential, with respective median effective regurgitant orifice area (cm²) of 0.45 [0.39, 0.50], 0.68 [0.65, 0.75], and 0.95 [0.85, 1.20]. Ninety-three percent of the entire cohort and 93% of severe, 94% of massive, and 96% of torrential patients, achieved moderate or less MR post-TEER (<em>p</em> = 0.850) with corresponding improvements in New York Heart Association Functional Classification and 12-item Kansas City Cardiomyopathy Questionnaire scores.</div></div><div><h3>Conclusions</h3><div>An expanded grading system demonstrated that patients with massive and torrential MR still achieve adequate procedural success with reduction in regurgitation and improvement in health status. Further evaluation of how an expanded MR grading scale may be useful is warranted.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100369"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529334","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":"Cardiovascular Mitosis","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2025.100409","DOIUrl":"10.1016/j.shj.2025.100409","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100409"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528668","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":"Transcatheter Aortic Valve Replacement in Patients With Small Aortic Annulus: An Observational Study","authors":"Hanad Bashir MD,&nbsp;Christian W. Schmidt MS,&nbsp;Kofi Ansah MD,&nbsp;Gustavo Mendez-Hirata MD,&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.2024.100338","DOIUrl":"10.1016/j.shj.2024.100338","url":null,"abstract":"<div><h3>Background</h3><div>The Small Annuli Randomized to Evolut or SAPIEN Trial showed superior hemodynamics of self-expanding valves (SEVs) over balloon-expandable valves (BEVs) in patients with small aortic annuli (SAA). The long-term clinical implications of these hemodynamic differences are unknown.</div></div><div><h3>Methods</h3><div>We conducted an observational cohort study of patients with SAA, defined as an aortic valve annular area ≤430 mm² on cardiac computed tomography, who underwent transcatheter aortic valve replacement using BEV or SEV at a single institution between August 2013 and February 2021. Patients undergoing valve-in-valve procedures or alternative access were excluded. Patient-prosthesis mismatch (PPM) was defined as moderate when indexed effective orifice area of 0.65-0.85 cm²/m² and severe when indexed effective orifice area was &lt;0.65 cm²/m² (or &lt;0.55 cm²/m² for body mass index &gt;30 kg/m²). The primary outcome of the study was mortality and major adverse cardiovascular events.</div></div><div><h3>Results</h3><div>A total of 258 patients were included. The majority were female (81%) with intermediate surgical risk (median STS risk score 4.23); 90 patients (35%) received a BEV (median age 80 years [73, 86]) and 168 (65%) received a SEV (81 years [75, 85], <em>p</em> = 0.699). Comorbidities and risk profiles were well balanced between groups. At 30 days post-transcatheter aortic valve replacement, SEV had lower aortic valve mean gradients (8 mmHg [6, 11] vs. BEV 14 mmHg [10, 18], <em>p</em> &lt; 0.001), lower peak velocities (1.86 m/s [1.60, 2.34] vs. BEV 2.52 m/s [2.14, 2.90], <em>p</em> &lt; 0.001), and were less likely to have PPM (SEV 18% vs. BEV 42% (<em>p</em> &lt; 0.001). At 3 years, both groups had similar mortality (SEV 23% vs. BEV 22%, <em>p</em> = 0.875). PPM was not associated with long-term mortality.</div></div><div><h3>Conclusions</h3><div>In patients with SAA, we observed no difference in mortality between SEV and BEV up to 3 years after the index procedure, despite early differences in valve hemodynamics.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100338"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528669","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":"Outcomes of Cardiac Tamponade Post-Transcatheter Aortic Valve Replacement: Results From a Tertiary Cardiac Center","authors":"Simrat Kaur MD ,&nbsp;Vinayak Nagaraja MD ,&nbsp;Paul Schoenhagen MD ,&nbsp;M. Marwan Dabbagh MD ,&nbsp;Najdat Bazarbashi MD ,&nbsp;Shameer Khubber MD ,&nbsp;Manpreet Kaur MD ,&nbsp;Gad Mohomad MD ,&nbsp;Beni Verma MD ,&nbsp;James Yun MD ,&nbsp;Lars Svensson MD, PhD ,&nbsp;Murat Tuzcu MD ,&nbsp;Zoran B. Popović MD, PhD ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Samir Kapadia MD","doi":"10.1016/j.shj.2024.100356","DOIUrl":"10.1016/j.shj.2024.100356","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac tamponade is a rare but potentially lethal complication of transcatheter aortic valve replacement (TAVR). There is paucity of evidence assessing the incidence and outcomes of patients with cardiac tamponade after TAVR.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of all patients who underwent TAVR at our institution from January 2013 to January 2019. The clinical characteristics of patients who developed cardiac tamponade in the periprocedural period were compared to the patients who did not develop tamponade. Qualitative and quantitative assessment of aortic annular calcium distribution on cardiac computerized tomography was analyzed.</div></div><div><h3>Results</h3><div>Twenty out of 2030 patients (0.9%) developed cardiac tamponade post-TAVR. The mean age of the cohort developing cardiac tamponade was 81.7 years, and 50% of them were men. Most of these were intraprocedural (70%) while the remaining were identified in the postprocedural period. The site of injury resulting in pericardial tamponade was thought to be from the injury to aortic annulus (50%), right ventricle (40%), and left ventricle (10%). Tamponade due to annular or left ventricular trauma was mostly identified intraprocedurally (91%; n ​= ​10 of 11), while patients with tamponade due to presumed right ventricular injury were mostly identified in the postprocedural period (62.5%; n ​= ​5 of 8) (<em>p</em> ​= ​0.009). Conservative management with supportive therapies was employed in 90% of patients with cardiac tamponade, while two patients had cardiac surgery. There was one in-hospital mortality, and another patient died within 30 days of the TAVR procedure.</div></div><div><h3>Conclusion</h3><div>The incidence of cardiac tamponade after TAVR (0.9%) was low, and this serious complication can be managed successfully in the majority of patients with streamlined processes in high-volume centers.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100356"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529330","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":"Successful Transseptal Transcatheter Aortic Valve Replacement With Monitored Anesthesia Care and Standard Delivery System","authors":"Zade Akras BS,&nbsp;Nabil Sabbak MD,&nbsp;Calvin C. Sheng MD,&nbsp;James Yun MD, PhD,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.shj.2024.100358","DOIUrl":"10.1016/j.shj.2024.100358","url":null,"abstract":"<div><div>Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment option for patients with symptomatic aortic stenosis across all surgical risk groups. Although the need for alternative access to transfemoral access is becoming less frequent due to better device profiles, there is a continued need for such options. Common approaches used today include subclavian, carotid, caval, aortic, or apical. However, the transseptal approach has not been described with the current S3 delivery system. We present, to our knowledge, the first reported case of a transseptal TAVR using the standard delivery system and under monitored anesthesia care (MAC). This case demonstrates that advances in maneuverability and device profile make transseptal delivery of the S3 valve a safe and effective approach in some patients with no other peripheral arterial access.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100358"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529332","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(25)00004-1","DOIUrl":"10.1016/S2474-8706(25)00004-1","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100412"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528667","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":"Change in Dicrotic Notch Index Predicts Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair for Mitral Regurgitation","authors":"Vishwum Kapadia,&nbsp;Shivabalan Kathavarayan Ramu MD,&nbsp;Maryam Majeed-Saidan MD,&nbsp;Rhonda Miyasaka MD,&nbsp;Serge Harb MD,&nbsp;Amar Krishnaswamy MD","doi":"10.1016/j.shj.2024.100361","DOIUrl":"10.1016/j.shj.2024.100361","url":null,"abstract":"<div><h3>Background</h3><div>Changes in the dicrotic notch characteristics in the aortic pressure waveform have not been adequately studied with mitral transcatheter edge-to-edge repair (M-TEER). In this study, we sought to determine the changes in the dicrotic notch index (DNI) with M-TEER and identify their significance in determining procedural success.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients undergoing M-TEER between 2019 and 2022 at our institution. DNI ([systolic-dicrotic pressure]/[systolic-diastolic pressure]) was calculated from invasive ascending aortic pressure waveforms. The cut point for change in DNI was determined and used to compare differences in composite clinical outcomes of mortality and heart failure hospitalization. To identify the determinants of change in DNI, variables including post-M-TEER MR and change in forward stroke volume (FSV) were measured.</div></div><div><h3>Results</h3><div>Of the 145 patients included in the study cohort, DNI significantly increased after M-TEER (0.49 ​± 0.11 to 0.52 ± ​0.11, <em>p</em> &lt; ​0.001). A cut point of 2.71% change in DNI identified higher probability of event-free survival at 1 year. Using this cut point, change in DNI was an independent predictor of event-free survival (hazard ratio: 0.45 [95% CI: 0.21-0.99], <em>p</em> ​= ​0.01). Of the studied variables, change in FSV was the only predictor of change in DNI (hazard ratio: 0.187 [95% CI: 0.072-0.302], <em>p</em> = 0.002) with significant correlation (r = 0.30, <em>p</em> &lt; ​0.001).</div></div><div><h3>Conclusions</h3><div>DNI increases after M-TEER, and the magnitude of increase in DNI is associated with better clinical outcomes. Further, increase in FSV correlates with increase in DNI. DNI measured during M-TEER procedure provides an additional simple measure of procedural success.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 2","pages":"Article 100361"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529333","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}