Structural Heart最新文献

{"title":"A Novel Invasive Hemodynamic Parameter (V′) to Predict Hemodynamic Response to Mitral Transcatheter Edge-to-Edge Repair","authors":"Maryam Muhammad Ali Majeed-Saidan MD,&nbsp;Shivabalan Kathavarayan Ramu MD,&nbsp;Besir Besir MD,&nbsp;Odette Iskandar MD,&nbsp;James Yun MD,&nbsp;Rhonda Miyasaka MD,&nbsp;Amar Krishnaswamy MD,&nbsp;Serge Harb MD,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.shj.2026.101069","DOIUrl":"10.1016/j.shj.2026.101069","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial (LA) V-wave amplitude can be higher with elevated left ventricular end-diastolic pressure, mitral regurgitation (MR), or both. This may cause hemodynamic and echocardiographic discordance when assessing MR. Identifying more specific hemodynamic correlates to MR severity helps in the setting of discordance. We examined the amplitude of the V-wave relative to the LA mean pressure following the reduction in MR after mitral transcatheter edge-to-edge repair (M-TEER).</div></div><div><h3>Methods</h3><div>A total of 231 patients who underwent M-TEER between 2019 and 2022 with reliable intraprocedural invasive hemodynamic waveforms were included. LA mean and V-wave pressures were measured pre- and post-M-TEER. V′ was calculated as follows: (V′ = V-wave – mean pressure).</div></div><div><h3>Results</h3><div>Our cohort (median age 79) included 65% and 35% patients with primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR), respectively. LA mean, V-wave, and V′ pressures decreased significantly after M-TEER in both groups. SMR patients had higher LA pressures after M-TEER. Baseline and post–M-TEER V′ did not differ among groups. In the overall cohort, pre– and post–M-TEER V′ were significantly higher in patients with &gt;2+ residual MR compared to ≤2+ MR. Patients with post–M-TEER V′ &gt;13 mmHg had worse composite outcomes of heart failure hospitalization or all-cause mortality (hazard ratio: 3.01; 95% CI: 1.68-5.4; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>M-TEER decreased LA mean, V-wave, and V′ pressures in PMR and SMR. Postprocedural V′ provides a useful measure of residual MR and clinical outcomes and guides the adequacy of M-TEER.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101069"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951920","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":"The Crack and the Light: Revisiting the Female Paradox After Transcatheter Aortic Valve Replacement","authors":"Ovidio De Filippo MD,&nbsp;Antonio Dalu MD,&nbsp;Fabrizio D’Ascenzo MD,&nbsp;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":"Same-Day Discharge After Left Atrial Appendage Closure: Ready for Prime Time but for Whom?","authors":"Pedro Cepas-Guillén MD, PhD,&nbsp;Maria Teresa Espinosa Moreno RN, MSc, PhDc,&nbsp;Eduardo Flores-Umanzor MD, PhD,&nbsp;Laura Sanchis MD, PhD,&nbsp;Xavier Freixa MD, PhD","doi":"10.1016/j.shj.2026.101074","DOIUrl":"10.1016/j.shj.2026.101074","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101074"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050595","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)00343-X","DOIUrl":"10.1016/S2474-8706(26)00343-X","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101134"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050755","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":"Redefining Procedural Success After Transcatheter Aortic Valve Implantation: Why Nonfatal Complications Matter","authors":"Marisa Avvedimento MD, PhD","doi":"10.1016/j.shj.2026.101102","DOIUrl":"10.1016/j.shj.2026.101102","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101102"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951919","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":"Same-Day Discharge After Left Atrial Appendage Closure and Early Readmissions: A 5-Year National Readmissions Database Analysis","authors":"Sangho Hyun MD,&nbsp;Chia-hung Sze MD,&nbsp;Aqeel Khanani DO,&nbsp;Jennifer Trube DO,&nbsp;Tughral Khan MD,&nbsp;Avinash Khanna MD","doi":"10.1016/j.shj.2026.101073","DOIUrl":"10.1016/j.shj.2026.101073","url":null,"abstract":"<div><h3>Background</h3><div>Same-day discharge (SDD) after left atrial appendage closure (LAAC) may reduce hospitalization burden, but concerns regarding early readmission after discharge remain.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the Nationwide Readmissions Database from 2016 through 2020. Adult patients undergoing inpatient LAAC were identified using International Classification of Disease-10 procedure code 02L73DK. The analytic cohort was restricted to length of stay (LOS) 0 or 1 day; SDD was defined as LOS 0 and overnight stay as LOS 1. Survey-weighted modified Poisson regression was used to estimate adjusted risk ratios (RRs) with year-specific hospital-clustered SEs. Models adjusted for demographics, insurance, income quartile, hospital characteristics, hospital LAAC volume, calendar year, and selected comorbidities.</div></div><div><h3>Results</h3><div>Among the 39,705 index LAAC hospitalizations, 1621 (4.1%) were SDD and 38,084 (95.9%) were overnight stay. SDD increased from 1.6% in 2016 to 7.7% in 2020. Crude 7-day readmission was 2.0% after SDD versus 2.4% after overnight stay, and 30-day readmission was 7.0% versus 7.6%, respectively. After adjustment, SDD was not associated with higher 7-day readmission (RR 0.89; 95% CI 0.62–1.29) or 30-day readmission (RR 1.00; 95% CI 0.82–1.22). Results were similar in missing-data and overlap-weighted sensitivity analyses. Common readmission categories included bleeding/anemia, cardiovascular/thromboembolic causes including heart failure/volume overload, infection/sepsis, and arrhythmia/conduction disorders.</div></div><div><h3>Conclusions</h3><div>Among selected short-stay inpatient LAAC procedures, SDD increased over time and was not associated with higher early readmission compared with overnight observation. These findings should be interpreted as reflecting outcomes among patients selected for SDD rather than evidence supporting universal SDD after LAAC.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101073"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050593","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":"Persistent Tricuspid Regurgitation Despite Mitral Transcatheter Edge-to-Edge Repair: Anticipate Early, Reassess Closely","authors":"Julien Dreyfus MD, PhD,&nbsp;David Messika-Zeitoun MD, PhD","doi":"10.1016/j.shj.2026.101058","DOIUrl":"10.1016/j.shj.2026.101058","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 9","pages":"Article 101058"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050594","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}