Structural Heart最新文献

{"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}

{"title":"Complex Percutaneous Coronary Intervention in Patients Requiring Transcatheter Aortic Valve Replacement","authors":"Thomas Gilliland MD,&nbsp;Tanush Gupta MD","doi":"10.1016/j.shj.2026.101054","DOIUrl":"10.1016/j.shj.2026.101054","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 101054"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731371","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":"Evolving Early Outcomes After Transcatheter Aortic Valve Replacement in Asian Patients: Temporal Trends From the OCEAN-TAVI Registry","authors":"Hirofumi Hioki MD,&nbsp;Masanori Yamamoto MD,&nbsp;Tetsuro Shimura MD,&nbsp;Shinichi Shirai MD,&nbsp;Yohei Ohno MD,&nbsp;Fumiaki Yashima MD,&nbsp;Toru Naganuma MD,&nbsp;Yusuke Watanabe MD,&nbsp;Futoshi Yamanaka MD,&nbsp;Gaku Nakazawa MD,&nbsp;Masahiko Noguchi MD,&nbsp;Masaki Izumo MD,&nbsp;Masahiko Asami MD,&nbsp;Hidetaka Nishina MD,&nbsp;Yasushi Fuku MD,&nbsp;Daisuke Hachinohe MD,&nbsp;Kenji Nishioka MD,&nbsp;Toshiaki Otsuka MD,&nbsp;Kentaro Hayashida MD,&nbsp;OCEAN-TAVI Investigators","doi":"10.1016/j.shj.2026.100851","DOIUrl":"10.1016/j.shj.2026.100851","url":null,"abstract":"<div><h3>Background</h3><div>As transcatheter aortic valve replacement (TAVR) has expanded across a broad range of surgical risk profiles, evaluating temporal changes in outcomes has become increasingly important, particularly in the Asian population where patient characteristics differ from those of the Western population. The aim of the study was to evaluate the temporal trends in short-term outcomes after TAVR over the past decade in a large Asian multicenter registry.</div></div><div><h3>Methods</h3><div>This retrospective multicenter registry included 13,245 patients who underwent TAVR at 18 centers from 2013 to 2023. Temporal trends in 30-day mortality, 30-day stroke, and 30-day pacemaker implantation (PMI), and paravalvular leakage (PVL) ≥ mild at discharge were assessed using multiple imputation and center-clustered generalized estimating equations. The effect modification by age and surgical risk was prespecified.</div></div><div><h3>Results</h3><div>The median age was 85 years, and the median Society of Thoracic Surgeons (STS) score was 5.6%. Over time, patient profiles shifted toward lower risk, and procedures became less invasive. Consistent across age and Society of Thoracic Surgeons risk strata, the overall risk-adjusted 30-day mortality remained low and did not change significantly over time. In contrast, the risk-adjusted PMI and PVL ≥ mild declined significantly over time, particularly in TAVR using balloon-expandable valves (BEVs). The risk-adjusted incidence of 30-day stroke did not change significantly.</div></div><div><h3>Conclusions</h3><div>Early mortality after TAVR in the Asian cohort has remained consistently low over the past decade. Although device-related complications such as PMI and PVL improved substantially, periprocedural stroke remained as a key unmet clinical challenge.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100851"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730201","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":"Predicting Transcatheter Heart Valve Expansion: A New Step Toward Durable Transcatheter Aortic Valve Implantation Outcomes","authors":"Antonin Trimaille MD, PhD","doi":"10.1016/j.shj.2026.100853","DOIUrl":"10.1016/j.shj.2026.100853","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 8","pages":"Article 100853"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731372","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":"Initial Experience With Automated 3D Color Flow Quantification of Mitral Regurgitation","authors":"Serge C. Harb MD,&nbsp;Joseph Hajj MD,&nbsp;Abdelrahaman Ahmed MD,&nbsp;Amar Krishnaswamy MD,&nbsp;Samir Kapadia MD,&nbsp;Patrick Collier MD,&nbsp;Richard Grimm DO,&nbsp;Rhonda L. Miyasaka MD","doi":"10.1016/j.shj.2026.100830","DOIUrl":"10.1016/j.shj.2026.100830","url":null,"abstract":"<div><div>Accurate quantification of mitral regurgitation (MR) is essential for preprocedural evaluation and intraprocedural decision-making during transcatheter mitral interventions. Conventional echocardiographic techniques, such as the proximal isovelocity surface area method, have numerous limitations. Proximal isovelocity surface area is sensitive to the timing of MR, orifice geometry, and jet eccentricity. Assumptions of hemispheric flow convergence and circular regurgitant orifices are often untrue, particularly in functional MR. As a result, nonholosystolic jets may lead to overestimation of MR severity, while multiple jets may cause underestimation.</div><div>To overcome these limitations, we describe our initial experience with the Philips 3D Automated Color Flow Quantification tool, used to focus on optimal image acquisition strategies and common pitfalls. This software enables automated calculation of regurgitant volume directly from 3D color Doppler data, allowing assessment of multiple and noncircular MR origins. By integrating a fluid dynamics model with artificial intelligence–based segmentation, the tool performs frame-by-frame systolic analysis, capturing temporal variations in regurgitant flow throughout systole.</div><div>Our study included patients with severe MR undergoing transcatheter edge-to-edge repair; MR quantification is important for both procedural planning and intraprocedural guidance with this population. Although further validation is needed before widespread adoption, accurate analysis is highly dependent on high-quality 3D color Doppler acquisition. This manuscript outlines key technical considerations for optimizing 3D color imaging—including balancing spatial resolution and temporal resolution, increasing frame rate, and addressing common analysis challenges—with illustrative figures and supplemental videos.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 7","pages":"Article 100830"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371346","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}