Structural Heart最新文献

{"title":"Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion","authors":"Shivaraj Patil MD ,&nbsp;Chaitanya Rojulpote MD ,&nbsp;Abhijit Bhattaru BS ,&nbsp;Avica Atri MD ,&nbsp;Krishna Vamsi Rojulpote BS ,&nbsp;Ola Khraisha MD ,&nbsp;Viha Atri MD ,&nbsp;William Frick MD ,&nbsp;Tarek Nafee MD ,&nbsp;Kishore Harjai MD ,&nbsp;Sumeet Mainigi MD ,&nbsp;Chien-Jung Lin PhD, MD","doi":"10.1016/j.shj.2024.100376","DOIUrl":"10.1016/j.shj.2024.100376","url":null,"abstract":"<div><h3>Background</h3><div>The commercial use of percutaneous left atrial appendage occlusion with the Watchman device is increasing in the United States. The purpose of this study was to evaluate center-related variation in total hospital costs for Watchman device implantation and identify factors associated with high hospital costs at a national level.</div></div><div><h3>Methods</h3><div>All adults undergoing elective left atrial appendage occlusion with Watchman were identified in the 2016-2018 National Inpatient Database. Mixed models were used to evaluate the impact of center on total hospital costs, adjusting for patient and center characteristics and length of stay.</div></div><div><h3>Results</h3><div>A total of 30,175 patients underwent Watchman device implantation at a median cost of $24,500 and demonstrated significant variability across admissions (interdecile range, $13,900-37,000). Nearly 13% of the variability in patient-level costs was related to the center performing the procedure rather than patient factors. Higher-volume centers had lower total costs and demonstrated lesser total cost variation. Centers with low procedural volume, occurrence of procedural complications, congestive heart failure, and length of stay were independent predictors of a high-cost hospitalization. Though complications were associated with increased expenditure, they did not explain the observed cost variation related to the center.</div></div><div><h3>Conclusions</h3><div>A significant proportion of variation in total hospital cost was attributable to the center performing the procedure. Addressing variability of Watchman-related costs is necessary to achieve high-quality value-based care.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100376"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372549","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":"Tricuspid Regurgitation in the Setting of Cardiac Implantable Electronic Devices","authors":"Omar M. Aldaas MD,&nbsp;Gary Ma MD,&nbsp;Quan Bui MD,&nbsp;Ryan R. Reeves MD,&nbsp;Ulrika Birgersdotter-Green MD","doi":"10.1016/j.shj.2024.100319","DOIUrl":"10.1016/j.shj.2024.100319","url":null,"abstract":"<div><div>Cardiac implantable electronic devices (CIEDs) have been increasingly used in the management of various rhythm disorders amidst an aging population with more prevalent cardiovascular comorbidities. Although generally well-tolerated and safe, implantation of CIEDs may result in or worsen tricuspid regurgitation (TR), which is associated with a higher risk of morbidity and mortality. Several mechanisms of TR following device implantation have been proposed, and multiple diagnostic tests, percutaneous and surgical interventions, and alternative pacing methods have been developed to address this. CIED-related TR thus requires a multidisciplinary team of experts in cardiac imaging, interventional cardiology, electrophysiology, and cardiothoracic surgery with a comprehensive understanding of this multifaceted disease. The objective of this review is to summarize the epidemiology, clinical presentation, and management of CIED-related TR.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100319"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140014","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":"Single-Center Experience of Omitting Preprocedure Transesophageal Echo for MitraClip Patients","authors":"Ethan Korngold MD,&nbsp;Kateri J. Spinelli PhD,&nbsp;Michael P. Simanonok PhD,&nbsp;Hsin-Fang (Grace) Li PhD,&nbsp;Logan Vincent MD,&nbsp;Brandon Jones MD","doi":"10.1016/j.shj.2024.100368","DOIUrl":"10.1016/j.shj.2024.100368","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100368"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372552","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":"Moderate Aortic Stenosis With Cardiac Damage: A New Type of Severe Aortic Stenosis","authors":"Nino Mihatov MD ,&nbsp;Philippe Pibarot DVM, PhD","doi":"10.1016/j.shj.2024.100336","DOIUrl":"10.1016/j.shj.2024.100336","url":null,"abstract":"<div><div>The clinical implications of severe aortic stenosis have been well established. Understanding of moderate aortic stenosis, however, continues to evolve. Athough moderate aortic stenosis may be less clinically impactful in patients with normal ventricular function, it may carry prognostic significance in those patients with a ventricle exhibiting signs of cardiac damage. Moderate aortic stenosis in the presence of cardiac damage or dysfunction may be prognostically comparable to that of severe aortic stenosis. Extravalvular risk parameters can inform aortic stenosis risk stratification. Three ongoing trials seek to evaluate transcatheter aortic valve assessment in patients with moderate aortic stenosis and signs of cardiac damage or left ventricular dysfunction.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100336"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720872","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(24)00143-X","DOIUrl":"10.1016/S2474-8706(24)00143-X","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100382"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720870","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":"Right Bundle Branch Block Pre-Transcatheter Aortic Valve Replacement: Is a Pacemaker the Answer for Everyone?","authors":"Lena Rivard MD, MSc","doi":"10.1016/j.shj.2024.100365","DOIUrl":"10.1016/j.shj.2024.100365","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100365"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720874","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":"Clinical and Economic Consequences of Delayed Transcatheter Aortic Valve Replacement","authors":"William S. Weintraub MD","doi":"10.1016/j.shj.2024.100325","DOIUrl":"10.1016/j.shj.2024.100325","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100325"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720951","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":"Prophylactic Pacemaker Implant in Patients Undergoing Transaortic Valve Replacement: Is Right Bundle Branch Block Enough?","authors":"Julie He MD,&nbsp;Jeanne E. Poole MD","doi":"10.1016/j.shj.2024.100366","DOIUrl":"10.1016/j.shj.2024.100366","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100366"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720875","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":"Futility: A Complex Concept","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2024.100378","DOIUrl":"10.1016/j.shj.2024.100378","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100378"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720871","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":"In-Hospital Outcomes and 30-Day Readmission Rate After Transcatheter and Surgical Aortic Valve Replacement in Liver Cirrhosis: A Contemporary Propensity-Matched Analysis","authors":"Abhinav Aggarwal MD ,&nbsp;Sun-Joo Jang MD, PhD ,&nbsp;Swarnima Vardhan MD ,&nbsp;Fabricio Malaguez Webber MD ,&nbsp;Md Mashiul Alam MD ,&nbsp;Madhurima Vardhan PhD ,&nbsp;Gilead I. Lancaster MD ,&nbsp;Yousif Ahmad MD, PhD ,&nbsp;Amit N. Vora MD, MPH ,&nbsp;Stuart W. Zarich MD ,&nbsp;Ignacio Inglessis-Azuaje MD ,&nbsp;Sammy Elmariah MD, MPH ,&nbsp;John K. Forrest MD ,&nbsp;Carlos D. Davila MD","doi":"10.1016/j.shj.2024.100327","DOIUrl":"10.1016/j.shj.2024.100327","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis.</div></div><div><h3>Methods</h3><div>Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database. Propensity-score matched analysis was performed to compare the clinical characteristics, in-hospital, and 30-day outcomes between the two groups.</div></div><div><h3>Results</h3><div>Between 2016 and 2019, 4047 patients with cirrhosis underwent TAVR (n = 3298) or SAVR (n = 749). TAVR adoption sharply rose, doubling the number of cases performed during the study period. Following propensity matching among 718 patients, the TAVR group consistently exhibited significantly lower rates of in-hospital mortality (2.2 vs. 7.5%; <em>p</em> = 0.002), bleeding (14.5 vs. 52.9%; <em>p</em> &lt; 0.001), vascular complications (1.4 vs. 5%; <em>p</em> = 0.011), hepatorenal syndrome (3.3 vs. 8.9%; <em>p</em> = 0.003), cardiogenic shock (2.8 vs. 7%; <em>p</em> = 0.015), mechanical circulatory support utilization (0.6 vs. 4.7%; <em>p</em> = 0.001), 30-day all-cause readmission rates (10.3 vs. 18.1%; <em>p</em> = 0.005), and 30-day unplanned readmission rates (10 vs. 16.6%; <em>p</em> = 0.015) compared to the SAVR group. The TAVR group had significantly shorter median hospital stays, lower non-home disposition rates, and reduced hospital costs.</div></div><div><h3>Conclusions</h3><div>TAVR is associated with significantly lower rates of in-hospital mortality, bleeding, vascular complications, hepatorenal syndrome, cardiogenic shock, mechanical circulatory support utilization, and 30-day readmission rates compared to SAVR and represents a safe therapeutic option for aortic valve replacement in patients with cirrhosis.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 6","pages":"Article 100327"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404235","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}