Structural Heart最新文献

{"title":"Increased Amounts of Epicardial Fat Tissue Are Not Associated With Mitral Annular Calcification in Patients With Severe Aortic Stenosis Planned for Transcatheter Aortic Valve Implantation","authors":"Maren Weferling MD ,&nbsp;Julia Treiber MD ,&nbsp;Christoph Liebetrau MD ,&nbsp;Andreas Rolf MD ,&nbsp;Yeong-Hoon Choi MD ,&nbsp;Efstratios I. Charitos MD ,&nbsp;Damini Dey PhD ,&nbsp;Samuel Sossalla MD ,&nbsp;Won-Keun Kim MD","doi":"10.1016/j.shj.2025.100422","DOIUrl":"10.1016/j.shj.2025.100422","url":null,"abstract":"<div><h3>Background</h3><div>Mitral annular calcification (MAC) is a common finding in the elderly that is associated with worse outcomes. It is postulated that MAC is a different form of atherosclerosis. Epicardial fat tissue (EFT) is in close contact with different heart structures and is especially pronounced in the atrioventricular grooves and the area surrounding the atrioventricular valve apparatus. The amount of EFT is associated with the extent of coronary artery disease, including plaque burden and coronary calcification. The aim of this study was to investigate whether EFT is also associated with the extent of MAC.</div></div><div><h3>Methods</h3><div>In this retrospective analysis of n = 543 (53.6% female) consecutive patients with high-grade aortic stenosis, EFT volume and MAC were assessed in the pre-transcatheter aortic valve implantation computed tomography scans. Patients with no/mild MAC and moderate/severe MAC were compared in terms of EFT volume and baseline, procedural, and postprocedural characteristics. Univariate and multivariable regression analyses were performed with MAC as dependent variable.</div></div><div><h3>Results</h3><div>Over one-quarter (n = 154; 28.4%) of the patients had moderate or severe MAC. The EFT volume between those with moderate/severe MAC and those with little or no MAC did not differ significantly: 130 (interquartile range 94-164) cm³ vs. 133 (interquartile range 95-176) cm³; <em>p</em> = 0.704. Accordingly, EFT volume did not predict increased MAC. Female sex, atrial fibrillation, and prior pacemaker implantation were independent predictors of moderate/severe MAC.</div></div><div><h3>Conclusions</h3><div>Increased EFT is not a predictor of MAC, and thus its unfavorable proinflammatory properties do not seem to play a significant role in the development of MAC.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100422"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patent Foramen Ovale Closure in Older Patients With Cryptogenic Stroke: Current Evidence and Next Steps","authors":"Pablo Vidal-Calés MD ,&nbsp;Laura Llull MD ,&nbsp;Sylvain Lanthier MD ,&nbsp;Juan H. del Portillo MD ,&nbsp;Laurent Desjardins MD ,&nbsp;Christine Houde MD ,&nbsp;Pierre-Olivier Sirois ,&nbsp;Xavier Freixa MD, PhD ,&nbsp;Ángel Chamorro MD, PhD ,&nbsp;Josep Rodés-Cabau MD, PhD","doi":"10.1016/j.shj.2025.100699","DOIUrl":"10.1016/j.shj.2025.100699","url":null,"abstract":"<div><div>Stroke is a major cause of morbidity and mortality worldwide, with recurrence risk increasing with age. In patients over 60 years of age with cryptogenic stroke, paradoxical embolism through a patent foramen ovale may be an important pathophysiology contributor, particularly when high-risk anatomical features (e.g., large shunt, atrial septal aneurysm) are present. Although patent foramen ovale closure has become a standard therapy in younger cryptogenic stroke patients, its benefit in older adults remains uncertain due to limited evidence and the need to exclude highly prevalent alternative causes like atrial fibrillation or carotid disease. A multidisciplinary heart-brain team is critical for accurate diagnosis, patient selection, and shared decision-making. Current guidelines vary and highlight the need for more robust data in this population. Recent observational studies suggest that patent foramen ovale closure in older patients may be safe and potentially reduce stroke recurrence compared to antithrombotic therapy alone. Ongoing randomized controlled trials are expected to provide definitive evidence on the efficacy and safety of patent foramen ovale closure in this age group, guiding future clinical decisions.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100699"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Cannulation Following Transcatheter Aortic Valve Replacement With Self-Expanding Evolut FX+ System: The CANNULATE TAVR II Study","authors":"Rafey Feroze MD ,&nbsp;Marco Frazzetto MD ,&nbsp;Lakshmi Prasad Dasi PhD ,&nbsp;Taylor Becker BS ,&nbsp;Luis Augusto Palma Dallan MD, PhD ,&nbsp;Anene Ukaigwe MD ,&nbsp;Steven J. Filby MD ,&nbsp;Gregory Rushing MD ,&nbsp;Guilherme F. Attizzani MD","doi":"10.1016/j.shj.2025.100483","DOIUrl":"10.1016/j.shj.2025.100483","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100483"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Experienced and Inexperienced Raters Using Automated Deep Learning Computed Tomography Analysis to Evaluate Tricuspid Valve and Right Heart Morphology","authors":"Isabel Mattig MD ,&nbsp;Maximilian Eichenberg MD ,&nbsp;Elena Romero Dorta MD ,&nbsp;Cheng-Ying Chiu MD ,&nbsp;Nanike Bühring MD ,&nbsp;Ann-Christine Stahl MD ,&nbsp;Georg Böning MD ,&nbsp;Lars-Arne Schaafs MD ,&nbsp;Marc Dewey MD ,&nbsp;Henryk Dreger MD","doi":"10.1016/j.shj.2025.100488","DOIUrl":"10.1016/j.shj.2025.100488","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100488"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Shunting for Heart Failure","authors":"Alexander M. Spring MD ,&nbsp;Andrea Scotti MD ,&nbsp;Julio Echarte-Morales MD ,&nbsp;Matteo Sturla MD ,&nbsp;Manaf Assafin MD ,&nbsp;Guillaume Bonnet MD ,&nbsp;Lorenzo D’Angelo MD ,&nbsp;Juan Torrado MD ,&nbsp;Sandhya Murthy MD ,&nbsp;Juan F. Granada MD ,&nbsp;Edwin Ho MD ,&nbsp;Leandro Slipczuk MD, PhD ,&nbsp;Ulrich P. Jorde MD ,&nbsp;Jozef Bartunek MD, PhD ,&nbsp;Azeem Latib MD","doi":"10.1016/j.shj.2025.100704","DOIUrl":"10.1016/j.shj.2025.100704","url":null,"abstract":"<div><div>Despite a plethora of pharmacological therapies for heart failure (HF), reducing the symptomatic burden in patients with advanced HF remains an unmet clinical need. Over the past decade, atrial shunting has emerged as a novel therapy for those with symptomatic HF despite optimal guideline-directed medical therapy. Initially thought of as a therapy reserved for those with diastolic HF, the field now spans the entire HF spectrum. In this review, we explore the physiology, devices, and trials that have shaped the field of atrial shunting. We detail how device-based interatrial shunts, no-implant interatrial shunts, and coronary sinus shunts aim to provide clinical benefit in specific patient populations and the limitations associated with their use.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100704"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incomplete Left Atrial Appendage Closure: How to Address the (Knowledge) Gap?","authors":"Yannick Willemen MD, PhD,&nbsp;Ole De Backer MD, PhD","doi":"10.1016/j.shj.2025.100466","DOIUrl":"10.1016/j.shj.2025.100466","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100466"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR Procedures","authors":"Mohammed Quader MD ,&nbsp;Neha Shah MPH ,&nbsp;Rebecca Deitch BS ,&nbsp;Barbara Lawson MD ,&nbsp;Delia Endicott NP ,&nbsp;Zachary Gertz MD","doi":"10.1016/j.shj.2025.100467","DOIUrl":"10.1016/j.shj.2025.100467","url":null,"abstract":"<div><h3>Background</h3><div>Since Food and Drug Administration approval of transcatheter aortic valve replacement (TAVR) in 2011, advancements in technology and procedural refinements have improved efficiency and safety. By systematically eliminating steps in the original TAVR protocol, we achieved reductions in procedural time, contrast volume, and fluoroscopy time without compromising outcomes.</div></div><div><h3>Methods</h3><div>Institutional TAVR data (November 2012 to September 2023) were analyzed, focusing on procedural times, contrast volume, radiation exposure, and outcomes. Four protocol modifications were compared: traditional protocol (2012 to 2016), elimination of rotational angiogram (2017 to 2020), elimination of balloon valvuloplasty (2020 to 2022), and elimination of femoral angiogram (2022 to 2023).</div></div><div><h3>Results</h3><div>Among 1095 TAVR procedures, 88.5% were femoral access, and 86.0% were done under conscious sedation. The mean age of patients was 79.0 ± 8.7 years, with 59% males. Most patients were classified in the Society of Thoracic Surgeons intermediate-risk category (38.4%), followed by prohibitive risk (30.0%), high risk (23.9%), and low risk (7.4%). Average procedural time, contrast volume, and fluoroscopy time were 88.4 ± 38.0 ​minutes, 73.0 ± 38.8 mL, and 13.8 ± 7.9 ​minutes, respectively. Adverse events occurred in 15%, with vascular complications (3.7%) being the most common. Mortality was 1.5%, highest in transapical (15%) and lowest in femoral (0.3%). Protocol modifications were associated with significant reductions in procedural time (59.99 ± 15.2 vs. 97.8 ± 33.9 ​minutes), contrast use (40.1 ± 26.6 vs. 92.9 ± 38.1 mL), fluoroscopy time (8.6 ± 7.4 vs. 18.5 ± 8.5 ​minutes), and complications (5.5 vs. 25.6%), all <em>p</em> ​&lt; ​0.001.</div></div><div><h3>Conclusions</h3><div>Systematic elimination of procedural steps was associated with reduced procedural time, contrast use, and fluoroscopy time, without compromising patient safety. These refinements may enhance procedural efficiency and patient outcomes.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100467"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, Efficacy, and Safety of the Mitral Annulo-TRIpsy in eXtreme Risk Patients","authors":"Gennaro Giustino MD ,&nbsp;Chantal Y. Asselin MSc, MD ,&nbsp;Mostafa Naguib MD ,&nbsp;Ahmad Jabri MD ,&nbsp;Leo Kar Lok Lai MD ,&nbsp;Robert Kipperman MD ,&nbsp;Kostantinos P. Koulogiannis MD ,&nbsp;Leo Marcoff MD ,&nbsp;Amr Abbas MD ,&nbsp;Pedro Villablanca MD ,&nbsp;Philippe Généreux MD","doi":"10.1016/j.shj.2025.100683","DOIUrl":"10.1016/j.shj.2025.100683","url":null,"abstract":"<div><h3>Background</h3><div>Severe calcific mitral stenosis is common and therapeutically challenging. Intravascular lithotripsy (IVL) can facilitate percutaneous balloon mitral valvuloplasty in patients not amenable to conventional therapies. We describe a modified technique using larger IVL balloons to ensure maximal annular contact and delivery of ultrasonic shockwaves to restore mitral leaflet pliability and reduce transvalvular gradients without the need for noncompliant valvuloplasty balloons.</div></div><div><h3>Methods</h3><div>Seven patients underwent the Mitral Annulo-TRIpsy in eXtreme risk patients (MATRIX) procedure at 3 tertiary structural heart disease centers in the United States. Transcatheter mitral valve replacement was contraindicated due to prohibitive risk of left ventricular outflow tract obstruction or insufficient annular calcification for anchoring of a balloon-expandable valve. IVL balloons were delivered using a large-bore transseptal sheath over three 0.014 wires. Runs of delivery of IVL therapy were repeated until satisfactory results in terms of mean mitral gradient (mMG) reduction were achieved.</div></div><div><h3>Results</h3><div>Median age was 78 years, and 14.3% were female. All patients presented with progressive New York Heart Association class III-IV symptoms and functional limitations. Pre-MATRIX mMG was 9.0 mmHg. The final mMG was 3.0 mmHg (absolute difference 6.3 mmHg; 95% CI 2.6-10.1 mmHg; <em>p</em> &lt;0.01). No conventional valvuloplasty balloons were used after IVL. All patients successfully underwent MATRIX. No major periprocedural complications were observed including death, stroke, major bleeding, or reintervention. No patients experienced worsening mitral regurgitation. All patients were discharged alive.</div></div><div><h3>Conclusions</h3><div>This small multicenter series demonstrates that IVL of calcified mitral stenosis using the MATRIX technique is feasible and safe and associated with effective reductions in mMG.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100683"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular Lithotripsy in Mitral Annulus Calcification-Related Mitral Stenosis: Hope or Hype?","authors":"Marina Urena MD, PhD","doi":"10.1016/j.shj.2025.100703","DOIUrl":"10.1016/j.shj.2025.100703","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100703"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aims & Scope","authors":"","doi":"10.1016/S2474-8706(25)00305-7","DOIUrl":"10.1016/S2474-8706(25)00305-7","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 8","pages":"Article 100713"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}