Structural Heart最新文献_第4页

Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100353

Shashank Shekhar MD, Amar Krishnaswamy MD, Grant Reed MD, MSc, James Yun MD, Rishi Puri MD, PhD, Samir Kapadia MD

{"title":"Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation","authors":"Shashank Shekhar MD, Amar Krishnaswamy MD, Grant Reed MD, MSc, James Yun MD, Rishi Puri MD, PhD, Samir Kapadia MD","doi":"10.1016/j.shj.2024.100353","DOIUrl":"10.1016/j.shj.2024.100353","url":null,"abstract":"<div><h3>Background</h3><div>Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).</div></div><div><h3>Methods</h3><div>Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database. Stroke, major stroke, in-hospital mortality, and 30-day readmission rates were compared between the CPD and no-CPD cohorts in a propensity score matched analysis. Association of CPD use with adverse events was analyzed using multivariable logistic regression models.</div></div><div><h3>Results</h3><div>Of 100,928 eligible TAVR patients with AF, CPD was used in 6.9% of patients with a mean age of 80 years. CPD use was independently associated with lower overall stroke (1.7% vs. 2.2%; odds ratio [OR] 0.81 [95% CI 0.68-0.98]; <em>p</em> = 0.032), major stroke (1.2% vs. 1.8%; OR 0.69 [0.55-0.86]; <em>p</em> = 0.001), in-hospital mortality (0.9 vs. 1.5%; OR 0.56 [0.43-0.72]; <em>p</em> < 0.001), and lower 30-day readmission rates (12.7% vs. 14.7%; OR 0.87 [0.81-0.94]; <em>p</em> < 0.001). Reduction in adverse events with CPD was noted in high-volume but not in low-volume TAVR centers.</div></div><div><h3>Conclusions</h3><div>The present point towards clear benefits of CPD use among patients with AF undergoing TAVR. In anatomically eligible patients, the potential benefit of debris capture may be considered especially as younger and lower risk patients become eligible for TAVR. Data from future trials and registries are required to further corroborate our findings.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100353"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372550","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}

引用次数: 0

A Review of “Access to Care” Issues in Aortic Stenosis Patients: A Negative Report Card

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100351

Adam M. Reisman MD , Sammy Elmariah MD, MPH

{"title":"A Review of “Access to Care” Issues in Aortic Stenosis Patients: A Negative Report Card","authors":"Adam M. Reisman MD , Sammy Elmariah MD, MPH","doi":"10.1016/j.shj.2024.100351","DOIUrl":"10.1016/j.shj.2024.100351","url":null,"abstract":"<div><div>The identification and management of patients with aortic stenosis exist along a continuum that includes healthy living, latent progression, diagnosis, treatment, and posttreatment recovery. Barriers to the provision of appropriate care for these patients can occur at any stage along this continuum. Despite the presence of diagnostic echocardiograms, many patients with aortic stenosis are never clinically recognized, and the rate of mismanagement worsens among underrepresented minority groups and women. Regarding the treatment of clinically recognized aortic stenosis, only about half of patients with symptomatic severe aortic stenosis actually undergo aortic valve replacement within 2 years of diagnosis. Treatment rates are even lower among patients with symptomatic low-gradient severe aortic stenosis. Although several strategies have been raised by experts within the field to help and improve the diagnosis and treatment of patients with aortic valve disease, timely referral to a heart valve team specialist whenever aortic valve replacement is being considered likely remains the most pertinent intervention. Connecting these patients with fully informed aortic valve disease experts helps facilitate shared decision-making discussions, thus ensuring that patients have the opportunity to learn about and potentially receive the lifesaving interventions available to them.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 1","pages":"Article 100351"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372386","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}

引用次数: 0

Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100376

Shivaraj Patil MD , Chaitanya Rojulpote MD , Abhijit Bhattaru BS , Avica Atri MD , Krishna Vamsi Rojulpote BS , Ola Khraisha MD , Viha Atri MD , William Frick MD , Tarek Nafee MD , Kishore Harjai MD , Sumeet Mainigi MD , Chien-Jung Lin PhD, MD

{"title":"Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion","authors":"Shivaraj Patil MD , Chaitanya Rojulpote MD , Abhijit Bhattaru BS , Avica Atri MD , Krishna Vamsi Rojulpote BS , Ola Khraisha MD , Viha Atri MD , William Frick MD , Tarek Nafee MD , Kishore Harjai MD , Sumeet Mainigi MD , 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}

引用次数: 0

Tricuspid Regurgitation in the Setting of Cardiac Implantable Electronic Devices 心脏植入式电子设备导致的三尖瓣反流

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100319

Omar M. Aldaas MD, Gary Ma MD, Quan Bui MD, Ryan R. Reeves MD, Ulrika Birgersdotter-Green MD

引用次数: 0

Single-Center Experience of Omitting Preprocedure Transesophageal Echo for MitraClip Patients

IF 1.4

Structural Heart Pub Date : 2025-01-01 DOI: 10.1016/j.shj.2024.100368

Ethan Korngold MD, Kateri J. Spinelli PhD, Michael P. Simanonok PhD, Hsin-Fang (Grace) Li PhD, Logan Vincent MD, Brandon Jones MD

引用次数: 0

Moderate Aortic Stenosis With Cardiac Damage: A New Type of Severe Aortic Stenosis 伴有心脏损伤的中度主动脉瓣狭窄：重度主动脉瓣狭窄的一种新类型