bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of transcatheter edge-to-edge repair for atrial secondary mitral regurgitation
Authors: Tanaka T , Sugiura A , Oeztuerk C , Vogelhuber J , Tabata N , Wilde N , Zimmer S , Nickenig G , Weber M 
Published: October 2022

Abstract

Background
Atrial secondary mitral regurgitation (ASMR) is a subtype of SMR that is characterized by normal left ventricular (LV) function, an enlarged left atrium and mitral annulus, and flattened leaflets. This anatomical feature is different from ventricular SMR (VSMR) and might therefore impact the procedural results of transcatheter edge-to-edge repair (TEER). The effectiveness and durability of TEER in patients with ASMR has not yet been well-studied.

Purpose
This study aimed to investigate the effectiveness of TEER and anatomical characteristics related to optimal MR reduction in patients with ASMR.

Methods
We retrospectively analyzed consecutive patients who underwent MitraClip at our institution. ASMR was defined as cases that met all of the following criteria: 1) normal mitral leaflets without organic disorder, 2) LV ejection fraction &gt;50%, and 3) absence of LV enlargement and segmental abnormality. The primary outcome measure was MR reduction to ≤1+, and its predictors were explored in a logistic regression analysis. Leaflet-to-annulus index (LAI) was measured using the mid-esophageal long-axis view in the A2-P2 segment as follows: (anterior leaflet length + posterior leaflet length) / anteroposterior length of the mitral annulus.

Results
Among 415 patients with SMR, 118 patients met the criteria for ASMR (mean age: 80±8 years; male: 39.8%) (Figure 1). Patients with ASMR had a larger mitral annulus diameter, shorter mobile posterior leaflet length, and smaller coaptation depth compared to those with VSMR.
The technical success rate was 90.7%, and the MR reduction to ≤1+ after TEER was achieved in 94 (79.7%) patients with ASMR, which was comparable with VSMR. The in-hospital mortality rate was 2.5%. In multivariable logistic analysis, a large left-atrial (LA) volume index and a low LAI were associated with a lower rate of MR reduction to ≤1+ after TEER for ASMR (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.97–0.99, and OR per 0.1 increase: 1.98; 95% CI: 1.13–3.45, respectively). The combined assessment of the LA volume index and LAI stratified the risk of residual MR ≥2+ after TEER (Figure 2).
In addition, the use of a newer generation of the MitraClip systems (NTR/XTR or G4 systems) was associated with a higher rate of MR reduction to ≤1+ compared to older generations (OR: 4.65; 95% CI: 1.67–13.00).

Conclusions
TEER with the MitraClip system achieved a high rate of MR reduction to ≤1+ in patients with ASMR. Furthermore, the new generations of the MitraClip system may provide a more effective reduction in ASMR. Although our findings suggest that TEER with the MitraClip system is a safe and feasible approach in patients with ASMR, the combined assessment of the LA volume index and LAI might be useful to refine the device selection for transcatheter mitral valve treatment in this subgroup of SMR patients.

Funding Acknowledgement
Type of funding sources: None.
Speckle tracking echocardiography in plasma cell disorders: the role of advanced imaging in the early diagnosis of AL (Light Chain) cardiac amyloidosis
Authors: De Carli G , Mandoli G E , Sciaccaluga C , Biagioni G , Marallo C , Turchini F , Ghionzoli N , Melani A , Barilli M , Pastore M C , Gozzetti A , Giacomin E , Focardi M , Valente S , Cameli M 
Published: October 2022

Abstract

Introduction
Cardiac involvement is described as the most important prognostic factor in light chain amyloidosis. An early diagnosis is mandatory to customize the follow-up timing and the best treatment. The aim of the study was to identify the role of advanced echocardiography in the diagnosis of amyloid light chain cardiac amyloidosis (ALCA).

Material and methods
Seventy-seven patients were prospectively included in the study: 22 patients with biopsy proven ALCA, 28 patients with multiple mieloma, and 27 with monoclonal gammopathy of undetermined significance. All patients underwent first and second level imaging including Speckle Tracking and complete biochemical profile. Univariate and Multivariate analysis was applied to the best multi-chamber predictor assessed with Receiver Operating Curve analysis. Continuous variables were discretized and compared with different subgroups based on multiparametric imaging assessment using available AL score.

Results
Biochemical indices have been confirmed as the best predictors of ALCA. More specifically, high sensitivity troponin (hsTn) and N-terminal pro brain natriuretic peptide (NT-pro-BNP) showed an AUC of 0.88 and 0.91 respectively. Among left ventricular systolic function parameters, left ventricular longitudinal strain (AUC: 0.92); apical sparing pattern (AUC: 0.75) and relative wall thickness (RWT) (AUC: 0.88) showed the best diagnostic accuracy. Atrial parameters such as left atrial volume index (LAVI) (AUC: 0.74), left atrial stiffness (LAS) (AUC: 0.82) and inter-atrial septum diameter (AUC: 0.75) showed a good diagnostic accuracy in ALCA (Figure 1). LAS and AL score maintained their diagnostic value in the multivariate model analysis (B=2,16; p=0,01 and B= 0,72; p&lt;0.01 respectively). However, only LAS, with a cut off value of 0.65, was able to discriminate ALCA when AL score was not detrimental (P&lt;0.001).

Conclusion
ALCA diagnosis often relies only on the biochemical profile. A comprehensive cardiac evaluation by a multiparametric imaging approach with LAS estimation is mandatory to ensure early diagnosis and a prompt treatment through a multidisciplinary team assessment.

Funding Acknowledgement
Type of funding sources: None.
Tricuspid regurgitation and atrial fibrillation at baseline independently predict two-year survival after transcatheter aortic valve implantation (TAVI)
Authors: Baez L , Moebius-Winkler S , Diab M , Ibrahim K , Kraeplin T , Schulze P C , Franz M 
Published: October 2022

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is the accepted state-of-the-art treatment for elderly patients suffering from severe symptomatic aortic stenosis (AS). Co-morbidities at baseline are of great impact not only for individual peri-procedural risk stratification but also for the determination of long-term prognosis. The latter is of certain clinical interest, since a variety of co-existing disorders can be effectively treated in addition to TAVI.

Purpose
The current study aimed to elucidate the prognostic value of a wide range of baseline characteristics and co-morbidities with respect to long-term survival of TAVI patients in a prospective real-world single-center registry study.

Methods
A total of 445 patients with severe AS, which were treated by transfemoral TAVI, were included. A wide range of clinical, laboratory, functional and imaging parameters were prospectively assessed at baseline prior to TAVI. Mortality was recorded at 30 days, 1 year and 2 years after TAVI.

Results
The mean age of patients in this typical TAVI cohort was 78.7±7.3 years, 52% were female and the mean STS score was 5±3.9%. The mortality rates were as follows: 3.6% after 30 days, 16.4% after 1 and 22.6% after 2 years. Multivariate analysis could identify the following independent predictors of 2-year mortality assessed at baseline: sex, age, AS entity other than high-gradient, atrial fibrillation (Afib), renal function, relevant TR, systolic pulmonary artery pressure (PAPsys) and six-minute walk distance (SMWD). Among those, the strongest predictive value could be shown for Afib (OR 2.505, CI 1.509–4.157, p&lt;0.001) and TR (OR 2.179, CI 1.105–4.299, p=0.025). Kaplan-Meier survival analysis displayed significantly worse 2-year survival rates in patients suffering from relevant TR (31.6% versus 17.4%, p&lt;0.001) and Afib (29.4% versus 14.8%, p&lt;0.001).

Conclusions
Taken together, the results of the current study demonstrate the prognostic value of cardiovascular co-morbidities assessed prior to TAVI. We identified relevant TR and Afib as the strongest independent predictors of long-term mortality in our cohort. Since both conditions are effectively treatable, special emphasis should be placed on the question, which patient might benefit from treatment, e.g., by transcatheter edge-to-edge repair of TR or rhythm control, in addition to TAVI.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Else Kröner-Fresenius-Stiftung, Research Program “Else Kröner-Forschungskolleg AntiAge”
Large comprehensive evaluation of new- vs. old-generation ACURATE neo self-expanding valve during TAVI procedures: a decrease in paravalvular leakage with an increase in post-procedural gradients?
Authors: Karameh H , Harari E , Almagor Y , Jubeh R , Shuvy M , Hellou E , Taha L , Butnaru A , Wolak A , Glikson M , Dvir D 
Published: October 2022

Abstract

Background
Contemporary data comparing new- versus old-generation transcatheter heart valve (THV) devices are lacking regarding several THV devices. We aimed to compare the safety and efficacy of old-generation device (OGD) ACURATE neoTM versus the newer generation device (NGD) ACURATE neo2TM THVs (Boston Scientific) in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods
An analysis of patients undergoing transfemoral TAVI with old-generation device ACURATE neoTM versus newer generation device ACURATE neo2TM from 2016 to 2021. The primary end-point was early safety events at 30-days post-valve implantation. Significant post-implantation paravalvular leakage (PVL) was considered as ≥moderate.

Results
A total of 249 patients were included in the evaluation; mean age was 81±7.2, and 95 (38.2%) were males. Of the total population 87 (35%) underwent TAVI with the NGD. Early safety events occurred in 21.8% NGD versus 19.1% in OGD (RR= 0.67, P=0.13). Permanent pacemakers were implanted within 30 days in 4.6% versus 6.2% in NGD versus OGD respectively (RR=1.343, P=0.77). Major vascular complications occurred in 5.7% in NGD versus 9.4% in OGD 9.4% (RR=1.6, P=0.46). More than mild PVL occurred significantly more often in OGD (P&lt;0.0001). Echocardiographic mean gradient post-procedure was 9 mmHg± 5 in OGD versus 11±4 mmHg in the NGD (P=0.0159).

Conclusion
New-generation ACURATE neo2TM devices were associated with less significant PVL. However, this new generation valve was also associated with higher residual gradients. This trend of decrease in PVL with an increase in gradients will be further studied.

Funding Acknowledgement
Type of funding sources: None.
Periprocedural outcomes of transcatheter aortic valve replacement (TAVR) in patients with and without cardiac amyloidosis-analysis from 2016–2019 national inpatient sample
Authors: Kambalapalli S , Baral N , Seri A , Paul T 
Published: October 2022

Abstract

Background
Cardiac Amyloidosis is often misdiagnosed due to its non-specific presenting symptoms. There is a lack of evidence on the clinical outcomes in patients with cardiac amyloidosis undergoing transcatheter aortic valve replacement (TAVR).

Purpose
To study periprocedural outcomes in patients hospitalised primarily for TAVR with and without cardiac amyloidosis.

Methods
This is a retrospective observational study involving index hospitalizations for TAVR between January 1, 2016 to December 31, 2019 from the National Inpatient Sample (NIS), the largest all-payer public database of hospital care data in the United States. Our study sample included discharged adult patients (≥18 years) primarily hospitalised for TAVR using ICD-10 codes. Confounders were adjusted using multivariable regression analysis.

Results
During 2016–2019, there were 43270 principal hospitalizations (unweighted sample) identified for TAVR, among them 4999 patients had a history of cardiac amyloidosis. Mean age was 79.3±8.4 years. Among patients hospitalised for TAVR, 54.4% (n=23539) were males, 45.6% (n=19731) were females (p&lt;0.001), 1.71% (n=740) developed cardiogenic shock, 1.53% (n=662) required mechanical ventilation with an in-hospital mortality of 1.3% (n=563). There were 87% Whites, 4.2% Blacks, 4.8% Hispanics, 1.3% Asians, and 2.7% were other races. A total of 23,819 (55.1%) hospitalizations had a Charlson Comorbidity Index (CCI) of three or higher.
After undergoing TAVR, compared to the non-cardiac amyloidosis cohort, the cardiac amyloidosis cohort had less females (27.8% vs 45.6%, p=0.01), had similar age (mean age: 80.2 vs 79.3; p=0.665), higher incidence of congestive heart failure (CHF) (100% vs 74%, p=0.012), higher mechanical ventilation requirement (11.1% vs 1.5%, p=0.001)) but with a similar length of hospital stay (3.9% vs 3.9%, p=0.99). Multivariate regression analysis revealed that TAVR in cardiac amyloidosis cohort did not significantly increase the odds of in-hospital mortality than the non-cardiac amyloidosis cohort (aOR: 5.2; 95% CI: 0.7, 38.3; p=0.103). However, females had higher odds of mortality post-TAVR compared to males (aOR: 1.45; 95% CI: 1.22, 1.73; p&lt;0.001) after controlling for age, sex, race, regional hospital location, hospital bed capacity, income, and CCI. There is an increasing trend of index TAVR hospitalizations with cardiac amyloidosis with 109.4 per 100,000 hospitalizations in 2016, 139.7 per 100,000 in 2017, 157.5 per 100,000 in 2018, 201.4 per 100,000 in 2019 (p trend&lt;0.001).

Conclusions
After TAVR, cardiac amyloidosis is associated with higher incidence of CHF increased need for mechanical ventilation, similar in-hospital mortality rate in comparison to non-cardiac amyloidosis cohort. There was an increasing trend in the index hospitalizations for TAVR with cardiac amyloidosis from 2016–2019.

Funding Acknowledgement
Type of funding sources: None.
Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention
Authors: Costa G , Marinho V , Costa M , Goncalves L , Teixeira R 
Published: October 2022

Abstract

Background
Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear.

Purpose
To compare the outcomes of PCI prior to TAVI in patients with significant coronary artery disease and severe aortic stenosis.

Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both retrospective and prospective studies comparing TAVI with PCI versus TAVI alone. Random-effects meta-analysis was performed.

Results
Eleven studies were included in which one was a randomized clinical trial. A total of 2530 patients were included, providing a 145 pooled death events (64 in TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes, our pooled analysis revealed a similar all-cause mortality (pooled OR, 1.24; 95% CI [0.80, 1.93], P=0.34; I2=27% - Figure), cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45; I2=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13], P=0.86; I2=0%). However, our analysis revealed a higher rate of myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P&lt;0.01; I2=0%) and major bleeding events (pooled OR, 1.40; 95% CI [1.02, 1.93], P=0.04; I2=0%) in the TAVI with PCI group. A 1-year clinical outcomes analysis revealed a trend for lower all-cause mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91], P=0.06; I2=0%), similar cardiovascular death rate (pooled OR, 1.15; 95% CI [0.70, 1.89], P=0.59; I2=6%) and major bleeding events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I2=0%).

Conclusion
Our pooled data suggests that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage.

Funding Acknowledgement
Type of funding sources: None.
Redo isolated tricuspid valve surgery: prediction of in-hospital mortality using the TRI-SCORE
Authors: Dreyfus J , Bohbot Y , Coisne A , Lavie-Badie Y , Riant E , Modine T , Le Tourneau T , Tribouilloy C , Donal E , Habib G , Selton-Suty C , Iung B , Obadia J F , Audureau E , Messika-Zeitoun D 
Published: October 2022

Abstract

Background
Redo isolated tricuspid valve surgery (ITVS) is rarely performed. The TRI-SCORE reliably predicts in-hospital mortality after ITVS on native valve but has not been tested in the setting of redo interventions.

Purpose
We aimed to compare the predictive value of the TRI-SCORE to other surgical risk scores for redo ITVS.

Methods
Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centers between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and the TRI-SCORE, Logistic EuroSCORE, EuroSCORE II and STS were calculated.

Results
We identified 70 patients who underwent a redo ITVS (mean age 54±15 years, 63% female). Prior intervention was a repair in 51% and a replacement in 49%. A tricuspid valve replacement was performed in all patients. In-hospital mortality was 10%. The TRI-SCORE was the only risk score associated with in-hospital mortality (p=0.01). Area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than with logistic EuroSCORE (0.58), EuroSCORE II (0.61) or STS (0.59). The table presents the observed and predicted values of in-hospital mortality according to TRI-SCORE categories.

Conclusion
The TRI-SCORE accurately predicted in-hospital mortality after redo isolated tricuspid valve surgery and may guide the clinical decision-making process especially as transcatheter therapies are emerging.

Funding Acknowledgement
Type of funding sources: None.
Transcatheter aortic valve replacement in patients with a concomitant aortic aneurysm
Authors: Gill A , Al-Taweel O , Fakhra S , Nadeem-Tariq A , Hawwass D , Ahsan C 
Published: October 2022

Abstract

Background
Although there is extensive literature present on transcatheter aortic valve replacement (TAVR), there is limited data on TAVR patients with a concomitant aortic aneurysm.

Purpose
In this study, we investigate the short-term, in-hospital outcomes of patients undergoing TAVR with and without an aortic aneurysm.

Methods
This was a retrospective cohort study comparing adult patients undergoing TAVR with and without an aortic aneurysm from 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted for a principal procedure of TAVR, principal diagnosis of aortic stenosis and secondary diagnosis of aortic aneurysm. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities, was used to compare mortality. The comorbidities adjusted for included coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, obesity and type 2 diabetes mellitus.

Results
109,170 patients met our inclusion criteria. Patients undergoing TAVR with an aortic aneurysm had 1.97 times higher odds of suffering in-hospital mortality compared to TAVR patients without an aortic aneurysm (aOR 1.97, 95% CI: 1.05–3.73; p=0.036). When separated by race, patients with an aortic aneurysm had higher mortality rates amongst White (3.4% vs 1.7%, p&lt;0.001) and Hispanic (5.2% vs 2.6%, p=0.11, Figure 1) patients. TAVR patients with an aortic aneurysm were predominantly male and had higher average Charlson Comorbidity Index scores (Table 1). Furthermore, these patients also had higher rates of comorbidities such as coronary artery disease, chronic obstructive pulmonary disease and prior myocardial infarction, but decreased rates of chronic kidney disease, hypertension, obesity and type 2 diabetes mellitus (Table 1). In terms of operative complications, TAVR patients with an aortic aneurysm were more likely to have intraoperative cardiac arrest (1.1% vs 0.4%, p&lt;0.001, Table 1). There was no significant difference between our two cohorts in postoperative cardiac arrest and postoperative cerebral infarction.

Conclusion
Patients undergoing TAVR with an aortic aneurysm had higher odds of suffering in-hospital mortality compared to patients undergoing TAVR without an aortic aneurysm. These patients are also at an increased risk of intraoperative cardiac arrest. Surgical intervention with a concomitant aortic aneurysm poses its own unique set of clinical challenges. Our findings emphasize the importance of risk-benefit analysis and collaborative discussion amongst the medical team prior to choosing the appropriate treatment modality. Additional studies should explore if certain races are at increased risk of operative complications and mortality.

Funding Acknowledgement
Type of funding sources: None.
Membranous septum length as predictor for permanent pacemaker implantation after TAVI
Authors: Jung S , Ammon F , Smolka S , Moshage M , Marwan M , Achenbach S 
Published: October 2022

Abstract

Background
High-degree atrioventricular (AV) block and permanent pacemaker (PPM) implantation represent major complications after transcatheter aortic valve implantation (TAVI). Extension of indication for TAVI towards subjects with lower surgical risk requires to reduce the likelihood for the requirement of permanent pacemaker (PPM) implantation. Data on the role of membranous septum length as potential predictor for AV block after TAVI are scarce.

Purpose
We examined the role of membranous septum length as potential predictor for AV block and the need for PPM implantation in a large cohort of consecutive subjects after TAVI.

Methods
In a cohort of 1365 patients without prior permanent pacemaker who underwent transfemoral TAVI, clinical and procedural characteristics were assessed systematically. Based on cardiac computed tomography performed prior to TAVI, membranous septum length was measured orthogonal to the anulus plane (see figure).

Results
Median age of subjects was 81 (IQR 7) years, 50% were male. Logistic euroSCORE was 12.8 (IQR 15.7), STS score 3 (2.7). 9,8% of subjects had a pre-interventional complete right bundle branch block (RBBB). 71% of patients received a balloon-expandable, 29% a self-expandable valve. In n=153 patients (11.2%), PPM implantation was necessary due to high-degree AV block. Median membranous septum length was 2.9 mm (IQR 2.5mm) in subjects who received a PPM versus 4.3 mm (IQR 3.2 mm) in subjects who did not need a PPM (p=0.061). In univariate regression analysis, pre-interventional complete RBBB (p&lt;0.001, OR 7.8), implantation of a self-expandable prosthesis (p=0002, OR 1.7) and membranous septum length (p=0.027, OR 0.9 per 1 mm) were identified as significant predictors for PPM implantation. In multivariate regression analysis, all parameters remained significant, including membranous septum length (p=0.009, OR 0.9 per 1 mm).

Conclusion
In a large cohort of consecutive patients, we were able to confirm the significant independent predictive value of membranous septum length, in addition to pre-interventional complete RBBB or implantation of a self-expandable prosthesis, regarding the occurrence of post-procedural AV block with the need for PPM implantation. The results may contribute to improved risk stratification for potential PPM implantation after TAVI.

Funding Acknowledgement
Type of funding sources: None.