Structural Heart Disease Interventions Research Articles

New devices of transcatheter interventions for structural heart disease in China.

New devices of transcatheter interventions for structural heart disease in China.

Closing the care gap: combining enhanced recovery with minimally invasive valve surgery.

Patients with advanced age and frailty require interventions for structural heart disease at an increasing rate. These patients typically experience higher rates of postoperative morbidity, mortality and prolonged hospital length of stay, loss of independence as well as associated increased costs to the healthcare system. Therefore, it is becoming critically important to raise awareness and develop strategies to improve clinical outcomes in the contemporary, high-risk patient population undergoing cardiacprocedures. Percutaneous options for structural heart disease have dramatically improved the therapeutic options for some older, frail, high-risk patients; however, others may still require cardiac surgery. Minimally invasive techniques can reduce some of the physiologic burden experienced by patients undergoing surgery and improve recovery. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) is a comprehensive, interdisciplinary, evidence-based approach to perioperative care. It has been shown to improve recovery and patient satisfaction while reducing complications and length of stay. Combining minimally invasive cardiac surgery with enhanced recovery protocols may result in improved patient outcomes for a patient population at high risk of morbidity and mortality following cardiac surgery.

Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Antithrombotic Therapy Following Structural Heart Disease Interventions: Current Status and Future Directions

Antithrombotic Therapy Following Structural Heart Disease Interventions: Current Status and Future Directions

Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review

There has been a surge in usage of cardiac computed tomography for evaluation of structural cardiac indications such as valvular heart disease, especially with the increase in transcatheter valve replacements. With this expanded usage has come increasingly detailed and diverse protocols, reconstruction and post-processing. With clinicians interested in very specific anatomical details, this atlas of protocols has become an expansive topic. In this article, we review the state-of-the-art protocols used in evaluation of structural heart disease interventions.

Utility of Photon Counting CT in Transcatheter Structural Heart Disease Interventions

Photon counting Computed Tomography (PCCT) is an innovative technology that utilizes a semiconductor detector and assigns x-ray photons to specific energy bins. PCCT features include ultra high-resolution, multi-energy binning, higher signal of iodine, lower artifacts, lower noise, and geometric radiation dose efficiency. These advantages may be highly beneficial in pre- and post-procedural assessment of transcatheter structural heart disease (SHD) interventions. Ultra-high resolution improves visualization of device structure and subtle findings such as hypoattenuated leaflet thickening, small vegetations and paravalvular leaks. High resolution also improves the evaluation of heavily calcified and stented coronary arteries, which are prevalent in high-risk transcatheter aortic valve replacement (TAVR) population. Visualization of heavily calcified coronary arteries and access vessels can also be improved by using multienergy calcium separation or high-energy virtual monoenergetic images (VMIs). PCCT allows use of low dose of iodinated contrast in severe renal dysfunction, due to inherent higher contrast-to-noise ratio of iodine, availability of a high-pitch helical mode and low-energy VMIs. High-energy VMIs can decrease artifacts including calcium blooming, beam hardening and metallic artifacts. Iodine maps enable quantification of extracellular volume without need for a non-contrast scan, facilitating the identification of cardiomyopathies like cardiac amyloidosis. Moreover, calcium score can be obtained from virtual non contrast (VNC) images derived from CT angiographic images. Additionally, VNC and iodine maps can characterize incidentally encountered lesions such as thrombus. In this article, we review the utility of PCCT in transcatheter SHD interventions.

Role of Magnetic Resonance Imaging in Transcatheter Structural Heart Disease Interventions

Minimally invasive and catheter-based therapies are increasingly being used in patients with structural heart diseases (SHD). Echocardiography and Contrast-enhanced Computed Tomography Angiography (CE-CTA) are used in procedural planning for evaluating suitability of these interventions in SHD. However, some patients may not be able to undergo CE-CTA due to renal impairment or history of severe contrast reaction to iodinated contrast agents. Cardiac magnetic resonance (CMR) imaging can be used as an alternative noninvasive cross- sectional imaging modality in such patients. Measurements required for planning transcatheter SHD interventions such as annular and vessel size, as well as qualitative and quantitative functional information, such as flow across a valve or structural defect can be obtained with MRI. Phase contrast MRI can be used to quantify intracardiac shunts. In this article, we discuss the emerging indications of MRI in preoperative assessment for minimally invasive and transcatheter interventions in structural heart diseases.

Right Mini-Thoracotomy in the Surgical Treatment of Structural Heart Diseases (SHDs): An Institutional Experience

Introduction: Surgical treatment of structural heart diseases continues to predominantly involve median sternotomy, despite the ongoing trends favoring minimally invasive approaches that have persisted for many years. In this study, we present data on structural heart disease (SHD) surgeries conducted by our institute using a right mini-thoracotomy approach. Patients and Methods: This single-center retrospective study included 58 patients who underwent right minithoracotomy procedures between February 2018 and June 1, 2023. Preoperative demographic and medical data were collected from patient files and records. Perioperative and 30-day outcome data were obtained through the national electronic record system. Results: The average age of the participants was 39.9. Female patients accounted for 31.6% (n= 18) of the participants. The majority of surgeries in this study involved peripheral cannulation and conventional cardioplegia. Mitral valve repair and atrial septal defect closure were the most common procedures performed. Intraoperative outcomes showed favorable results, with no instances of significant bleeding, structural complications, or mortality. Regarding the postoperative 30-day outcomes, the stroke rate was 1.8% (n= 1) among the patients. There were no reported cases of transient ischemic attack (TIA), myocardial infarction (MI), and mortality. The conversion to median sternotomy occurred in 3.4% (n= 2) of the cases. Reoperation and reexploration were required in 1.8% (n= 1) of the cases. The mean length of stay in the ICU was 1.7 days, while the mean length of ward stay was 4.2 days. Conclusion: This study contributes to the evidence supporting the shift towards minimally invasive approaches in the surgical management of structural heart disease. The low rate of intraoperative conversion, absence of major complications, and favorable postoperative outcomes highlight the safety and feasibility of right mini-thoracotomy. Continued advancements in surgical techniques and clinical expertise are expected to further optimize patient outcomes and improve the quality of care in this field.

Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease.

Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the last decade, three-dimensional (3D) transesophageal echocardiography (TEE) has become one of the most accessed imaging methods for structural interventions. Although 3D-TEE can assess cardiac structures and functions in real-time, its limitations (e.g., limited field of view, image quality at a large depth, etc.) must be addressed for its universal adaptation, as well as to improve the quality of its imaging and interventions. This review aims to present the role of TEE in the intraprocedural guidance of percutaneous structural interventions. We also focus on the current and future developments required in a multimodal image integration process when using TEE to enhance the management of congenital and SHD treatments.

National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions.

Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.

Effectiveness of a radiation protective device of interventional echocardiographers during structural heart disease interventions

Interventional echocardiographers (IE) have a crucial role in growing structural heart interventional procedures. Previous studies showed a 5 times higher exposure of IE than that of the invasive cardiologist. No dedicated and adapted radiation protection device currently exists for IE. It is from this observation that the interventional cardiology team of the Nantes University Hospital, together with the company “LemerPax”, have designed a radiation protection cabin (EchoSafe) dedicated to the protection of the IE in the operative room. The objective of this study is to evaluate the radioprotective performances of this cabin in real life. We included during 6 months all procedures that required transesophageal echocardiography. These procedures were divided into two groups (the first on which the usual protection device were used, i.e. a leaded glass door – the second on which the “Echosafe” device was used). We matched the procedures to obtain a total amount of irradiation estimated by the DAP (dose area product) close between the two groups. Irradiation measurements of the IE were performed with 10 TLD (thermoluminescent detectors) distributed over the whole body. We included a total of 64 procedures: 24 procedures in the control group, and 40 in the “echosafe” group. The cumulative DAP for each group was 75,206.9 Cgy/cm2 in the control group, and 70,042 mGy.cm2 in the echosafe group. Patient characteristics were identical between the two groups. The results show that in the “echosafe” group, irradiation was below the dose limit for the left lens, shoulders, thorax, and neck, a 49% reduction in irradiation of the right lens, 76% of the right wrist, 12% of the left wrist, 49% of the pubis, and 36% of the right ankle. The “echosafe” device offers a clear reduction in the irradiation of the IE during structural heart intervention. Irradiation measurment of the sonographer (Fig. 1).

Holding us back? tackling inequalities in the detection and treatment of structural heart disease in Europe

Holding us back? tackling inequalities in the detection and treatment of structural heart disease in Europe

Evolution of interventional imaging in structural heart disease.

Treatments for structural heart diseases (SHD) have been considerably evolved by the widespread of transcatheter approach in the last decades. The progression of transcatheter treatments for SHD was feasible due to the improvement of devices and the advances in imaging techniques. In this setting, the cardiovascular imaging is pivotal not only for the diagnosis but even for the treatment of SHD. With the aim of fulfilling these tasks, a multimodality imaging approach with new imaging tools for pre-procedural planning, intra-procedural guidance, and follow-up of SHD was developed. This review will describe the current state-of-the-art imaging techniques for the most common percutaneous interventions as well as the new imaging tools. The imaging approaches will be addressed describing the use in pre-procedural planning, intra-procedural guidance, and follow-up.

Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures

BackgroundThe distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear. ObjectivesThis study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures. MethodsA Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]). ResultsThe simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used. ConclusionsDuring SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478)

Evolving Developments in Cardiac CT.

In this review, the authors describe some of the latest cardiac CT advances in the evaluation of cardiovascular disease. This includes automated coronary plaque quantification and subtyping, and cardiac CT fractional flow reserve and CT perfusion as techniques to noninvasively assess the physiologic significance of coronary stenosis. The authors also focus on noncoronary applications involving the expanding role of cardiac CT in structural heart disease interventions. Developments in cardiac CT for the evaluation of diffuse myocardial fibrosis and infiltrative cardiomyopathy and for functional analysis of myocardial contractile dysfunction are discussed. Finally, the authors review studies evaluating photon-counting CT in cardiac disease.

Chinese guideline for the clincal application of transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR), as an important procedure for aortic valve diseases worldwide, features with a late start and rapid development in China. In the process of clinical application, the lack of standard guidelines and training system has brought challenges to the widespread use of this technique. In order to standardize the application of TAVR technique and improve the quality of medical care, the National Center for Cardiovascular Diseases and the National Center for Quality Control of Structural Heart Disease Intervention, together with the Chinese Society of Cardiology and the Chinese Society for Thoracic and Cardiovascular Surgery, jointly established an expert group on the guidelines for TAVR, combined with the recommendations of international guidelines and the current clinical practice in China, integrated the latest evidence in China and worldwide to develop the clinical guideline of TAVR with extensive consultation (Chinese Expert Consensus). The guideline mainly included 11 parts: methods, epidemiological feature, TAVR devices, requirements of cardiac teams, recommendations for TAVR indications, perioperative multimodality imaging evaluation, surgical procedures, anti-thrombotic strategies after TAVR, prevention and treatment of complications, postoperative rehabilitation and follow-up, limitations and prospects, aiming to provide reasonable recommendations for all-level clinicians in China.

CRT-200.02 National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

CRT-200.02 National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

Minimally invasive direct coronary artery bypass and percutaneous coronary intervention followed by transcatheter aortic valve implantation: A promising concept in high-risk octogenarians.

In this article, we present our initial clinical experience with staged minimally invasive direct coronary bypass (MIDCAB), percutaneous coronary intervention (PCI), and transcatheter aortic valve implantation (TAVI) in high-risk octogenarians (Hybrid). The use of percutaneous techniques for managing structural heart diseases, especially in elderly high-risk patients, has revolutionized the treatment of structural heart diseases. These procedures are present predominantly being offered as isolated interventions. The feasibility, clinical benefit, and outcomes of combining these techniques with MIDCAB have not been sufficiently explored and have subsequently been underreported in the contemporary literature. Four consecutive octogenarians with severe aortic stenosis (AS) and complex coronary artery disease (CAD) that were at high risk for conventional surgery with extracorporeal circulation (ECC) were discussed in our Multidisciplinary Heart Team (MDH). Our MDH consisted of an interventional cardiologist, cardiac surgeon, and cardiac anesthesiologist. A hybrid approach with the alternative strategy comprising of MIDCAB, PCI, and TAVI in a staged fashion was agreed on. All 4 patients had both PCI/stenting and MIDCAB prior to deployment of the TAVI-prosthesis. From January 2019 to December 2020, 4 consecutive patients aged between 83 and 85 (3 male/1 female) years were scheduled for MIDCAB/PCI followed by percutaneous treatment of severe symptomatic AS. Intraoperatively, one patient was converted to full sternotomy, and surgery was performed by off-pump coronary artery bypass grafting. The overall procedural success rate was 100% in all 4 patients with resolution of their initial presenting cardiopulmonary symptoms. There were no severe complications associated with all hybrid procedures. There was no 30-day mortality in all patients. All patients were discharged home with a median hospital stay ranging between 9 and 25 days. All patients have since then been followed-up regularly. There was one noncardiac-related mortality at 6-months postsurgery. All other patients were well at 1-year follow-up with improved New York Heart Association Class II. In a selected group of elderly, high prohibitive risk patients with CAD and severe symptomatic AS, a staged approach with MIDCAB and PCI followed by TAVI can be safely performed with excellent outcomes. We advocate a MDH-based preliminary evaluation of this patient cohort in selecting suitable patients and appropriate timing of each stage of the hybrid procedure.

Sex Differences in Transcatheter Structural Heart Disease Interventions: How Much Do We Know?

The number of structural heart disease interventions has greatly increased in the past decade. Moreover, interest in the sex-specific outcomes of various cardiovascular conditions and procedures has increased. In this review, we discuss the sex differences in the clinical profiles and outcomes of patients undergoing the most commonly performed structural procedures: transcatheter aortic valve replacement, transcatheter edge to edge repair of the mitral and tricuspid valve, transcatheter pulmonary valve replacement, patent foramen ovale closure and left atrial appendage occlusion. We shed light on potential reasons for these differences and emphasize the importance of increasing the representation of women in randomized clinical trials, to understand these differences and support the application of these cutting-edge technologies.