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New Frontiers in Structural Heart Disease
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New Frontiers in Structural Heart Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 July 2022) | Viewed by 11273

Special Issue Editor

Dr. Edward Koifman

E-Mail Website
Guest Editor
Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
Interests: structural heart disease; complex coronary interventions; intracoronary imaging and physiology

Special Issue Information

Dear Colleagues,

In recent years, the field of structural heart disease has experienced an immense evolution in diagnostic and treatment modalities, including transcatheter aortic valve implantation (TAVI), which has expanded in application from high-surgical-risk to low-risk patients and will be a disruptive technology in the management of aortic valve disease patients. Mitral clip has shown superb results for the mortality and rehospitalization of heart failure patients with mitral regurgitation and is currently also being studied in tricuspid regurgitation patients. The percutaneous closure of the left atrial appendage has been shown to reduce bleeding, and in patients at high risk of bleeding, patent foramen ovale closure has been shown to reduce recurrent strokes. These developments have enabled a further understanding of the disease process and improved diagnostic pathways such as the use of various imaging software and research into various conditions such as low-flow, low-gradient aortic stenosis. Further therapeutic solutions are in development for various structural heart disease conditions, while the diagnosis and therapy of these patients is continuously improving, allowing safer, more efficacious, less invasive and more personalized treatment options.

The current issue is aimed at presenting cutting-edge research and a review of recent developments in the various structural heart disorders.

Kind regards,

Dr. Edward Koifman
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • structural heart disease
  • aortic valve disease
  • mitral valve disease
  • tricuspid valve disease
  • left atrial appendage closure
  • patent foramen ovale
  • atrial septal defect

Published Papers (6 papers)

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Research

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6 pages, 372 KiB  
Article
Transcatheter Left Atrial Appendage Occlusion: A Multi-Center Real Life Experience
by Ziad Arow, Tzipi Hornik-Lurie, Mustafa Gabarin, Alexander Omelchenko, Rami Barashi, Yoav Arnson, Abid Assali and David Pereg
J. Clin. Med. 2022, 11(23), 6944; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11236944 - 25 Nov 2022
Viewed by 1307
Abstract
(1) Background: left atrial appendage occlusion (LAAO) is considered an effective and relatively safe treatment for the prevention of thromboembolic events in patients with atrial fibrillation and a contra-indication for anticoagulation. We present a large multicenter real-world experience of transcatheter LAAO implementation in [...] Read more.
(1) Background: left atrial appendage occlusion (LAAO) is considered an effective and relatively safe treatment for the prevention of thromboembolic events in patients with atrial fibrillation and a contra-indication for anticoagulation. We present a large multicenter real-world experience of transcatheter LAAO implementation in patients with atrial fibrillation who cannot be treated with chronic anti-coagulation; (2) Methods: included were atrial fibrillation patients who underwent transcatheter LAAO between 1 January 2016 and 30 June 2021. The study was conducted using the electronic health record database of Clalit Health Services (CHS). The primary outcomes included hemorrhagic and ischemic stroke following LAAO; (3) Results: included were 389 atrial fibrillation patients. During a median follow-up of 2.1 years, 13% patients had ischemic cerebrovascular accident (CVA), and 4.4% patients had hemorrhagic CVA. While the risk of ischemic stroke increased gradually over time, the risk of hemorrhagic CVA was highest during the first 3 months following the procedure. Moreover, previous ischemic stroke was the only significant predictor for both hemorrhagic and ischemic stroke following LAAO; (4) Conclusions: while the annual performance rate of transcatheter LAAO has increased significantly over the past years, post procedural long-term prognosis remains poor with a substantial risk of both thrombotic and bleeding events. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
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7 pages, 245 KiB  
Article
Preventive Impella® Support in High-Risk Patients Undergoing Cardiac Surgery
by Kálmán Benke, Edina Korça, Anniek Boltjes, Roland Stengl, Britt Hofmann, Meradjoddin Matin, Katharina Krohe, Yuliana Yakobus, Jens Michaelsen, Levan Khizaneishvili, Gábor Szabó and Gábor Veres
J. Clin. Med. 2022, 11(18), 5404; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11185404 - 14 Sep 2022
Cited by 11 | Viewed by 2231
Abstract
Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic [...] Read more.
Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic use of the Impella pump in high-risk patients undergoing elective cardiac surgery. Methods: In this single-center retrospective study, 14 patients with LV-EF (≤30%) undergoing cardiac surgery received a prophylactic, perioperative Impella (5.0, 5.5) support between 2020 and 2022. Results: The mean age at surgery was 64.2 ± 2.6 years, the mean preoperative LV-EF was 20.7% ± 1.56%. The duration of Impella support was 4 (3–7.8) days and the 30-day survival rate was 92.85%. Acute renal failure occurred in four patients who were dialyzed on average for 1.2 ± 0.7 days. Mechanical ventilation was needed for 1.75 (0.9–2.7) days. Time to inotrope/vasopressor independence was 2 (0.97–7.25) days with a highest lactate level (24 h postoperatively) of 3.8 ± 0.6 mmol/l. Postoperative LV-EF showed a significant improvement when compared to preoperative LV-EF (29.1% ± 2.6% vs. 20.7% ± 1.56% (p = 0.022)). Conclusion: The prophylactic Impella application seems to be a safe approach to improve the outcomes of this patient population. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
11 pages, 1417 KiB  
Article
Dynamics of Cognitive Function in Patients with Heart Failure Following Transcatheter Mitral Valve Repair
by Muhammed Gerçek, Anca A. Irimie, Mustafa Gerçek, Henrik Fox, Vera Fortmeier, Tanja K. Rudolph, Volker Rudolph and Kai P. Friedrichs
J. Clin. Med. 2022, 11(14), 3990; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11143990 - 09 Jul 2022
Cited by 1 | Viewed by 1417
Abstract
Aims: Interventional transcatheter edge-to-edge mitral valve repair (TMVR) is an established treatment option for patients with severe mitral regurgitation (MR) and high operative risk. Cognitive impairment is one of the most common conditions among often extensive comorbidities in these patients. The specific patterns [...] Read more.
Aims: Interventional transcatheter edge-to-edge mitral valve repair (TMVR) is an established treatment option for patients with severe mitral regurgitation (MR) and high operative risk. Cognitive impairment is one of the most common conditions among often extensive comorbidities in these patients. The specific patterns of cognitive decline and particularly the effect of TMVR are not well described. Thus, this study aimed to investigate into the impact of TMVR on cognitive impairment, exercise capacity, and quality of life. Methods: Cognitive function (executive, naming, memory, attention, language, abstraction, and orientation) was assessed with the standardized Montreal Cognitive Assessment test (MoCA; range between 0 and 30 points) before and 3 months after TMVR in 72 consecutive patients alongside echocardiographic examination and assessment of exercise capacity (six-minute walk test) as well as quality-of-life questionnaires (Minnesota living with heart failure questionnaire, MLHF-Q). Results: Patients’ median age was 81 [76.0; 84.5] years, 39.7% were female with a median EuroScore II of 4.4% [2.9; 7.7]. The assessment of cognitive function showed a significant improvement of the cumulative MoCA-Test result (from 22.0 [19.0; 24.5] to 24 [22.0; 26.0]; p < 0.001) with significant changes in the subcategories executive (p < 0.001), attention (p < 0.001), abstraction (p < 0.001), and memory (p < 0.001). In addition, quality of life (from 47.5 [25.0; 69.3] to 24.0 [12.0; 40.0]; p < 0.001) and exercise capacity (from 220.0 m [160.0; 320.0] to 280.0 m [200.0; 380.0]; p = 0.003) increased significantly 3 months after the TMVR procedure. Conclusions: TMVR leads to a significant improvement of cognitive function, exercise capacity, and quality of life in patients with chronic heart failure in 3 months follow up and again highlights the benefit of the evermore established TMVR procedure for patients with high operative risk. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
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9 pages, 607 KiB  
Article
Experience of Combined Procedure during Percutaneous LAA Closure
by Guillaume Domain, Nicolas Dognin, Gilles O’Hara, Josep Rodès-Cabau, Jean-Michel Paradis, Camille Strubé, Mathieu Bernier, Kim O’Connor, Jonathan Beaudoin, François Philippon, Erwan Salaun and Jean Champagne
J. Clin. Med. 2022, 11(12), 3280; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11123280 - 08 Jun 2022
Cited by 1 | Viewed by 1670
Abstract
Introduction: Percutaneous left atrial appendage closure (LAAC) is an alternative to oral anticoagulants (OAC) in patients with non-valvular atrial fibrillation (AF) and contraindication to long-term OAC. Combined strategy with percutaneous LAAC at the same time of other cardiac structural or electrophysiological procedures has [...] Read more.
Introduction: Percutaneous left atrial appendage closure (LAAC) is an alternative to oral anticoagulants (OAC) in patients with non-valvular atrial fibrillation (AF) and contraindication to long-term OAC. Combined strategy with percutaneous LAAC at the same time of other cardiac structural or electrophysiological procedures has emerged as an alternative to a staged strategy. Aim: To describe our experience with combined LAAC procedures using Watchman™ devices. Methods: All patients with combined LAAC procedures using Watchman™ (WN) devices performed from 2016 to 2021 were included. The primary safety endpoint was a composite of periprocedural complications and adverse events during the follow-up. The primary efficacy endpoint included strokes, systemic embolisms, major bleeding and cardiovascular death. Results: From 2016, among 160 patients who underwent LAAC using WN devices, 19 underwent a combined strategy: 7 transcatheter edge-to-edge mitral valve repair (TEMVR) (37%), 6 typical atrial flutter ablation (31%), 2 leadless pacemaker (LP) implantation (10%) and 4 AF ablation (22%). The WN device was successfully implanted in 98% and 100% of cases for single and combined LAAC procedures, respectively (p = 0.63). Median follow-up was 13 months (IQR 25/75 3/24). Device-related complications occurred in 6 out of 141 patients (4%) who underwent single LAAC and in no (0/19) patient in the combined LAAC procedure (p = ns). The procedural-related complications did not differ significantly between groups (5% vs. 10%, respectively, in the single and combined group, p = 0.1). Conclusion: Combined procedure using the Watchman™ devices and one other structural or electrophysiological procedure appears safe and effective. Larger series are needed to confirm these results. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
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13 pages, 1085 KiB  
Article
High Post-Procedural Transvalvular Gradient or Delayed Mean Gradient Increase after Transcatheter Aortic Valve Implantation: Incidence, Prognosis and Associated Variables. The FRANCE-2 Registry
by Romain Didier, Clément Benic, Bahaa Nasr, Florent Le Ven, Sinda Hannachi, Hélène Eltchaninoff, Edward Koifman, Patrick Donzeau-Gouge, Jean Fajadet, Pascal Leprince, Alain Leguerrier, Michel Lièvre, Alain Prat, Emmanuel Teiger, Thierry Lefevre, Thomas Cuisset, Herve Le Breton, Vincent Auffret, Bernard Iung and Martine Gilard
J. Clin. Med. 2021, 10(15), 3221; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153221 - 22 Jul 2021
Cited by 9 | Viewed by 2232
Abstract
Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on [...] Read more.
Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG < 20 mmHg without DMGI > 10 mmHg (control); (2) PPMG < 20 mmHg with DMGI > 10 mmHg (Group 1); and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1(n = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, p = 0.27). In Group 2 (n = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, p = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG < 20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, p = 0.73). Patients with PPMG > 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
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Review

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11 pages, 3337 KiB  
Review
Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures
by Amnon Eitan, Hussein Sliman, Avinoam Shiran and Ronen Jaffe
J. Clin. Med. 2022, 11(8), 2104; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11082104 - 09 Apr 2022
Cited by 1 | Viewed by 1517
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse [...] Read more.
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications. Full article
(This article belongs to the Special Issue New Frontiers in Structural Heart Disease)
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