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Background: Access site complications are very common complications in transcatheter aortic valve replacement (TAVR). Usually, a second arterial sheath is placed either in the contralateral femoral artery or in the radial artery as a simplified approach. This study aimed to investigate the safety and effectiveness of a full unilateral access using the ipsilateral superficial femoral artery (iSFA) in TAVR and to determine whether it simplifies the procedure., Methods: This single-center retrospective audit analyzed the first 100 TAVR cases between February 2022 and January 2023 using iSFA as default secondary access. The primary outcomes included 30-day device success, bleeding, and vascular access-related complications. The last 100 bilateral cases and all bilateral cases (n = 656) served as controls., Results: Of the 143 transfemoral TAVRs performed during the study period, 43 patients were excluded. The remaining 100 patients (median age, 84 years; interquartile range, 80-89 years; median EuroSCORE II, 2.46; interquartile range, 1.65-3.97) were analyzed. The vascular access-related complication rates were 11% (main access, 55%; secondary access, 45%), with a 97% device success rate. In the control group of all bilateral cases, device success and vascular access-related complication rates were 93% and 17%, respectively. In the experimental group, access complications were promptly managed in the catheterization laboratory. All cases requiring interventions other than manual compression were successfully managed using iSFA., Conclusions: The total unilateral approach using iSFA was safe and effective, shortening the time to address main access complications, providing ergonomic advantages for operators, and enhancing patient comfort., (© 2024 Wiley Periodicals LLC.)

Background: The management of Transcatheter Aortic Valve Implantation (TAVI) patients with a small aortic annulus (SAA) postures a substantial challenge, increasing the risk of patient- prosthesis mismatch (PPM) and overall mortality., Aims: This study aimed to compare the hemodynamic and clinical outcomes of transcatheter balloon-expandable valve (BEV) versus transcatheter self-expandable valve (SEV) in SAA., Methods: We conducted propensity score matching (PSM) of severe AS patients with SAA who underwent trans-femoral TAVR and enrolled to the Israeli TAVR registry between the years 2008 and 2023. SAA was defined as an aortic-valve annulus area ≤ 430 mm 2 . Since the BEV used have a smaller size cut-off, an additional analysis on very small aortic annulus (vSAA) as defined as aortic-valve annulus area ≤ 345 mm 2 was performed., Results: The study included 1364 consecutive patients with SAA of (BEV n = 485; SEV n = 879) at a mean age of 82 ± 7 years, of whom the vast majority were female (83%). Propensity-matched groups comprised of 329 and 122 paired for the SAA and vSAA patients, respectively. As compared to BEV in the SAA and vSAA analyses, SEV showed lower rates of postprocedural of LBBB (32% vs. 22% and 41% vs. 22%; both p < 0.01, respectively), however, higher rates of major vascular complications (2% vs. 7% and 2% vs. 12%; both p < 0.01, respectively) and major or life-threatening bleeding but only in vSAA group (17% vs. 9.1%, p = 0.009). One-month mortality was higher in the SEV versus BEV in both SAA and vSAA comparisons (2% vs. 0.6%, p = 0.048 and 3% vs. 0%, p = 0.018; respectively). A nonsignificant trend of higher 5-year mortality was observed in univariate models, noted mainly in vSAA patients (22% vs. 19%, p = 0.385; 24% vs. 15%, p = 0.073)., Conclusions: The present analysis observed higher rates of major vascular complications and 1-month mortality in SAA and vSAA treated with SEV. A similar nonsignificant trend toward long-term mortality for the vSAA group was observed and should be evaluated in larger cohorts., (© 2024 Wiley Periodicals LLC.)

Background: The Hydra CE study revealed 1-year favorable efficacy of TAVR, showing a large effective orifice area (EOA), low gradient, and acceptable complication rates., Aims: We evaluated the 3-year clinical and hemodynamic outcomes of Hydra self-expanding transcatheter aortic valve (manufactured by Vascular Innovations Co Ltd, Nonthaburi, Thailand; a subsidiary of Sahajanand Medical Technologies Limited, India) in patients with symptomatic severe aortic stenosis at high or extremely high surgical risk., Methods: The Hydra CE study was a prospective, multicenter, single-arm study. A total of 157 patients were enrolled in the study, out of whom 54 patients from two centers (Lithuania and Poland) had provided consent for long-term follow-up at recruitment, with a planned 5-year follow-up period. The primary endpoint was all-cause mortality, and patients were followed up for up to 3 years, with an assessment of clinical and echocardiographic outcomes., Results: Among the 54 patients, the average age was 81.0 ± 4.1 years. The mean STS score was 3.2 ± 2.0%. At 3 years, all-cause mortality had occurred in 14.8% of patients, including 3.7% cardiovascular deaths and 1.9% device-related deaths. There was a progressive enhancement in EOA that is, 0.68 ± 0.15 cm 2 at baseline to 1.97 ± 0.52 cm 2 at 3 years (p < 0.001) as well as significant improvement in the mean aortic valve gradient that is, 53.4 ± 14.24 mmHg at baseline to 8.6 ± 2.80 mmHg at 3 years (p < 0.001). New permanent pacemaker implantation rates up to 3-year follow-up was 12.9%., Conclusion: The 3-year results of the Hydra CE study demonstrated consistent improvements in hemodynamics over time. The study also revealed favorable safety and efficacy trends, along with low occurrences of new permanent pacemaker implantations and paravalvular leaks., (© 2024 Wiley Periodicals LLC.)

Introduction: Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are established interventions for alleviating symptoms and enhancing survival in individuals with severe aortic stenosis (AS). However, the long-term outcomes and incidence of reintervention associated with TAVI and SAVR remain uncertain., Methods: We conducted a systematic review and meta-analysis to compare the incidence of reintervention in TAVI versus SAVR. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were pooled with a random-effects model. A p-value < 0.05 was considered statistically significant., Results: Nine RCTs were included, with 5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition, TAVI significantly reduced the incidence of new-onset atrial fibrillation (RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55), cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR 0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI 0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI 0.79-1.41; p = 0.72) between groups., Conclusions: In patients with severe AS, TAVI significantly increased the incidence of reinterventions and the need for pacemakers as compared with SAVR., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest. Ethical approval: Not applicable. Consent to participate: Not applicable. Consent to publication: Not applicable., (© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Aortic valve calcification (AVC) has been explored as a powerful predictor of procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). However, little evidence exists on its impact on intra-annular devices' performance. We aimed to investigate the impact of AVC burden and distribution pattern on the occurrence of paravalvular leak (PVL), conduction disturbances requiring permanent pacemaker implantation (PPI) and 30-day clinical outcomes in patients undergoing TAVI with a self-expanding, intra-annular device. According to AVC, 103 patients enrolled in a single medical centre from November 2019 to December 2022 were divided into tertiles. Valve Academic Research Consortium (VARC)-3 definitions were used to classify procedural complications and outcomes. Patients in the highest AVC tertile showed an increased occurrence of mild or more PVL and conduction disorders (p < 0.001 and p = 0.006). AVC tertiles (highest tertile) emerged as an independent predictor of PVL (OR 7.32, 95%CI 3.10-17.28, p < 0.001) and post-TAVI conduction disturbances (OR 3.73, 95%CI 1.31-10.60, p = 0.013) but not of PPI (OR 1.44, 95%CI 0.39-5.35, p = 0.579). Considering calcium distribution, ROC analyses revealed that annular AVC but not left ventricle outflow tract (LVOT) calcium burden significantly indicated the development of PVL (AUC 0.863, 0.77-0.93, p < 0.001) and conduction disorders/PPI (AUC 0.797, 0.70-0.89, p < 0.001 and 0.723, 0.58-0.86, p = 0.018, respectively). After adjustment for age and sex, the highest tertile remained an independent predictor of the 30-day composite outcome (death, myocardial infarction, stroke, major vascular complications, type 3/4 bleedings, acute kidney injury, PPI and ≥ moderate PVL) (OR 3.26; 95%CI 1.26-8.40, p = 0.014). A higher AVC is associated with an increased risk of PVL and conduction disturbances after TAVI with a self-expanding, intra-annular device. However, our findings suggest a minor role for LVOT calcification compared with annular AVC in the performance of this specific prosthesis., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Predicting coronary artery occlusion after transcatheter aortic valve replacement (TAVR) is usually based on computed tomography angiography (CTA). The primary risk factors seem to be a low coronary artery take-off and a small aortic root. However, CTA sometimes provides ambiguous risk assessment, and even if a potentially risky coronary artery is secured with a guidewire, the need for coronary stenting after valve implantation often remains uncertain. To reduce uncertainty, intravascular ultrasound (IVUS) can be used. The following two cases highlight the utility of IVUS in addressing these issues., (© 2024 Wiley Periodicals LLC.)

Transcatheter aortic valve implantation (TAVI) is the main treatment option for patients with severe aortic stenosis (AS) and older age. Improved imaging techniques have enabled better patient selection, and the main role is played by echocardiography. Methods more sensitive than LVEF in assessing cardiac function, such as global longitudinal strain (GLS) and myocardial work (MW), have become widespread, and other methods, like hemodynamic forces (HDFs), might be promising. The aim of this paper is to systematically review the parameters of GLS, MW, and HDF as predictors of reverse remodeling and their association with outcomes in patients with AS undergoing TAVI. In particular, the focus will be on the examination of the influence of TAVI on left atrial and ventricular function and right ventricular function., (© 2025 Wiley Periodicals LLC.)

Despite the widespread adoption of valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) for patients with failed aortic bioprosthesis, the effectiveness of this treatment for Japanese patients frequently associated with small aortic annuli remains unclear. From December-2011 to October-2022, 41 consecutive patients undergoing VIV-TAVR were enrolled in this study. The endpoints were technical success, device success, early safety, and two-year mortality according to implanted surgical valve size (small valves: 19-mm and 21-mm, n = 23; large valves: 23-mm and 25-mm, n = 18). The patient population had a mean age of 80.5 years, 46.3% male. Technical success, device success, and early safety rates were 100%, 70.7%, and 87.8%, respectively. There was no significant increase in the transprosthetic gradient throughout the follow-up (mean pressure gradient pre-VIV, post-VIV, at one-year, and at two-year; 37.0 mmHg, 16.5 mmHg, 15.0 mmHg, and 12.0 mmHg, respectively). While technical success and two-year mortality were comparable (87.5% vs. 86.7%, log-rank p = 0.816), device success was significantly lower in the small valves than in the large valves (56.5% vs. 88.9%, p = 0.038). Early safety trended lower in the small valves. Valve hemodynamic performance improved in both groups, but severe prosthesis-patient mismatch was more common in the small valves. VIV-TAVR demonstrated acceptable technical performance and relatively low mid-term mortality in this Japanese population, irrespective of aortic annular size. However, device success and early safety were significantly worse in patients with small valves than in those with large valves., Competing Interests: Declarations. Conflict of interest: Kensuke Takagi has received lecture fees from Abbott Medical Japan Co., Ltd., Edwards life sciences, and DAIICHI SANKYO Co., Ltd., (© 2024. The Author(s) under exclusive licence to Japanese Association of Cardiovascular Intervention and Therapeutics.)

Purpose: The objective of this study was to assess the effect of exercise-based cardiac rehabilitation (CR) with individualized exercise prescription in patients with chronic heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) in a randomized controlled trial., Methods: A total of 60 patients with chronic HF who received TAVR treatment were randomly divided into the control group (n = 30) and exercise training (ET) group (n = 30). The control group was treated with conventional rehabilitation, and the ET group was given personalized exercise-based CR based on a cardiopulmonary exercise test (CPX). The CPX parameters, echocardiography, 6-minute walk test distance, and quality of life were evaluated in the two groups., Results: All patients who completed symptom-restricted CPX showed no complications. After the 12-week rehabilitation period, the levels of anaerobic threshold, peak oxygen uptake, peak oxygen pulse, peak power, left ventricular ejection fraction, and 6-minute walk test distance in the ET group were significantly higher than those in the control group ( P  < .05). Scores on the Minnesota Life with Heart Failure Questionnaire in the ET group were lower than those in the control group ( P < .05)., Conclusion: Exercise-based CR significantly improves cardiopulmonary function, exercise tolerance, and quality of life in patients with chronic HF who undergo TAVR., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Permanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry., Methods: Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure., Results: From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus., Conclusion: From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed., Competing Interests: Declaration of competing interest Dr. Harvey is a proctor and serves on the speakers' bureau and advisory board for Medtronic and Boston Scientific, is a proctor and serves on the speakers' bureau for Abiomed, and serves on the advisory board for Avail and Opsens; Dr. Puri is a consultant, speaker and proctor for Medtronic, consults for Centerline Biomedical, Boston Scientific, Abbott, Philips, Products & Features, Shockwave Medical, VDyne, VahatiCor, Advanced Nanotherapies, NuevoSono, TherOx, GE Healthcare, BioVentrix, Protembis, and has equity interest in Centerline Biomedical, VahatiCor and NuevoSono. Dr. Grubb has served as a consultant, speaker, proctor and advisory board member for Boston Scientific and Medtronic, as a member of the advisory board for Abbott, and as a principal investigator for Medtronic and a speaker for Edwards Lifesciences; Dr. Yakubov has received institutional research grants from Boston Scientific and Medtronic; Dr. Mahoney is a consultant and proctor for Medtronic, Abbott, and Edwards; Dr. Gada is a consultant to Abbott, Bard, Edwards LifeSciences and Medtronic; Dr. Coylewright has received research grants from Edwards Lifesciences and Boston Scientific; and has served on consulting/advisory boards for Medtronic, and Occlutech; Dr. Poulin has nothing to disclose; Dr. Chetcuti serves as a consultant for Boston Scientific and consultant and proctor for Medtronic; Dr. Sorajja reports grants and personal fees from Medtronic, grants and personal fees from Edwards Lifesciences, grants and personal fees from Abbott Vascular, personal fees from Anteris, personal fees from WL Gore, grants and personal fees from Boston Scientific, outside the submitted work; Dr. Rovin serves as a consultant, proctor and speaker for Abbott and Medtronic; Ms. Eisenberg is a shareholder and employee of Medtronic plc; Dr. Reardon has received fees to his institution from Medtronic for consulting and providing educational services., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: The prognostic significance of noninvasive myocardial work (MW) indices in patients undergoing transcatheter aortic valve implantation (TAVI) has not been adequately examined., Methods: We retrospectively selected 88 consecutive patients (mean age 79.9 ± 6.4 years, 40% males) with severe aortic stenosis scheduled for TAVI enrolled in the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, and left bundle branch block (LBBB) at baseline. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were measured by echocardiography at baseline and at 30 days. Accuracy of the noninvasive measures was assessed by invasive evaluation of MW., Results: In the overall population, a significant reduction in GWI (2406 ± 567 vs. 2063 ± 515 mmHg% before and after TAVI respectively, P  < 0.001), GCW (2783 ± 616 vs. 2380 ± 495 mmHg%, P  < 0.001) and GWW (238 ± 203 vs. 186 ± 135 mmHg%, P  = 0.015) was observed at 30 days after TAVI. GWE improved only in patients who did not develop left ventricular dyssynchrony due to new-onset LBBB or pacemaker implantation following TAVI. In a multivariable Cox-regression analysis, GWE after TAVI (hazard ratio 0.892, 95% confidence interval 0.81-0.97; P  = 0.011) was the strongest predictor of adverse events (a composite of all-cause death, worsening of dyspnea, or rehospitalization for cardiovascular events) at 1-year follow-up., Conclusions: TAVI results in significant changes in MW indices, including an early decrease in GWI, GCW and GWW, and an improvement in GWE in patients without left ventricle dyssynchrony. A GWE equal or less than 92% at 30 days is indicative of poor clinical outcomes at 1 year., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Background: A history of hospitalization for heart failure (HHF) before transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement is associated with the prognosis of patients with severe aortic stenosis (AS). However, the impact of prior HHF on clinical outcomes after contemporary TAVI using new-generation transcatheter heart valves (THVs) has not been thoroughly investigated., Methods: Using data from the aLliAnce for exPloring cLinical prospects of AortiC valvE disease (LAPLACE)-TAVI registry, we investigated 2,752 patients who underwent TAVI with new-generation THVs with a median follow-up of 627 days. The primary outcomes were all-cause mortality and heart failure readmission after TAVI., Results: Patients with a history of HHF (n = 809) showed a higher 30-day mortality than patients without prior HHF (n = 1,943). A Kaplan-Meier analysis revealed that the prior HHF group showed a higher incidence of the primary outcome than the non-prior HHF group (27.4% vs. 16.4%, log-rank p = 0.001). In a Cox regression analysis, prior HHF was significantly associated with the risk of the primary outcome, even after adjusting for covariates (hazard ratio, 1.344; 95% confidence interval, 1.103-1.638; p = 0.003). A subanalysis showed that the prior HHF group with ejection fraction (EF) ≥ 50% had a higher risk of the primary outcome than the non-prior HHF group, whereas the prior HHF group with EF < 50% had the worst outcome., Conclusion: A history of prior HHF is associated with worse outcomes in patients with severe AS, both in those with preserved EF and those with reduced EF, even after TAVI using new-generation devices., (© 2024 Wiley Periodicals LLC.)

Few centers routinely report aortic arch calcification (AAC) due to the lack of an easy and effective evaluation method. The association between AAC and the clinical prognosis of patients who undergo transcatheter aortic valve replacement (TAVR) is unclear. We aimed to develop a rapid method to evaluate AAC in patients who underwent TAVR and to further assess their prognosis. We enrolled 464 consecutive patients with aortic stenosis who underwent TAVR. Patients with severe (11.2%), moderate (18.5%), mild (58.2%), and no (12.1%) AAC had an estimated 3-year all-cause mortality incidence of 39.6%, 20.8%, 13.4%, and 6.7% (log rank p < 0.001), respectively. Patients with severe AAC had a significantly higher incidence of both cardiovascular (log rank p = 0.002) and non-cardiovascular mortality (log rank p = 0.009), whereas patients with moderate AAC had a higher incidence of only non-cardiovascular mortality (p = 0.003) compared with patients with no/mild AAC. Moderate/severe AAC was an independent predictor of 3-year all-cause mortality in univariate (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.41-4.03; p = 0.001) and multivariate COX regression analyses (HR: 1.78, 95%CI: 1.04-3.06; p = 0.037). Our rapid semi-quantitative method to evaluate AAC is highly reproducible and can be used to assess AAC in patients who undergo TAVR., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Medical Ethics Committee of the Second Affiliated Hospital of Zhejiang University, Hangzhou, China. Informed consent: All patients provided written informed consent for the TAVR procedures and the use of anonymous data for research., (© 2025. The Author(s).)

Background: The aim of this study was to investigate whether the level of decrease in cerebral oxygen saturation during the valve placement phase of the transcatheter aortic valve implantation (TAVI) procedure under sedation has an effect on postoperative delirium (POD)., Methods: The study initially assessed 50 patients between the ages of 50 and 90 years with an indication for TAVI by the cardiac team. Regional cerebral oxygen saturation (rScO2) was measured using Near-infrared spectroscopy (NIRS) before the procedure (T1), during surgical field sterilization (T2), catheter placement (T3), wire manipulation (T4), valve placement (T5) and access site artery repair (T6). Confusion Assessment Method for The Intensive Care Unit (ICU-CAM) test was performed on intensive care unit and the presence of POD was questioned. Patients were divided into two groups as those without POD (Group 1) and those with POD (Group 2)., Results: The study was completed with 41 patients in total. While POD was present in 12 (29.3%) of the patients evaluated intensive care unit, POD was not observed in 29 (70.7%) patients. The rScO2 value measured at T5 was significantly lower in Group 2 compared to Group 1 (p < 0.001)., Conclusions: In our study, the rate of POD after TAVI was as high as 29.3%. Low rScO2 during valve placement was associated with delirium. Our findings indicate that NIRS devices could be a useful tool for assessing the risk of POD during the TAVI procedure; however, further research is needed to validate their routine clinical use., Competing Interests: Declarations. Ethics approval and consent to participate: All study protocols were carried out in accordance with relevant guidelines and regulations and were approved by the Ethics Committee of Istanbul University-Cerrahpaşa (Date: 31.03.2021, Number: E-69291215-900-65040), Istanbul, Turkey, prior to the initiation of the study. Patients were verbally informed about the data acquisition protocol, and written informed consent was obtained from all participants and/or their legal guardians. The study adhered to the principles of the Declaration of Helsinki, with no violations during the informed consent and data acquisition process. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Valve-in-valve transcatheter aortic valve replacement (TAVR) is a recognized alternative for treating the structural valve deterioration of bioprosthetic valves. Recent guidelines and trials have expanded the indications for TAVR to include younger patients with structural valve deterioration. In this study, we aimed to examine the outcomes of valve-in-valve TAVR across different age groups to understand the age-related clinical outcomes of treating structural valve deterioration following surgical aortic valve replacement and TAVR., Methods and Results: In this retrospective study, we included patients who underwent valve-in-valve TAVR at our center. We compared procedural complications and clinical outcomes among patients <75 years of age (n=99), those 75 to 84 years of age (n=103), and those ≥85 years of age (n=71). Echocardiography and computed tomography were used for follow-up evaluations. This study included 273 patients and revealed a low in-hospital complication rate across all age groups. Although the 3-year risk of all-cause mortality was higher in patients >85 years of age, no significant differences in the incidence of stroke/transient ischemic attack were observed among age groups. All groups exhibited significant improvements in valve hemodynamics that persisted for 3 years. Although leaflet thrombosis assessed using computed tomography imaging 30 days post-TAVR was more prevalent in the older group, age was not an independent predictor of this outcome., Conclusions: Valve-in-valve TAVR was associated with an increased 3-year mortality risk among older patients despite consistent hemodynamic benefits across all age groups. Age-related differences in leaflet thrombosis did not predict hypoattenuated leaflet thickening, indicating that further studies are necessary to elucidate its implications.

Background and Aims: Data from randomized trials investigating different access closure strategies after transfemoral transcatheter aortic valve implantation (TF-TAVI) remain scarce. In this study, two vascular closure device (VCD) strategies to achieve haemostasis after TF-TAVI were compared., Methods: The ACCESS-TAVI (Comparison of Strategies for Vascular ACCESS Closure after Transcatheter Aortic Valve Implantation) is a prospective, multicentre trial in which patients undergoing TF-TAVI were randomly assigned to a strategy with a combined suture-/plug-based VCD strategy (suture/plug group) using one ProGlide™/ProStyle™ (Abbott Vascular) and one Angio-Seal® (Terumo) vs. a suture-based VCD strategy (suture-only group) using two ProGlides™/ProStyles™. The primary endpoint was a composite of major or minor access site-related vascular complications during index hospitalization according to Valve Academic Research Consortium 3 criteria. Key secondary endpoints included time to haemostasis, bleeding type ≥ 2, and all-cause mortality over 30 days., Results: Between September 2022 and April 2024, 454 patients were randomized. The primary endpoint occurred in 27% (62/230) in the suture/plug group and 54% (121/224) in the suture-only group [relative risk .55 (95% confidence interval: .44, .68); P < .001]. Time to haemostasis was significantly shorter in the suture/plug group compared with the suture-only group (108 ± 208 s vs. 206 ± 171 s; P < .001). At 30 days, bleeding type ≥ 2 occurred less often in the suture/plug group compared with the suture-only group [6.2% vs. 12.1%, relative risk .66 (.43, 1.02); P = .032], with no significant difference in mortality., Conclusions: With regard to the composite of major or minor access site-related vascular complications, a combined suture-/plug-based VCD strategy was superior to a suture-based VCD strategy for vascular access closure in patients undergoing TF-TAVI., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: The growing elderly population contributes to an increasing prevalence of severe degenerative native aortic valve (AV) or mitral valve (MV) disease in combination with bio-prosthetic valve failure of prior implanted (aortic or mitral) bio-prostheses, as well as concomitant failure of both aortic and mitral bio-prosthetic valves. A combined surgical AV and MV replacement carries a markedly higher risk, especially in the redo setting. Transcatheter double-valve implantation (TDVI) is emerging as a promising alternative that may mitigate the risks of redo surgery. The evidence for TDVI is very limited. This study aims to address the current gap in the literature by analysing a large institutional series of single-stage TDVI., Methods: Single-centre retrospective analysis of all patients (n = 13) undergoing simultaneous transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve implantation (TMVI) from October 2018 until April 2024. Primary end-points were Valve Academic Research Consortium-3 (VARC-3) and Mitral Valve Academic Research Consortium (MVARC) technical success, 30-day device success and early safety (MVARC procedural success). Secondary end-points included echocardiographic TDVI performance, adverse events, symptom change and survival., Results: The median age of patients was 77 years, with 7/13 (53.8%) females. Median EuroSCORE II was 16.9%. All patients presented with structural valve degeneration with severe haemodynamic valve deterioration according to the VARC-3 definition. Procedural outcomes showed 100% technical success. There was absence of 30-day mortality (0%). Thirty-day device success and early safety/MVARC procedural success were 100%. No major adverse events occurred. After TDVI, the median New York Heart Association functional class improved from III to II., Conclusions: TDVI appears to be a safe and effective alternative to surgical redo double-valve replacement for selected patients. Our findings support the feasibility of TDVI with excellent early outcomes. Further prospective multicentre studies with larger cohorts are needed to validate the long-term effects and to establish TDVI as a guideline consideration., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Hospital-associated disability (HAD), a decline in the ability to perform activities of daily living (ADL) during hospitalization, is a modifiable target in integrated care for older adults. The aim of this study was to determine the impact of inpatient cardiac rehabilitation (CR) on the development of HAD in older patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)., Methods: Older patients undergoing TAVI were extracted from the Japanese nationwide database (JROAD-DPC) from April 2014 to March 2021 and were divided into patients receiving inpatient CR (CR group) and a non-CR group. HAD was defined as a decrease in the Barthel Index (BI) score ≥5 points at discharge compared with the score at admission., Results: Of 19,789 eligible patients, 17,066 (86%) underwent inpatient CR. The overall prevalence of HAD was 9.6%, with a lower incidence in the CR group than in the non-CR group (8.8% vs. 14.2%, p < 0.001). Random forest analysis revealed key features associated with HAD risk including BI score at admission, inpatient CR participation, age, body mass index (BMI), and chronic kidney disease. The results of multivariate logistic regression analysis showed that participation in inpatient CR was associated with a lower odds ratio (OR) of HAD (OR, 0.62; 95% confidence interval, 0.54-0.70), with similar results in inverse probability of treatment weighting-adjusted logistic regression analyses (OR, 0.82; 95% confidence interval, 0.77-0.88). Analyses in subgroups of interest showed heterogeneity in the effects of inpatient CR with possible loss in patients with a BMI of <18.5 kg/m 2 or a BI score of less than 60 points at admission., Conclusions: The data suggest a beneficial effect of inpatient CR participation on the prevention of HAD in older patients undergoing TAVI, but the effect may be limited in lean patients with disability for ADL before TAVI., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: The "weekend effect" on hospital admissions has been extensively studied, showing increased risks for patients admitted on weekends than those admitted on weekdays. We aimed to assess the "weekend effect" on in-hospital outcomes in patients undergoing transcatheter aortic valve replacement (TAVR)., Methods: A nationwide cohort study was conducted using the National Inpatient Sample Database. We identified 82,094 eligible patients aged ≥ 18 years admitted for TAVR between 2013 and 2021. Patients were grouped into weekend or weekday cohorts based on day of admission. Propensity score matching (PSM) and multivariate regression models were employed to evaluate outcomes. After PSM, 2,688 weekend admissions and 13,440 weekday admissions were included in the analyses., Results: Multivariable regression, adjusted for propensity score, revealed that weekend admission was associated with 45% higher odds of in-hospital mortality (adjusted odds ratio: 1.45; 95% confidence interval: 1.13-1.85). Significant heterogeneity in mortality was observed based on admission urgency, with a 3.27 times higher increased risk of death observed for elective admissions on weekends than on weekdays (P for interaction = 0.001). Moreover, weekend admissions had significantly higher adjusted odds for cardiogenic shock, permanent pacemaker implantation, endocarditis, acute kidney injury, acute ischemic stroke, and blood transfusion. There was a trend of higher in-hospital mortality for weekend over weekday admissions throughout the study period., Conclusions: Weekend admissions for TAVR had higher mortality, complications, and resource utilization, particularly in elective cases. Our findings suggest that patients admitted for TAVR during weekends are at high risk and warrant special attention., Competing Interests: Declarations. Ethics approval and consent to participate: Given the public accessibility of the NIS database ( www.hcup-us.ahrq.gov ) and the absence of individually identifiable information, the local institutional review board deemed informed consent unnecessary under the Health Insurance Portability and Accountability Act. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: Accurate mortality prediction following transcatheter aortic valve implantation (TAVI) is essential for mitigating risk, shared decision-making and periprocedural planning. Surgical risk models have demonstrated modest discriminative value for patients undergoing TAVI and are typically poorly calibrated, with incremental improvements seen in TAVI-specific models. Machine learning (ML) models offer an alternative risk stratification that may offer improved predictive accuracy., Methods: PubMed, EMBASE, Web of Science and Cochrane databases were searched until 16 December 2023 for studies comparing ML models with traditional statistical methods for event prediction after TAVI. The primary outcome was comparative discrimination measured by C-statistics with 95% CIs between ML models and traditional methods in estimating the risk of all-cause mortality at 30 days and 1 year., Results: Nine studies were included (29 608 patients). The summary C-statistic of the top performing ML models was 0.79 (95% CI 0.71 to 0.86), compared with traditional methods 0.68 (95% CI 0.61 to 0.76). The difference in C-statistic between all ML models and traditional methods was 0.11 (p<0.00001). Of the nine studies, two studies provided externally validated models and three studies reported calibration. Prediction Model Risk of Bias Assessment Tool tool demonstrated high risk of bias for all studies., Conclusion: ML models outperformed traditional risk scores in the discrimination of all-cause mortality following TAVI. While integration of ML algorithms into electronic healthcare systems may improve periprocedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Epicardial Adipose Tissue (EAT) volume is associated with the risk of cardiovascular events, which can be assessed by cardiac computed tomography. However, he optimal method and their prognostic utility in patients following transcatheter aortic valve replacement (TAVR) is unknown., Methods: We evaluated 258 participants, focusing on changes in EAT volume using cardiac CT enhancement. EAT volume was automatically computed as three-dimensional voxels between -190 to -30 HU on contrast-enhanced slices. Univariate and multivariable Cox regression analyses were conducted to assess the association of various clinical parameters and EAT volume indices with major adverse cardiovascular events (MACE)., Results: During a median follow-up of 2.0 years [IQR, 1.8-2.3 years], 34 participants (median age 73 [IQR: -13.1 to -8.3) years, 55.4 % male) experiencing MACE. The optimal cutoff values for EAT volume change fraction (EATVCF) was 15.2 %, determined by the Youden-index. Kaplan-Meier curve analysis revealed that patients with high EATVCF were at higher risk (p < .01). In Cox regression, EATVCF (hazard ratio [HR]: 0.92, 95 % CI: 0.87 to 0.97, p = .001) remained significantly associated with MACE after adjusting for clinical factors. The addition of EATVCF to the clinical model increased the net Reclassification Improvement (NRI) by 30.1 % (95 % CI: 0.07-1.16)., Conclusion: EAT volume change fraction emerged as a significant predictor of MACE post-TAVR, highlighting the clinical value of EAT volume assessment in cardiovascular risk stratification., Competing Interests: Declaration of competing interest This study has received funding by The Medical Science and Technology Project of Zhejiang Province, China (Grant Numbers 2021KY393) and the National Key Research and Development Program of China (Grant Numbers. 2018YFE0198400)., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Transcatheter aortic valve replacement (TAVR) harbors the risk of periprocedural complications that require emergent cardiac surgery, or "surgical bailout." Surgical bailout intends to be lifesaving but is associated with high mortality. This has given rise to discussion on the necessity of surgical backup during TAVR. Therefore, recent studies in contemporary TAVR patients are warranted., Objectives: This study aimed to assess the incidence, trends, and clinical outcomes of surgical bailout in patients undergoing transfemoral TAVR., Methods: The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2) study contains patient-level data from 10 clinical studies with patients undergoing TAVR between 2007 and 2022., Results: A total of 24,010 patients undergoing transfemoral TAVR were included. The mean age was 81.5 ± 6.7 years, and 56% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality declined over time (2007-2014: 7.1% [Q1-Q3: 4.3%-14.8%] vs 2015-2022: 3.9% [Q1-Q3: 2.6%-6.0%]; P < 0.001). Surgical bailout was reported in 125 (0.52%) patients, and its incidence decreased over time, from 0.84% in 2007 to 2010 to 0.25% in 2019 to 2022 (P trend  < 0.001). Surgical bailout was more frequently observed in women compared with men (0.61% vs 0.41%; P = 0.03). Ventricular perforation was the most prevalent reason for surgical bailout (28.0%). Patients who underwent surgical bailout reported higher mortality rates during the 1-year follow-up compared with patients without surgical bailout (68.3% vs 15.3%; HR: 8.60; 95% CI: 6.74-10.97; P < 0.001). Interestingly, patients surviving the first 90 days reported a similar mortality risk (HR: 2.19; 95% CI: 0.91-5.27; P = 0.08)., Conclusions: The incidence of surgical bailout is very low in the contemporary TAVR population. Mortality rates remain high among patients requiring surgical bailout during transfemoral TAVR, but this risk diminishes in patients surviving the postprocedural period. (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2 [CENTER2]; NCT03588247)., Competing Interests: Funding Support and Author Disclosures This research was supported by the Netherlands CardioVascular Research Initiative, the Dutch Heart Foundation (CVON 2018-28 and 2012-06 Heart Brain Connection), the Dutch Federation of University Medical Centres, the Netherlands Organisation for Health Research and Development, the Royal Netherlands Academy of Sciences, and the Netherlands Organization for Health Research and Development. Dr de Brito Jr is a proctor for Edwards Lifesciences and Medtronic. Dr Barbanti is a consultant for Edwards Lifesciences; and has received speaker honoraria from Medtronic and Biotronik. Dr Latib is a consultant for Medtronic; and has received honoraria from Abbott Vascular. Dr Pagnesi has received personal fees from Abbott Vascular. Dr Delewi has received educational grants from Boston Scientific, Edwards Lifesciences, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Mid-term comparative data for the self-expanding ACURATE neo2 transcatheter heart valve and the balloon-expandable SAPIEN 3 Ultra are lacking., Objectives: The aim of this study was to compare 1-year outcomes after transcatheter aortic valve replacement of these 2 valves., Methods: A total of 2,106 patients from 3 centers (neo2, n = 1,166; Ultra, n = 940) undergoing transfemoral transcatheter aortic valve replacement were analyzed retrospectively. The primary endpoint was the composite of all-cause mortality, stroke, and rehospitalization at 1 year. Secondary endpoints were the individual components of the primary endpoint at 1 year. To adjust for baseline differences, nearest neighbor propensity score matching was used., Results: After matching (702 pairs), baseline characteristics were similar between groups. Device success was more common in the neo2 group (87.5% vs 82.3%; P = 0.007), irrespective of matching. DP mean after the procedure was higher for Ultra (13 mm Hg [Q1-Q3: 10-15 mm Hg] vs 8 mm Hg [Q1-Q3: 6-11] mm Hg; P < 0.001). Rates of paravalvular leakage, device embolization, and multiple valve implantations were more common in the neo2 arm, whereas major cardiac structural complications and major vascular complications occurred more frequently in the Ultra group. All other in-hospital complication rates were similar between the 2 groups. At 1 year, the cumulative incidence of the primary endpoint (14.1% for neo2 vs 14.5% for Ultra; P = 0.819) was similar between the groups. Likewise, the individual components showed no difference between the groups., Conclusions: Despite differing immediate results, the outcomes at 1 year, including the composite of all-cause mortality, stroke, or hospitalization, were similar for neo2 and Ultra transcatheter heart valves., Competing Interests: Funding Support and Author Disclosures Dr Kim has received proctor and/or speaker and/or advisory honoraria from Abbott, Boston Scientific, Edwards Lifesciences, Meril Life Sciences, Shockwave, and HID Imaging. Dr Choi has received speaker and proctor fees from Edwards Lifesciences, CytoSorbents, and Getinge. Dr Charitos is a proctor for Boston Scientific. Dr Rheude has received lecture fees from Abbott, AstraZeneca, SIS Medical, and Translumina; and has received travel support from Boston Scientific and Eli Lilly (not related to the present work). Dr Joner has received lecture fees and research grants from Edwards Lifesciences and Boston Scientific; and is a consultant for Biotronik and OrbusNeich. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Conductive disturbances requiring permanent pacemaker (PPM) implantation remain a major concern after transcatheter aortic valve implantation (TAVI)., Aims: To assess the impact of aortic valve calcium score (AVCS) on conductive disturbances requiring PPM after TAVI., Methods: All patients who underwent TAVI with accessible AVCS from the preprocedural CT scan report were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disturbance requiring PPM at 30 days. The association between PPM and AVCS, with its incremental prognostic value, was analysed using multivariable logistic regression, receiver operating characteristic curve analysis and likelihood ratio (LR) test., Results: We included 761 patients of which 125 (16%) required PPM at 30 days. AVCS score was significantly higher in patients requiring PPM (3788 (2487-5218) vs 3050 (2043-4367) AU, p<0.001). Using multivariable analysis, preprocedural right bundle branch block (RBBB) (OR 6.61, 95% CI 3.82 to 11.5, p<0.001), first atrioventricular block (OR 1.71, 95% CI 1.03 to 2.83, p=0.037), self-expanding valve (OR 3.25, 95% CI 1.17 to 9.09, p=0.025) and AVCS>4510 AU (OR 1.83, 95% CI 1.04 to 3.20, p=0.035) were independently associated with PPM. AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPM risk factors. An algorithm was proposed based on the initial presence of RBBB, AVCS and the type of implanted valve., Conclusion: Even if RBBB remained the strongest predictor of PPM post-TAVI, this study suggests that a high AVCS may help identifying patients at increased risk of PPM after TAVI, especially among those without pre-existing RBBB., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background : Transcatheter aortic valve implantation (TAVI) has emerged as a pivotal intervention for managing severe aortic stenosis in high-risk surgical patients. Objective : This study aimed to evaluate the impacts of procedural factors and patient characteristics on TAVI outcomes, with a focus on survival rates, cardiac mortality, and associated complications. Methods : A retrospective, single-center study involving 224 patients who underwent TAVI at the Lithuanian University of Health Sciences from September 2021 to April 2023 was conducted. Data encompassing demographic characteristics, medical history, procedural specifics, and follow-up outcomes were analyzed. Survival and adverse events were assessed at 30 days, 6 months, and 12 months post-TAVI. Results: The study included 224 patients. The mean age in the non-death group was 80 ± 6.17 years (range, 49-91), while that in the cardiac death group was 81.5 ± 6.14 years (range, 70-94; p = 0.079). Males accounted for 37.7% of the non-death group and 50% of the cardiac death group ( p = 0.304). Statistical analyses identified factors significantly associated with mortality and complications. The overall survival rate was 88.8%, with cardiac-related mortality observed in 8% of patients. Increased fluoroscopy time ( p < 0.001), a higher contrast volume ( p = 0.005), and less improvement in aortic valve velocity post-TAVI ( p = 0.031) were significantly associated with cardiac mortality. Advanced age and a reduced left ventricular ejection fraction (<50%) were prominent predictors of adverse outcomes. Patients with non-coronary cusp calcification exhibited lower cardiac mortality ( p = 0.005), while mitral valve regurgitation was linked to poorer outcomes ( p = 0.015). Logistic regression analysis underscored the incremental risks posed by procedural complexities and comorbidities. Conclusions : Procedural factors such as fluoroscopy duration and contrast volume, along with patient-specific attributes including age, left ventricular function, and valve calcification patterns, critically influence TAVI outcomes. These findings emphasize the need for tailored procedural strategies and patient management protocols to mitigate risks and enhance the efficacy of TAVI interventions.

Background: Increasing demand for transcatheter aortic valve implantation (TAVI) places greater emphasis on the efficiency of pathways and services. A significant limitation to increasing TAVI capacity is the availability of cardiac catheterisation laboratory time. We have developed a novel complexity scoring system (TAVI ComplEXity; TEX score) which can aid in planning lists with appropriate case selection. To validate the TEX score, we have undertaken a retrospective analysis of TAVI cases. The hypothesis is that increasing TEX score correlates with increased procedural duration and reduced valve academic research consortium (VARC) 3 technical and device success., Methods: The TEX score assigns patients to a complexity level of 1 (low), 2 (intermediate) or 3 (high) based on the presence of specific clinical and anatomical variables. For validation purposes, comparisons were made between patients in the three complexity levels with respect to procedural duration as well as VARC-3 technical success, device success and early safety., Results: The validation study included 1034 consecutive patients who underwent TAVI between June 2021 and October 2023. Of these, 582 (56.3%) were classified as level 1 complexity, 377 (36.5%) level 2 and 75 (7.3%) level 3. Significant differences were observed between the three groups with respect to procedural duration (73.7 min vs 85.6 min vs 136 min; p<0.001), VARC-3 technical success (97.9% vs 96.6% vs 92%; p<0.05) and VARC-3 device success (96.2% vs 92.3% vs 86.6%; p<0.001)., Conclusion: The TEX score is a simple tool which allows stratification of patients into three levels of complexity. Increasing complexity levels correlate with increasing procedural duration and reduced VARC-3 technical and device success. This is potentially useful for scheduling patients onto appropriate lists., Competing Interests: Competing interests: DJB is a consultant and proctor for Medtronic plc and Abbott Vascular, as well as a consultant for Edwards Lifesciences and Boston Scientific. CM is a proctor for Edwards Lifesciences, Medtronic plc and Abbott Vascular and has received honorary speaking fees from Boston Scientific. MC has received educational speaking fees from Medtronic plc, Abbott Vascular and Boston Scientific. NA has received honorary speaking fees from Medtronic and Abbott Vascular., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Transcatheter aortic valve replacement (TAVR) is a common treatment for severe aortic stenosis (AS), but it carries the risk of severe complications, including device embolization. We present a case of a TAVR valve embolization into the left ventricular outflow tract (LVOT), diagnosed with transesophageal echocardiography (TEE) shortly after device deployment. The dislodged valve was successfully retrieved from the LVOT into the aorta, flattened, and stabilized with a thoracic endovascular aneurysm repair (TEVAR) stent, enabling the successful implantation of a new TAVR valve., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 International Anesthesia Research Society.)

Background: The application of transcatheter aortic valve replacement (TAVR) has been developed on different populations in many clinical studies. However, research dedicated to the application of emergency TAVR in patients with aortic stenosis (AS) experiencing cardiogenic shock is limited., Objective: To investigate the safety and effectiveness of emergency TAVR in AS patients with circulatory collapse., Methods: Studies on the application of emergency TAVR in AS patients with cardiogenic shock were screened from PubMed, Web of Science, and Embase databases. Two researchers independently screened the literature-extracted data and conducted a meta-analysis was conducted using STATA 16.0 software., Results: 17 studies comprising 36,886 patients undergoing emergency TAVR and 8,530 patients undergoing emergency SAVR or BAV. Emergency TAVR showed no difference in valve implantation success rate compared to elective TAVR. At 30-day endpoints comparison, emergency TAVR exhibited significantly higher all-cause mortality and readmission rates than elective TAVR (RR=2.73 95 %CI 2.04-3.65, P < 0.01; RR=1.2 95 %CI 0.9-1.6, P < 0.01), but reduced mortality risk compared to emergency SAVR/BAV (RD=-0.15 95 %CI -0.25 to -0.04, P = 0.005). At one year post-operation, people with emergency TAVR continued to have higher all-cause mortality than elective TAVR (RR=1.55 95 %CI 1.37-1.74, P < 0.01) but similar with emergency SAVR/BAV (RD=-0.04 95 %CI -0.33 to 0.25, P = 0.796). Rates of severe bleeding and new-onset renal dialysis were higher after emergency TAVR, compared to elective TAVR, while the incidences of permanent pacemaker implantation, severe paravalvular leakage and stroke were similar., Conclusion: Despite emergency TAVR having higher readmission and mortality rates compared to elective TAVR, it is a relatively safe and effective treatment in cases of cardiogenic shock compared to emergency BAV/SAVR., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The prognostic significance of renal artery calcification (RAC) is unknown in patients with severe aortic stenosis (AS) eligible for transcatheter aortic valve implantation (TAVI). RAC can be assessed by computed tomography (CT) performed during pre-interventional planning for TAVI. This study aimed at investigating the utility of RAC for predicting survival after TAVI. In this longitudinal cohort study, RAC volume was measured by CT in 268 consecutive patients with severe AS undergoing TAVI. Association of RAC with mortality was assessed using Cox regression analysis. RAC was evaluated as a binary parameter and in a supplementary analysis as a logarithmically transformed continuous variable. Over a median follow-up time of 9.6 years, 237 (88.4%) patients died, with 174 (73.4%) deaths attributable to a cardiovascular cause. RAC was highly prevalent (N = 150 (86.2%)) among patients suffering cardiovascular death. Competing risk cumulative incidence curves revealed a higher occurrence of cardiovascular death in patients with RAC (P-value = 0.008), while this was not the case for non-cardiovascular death (P-value = 0.71). RAC was independently associated with cardiovascular death (HR 1.61 [95% CI: 1.01-2.57]; P = 0.047) after adjustment for age, sex, cardiovascular risk factors, impaired renal function, and aortic valve calcification. The presence or absence of RAC rather than its volume was important in all the analyses. RAC is a strong and independent predictor of cardiovascular death in patients with severe AS undergoing TAVI. Given its favourable properties for event prediction, RAC may be considered valuable for prognostic assessment of TAVI patients., Competing Interests: Declarations. Ethical approval: Ethical approval and informed consent were obtained prior to including patients for data collection and evaluation. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Abstract: This case report details the interdisciplinary care provided to a 48-year-old male patient with severe aortic valve stenosis who underwent transcatheter aortic valve replacement in a community hospital setting. Focus is placed on the interdisciplinary team model demonstrated in the care of this patient, including interventional cardiology and cardiothoracic surgery from the outpatient to the inpatient setting. The use of decision-making tools, including the Society of Thoracic Surgeons Risk Calculator, and a collaborative, shared decision-making approach will be discussed. The care and evaluation of the patient will be presented and compared with the American College of Cardiology/American Heart Association guidelines., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: In patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), data on the differences in subsequent cardiac structure and function among stratified groups with flow gradient patterns through the aortic valve are insufficient., Methods and Results: In this large multicenter study, 4523 patients undergoing TAVI for severe AS between 2013 and 2019 were divided into three groups according to the following criteria: (i) high-gradient AS (HG-AS) [mean pressure gradient (MPG) ≥ 40 mmHg], (ii) classical low-flow low-gradient AS (cLFLG-AS) [MPG < 40 mmHg, left ventricular (LV) ejection fraction (LVEF) <50%], and (iii) paradoxical low-flow low-gradient AS (pLFLG-AS) [MPG < 40 mmHg, LVEF ≥ 50% but stroke volume index (SVi) <35 mL/m2]. Echocardiography was performed at baseline, post-procedure, and 1 year post-TAVI. 3697, 507, and 319 patients had HG-AS, cLFLG-AS, and pLFLG-AS, respectively. After adjusting for clinical factors, cLFLG-AS and pLFLG-AS had an ∼1.5-fold higher 2-year all-cause mortality compared with HG-AS. During 1 year following TAVI, compared with HG-AS, cLFLG-AS showed greater reduction of LV systolic diameter (LVDs) and LV diastolic diameter (LVDd) and greater increase of LVEF (P < 0.001 for all), and changes in LV mass index (LVMi) and SVi were comparable (P = 0.915 and P = 0.821, respectively). However, pLFLG-AS demonstrated less reduction of LVDs and LVDd (P = 0.039 and P = 0.001, respectively), less improvement of LVEF and LVMi (P = 0.045 and P < 0.001, respectively), and comparable change in SVi (P = 0.364)., Conclusion: During 1 year post-TAVI, compared with HG-AS, cLFLG-AS achieves smaller LV diameters, greater increase in LVEF, and comparable regression of LVMi, whereas pLFLG-AS does not., Competing Interests: Conflict of interest: Dr Izumo is a screening proctor for Edwards Lifesciences. Dr Yashima, Dr Ohno, and Dr Asami are clinical proctors for Medtronic. Dr Takagi, Dr Naganuma, Dr Mizutani, and Dr Ueno are clinical proctors for Edwards Lifesciences and Medtronic. Dr Yamamoto, Dr Shirai, Dr Tada, Dr Watanabe, and Dr Hayashida, are clinical proctors for Edwards Lifesciences, Abbott Medical, and Medtronic. The remaining authors have nothing to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up., Objectives: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR., Methods: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population., Results: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls., Conclusions: End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population., Competing Interests: Funding Support and Author Disclosures Dr Christensen has received an independent research grant from the Lundbeck Foundation. Dr Nouhravesh has received unrelated speaker honoraria from Bayer and AstraZeneca. Dr Bække has received funding from Boston Scientific, Abbott, and Medtronic not related to this manuscript. Dr De Backer has received institutional grants and consulting fees from Abbott and Boston Scientific. Dr Schou has received lecture fees from Boehringer, AstraZeneca, Novartis, and Novo Nordisk. Dr Køber has received speaker fees from AstraZeneca, Bayer, Boehringer, and Novatis. Dr Fosbøl has received an independent research grant from Novo Nordisk Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Acute kidney injury (AKI) complicates transcatheter aortic valve replacement (TAVR), leading to higher mortality. The incidence and effects of AKI on clinical outcomes in patients undergoing TAVR without chronic kidney disease (CKD) are unclear. We aimed to determine the association between AKI and in-hospital outcomes in patients with TAVR using propensity score matching (PSM)., Methods: Using International Classification of Diseases-10th Revision codes, we queried the National Inpatient Sample for TAVR performed between 2016 and 2021. Patients were divided into two groups according to perioperative AKI development. Patients with CKD or on permanent hemodialysis at baseline were excluded. We conducted 1:1 PSM to assemble a cohort of patients with similar baseline characteristics. Multivariate logistic regression was used to assess the association between AKI and in-hospital outcomes. Sensitivity analysis was conducted to evaluate the robustness of our inferences., Results: Of 47,372 unweighted patient admissions for TAVR, 1617 (3.41%) had a concomitant diagnosis of AKI. The incidence of AKI decreased from 4.82 to 3.18% from 2016 to 2021 (P-trend < 0.01). Before PSM, patients with AKI had a significantly higher rate of in-hospital mortality compared with those without AKI (6.12% vs. 0.48%, respectively; odds ratio [OR] 8.59, 95% confidence interval [CI] 6.32-11.68). Using the PSM algorithm, 1579 well-matched patients were included in each group. After PSM, an association was observed between patients with TAVR and concomitant AKI and a higher risk of in-hospital mortality (6.21% vs. 1.08%, respectively; OR 5.96; 95% CI 3.54-10.04). In subgroup analyses stratified according to age (≤ 80 and > 80 years), sex (male/female), and hypertension status, consistent associations were observed between AKI and the risk of in-hospital mortality. AKI patients were at higher risk for acute myocardial infarction (OR 1.78, 95% CI 1.35-2.34), major bleeding (OR 1.62, 95% CI 1.13-2.33), blood transfusion (OR 1.65, 95% CI 1.28-2.11), and cardiogenic shock (OR 3.73, 95% CI 2.77-5.01). No significant betweengroup differences were observed in stroke (P = 0.12)., Conclusion: AKI was a strong predictor of in-hospital mortality in patients undergoing TAVR without CKD and was associated with higher post-procedure complication rates., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Every participant provided a written consent to publish their information collected by this survey, excluding their name and ID number. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable. Conflict of interest: The authors have no conflicts of interest to declare., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear., Methods: This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models., Results: There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; P = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; P = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33])., Conclusion: In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association., Competing Interests: Conflict of Interest Disclosure: Basel Ramlawi is a consultant for AtriCure, Boston Scientific, CORCYM, Medtronic, and Shockwave Medical. The other authors have no conflicts of interest to declare., (© 2024 The Authors. Published by The Texas Heart Institute®.)

Background: Transcatheter aortic valve replacement (TAVR) pushes aside the diseased native aortic valve and creates a native neo-sinus bordered by the aortic root wall and the displaced native valve. There are limited data on the progression of native valve disease post-TAVR and no previous analysis of the native neo-sinus., Methods: Native aortic valves and native neo-sinus explants obtained post-TAVR were evaluated histologically (hematoxylin and eosin, Movat pentachrome, and Martius Scarlet Blue stains) and by immunohistochemistry (TGF-β1 [transforming growth factor-beta 1], FAP [fibroblast activation protein], and ALP [alkaline phosphatase]) to assess disease mechanisms., Results: Native aortic valves were obtained from 20 patients from 0 to 2583 days (7.08 years) post-TAVR. Native leaflets showed persistent calcific aortic stenosis-like disease activity with positivity for ALP and FAP. Native valve remodeling was observed as changes in architecture evident in explants >1.5 years, which was observed as crumpling of the leaflets. Disease activity was also present in native neo-sinuses with transcatheter heart valve implant durations >1 year with positive staining for TGF-β1, FAP, and ALP. Extensive native neo-sinus remodeling occurred with replacement and filling-in of this space with contiguous extracellular matrix, calcific deposits, and microvessels., Conclusions: Following TAVR, there is ongoing calcific aortic stenosis-like disease with architectural changes to native leaflets and extensive remodeling of the native neo-sinus, evidenced by replacement and contiguous filling-in of the native neo-sinus blood pool space with increasing implant duration. The dynamic nature of these tissues has potential implications for neo-sinus flow, valve degeneration, and re-intervention., Competing Interests: Dr Meier has received an institutional grant from Edwards Lifesciences. Dr Sellers is a consultant for Edwards Lifesciences, Medtronic, and Anteris, and received research support from Edwards Lifesciences, Medtronic, Vivitro Labs, and HeartFlow. H. Gill is supported by the Canadian Institutes of Health Research CGS-D award. Dr Webb is a consultant to Edwards Lifesciences, and received research support from Edwards Lifesciences, Boston Scientific, and Abbott. Dr Seidman is a consultant for Baylis Medical Technologies. J. Sathananthan has been a consultant to Edwards Lifesciences, Anteris, Medtronic, and is an employee of Boston Scientific. Dr Khan is a proctor for Edwards Lifesciences and Medtronic and has equity in Transmural Systems, and received educational grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Philips. The other authors report no conflicts.

Introduction: Chest radiotherapy has been utilized to treat intra-thoracic and mediastinal tumors. Chest wall irradiation (C-XRT) survivors frequently develop valvular disease, including aortic stenosis, which eventually requires valve replacement. Previous trials have shown worse outcomes with surgical aortic valve replacement. However, transcatheter aortic valve replacement (TAVR) outcomes-related data in patients with C-XRT is limited., Methods: The national inpatient sample (NIS) database was queried from 2016 to 2020 to identify adult hospitalizations with TAVR, which were dichotomized based on a history of C-XRT using ICD-10-CM codes. Propensity score matching was performed to derive age, sex, hospital characteristics, and co-morbidities matched controls without a history of C-XRT. The outcomes studied were inpatient mortality and complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression were used to analyze the outcomes., Results: Of 296,670 patients who underwent TAVR between 2016 and 2020, 515 had a history of C-XRT. Upon propensity score matching in patients undergoing TAVR, Patients with a history of C-XRT showed significantly lower adjusted odds of in-hospital mortality (adjusted odd ratio [aOR] 0.04, 95 % CI [0.003-0.57], p = 0.017), lower mean LOS by 1.6 days (-1.88 to -1.26 days, p < 0.001) and reduced mean THC (-$74,720, [-$88,784 to -$60,655], p < 0.001). Additionally, patients with C-XRT had significantly lower adjusted odds of inpatient complications, mainly acute myocardial infarction, cerebrovascular events, acute respiratory failure, acute kidney injury, need for vasopressors and cardiopulmonary resuscitation, whereas similar odds of complications, including a requirement of intubation, mechanical ventilation, hemodialysis, and cardiogenic shock., Conclusion: Our analysis showed reduced adjusted odds of in-hospital mortality, length of stay, total hospital charges, and inpatient complications in patients undergoing TAVR with a history of C-XRT. TAVR appears to be a safe and viable alternative in this population subgroup., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)