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Background: Transcatheter edge-to-edge repair (TEER) is increasingly utilized for mitral regurgitation (MR), particularly in high-risk patients. However, when TEER fails, patients often require mitral valve surgery, which remains challenging due to patients' compromised condition. This study aims to evaluate short and long term surgical outcomes following failed TEER., Methods: This meta-analysis included observational studies with reported outcomes of mitral valve surgery after failed TEER published until September 2024. Multivariable Meta-regressions were performed to predict short and long-term mortality. Kaplan-Meier function was reconstructed from individual studies., Results: Sixteen studies were included with a total sample of 892 patients. The mean age was 74.8 years (55% males), with most patients (87.8%) in NYHA III/IV before surgery. Pooled mean STS-PROM score before indexed TEER was 6.3%. Surgical indications were recurrent MR ≥3+ (93%), mitral stenosis (17%), and endocarditis (2.7%). The average time between TEER and surgery was 6.4 months. Mitral valve replacement (MVR) was performed in 83.8% of cases. Thirty-day all-cause mortality was 12.2% but significantly lower for elective cases (2.5%). At a mean follow-up of 14.7 months, mortality was 28.3%. Preoperative incidence of CAD, lower LVEF, rate of concomitant procedures, and functional mitral regurgitation were predictors of short and long-term outcomes., Conclusion: Mitral valve surgery after failed TEER presents significant challenges, yet acceptable outcomes are achievable, particularly in elective cases. Complete treatment of concomitant lesions may improve outcomes in patients with preserved LVEF. Future research should stratify outcomes based on emergent versus elective surgery and MR etiology to guide tailored surgical strategies., (Copyright © 2025. Published by Elsevier Inc.)

Background/purpose: To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis., Methods/materials: This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). Propensity score matching was used to compare the two groups. The effect of PCI, SYNTAX score, and residual SYNTAX score was also analyzed., Results: The median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0-72 months), the rate of coronary intervention was significantly higher in CAD patients (p = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (p = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all p values >0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted p = 0.06)., Conclusions: Despite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality., Competing Interests: Declaration of competing interest Basel Ramlawi is a consultant for Medtronic, Boston Scientific, AtriCure, Shockwave, and Corcym. The other authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study investigated the impact of aortic diameter on late aortic dilation of the residual dissected aorta after tear-oriented aortic replacement for acute DeBakey type I aortic dissection., Methods: Of 133 patients who underwent aortic replacement for acute DeBakey type I/II aortic dissection between 2008 and 2019, 45 patients with a residual dissected aorta after surgery for acute DeBakey type I aortic dissection and who underwent computed tomography at predischarge and after 1 year were retrospectively assessed. The aortic diameter and false lumen area were measured at 3 levels: the maximal aortic site, seventh thoracic vertebra, and celiac axis. Multivariable Cox regression analysis was employed to identify the predictors of late aortic dilation, defined as an aortic growth rate of ≥5 mm/year or a maximal aortic diameter of ≥55 mm., Results: During a median follow-up of 75 [range: 13-152] months, 6 patients (5 men; mean age: 57 ± 14 years) experienced aortic dilation. All 6 patients had the maximal aortic diameter between the distal aortic arch and seventh thoracic vertebra level at the last computed tomography. Multivariable Cox regression analysis showed that the predischarge maximal aortic diameter was an independent determinant of late aortic dilation (hazard ratio: 2.28/mm, 95% confidence interval: 1.10-5.86)., Conclusions: Predischarge maximal aortic diameter is a significant predictor of late aortic dilation in patients with a residual dissected aorta after tear-oriented surgical repair of acute DeBakey type I aortic dissection., (Copyright © 2021. Published by Elsevier Inc.)

Background: To investigate the effect of unilateral internal iliac artery (IIA) embolization for endovascular aortic repair (EVAR) on gluteal muscle size., Methods: We assessed the gluteal muscle size in 111 consecutive patients who underwent elective EVAR with unilateral IIA embolization (n = 31) or without IIA embolization (n = 80) for abdominal aortic and/or iliac artery aneurysm. The cross-sectional area (CSA) of the gluteus maximus (G max ) and gluteus medius/minimus (G med/min ) was measured on computed tomography preoperatively, 6 months postoperatively, and final follow-up. Mean changes in the G max and G med/min CSA were evaluated using a mixed model analysis of variance., Results: In the patients with embolization, both the G max and G med/min CSA significantly decreased over time on the embolization and nonembolization sides (P < 0.001); however, embolization did not affect the changes in the G max CSA (P = 0.64) and G med/min CSA (P = 0.99). In the patients with embolization and those without embolization, both the G max and G med/min CSA significantly decreased over time (P < 0.001); however, embolization did not affect the changes in the G max CSA (P = 0.76) and G med/min CSA (P = 0.11)., Conclusions: Unilateral IIA embolization was not associated with gluteal muscle atrophy after EVAR. Pre-emptive unilateral IIA embolization for EVAR seems to be an acceptable procedure in terms of maintenance of gluteal muscle size., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Aortic stent grafting can cause aortic stiffening and increase pulse wave velocity (PWV), which can potentially affect long-term cardiovascular outcomes. The aim of this study was to clarify the factors contributing to increases in PWV after thoracic endovascular aortic repair (TEVAR)., Methods: We included 64 patients with thoracic aortic pathology (51 men; mean age, 73 years) who underwent elective TEVAR, in this study. TEVAR was performed for degenerative aortic aneurysm (n = 43) or aortic dissection (n = 21), and the treatment length was 175 ± 52 mm. Brachial-ankle PWV (baPWV) was obtained before and 1 week after TEVAR. Univariable and multivariable logistic regression analyses were used to determine the predictors of increases in baPWV of ≥100 cm/sec after TEVAR., Results: baPWV increased from 1,851 ± 392 cm/sec to 2,047 ± 479 cm/sec, and the change in baPWV (ΔbaPWV) was 195 ± 339 cm/sec (95% confidence interval, 111-280). Thirty-seven patients (58%) had ΔbaPWV ≥100 cm/sec after TEVAR. In the multivariable analysis, in addition to Δheart rate and Δsystolic blood pressure, age (odds ratio, 1.21/year; 95% confidence interval, 1.05-1.40) and coronary artery disease (odds ratio, 12.0; 95% confidence interval, 1.20-121) were independent determinants of ΔbaPWV ≥100 cm/sec after TEVAR, whereas ΔbaPWV ≥100 cm/sec was not associated with treatment length or device type., Conclusions: TEVAR was associated with PWV progression, especially in older patients with coronary artery disease, whereas treatment length or device type was not a predictor of PWV progression after TEVAR., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We report a case of aortic prosthetic valve endocarditis presenting with subaortic stenosis without perivalvular leakage and vegetations in the left ventricular outflow and right atrium, the latter being attached to the atrioventricular septum. Intraoperatively, an abscess that had formed on the aortic annulus and perforated to the right atrium was unexpectedly found, the fistula being occluded by vegetations. Even when no left-to-right shunts are detected by imaging, vegetations adjacent to the atrioventricular septum may conceal a left ventricle-right atrium fistula, resulting in prosthetic valve endocarditis presenting clinically as subaortic stenosis without perivalvular leakage., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)