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Background: Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration. Methods: We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with PPM and the relationship to patient functional status and survival post‐TAVI. Results: We found that 82 (26.2%) of subjects had moderate and 37 (11.8%) had severe PPM post‐TAVI. There was less relative improvement in LVEF with PPM (1.9 ± 21.3% vs. 8.2 + 30.1%, p =.045). LV GLS also exhibited less relative improvement in those with PPM (13.4 + 34.1% vs. 30.9 + 73.3%, p =.012). NYHA functional class improved in 84.3% of subjects by one grade or more. Echocardiographic markers of PPM were worse in those without improvement in NYHA class (mean AT/ET was.29 vs..27, p =.05; DVI was.46 vs..51, p =.021; and iEOA was.8 cm/m2 vs..9 cm/m2, p =.025). There was no association with PPM and survival. Conclusions: There was no improvement in LVEF and less improvement in LV GLS in those with PPM post‐TAVI. Echocardiographic markers of PPM were present in those with lack of improvement in NYHA functional class. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We present a case of a quadriplegic male who developed ventricular fibrillation associated with an anomalous aortic origin of the right coronary artery. Successful revascularization was achieved with percutaneous coronary intervention. This case highlights the application of an unconventional approach to resolve ischemia in a patient with prohibitive surgical risk. [ABSTRACT FROM AUTHOR]

Tricuspid valve (TV) degeneration after surgical repair with an annuloplasty ring is problematic as redo operation carries high mortality. This can be addressed with transcatheter therapies to implant a valve within in prior ring (tricuspid valve‐in‐ring). When an incomplete ring is present, paravalvular leak is commonly encountered after tricuspid valve‐in‐ring (TViR) implant; however, this can be addressed with paravalvular leak closure devices. Multimodality imaging including cardiac computed tomography and three‐dimensional (3D) transesophageal echocardiography (TEE) are important for successful TViR implant. We report a case of tricuspid regurgitation after tricuspid repair with an incomplete annuloplasty ring and subsequent paravalvular leak closure. [ABSTRACT FROM AUTHOR]

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high‐grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long‐term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high‐grade or complete AV block after TAVR who remain dependent on the PPM in follow‐up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon‐expandable, 18.1% self‐expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow‐up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self‐expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow‐up (< 30 days). The use of self‐expanding valves and PBD are associated with a markedly increased risk of PPM dependency. [ABSTRACT FROM AUTHOR]

Abstract: Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS. Methods and results: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60–90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00–1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03–1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15–2.11). This association was similar in patients with left ventricular systolic dysfunction (EF <40%, adjusted HR 1.52, 95% CI 0.98–2.35) and preserved systolic function (EF ≥40%, adjusted HR1.58, 95% CI 1.05–2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62–1.80 for PSF, HR 1.13, 95% CI 0.71–1.80 for LVSD). Conclusions: In AHFS, patients with CAD have a higher 60–90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population. [Copyright &y& Elsevier]

Objective: Surgical reoperation for aortic homograft structural valve degeneration (SVD) is a high-risk procedure. Transcatheter aortic valve replacement (TAVR) for homograft-SVD is an alternative to reoperation, but descriptions of implantation techniques are limited. This study compares outcome in patients undergoing into two groups by the type of previously implanted aortic valve prosthesis: TAVR for failed aortic homografts (TAVR-H) or for stented aortic bioprostheses (TAVR-BP)., Methods: From 2015 to 2017, TAVR was performed in 41 patients with SVD. Thirty-three patients in the TAVR-BP group (six for SVD of valved conduits), and eight patients in the TAVR-H group. The Valve Academic Research Consortium criteria were used for outcome reporting purposes., Results: The patients with TAVR-BP had predominant prosthetic stenosis (94%, p = .002), whereas TAVR-H individuals presented mostly with regurgitation (88%, p = <.001). Patients with TAVR-H received: Sapien-3 (6), Sapien-XT (1), and CoreValve (1) devices. Low, 40% ventricular fixation in relation to homograft annulus was attempted to anchor the prosthesis on the homograft suture-line. One patient with TAVR-BP experienced intraoperative distal prosthesis migration and Type-B aortic dissection, and two patients in the TAVR-H group had late postoperative proximal device migration. In both groups, there was zero 30-day mortality, stroke, or pacemaker implantation., Conclusions: TAVR for failing aortic homografts may be a feasible and safe alternative to high-risk surgical reintervention. Precise, 40%-ventricular device positioning appears crucial for prevention of late paravalvular leak/late prosthesis migration and minimizing the risk of repeat surgical intervention., (© 2020 Wiley Periodicals LLC.)