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The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques. [ABSTRACT FROM AUTHOR]

The article focuses on the Department of Cardiology in West China Hospital of Sichuan University in China. Topics discussed include the history and status of West China Hospital, its multidisciplinary heart valve team, and its clinical research on transcatheter aortic valve implantation in bicuspid anatomy and in calcific aortic stenosis.

Background: Studies of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) specifically for bicuspid aortic valve (BAV) patients are lacking. We aim to delineate possible aspects that might affect the incidence of PPI in a retrospective cohort of BAV patients treated with early-generation self-expanding devices.Methods: A total of 80 patients with bicuspid morphology who successfully underwent TAVR by self-expanding devices without prior PPI were included. Baseline clinical, echocardiographic, and angiographic characteristics, procedural and post-procedural details were collected.Results: The incidence of PPI after early-generation self-expanding valves in this BAV cohort was 26.3%. Baseline characteristics were comparable between patients requiring PPI post-TAVR or not. Perimeter oversizing greater than 20% significantly increased the risk of PPI compared with an oversizing of 10-20% (OR 5.08 [1.22, 21.07], P = 0.03). The proportion of patients with a depth of implantation greater than 6 mm was significantly higher in those who required PPI (82.4% vs 54.3%, P = 0.04). When testing the impact of depth of implantation >6 mm and oversizing in different morphologies, only in type 1 bicuspid patients and by oversizing>20% increased the risk of PPI (OR 12.00 [1.25, 115.36], P = 0.03) compared with an oversizing of 10-20%.Conclusions: Excessive perimeter oversizing in relation to aortic annulus and depth of implantation greater than 6 mm should be avoided to improve PPI post-TAVR for BAV patients receiving self-expanding devices, especially for type 1 BAV. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion.Background: It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonraphe bicuspid AS.Methods: This retrospective study enrolled consecutive patients with severe symptomatic AS and type-0 bicuspid aortic valve, who underwent TAVR at our institution between 2012 and 2017. TAVR outcomes were defined based on the Valve Academic Research Consortium-2 recommendations.Results: Compared to patients with mixed cusp fusion (44/71), those with coronary cusp fusion (27/71) had a larger ellipticity index for the aortic annulus (21.9% ± 9.0% vs 15.6% ± 9.3%, p=0.007) and increased left ventricular outflow tract obstruction (31.1% ± 9.4% vs 26.9% ± 7.5%, p=0.04) but comparable rates of second valve implantation (15.9% vs 14.8%), mild paravalvular leakage (PVL, 38.5% vs 30.2%), permanent pacemaker implantation (PPM, 25.9% vs 15.9%), and 30-day mortality (7.4% vs 6.8%). Use of a first-generation transcatheter heart valve was associated with higher risk for mild PVL (odds ratio (OR) = 4.37; 95% confidence interval (95% CI) = 1.14-16.75; p=0.03) but not PPM (OR = 0.77; 95% CI = 0.22-2.62; p=0.67), whereas a larger oversizing ratio tended to be associated with a higher PPM rate (OR = 1.49; 95% CI = 0.46-4.86; p=0.51) but lower incidence of mild PVL (OR = 0.51; 95% CI = 0.19-1.35; p=0.17).Conclusions: In AS patients with type-0 bicuspid valves, cusp fusion morphology does not affect the procedural or clinical results of TAVR. Use of second-generation transcatheter heart valves may provide more favorable results in such patients. This trial is registered with NCT01683474. [ABSTRACT FROM AUTHOR]

Introduction: Little has been reported on dietary choices and obesity in patients with valvular heart disease. Hypothesis: We hypothesized that obesity is prevalent in patients with aortic stenosis and that significant differences in heart-healthy dietary choices may be observed between obese and non-obese patients. Methods: Consecutive patients with severe or critical aortic stenosis (AS) were evaluated in a busy Heart Valve Clinic for consideration of surgical or transcatheter valve replacement. All patients underwent a detailed dietary evaluation with a rate your plate (RYP) questionnaire. Obesity was defined as body mass index (BMI) ≥ 30 kg/m2. Dietary data was stratified according to presence of obesity. Data was analyzed by student's t-test for continuous data and chi-squared analysis for categorical data. Results: A total of 138 patients were evaluated; of these, 41 (29.7%) were obese. Overall there was no difference in the RYP score for obese and non-obese patients. However, obese patients scored significantly worse on RYP heart-healthy (HH) choices for fried foods and grains (table) with no significant differences in other categories. Conclusions: Obesity is common in patients with severe aortic stenosis. Self-reported heart-healthy choices differ only in categories of fried foods and grains (figure) which may be a good initial focus for nutritional intervention in this population. [ABSTRACT FROM AUTHOR]

Background Limited date describing the procedural, clinical and valve performance results of transcatheter aortic valve replacement (TAVR) in patients with bicuspid versus tricuspid aortic stenosis (TAV). Methods Procedural and clinical results were defined and reported according to VARC-2 criteria. Results Consecutive 87 patients with BAV and 70 patients with TAV were included. Compared to patients with TAV, patients with BAV had similar incidence of second valve implantation (14.9% vs 12.9%, p = 0.708), more than mild paravalvular leakage (PVL, 40.2% vs 31.9%, p = 0.288), permanent pacemaker implantation (PPM, 24.1% vs 28.6%, p = 0.53). Furthermore, the procedural and clinical results of TAVR also did not differ between patients with type 0 and type 1 (second valve implantation: 18.4% vs 11.8%, p = 0.71, PVL: 38.8% vs 41.2%, p = 0.83, PPM: 18.4% vs 31.6%, p = 0.16). The hemodynamic outcomes were similar in patients with BAV and TAV at 1-year (maximum velocity, 2.3 vs 2.2 m/s, p = 0.307) and 2-year (2.3 vs 2.1 m/s, p = 0.184) follow-up respectively. Adjusted binary logistic regression analysis found oversizing ratio at 14.45–20.57% is at lower risk for more than mild PVL (OR, 0.069, 95% CI, 0.011–0.428, p = 0.004). Moreover, the Kaplan–Meier survival analysis revealed that TAVR in type 0 BAV, type 1 BAV and TAV have comparable risk for midterm mortality (Log rank, p = 0.772). Conclusion TAVR in whatever type of BAV appeared to be safe and efficacy, and TAVR in BAV was associated with comparable bioprosthetic function during follow up compared to patients with TAV. [ABSTRACT FROM AUTHOR]

Introduction: Diet and hyperlipidemia are correlated to coronary atherosclerosis, whose progression may be modulated by statin therapy. Aortic stenosis and calcification are atherosclerotic processes but they are not influenced by statin therapy. Limited data is available on the influence or correlates of diet on aortic valve calcification. Hypothesis: We hypothesized that diet may be related to aortic valve calcification (AVC) on computed tomography (CT). Methods: Consecutive patients with severe or critical aortic stenosis (AS) were evaluated in a busy Heart Valve Clinic and underwent both detailed dietary evaluation with a rate your plate (RYP) questionnaire and a high resolution CT as part of their work-up for valvular intervention (medical therapy, surgical or transcatheter aortic valve replacement). AVC volume was quantified using a validated method based on a higher threshold of detection from the contrast CT (850 Hounsfield Units, HU-850). Dietary data was separated according to patients in the highest tertile of AVC. Results: A total of 117 patients were evaluated. The upper tertile threshold of AVC was identified as 284.5 mm3 (figure: examples above and below this threshold are shown). Higher scores on RYP identify heart-healthy choices. There were no differences in the overall total RYP score or percentages of specific heart-healthy dietary choices according to AVC severity (table). Conclusions: AVC severity is unrelated to heart-healthy dietary choices in patients with aortic stenosis. [ABSTRACT FROM AUTHOR]