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Background: Recent studies suggest that atrioventricular (AV) conduction may recover after pacemaker (PM) implantation following transcatheter aortic valve replacement (TAVR), but little is known about long-term follow-up of such patients., Objective: The purpose of this study was to evaluate the long-term percentage of right ventricular pacing in patients who underwent TAVR and required PM implantation stratified based on the indication for permanent pacing., Methods: Retrospective analysis of all consecutive patients who underwent TAVR from February 2008 to August 2019 at 3 centers was performed. Patients already implanted with a PM/implantable cardioverter-defibrillator (ICD) before TAVR, implanted with a cardiac resynchronization therapy device, or implanted >30 days after TAVR were excluded. Eligible patients were divided into 2 groups based on the presence (persistent atrioventricular block [AVB] group) or absence (nonpersistent AVB group) of persistent third-degree AVB after TAVR., Results: A total of 1594 patients underwent TAVR. Two hundred four patients were implanted with a PM or ICD after TAVR and 32 met exclusion criteria, so 172 patients were eligible (median time TAVR-PM implant 4 days) for a total of 352 follow-up visits analyzed. A significant difference in the percentage of ventricular pacing was observed at follow-up performed 7-90 days after implantation (98% persistent AVB group vs 8% nonpersistent AVB group; P <.001). This difference remained significant at follow-up performed 91-270 days (95% vs 3.5%; P <.001), 271-540 days (95.5% vs 3%; P = .006), and 541-900 days (97.4% vs 2.2%; P <.001) after implantation., Conclusion: Patients requiring PM implantation due to persistent third-degree AVB after TAVR were less likely to show AV conduction recovery, whereas patients implanted for other indications showed a low percentage of pacing during follow-up., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Transcatheter valve-in-valve treatment of degenerated supra-annular stentless bioprostheses may be challenging and associated with a high risk of coronary occlusion. Preprocedural imaging evaluation is a key step to assess feasibility and to minimize or prevent coronary occlusion. We report the case of a degenerated Freedom Solo valve, treated with a balloon-expandable valve and a previously deflated stent positioned at the level of both coronary ostia. The procedure was successful but stent inflation at the right coronary ostium was required due to slow flow that occurred after valve implantation.

Transcatheter aortic valve implantation has been designed to treat high-risk surgical patients affected by severe aortic stenosis, many of whom are affected by chronic kidney disease. To perform transcatheter self-expandable valve implantation, multiple contrast injections are required to monitor the procedure, so these patients are at increased risk of acute kidney injury. We described self-expandable transcatheter aortic valve implantation without contrast media in an 80-year-old man affected by severe aortic stenosis and endstage chronic kidney disease., (© The Author(s) 2015.)

Abstract Current guidelines recommend a three- to six-months dual antiplatelet therapy (DAPT) in patients undergoing transcatheter aortic valve replacement (TAVR) or to continue with oral anticoagulant agents (OAC) if already indicated before procedure. However, recent studies showed that treatment with aspirin has the same efficacy of DAPT but it was associated with a significant reduction of major bleeding. Furthermore, half of cerebrovascular events, occurring >24 h after procedure, may be related to new onset of atrial fibrillation or to subclinical leaflets thrombosis and they may be prevented by use of OAC rather than antiplatelet therapy. In absence of very high bleeding risk and of recent percutaneous coronary intervention, the use of OAC over SAPT or DAPT might theoretically be considered in patients undergoing TAVR waiting for results of ongoing clinical trials. Highlights • Dual antiplatelet therapy (DAPT) is recommended after transcatheter aortic valve replacement (TAVR). • Single antiplatelet therapy (SAPT) seems to provide the same protection by thrombotic events with less bleeding risk. • Oral anticoagulant therapy (OAC) was more protective than APT on later cerebrovascular events occurring after TAVR. • OAC might theoretically be considered in patients undergoing TAVR without high bleeding risk over SAPT or DAPT. [ABSTRACT FROM AUTHOR]

Objective Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients. Methods From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2 ± 6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures. Results Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29 mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5 mm Hg. The paravalvular regurgitation was ≤ grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2 years is 84.7 ± 5.3%. Conclusions Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure. [ABSTRACT FROM AUTHOR]