Search

New persistent left bundle branch block (NP-LBBB) has been associated with adverse outcomes after TAVI but few predictors thus far reported. We sought to identify predictors of NP-LBBB after TAVI with EvolutR/PRO (ER/EP). From 1/2016 to 4/2019, 544 patients from 2 centers underwent TAVI with Evolut (54% ER, 46% EP) for severe native aortic stenosis. Patients with previous LBBB and pacemaker were excluded. Aortic root analysis was performed using 3Mensio Valves Software and membranous septal length (MSL) was determined using the standard coronal view. Clinical, anatomic and procedural characteristics of 396 Evolut were analyzed and predictors of NP-LBBB were identified. Valve Academic Research Consortium-2 outcomes were reported. At discharge, NP-LBBB was seen in 76(19.2%) patients. NP-LBBB in Evolut was associated with implant depth at left coronary cusp (p = 0.004) and 34 mm ER (p = 0.026). Independent predictors of NP-LBBB in Evolut were shorter MSL (odds ratio [OR] = 0.82 per mm septum, 95% confidence interval [CI] = 0.68 to 0.98,p = 0.030), left ventricular outflow tract (LVOT) eccentricity (OR = 1.04 per %, 95% CI = 1.01 to 1.06,p = 0.002), implant depth at noncoronary cusp (NCC) (OR = 1.28 per mm ventricular, 95% CI = 1.11 to 1.48,p = 0.001) and annular perimeter oversizing ≥20% (OR = 2.38, 95% CI = 1.20 to 4.72, p = 0.013). On ROC curve analysis, MSL ≤6.5 mm, NCC depth ≥3 mm and LVOT eccentricity ≥35% were optimal threshold values to predict NP-LBBB. In Conclusion, shorter MSL, LVOT eccentricity, annular oversizing and deeper implant depth are novel predictors of NP-LBBB in Evolut TAVI. Preprocedural CT assessment of aortic root anatomy may help identify patients at risk for NP-LBBB. In such patients, modifying procedural factors such as higher implant and less annular oversizing may reduce the risk of NP-LBBB. Further evaluation of our hypothesis is warranted.

Aims Paravalvular leak (PVL) remains an important issue in TAVI. The Edwards SAPIEN 3 (S3) valve has reduced PVL but in up to one third of patients mild leak remains. Our study aimed to identify predictors of mild PVL after TAVI with the S3 valve. Methods and results From October 2015 to May 2017, 122 consecutive patients underwent S3 TAVI for symptomatic severe aortic stenosis. Thirty-three patients with mild PVL on transthoracic echocardiography at 30-day follow-up were compared to 89 with none/trace PVL. Thirty-day mortality was 2.5% (n=3), with zero stroke and major vascular complications. There were no differences between the two groups in patient characteristics, annular and left ventricular outflow tract (LVOT) sizing, distribution and severity of annular calcification, valve implantation technique, post-dilatation and implant depth. Mild PVL was associated with higher annular eccentricity (p=0.04) and moderate-severe LVOT calcification (p=0.03). Independent predictors of mild PVL were LVOT eccentricity (OR 1.05 per % ellipticity, 95% CI: 1.02-1.09, p=0.005), discordant sizing (OR 3.08, 95% CI: 1.20-7.90, p=0.02) and three-leaflet calcification (OR 13.3, 95% CI: 2.66-66.7, p=0.002). Conclusions LVOT eccentricity and discordant sizing predict PVL after S3 TAVI. Further studies are needed to understand their mechanism and significance.

Acute afterload mismatch after surgery for mitral regurgitation (MR) with transient left ventricular dysfunction is well known, but not described after transcatheter mitral valve repair with MitraClip, except in functional MR and cardiomyopathy. MitraClip to manage acute severe MR and cardiogenic shock has also been rarely reported. We report here a 77-year-old female who presented with acute severe degenerative MR from a flail posterior leaflet, with cardiogenic shock requiring intra-aortic balloon pump support. She was medically stabilized and underwent successful MitraClip repair with mild residual MR, but developed acute afterload mismatch and severe left ventricular dysfunction and shock 24 hr after her procedure. Patient was medically managed with intra-aortic balloon pump and inotropic support. She subsequently fully recovered with normal ventricular function and was discharged after 14 days. Patient remained asymptomatic in NYHA I functional class 9 months after MitraClip repair, with mild residual MR and normal ventricular function. MitraClip repair in patients with acute severe degenerative MR and cardiogenic shock is a less invasive and potentially safer alternative to open surgery, but acute afterload mismatch may occur and requires prompt diagnosis and management for a successful outcome. © 2017 Wiley Periodicals, Inc.

AIMS Pacemaker lead-associated severe tricuspid regurgitation (TR) can lead to right heart failure and poor prognosis. Surgery in these patients carries significant morbidities. We describe a successful treatment of symptomatic severe TR by leadless pacemaker implantation followed by tricuspid valve (TV) repair with the MitraClip NT. METHODS AND RESULTS A 71-year-old frail female with poor functional status, chronic atrial fibrillation and permanent pacemaker implantation in 2012 presented with symptomatic moderate-severe mitral regurgitation (MR) and severe TR with the pacemaker lead as the culprit. She was deemed extreme risk for double valve surgery and, because of her pacemaker dependency, the decision was to stage her interventions first with transcatheter mitral repair, then laser lead extraction and leadless pacemaker implantation to free the TV from tethering, then TV repair. An obstructive LAD lesion was identified and treated during mitral repair with the MitraClip NT. The Micra leadless pacemaker implantation and subsequent TV repair with the MitraClip NT were successful and the patient's MR improved to mild and TR to moderate, respectively. CONCLUSIONS We report here a first successful transcatheter strategy to treat lead-associated severe TR by leadless pacemaker and MitraClip. Removing the pacemaker lead relieved leaflet tethering and improved the reparability of the TV.

Transcatheter aortic valve replacement (TAVR) is expanding to younger, lower-risk patients, but rates of new persistent left bundle branch block (NP-LBBB) with the newer-generation Edwards SAPIEN 3 (S3) valve (Edwards Lifesciences, Irvine, California) have increased, are associated with adverse

Post procedural mitral stenosis (PPMS) is associated with adverse outcomes in subjects undergoing transcatheter mitral valve repair (TMVR). We hypothesized that smaller mitral annular dimensions would be associated with increased risk of PPMS. 3D TEE images previously acquired in 49 subjects

Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare yet life-threatening complication. Emergent resection of the obstructing calcium is a quick and simple method to restore coronary perfusion in TAVR over emergency CABG. doi: 10.1111/jocs.12752 (J Card Surg 2016;31:315-317).

New permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) has been associated with impaired ventricular recovery and increased heart failure readmissions, but few predictors have been reported. We sought to identify predictors of new-PPI after TAVR with EvolutR/

New persistent left bundle branch block (NP-LBBB) has been associated with adverse outcomes after transcatheter aortic valve replacement (TAVR), but few predictors have thus far been reported. We sought to identify predictors of NP-LBBB after TAVR with the Edwards Sapien3 (S3) valve. From October

New persistent Left Bundle Branch Block(NP-LBBB) and permanent pacemaker(PPM) implantation after TAVR is not benign. We aim to identify predictors of NP-LBBB and new-PPM after Medtronic EvolutR(ER) TAVR. From 3/2014 to 12/2017, 294 patients from 3 centers with severe native aortic stenosis

Impact of transcatheter heart valve(THV) selection on prosthesis-patient mismatch(PPM) remains unknown. We aimed to compare incidence of moderate and severe PPM between Sapien3(S3) and EvolutR/Pro(ERP) in a theoretical model. From 10/2015 to 9/2018, standardized effective orifice area(EOA) of 1401

New Persistent Left Bundle Branch Block(NP-LBBB) and permanent pacemaker(PPM) implantation after TAVR is not benign. We aim to identify novel predictors of new-LBBB and NP-PPM after Edwards Sapien3(S3) TAVR From 3/2014 to 12/2017, 407 patients from 3 centers with severe native aortic stenosis

Transcatheter aortic valve replacement (TAVR) is expanding to younger patients, but the feasibility of TAVR in failing transcatheter aortic valves (TAV) remains unknown. We determine the feasibility of TAV-in-TAV after SAPIEN 3 (S3) TAVR. From October 2015 to April 2019 at 2 centers, 610 S3 TAVRs

Left atrial pressure (LAP) and V-wave reduction are markers of successful transcatheter mitral repair but no simple method of continuous monitoring exists. We report our multicenter experience on continuous LAP monitoring during MitraClip repair. From 11/2016 to 8/2017, 74 prohibitive risk patients

Patients with aortic stenosis undergoing TAVR often have mitral disease. Transcatheter mitral valve replacement (TMVR) is a potential option in these patients, but TAVR may affect mitral annular geometry impacting their candidacy for TMVR. We evaluated mitral annular characteristics before and after

Patients with aortic stenosis undergoing TAVR often have severe mitral regurgitation. Some of them are not anatomical candidates for Mitraclip. Transcatheter mitral valve replacement (TMVR) is a promising alternative, but risk left ventricular outflow tract obstruction (LVOTO). Aortomitral annular

Annular sizing predicts paravalvular leak (PVL) and new persistent left bundle branch block (pLBBB), but little is known on Left Ventricular Outflow Tract (LVOT) anatomy on TAVR outcomes. We propse an LVOT seal zone to quantify LVOT-Annular mismatch and derive a “non-tubular index (NTI)”, to

Background: Patients undergoing transcatheter aortic valve replacement (TAVR) often have concomitant severe mitral regurgitation. A portion of these patients are not anatomical candidates for a mitraclip procedure. Transcatheter mitral valve replacement (TMVR) is a promising alternative, but has a