Transcatheter aortic valve implantation (TAVI) is a therapeutic modality for high-surgical-risk patients with severe aortic stenosis. This study describes the outcomes of TAVI performed in Qatar.

The Qatar TAVI registry (QATAVI) was established to report the outcomes of TAVI procedures performed at Hamad Medical Corporation- Heart Hospital between October 2012 and December 2023. Data were collected both prospectively and retrospectively.

241 patients underwent TAVI, with a mean age of 73 ± 8 years. The device success rate was 98.8 %. In-hospital para-valvular leak (PVL) was as follows; mild 8.3 %, moderate 0.8 %, and severe 0.0 %. At 1-year, PVL was mild 2.9 %, moderate 0.4 %, and severe 0.0 %. At 2 years, 0.4 % had mild PVL, moderate 0.4 %, and severe 0.0 %. The incidence of stroke was 2.1 % during hospitalization, 2.1 % at 1 year, and 1.2 % at 2 years. For myocardial infarction, the in-hospital rate was 0.8 %, at 1 year 3.3 %, and 1.2 % at 2 years. 3.7 % developed heart failure during the hospital stay, 15.4 % at 1 year, and 4.6 % at 2 years. The 30-day mortality rate was 2.0 %, while a 1-year survival rate was 91 %. Among the 1-year mortality, 67 % died from non-cardiovascular causes.

The inaugural report of QATAVI demonstrates a success rate that matches international standards, favorable early and late valvular functions, and improved clinical outcomes related to major adverse cardiovascular events. Moreover, the survival rates observed in this cohort align with those reported in global registries, demonstrating the safety and effectiveness of the TAVI procedure in Qatar.

Myocardial fibrosis contributes to LV mechanical dyssynchrony and fibroblast activation protein is considered as a specific biomarker related to tissue remodeling. The authors aimed to explore the relationship between LVMD and myocardial fibrosis, and patterns of LV fibrosis distribution in CAD and Degenerative Mitral Valve Regurgitant (DMVR) participants by the technique of 18F-AlF-FAPI PET/MR.

37 CAD and DMVR participants with LVMD and normal ones underwent cardiac PET/MR imaging, the correlations between SUVmean of FAPI-uptakes and score/percentage of LV wall thickening, peak myocardial strains, and displacements were analyzed in PET/MR images, and ejection fractions and function parameters of mitral valve were compared.

There was inverse correlation between SUVmean and score/percentage of LV wall thickening, peak circumferential and short-axial radial myocardial strains, and global peak myocardial strains and ejection fractions showed a decrease significantly in participants with heart diseases. In CAD participants, FAPI was distributed in the ischemic coronary arteries regions. Functions of myocardium in LAD and RCA regions were sensitive to fibrosis, however, those in LCX regions were resistant to fibrosis. In DMVR participants, high uptakes of FAPI were the locations of the valve annulus and papillary muscles, and SUVmean in the basal inferospetal/basal inferior segments were a positive correlation with function parameters of the mitral valve.

Uptake of 18F-AlF-FAPI in the myocardium could detect fibrosis and predict LVMD in CAD and DMVR participants. Moreover, there were different distributions of FAPI-uptake in those participants. In DMVR participants, SUVmean in the basal inferospetal/basal inferior segments could assess dysfunction of the mitral valve.

Valvular heart disease (VHD) is the third leading cause of cardiovascular morbidity, with its incidence and public health impact projected to increase significantly. This study adopts a novel perspective, focusing on elderly individuals residing in rural areas, highlighting the unique dynamics of small-town settings.

This multicenter, observational study was conducted from May 2022 to September 2023, under the coordination of the AOU Careggi Echo Core-Lab, which managed the entire screening program. In 10 small Italian villages, each municipality facilitated the enrollment of asymptomatic individuals aged ≥ 65 years, with no prior VHD history, through voluntary participation. Participants were grouped into three age categories (65-69, 70-74, and ≥ 75 years) and underwent a thorough evaluation, including a Quality of Life (QoL) questionnaire and comprehensive echocardiographic assessment focusing on VHD detection and grading.

Among 1,113 participants, the prevalence and severity of VHD showed a significant increase with age (p < 0.0001). Remarkably, 94% of individuals aged ≥ 75 years had at least one valvular defect, with 22.5% presenting moderate or severe valvulopathy, including a prevalence of 4.8% for moderate or severe aortic valve stenosis and 7.5% for mitral regurgitation. Right-sided valvulopathies followed a similar trend, affecting 71.9% of elderly participants. QoL evaluations revealed a generally positive perceived health status, with a mean score of 77 ± 16.

Our registry highlights that the prevalence of VHD in asymptomatic individuals over 65 years living in small Italian communities is substantial, increases with age, and is predominantly degenerative in etiology. Notably, most individuals with undiagnosed VHD perceived themselves as healthy.

Aortic anatomy may pose challenges to the advancement of the delivery catheter system (DCS) and affect the outcome of self-expanding transcatheter aortic valve replacement (SE-TAVR). This study aimed to develop a preprocedural CT-based nomogram to predict the passability of DCS and clinical SE-TAVR outcomes.

Data of 348 patients who underwent transfemoral SE-TAVR were retrospectively collected from May 2018 to December 2023. A number of 118 patients received snare catheter, indicating poor DCS passaibility. All patients were randomized to development (n = 244) and validation (n = 104) sets. A predictive model was constructed by logistic regression and presented as a nomogram, which indicated that larger aortic angle, severe calcification, larger ascending aorta diameter, coronary ostial height of ≤10 mm, and bicuspid aortic valve were independent anatomical risk factors for poor DCS passability during SE-TAVR. Subsequently, the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were depicted to assess the performance of the nomogram, revealing its good accuracy and concordance. This model also showed that patients with poor DCS passability were more likely to develop significant postprocedural paravalvular leak (PVL).

The model adequately predicts the DCS passability during SE-TAVR, which provides a comprehensive profile of risk factors for poor DCS passability and indicates coronary ostial height of ≤10 mm as a novel anatomical risk factor, in addition to the larger aortic angle, severe calcification, larger ascending aorta diameter, and bicuspid aortic valve. Patients with poor DCS passability are more likely to develop significant PVL.

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, particularly in patients at high risk of adverse events for traditional open-heart surgery. Since the early 2000s, TAVR has evolved rapidly with advancements in device technology, procedural techniques, and patient selection criteria. Over the past 20 years, this catheter-based procedure has significantly improved patient survival and quality of life, demonstrating both the safety and efficacy of TAVR, even in patients at low surgical risk. This paper reviews the latest advances in valve design and strategies for treating aortic stenosis. It explores the challenges with long-term outcomes given the younger age of patients undergoing TAVR and the prospects of emerging technologies to improve long-term outcomes.

Transcatheter aortic valve replacement (TAVR) is a proven treatment for severe aortic stenosis. Transfemoral access is the most prevalent method, achieved either surgically or percutaneously. This study compared in-hospital outcomes and length of stay between surgical cut-down and fully percutaneous approaches.

This retrospective, propensity-matched study analyzed medical records of all patients who underwent transfemoral TAVR at our center from January 2019 to December 2023. Outcomes were assessed based on Valve Academic Research Consortium-2 (VARC-2) consensus criteria.

A total of 251 TAVR patients (77 propensity score-matched pairs) were included (55% female) with a median (IQR) age of 80 (11) years. Surgical cut-down showed fewer vascular complications, bleeding, and transfusions. No death was reported in this group. Fewer mean hospitalization days were observed in the total cohort over the years (p < 0.001). This reduction was more pronounced after 2021 when the surgical approach was adopted. Mean hospitalization days were 6.40 ± 6.46 for percutaneous and 4.34 ± 1.61 for surgical groups (p < 0.001).

Surgical cut-down for TAVR femoral access yields superior outcomes and shorter hospital stays compared to fully percutaneous methods.

 Severe tricuspid regurgitation (TR) adversely affects long-term survival; however, isolated tricuspid valve (TV) surgery has been rarely performed due to high operative mortality. In addition, the previous literature included heterogeneous TR etiologies. Therefore, we aimed to elucidate early and long-term outcomes of isolated TV surgery for functional TR.

 An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.

 This meta-analysis included seven studies. Pooled analyses showed that 68% (35, 89) of patients had preoperative atrial fibrillation or flutter, and 58% (11, 94) had a history of left-sided valve surgery. Seventy-three percent (65, 80) of patients had at least one physical exam finding of right-sided heart failure, and 57% (44, 69) were in New York Heart Association class III or IV. TV replacement was more common than repair. In TV replacement, bioprosthetic valve (39%, 13, 74) was more common than mechanical prosthesis (22%, 18, 26). The early mortality rate was 7%. Twenty percent of patients required a permanent pacemaker postoperatively. The overall 1- and 5-year survival rates were 84.5 and 69.1%, respectively.

 More than half of the patients who underwent isolated TV surgery for functional TR had undergone left-sided valve surgery and had significant heart failure symptoms at the time of surgery. Further studies on the surgical indication for concomitant TV surgery at the time of left-sided valve surgery and the appropriate timing of surgery for isolated functional TR are needed to improve survival.

Recent studies on the effects of preoperative tricuspid regurgitation (TR) severity and concomitant tricuspid valve (TV) surgery in patients undergoing aortic valve replacement (AVR) have yielded conflicting results, complicating the decision making on concomitant TV surgery in AVR.

The purpose of this study was to investigate the impact of preoperative TR severity on outcomes of AVR and to assess the impact of concomitant TV surgery.

Patients who underwent AVR from 2000 to 2022 were included. The primary outcome was all-cause mortality, and the secondary outcome was a composite of mortality, TV-related reoperation, stroke, and heart failure. For patients with moderate TR, the impact of TV surgery was analyzed using the inverse probability of treatment weighting to address for selection bias.

A total of 2,679 consecutive patients (median 7.22 years, Q1-Q3: 4.21-11.83 years) constituted the study cohort. At baseline, TR severity was none-to-trivial, mild, moderate, and severe in 1,688 (63.0%), 731 (27.3%), 215 (8.0%), and 45 (1.7%) patients, respectively. Clinical outcomes demonstrated significant disparities depending on baseline TR severity (P for trend < 0.001). After adjusting for potential covariates, TV surgery did not affect overall survival among patients with moderate TR (HR: 0.57; 95% CI: 0.21-1.50). However, the TV surgery group exhibited a favorable composite outcome and lower TV-related reoperation rate (HR: 0.37; 95% CI: 0.15-0.92, and subdistribution HR: 0.07; 95% CI: 0.01-0.63, respectively).

In patients who underwent AVR, baseline TR severity correlated with unfavorable clinical outcomes. Concomitant TV surgery reduced the rate of TV-related reoperations, but not mortality, among patients with moderate TR.

Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outcomes in TAVR patients, though data are limited. This meta-analysis aims to evaluate the impact of CTO on TAVR outcomes.

A comprehensive literature search was conducted across multiple electronic databases to identify studies comparing TAVR outcomes in patients with and without CTO. Pooled risk ratios (RR) with 95 % confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was all-cause mortality, with several secondary endpoints also assessed.

Six studies involving a total of 331,159 TAVR patients were included in this meta-analysis. CTO was associated with a significantly increased risk of in-hospital mortality (RR: 1.24; 95 % CI: 1.01, 1.52; p = 0.04), acute myocardial infarction (RR: 1.67; 95 % CI: 1.48, 1.89; p < 0.00001), acute kidney injury (RR: 1.46; 95 % CI: 1.37, 1.56; p < 0.00001), and vascular complications (RR: 1.47; 95 % CI: 1.28, 1.69; p < 0.00001). No significant differences were observed in all-cause mortality (RR: 1.21; 95 % CI: 0.76, 1.93; p = 0.42), stroke (RR: 1.09; 95 % CI: 0.91, 1.30; p = 0.37), or bleeding events (RR: 1.19; 95 % CI: 1.00, 1.41; p = 0.06).

CTO poses a significant risk in TAVR patients, particularly for in-hospital mortality and acute myocardial infarction. A multidisciplinary approach is recommended for these patients, with consideration given to revascularization before TAVR. Further studies are needed to evaluate the potential benefits of prior CTO-PCI.

We compared adults with mitral stenosis (MS) to 8 controls (CONT) to see how pulmonary impedance and wave reflections differ at baseline and after balloon valvuloplasty.

We separated the MS patients into groups according to mean pulmonary artery pressure: moderate (MOD; ≤ 26 mmHg, n = 21) and high (HIGH; > 26 mmHg, n = 33). We made baseline high-fidelity measurements in all patients, in the MS groups after vasodilation with nitroprusside, immediately and 4 months after balloon valvuloplasty.

Comparing MOD vs CONT, using the Kruskal-Wallis test with Bonferroni correction, reveals evidence for higher baseline input resistance (R) (489 vs 205 dyne-sec/cm5, P = 0.07); first harmonic of impedance modulus (Z1) (97.3 vs 27.6 dyne-sec/cm5, P = 0.01); first zero crossing of impedance phase angle (F0) (4.49° vs 2.19°, P = 0.02) but no difference in wave reflection index (Pb/Pf). Baseline HIGH vs CONT comparisons reveal stronger evidence and larger differences than MOD for R (995 vs 205, P < 0.001); Z1 (151 vs 27.6, P < 0.001); F0 (5.25 vs 2.19, P < 0.001); as well as Pb/Pf (0.69 vs 0.42, P < 0.001). Responses to nitroprusside and valvuloplasty are also greater in the HIGH than MOD, but the HIGH parameters still differ from the CONT. Four months after valvuloplasty there is evidence for reverse remodeling in both groups. Further analyses reveal that sinus rhythm and younger age are potentially important factors for remodeling.

MS causes alterations in pulmonary hemodynamics that differ according to pressure levels. These changes are only partially reversed immediately after valvuloplasty. There is evidence for reverse remodeling 4 months afterwards.

 This randomized controlled trial was designed to compare 1-year hemodynamic performances and clinical outcomes after aortic valve replacement (AVR) using a recently introduced (the AVALUS group) and worldwide used (the CEPME group) bovine pericardial bioprostheses.

 Patients were screened to enroll 70 patients in each group based on a noninferiority design. The primary endpoint of the trial was the mean pressure gradient across the aortic valve (AVMPG) at 1 year after surgery. One-year echocardiographic data were obtained from 92.1% (129 of 140 patients) of the study patients.

 There were no differences in baseline characteristics, including sex and body surface area (1.64 ± 0.18 vs. 1.65 ± 0.15 m2) between the groups. The AVMPG on 1-year echocardiography was 14.0 ± 4.3 and 13.9 ± 5.1 mmHg in the AVALUS and CEPME groups, respectively (the p-value for noninferiority was 0.0004). In the subgroup analyses for the respective size of the prostheses, AVMPG of the 19-mm prostheses was significantly lower in the AVALUS group than in the CEPME group (14.0 ± 4.3 vs. 20.0 ± 4.7 mmHg, p = 0.012), whereas those of the other sizes were not significantly different between the two groups. There were no significant differences in the effective orifice area (1.49 ± 0.40 vs. 1.53 ± 0.38 cm2, p = 0.500) or effective orifice area index (0.91 ± 0.22 vs 0.93 ± 0.23 cm2/m2, p = 0.570) in all the patients, or in the subgroup analysis for the 19-mm prosthesis. There were no differences in the 1-year clinical outcomes between the two groups.

 The 1-year hemodynamic and clinical outcomes of the AVALUS group were noninferior to those of the CEPME group (NCT03796442).

To intra-individually investigate the variation of coronary artery calcium (CAC), aortic valve calcium (AVC), and mitral annular calcium (MAC) scores and the presence of blur artifacts as a function of temporal resolution in patients undergoing non-contrast cardiac CT on a dual-source photon counting detector (PCD) CT. This retrospective, IRB-approved study included 70 patients (30 women, 40 men, mean age 78 ± 9 years) who underwent ECG-gated cardiac non-contrast CT with PCD-CT (gantry rotation time 0.25 s) prior to transcatheter aortic valve replacement. Each scan was reconstructed at a temporal resolution of 66 ms using the dual-source information and at 125 ms using the single-source information. Average heart rate and heart rate variability were calculated from the recorded ECG. CAC, AVC, and MAC were quantified according to the Agatston method on images with both temporal resolutions. Two readers assessed blur artifacts using a 4-point visual grading scale. The influence of average heart rate and heart rate variability on calcium quantification and blur artifacts of the respective structures were analyzed by linear regression analysis. Mean heart rate and heart rate variability during data acquisition were 76 ± 17 beats per minute (bpm) and 4 ± 6 bpm, respectively. CAC scores were smaller on 66 ms (median, 511; interquartile range, 220-978) than on 125 ms reconstructions (538; 203-1050, p < 0.001). Median AVC scores [2809 (2009-3952) versus 3177 (2158-4273)] and median MAC scores [226 (0-1284) versus 251 (0-1574)] were also significantly smaller on 66ms than on 125ms reconstructions (p < 0.001). Reclassification of CAC and AVC risk categories occurred in 4% and 11% of cases, respectively, whereby the risk category was always overestimated on 125ms reconstructions. Image blur artifacts were significantly less on 66ms as opposed to 125 ms reconstructions (p < 0.001). Intra-individual analyses indicate that temporal resolution significantly impacts on calcium scoring with cardiac CT, with CAC, MAC, and AVC being overestimated at lower temporal resolution because of increased motion artifacts eventually leading to an overestimation of patient risk.

There is a scarcity of data for perioperative outcomes of octogenarians undergoing tricuspid transcatheter edge-to-edge repair (TEER), despite both the potential procedural effectiveness in treating tricuspid regurgitation and a low incidence of severe complications observed in the nonelderly population. We assessed the characteristics and outcomes of TEER in octogenarians compared to those in patients under 80 years old treated at a referral tertiary teaching hospital. We retrospectively enrolled all adult patients undergoing tricuspid TEER. The population was stratified based on age: ≥80 and <80 years. Inverse probability of treatment weighting (IPTW) propensity score was used to mitigate the risk of selection bias. Between January 2017 and September 2023, 101 patients underwent tricuspid TEER. Thirty-six (36%) were octogenarians. Crude treatment estimates indicated that preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly higher in octogenarians compared to younger patients (19 mm [IQR: 17 to 21] vs. 17 mm [IQR: 14-18]; p = 0.005). At discharge, octogenarians showed a TAPSE 2.71 mm higher than that observed in the <80 age group (95% CI: 0.79 to 4.62; p = 0.006) according to crude treatment estimates. After adjusting with IPTW-weighting, the TAPSE difference remained significant, with octogenarians having a 2.44 mm higher TAPSE (95% CI: 0.54 to 4.35; p = 0.012). IPTW-adjusted analyses indicated comparable clinical outcomes between the two groups. Adverse events and survival in octogenarians were similar to those observed in patients aged <80 years. Our findings indicate that age alone should not be the sole criterion to deny TEER.

Background/Objectives: Pleural effusions may be seen in patients with severe AS complicated by hemodynamically significant heart failure. However, there are no data on the association between pleural effusion and long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess the impact of pre-procedural pleural effusion on long-term mortality in these patients. Methods: A retrospective, single-center analysis was conducted on 401 patients who underwent TAVI between January 2010 and December 2023. The patients were categorized into two groups based on the presence of pleural effusion, which was assessed via pre-procedural imaging using thoracic computed tomography (CT). Results: Pleural effusion was present in 158 patients (39.4%). The patients with pleural effusion had significantly higher long-term mortality rates compared to those without pleural effusion (46.2% vs. 24.3%, p < 0.001). Multivariate analysis identified pleural effusion as an independent predictor of long-term mortality (HR: 1.568, 95% CI: 1.065-2.308, p = 0.023). Also, the patients with pleural effusions had a higher long-term mortality rate compared with those without pleural effusions (log-rank p < 0.001). Conclusions: Pre-procedural pleural effusion is independently associated with increased long-term mortality in TAVI patients. Early recognition and management of pleural effusion are critical for optimizing outcomes in this high-risk population.

Transcatheter aortic valve replacement (TAVR) recipients frequently have an indication for long-term oral anticoagulation, including atrial fibrillation or systemic thromboembolic disease. It remains unclear if there are differences in safety and effectiveness between direct oral anticoagulants (DOAC) and warfarin in this patient population.

Clinical outcomes were compared between TAVR recipients receiving DOACs or warfarin using data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry linked with Centers for Medicare & Medicaid Services claims data. The analysis included patients from the TVT registry who underwent successful TAVR and were discharged on either a DOAC or warfarin between January 2013 and May 2018. The primary outcome was any bleeding requiring hospitalization from discharge to 1 year. Secondary outcomes included all-cause mortality and stroke from discharge to 1 year. Multivariable Cox proportional hazards regression models were used to compare these outcomes between the 2 groups.

A total of 29,142 patients underwent TAVR and were discharged on oral anticoagulation, among whom 10,973 (37.7%) were discharged on a DOAC. The use of DOACs increased throughout the study period and exceed the use of warfarin by the final year (2018). The cumulative incidence of bleeding requiring hospitalization at 1 year (11.8% vs 15.2%, P < .001) and all-cause mortality (15.5% vs 17.5%, P < .001) was significantly lower in DOAC group while stroke (2.47% vs 2.39%, P = .64) was not statistically different between groups. In an adjusted model, the use of a DOAC as opposed to warfarin was associated with a significantly lower risk of bleeding requiring hospitalization (adjusted hazard ratio 0.49, 95% confidence interval 0.43-0.56), all-cause mortality (adjusted hazard ratio 0.61, 95% confidence interval 0.57-0.66), and stroke (adjusted hazard ratio 0.86, 95% confidence interval 0.81-0.92) (all P < .001).

In this analysis of TAVR recipients discharged on oral anticoagulation in a large U.S. registry, the use of a DOAC rather than warfarin was associated with a lower risk of bleeding requiring hospitalization, all-cause mortality, and stroke from discharge to 1 year. Future randomized studies will be necessary to establish the optimal choice of anticoagulant in TAVR patients.

Mitral regurgitation (MR) or tricuspid regurgitation (TR) is often an indicator of poor prognosis in patients with aortic stenosis (AS). Our study aims to compare transcatheter aortic valve implantation (TAVI) outcomes in patients with and without concomitant MR or isolated TR. Using the national readmission database (2016-2020), we identified patients with severe AS undergoing TAVI. We used multivariable regression for adjusted analysis and the Propensity Score Matching (PSM) model. Among 315,163 hospitalizations for TAVI, 14,577 (4.6 %) had concomitant MR, while 3859 (1.2 %) had isolated TR. On PSM, TAVI in concomitant MR was associated with higher acute CHF (50.1 % vs 43.7 %, p-value < 0.001), mechanical circulatory support (MCS) need (1.5 % vs 0.9 %, p-value: 0.001), acute myocardial infarction (5.6 % vs. 4.3 %, p-value < 0.001) and net adverse events (61.5 % vs. 59.2 %, p-value: 0.002) while the mortality difference was not significant (p > 0.05). Higher total costs ($58,104 vs $55,183, p-value < 0.001), 90- (22.8 % vs. 21.2 %), and 180-day readmission rates (32.1 % vs. 29.4 %) were also observed [p-value < 0.05]. Similarly, TAVI in the presence of isolated TR was associated with higher cardiogenic shock (3.2 % vs. 1.8 %, p: 0.004) and MCS need (1.5 % vs 0.7 %, p: 0.009). TAVI with coexisting TR showed higher rates of 30-day (13.4 % vs. 11.2 %), 90-day (26 % vs. 21.2 %), and 180-day (34.3 % vs 29.1 %) readmission rates [p < 0.05]. A higher median length of stay (3 vs. 2 days) and total cost ($60,376 vs. $55,183) [p-value < 0.001] were also observed. TAVI in concomitant MR or TR was associated with higher periprocedural adverse events, increased healthcare burden & readmission rates.

Aortic valve disease (AVD) is a highly prevalent condition worldwide. Aortic valve replacement (AVR) is the surgical treatment for those with severe disease. Common etiologies of AVD include aortic stenosis (AS), aortic insufficiency (AI), endocarditis, and congenital diseases. Shared decision-making plays a large role in the treatment methodology chosen for each patient. Selection of valve type and surgical intervention requires strong considerations of age and compatibility with vitamin K antagonists (VKAs) to ensure optimal post-operative outcomes. Due to the development of novel surgical techniques, including transcatheter AVR (TAVR) and placement of sutureless valves, patients who previously had limited access to AVD surgical options can now be considered for AVR. Further research into therapeutic development is imperative to improve patient short- and long-term outcomes as well as widen surgical candidacy for those seeking AVR for the management of AVD. Overall, AVR will continue to hold its prominent role in the treatment of AVD.

Aortic valve replacement (AVR) is recommended for symptomatic severe aortic stenosis (AS) patients. However, evidence of its role in asymptomatic patients with severe AS remains controversial. Hence, a systematic review and meta-analysis of randomized controlled trials comparing AVR to conservative management in patients with asymptomatic severe AS was conducted. A systematic literature search was performed on electronic databases including MEDLINE (via PubMed), Embase, and Cochrane CENTRAL Library until November 2024. A random effects model was used to pool individual risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) using Review Manager Version 5.4.1 to calculate pooled effect estimates. Three randomized controlled trials with 1203 patients (42% females) were included. On pooled analysis, AVR significantly reduced the risk of hospitalization for heart failure (RR = 0.11, CI: 0.02-0.56, P = 0.008) compared with conservative care. However, there were no significant differences between the 2 groups in all-cause mortality (RR = 0.63, CI: 0.36-1.11, P = 0.11), stroke (RR = 0.59, CI: 0.35-1.01, P = 0.05), myocardial infarction (RR = 0.43, CI: 0.06-2.92, P = 0.38), or thromboembolic events (RR = 0.54, CI: 0.13-2.29, P = 0.40). In asymptomatic patients with severe AS, AVR significantly reduces the risk of hospitalization due to heart failure, with comparable risks in terms of all-cause mortality, myocardial infarction, stroke, and thromboembolic events compared with conservative management.

Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired valvular disorder. Patient risk stratification and the development of an accurate and reliable tool are crucial in identifying suitable candidates for TAVI. The present review summarized the current state of knowledge on the influence of selected factors on the outcomes and course of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Methods: The inclusion criteria for the present systematic review were as follows: (1) studies indexed in the medical databases PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus; (2) full-text articles available in English; (3) papers published between 2013 and 2023; and (4) addressing the topic of assessing the impact of factors on the outcomes of patients with aortic stenosis undergoing TAVI. This review used PRISMA 2020 reporting guidelines for systematic reviews and meta-analyses. Results: One hundred and thirty-two studies were eligible for this review. The available studies showed an association of psychosocial and socioeconomic factors, valve parameters, comorbidities, clinical factors, treatment-related factors, biomarkers, and treatment methods with the outcomes of patients with AS undergoing TAVI. Conclusions: Given the conflicting results obtained regarding the impact of right ventricular dysfunction, paravalvular leaks, and treatment method on the mortality of patients undergoing aortic valve implantation, further research in these areas is needed. In view of the researchers' differing views on some of the factors affecting patient outcomes after TAVI, further analysis is needed to develop a new tool for assessing predictive outcomes in AS patients. This study is registered at PROSPERO (CRD42024612752).

Transcatheter aortic valve implantation (TAVI) has become a first-line management option across all risk categories of elderly patients with symptomatic severe aortic stenosis. As the indications of TAVI expand, the age and the surgical risk of patients who undergo TAVI is decreasing making lifetime management after TAVI more compelling. After TAVI, patients endure an incremental risk of acute coronary syndromes, which have unique mechanisms and management challenges that are yet to be fully understood. In this report, we review the mechanisms, the natural history, and the management of post-TAVI acute coronary syndromes.

To assess the knowledge level of physicians on anticoagulation management and identify their training needs to ensure the safety and efficacy of warfarin therapy among patients.

This project adopted convenient sampling and collected survey questionnaires online to investigate physicians' management level in aspects such as basic anticoagulation knowledge, routine adjustment of warfarin dosage, and management of warfarin complications and special situations after mechanical valve replacement.

Among the 232 participants in this survey, 158 were male (68.10%), and 74 were female (31.90%); Grade III hospitals accounted for 61.21%; cardiovascular medicine department accounted for 65.09%; primary, intermediate, and advanced title holders each accounted for about one-third. The respondents had a good foundation in warfarin anticoagulation knowledge, and most physicians could guide patients in anticoagulation treatment. However, there were still many respondents who answered incorrectly on some basic questions. Using the chi-square test, the analysis of the impact of gender, age, hospital level, department, education, and title on the knowledge level of warfarin anticoagulation found that gender had no statistical significance in all items; age, department, and title had statistically significant differences in the impact on the knowledge level of anticoagulation in the respondent (P < 0.05).

The respondents have good anticoagulation knowledge on basic items, but some healthcare professionals have insufficient understanding of some items, such as the approximate time required for INR to reach a stable value and the use of warfarin in pregnant women, posing significant risks in clinical work. Relevant healthcare professional training should be strengthened on extended knowledge on warfarin.

Prosthetic heart valves (PHV) have been studied for around 70 years. They are the best alternative to save the life of patients with cardiac valve diseases. However, current PHVs may still cause significant disadvantages to patients. In general, native heart valves show complex structures and reproducing their functions challenges scientists. Valve repair and replacement are the options to heal heart valve diseases (VHDs), such as stenosis and regurgitation, which show high morbidity and mortality worldwide. Valve repair contributes to the performance of cardiac cycles. However, it fails to restore valve anatomy to its normal condition. On the other hand, replacement is the only alternative to treat valve degeneration. It may do so by mechanical or bioprosthetic valves. Although prostheses may restructure patients' cardiac cycle, both prostheses may show limitations and potential disadvantages, such as mechanical valves causing thrombogenicity or bioprosthetic valves, calcification. Thus, prostheses require constant improvements to remedy these limitations. Although the design of mechanical valve structures has improved, their raw materials cause great disadvantages, and alternatives for this problem remain scarce. Cardiac valve tissue engineering emerged 30 years ago and has improved over time, e.g., xenografts and fabricated heart valves serving as scaffolds for cell seeding. Thus, this review describes cardiac valve substitutes, starting with the history of valvular prosthesis transplants and ending with some perspectives to alleviate the limitations of artificial valves.

Lack of consensus on the treatment of tricuspid regurgitation (TR) has limited operative management for decades. However, emerging evidence indicates that intervening on moderate tricuspid regurgitation during concomitant cardiac surgery can be beneficial with appropriate patient selection. Furthermore, advances in transcatheter therapies have changed the landscape of managing tricuspid disease.

For severe aortic stenosis (AS) patients awaiting valve replacement, managing acute decompensated heart failure (ADHF) is crucial due to poor prognosis. The LOHAS registry evaluated the effect of tolvaptan in patients (mean age: 85 years) with severe AS and ADHF, demonstrating stable hemodynamics and sufficient diuresis. We investigated predictors of rapid successful decongestion. In the LOHAS study, eligible patients received tolvaptan (7.5 mg) on day 1 plus standard ADHF treatments. Patients were divided based on decongestion achievement on day 4. Of 59 enrolled, 35 (59%) achieved decongestion (decongestion group), and 24 (41%) remained congested (congestion group). Changes in body weight, renal function, and hemodynamics were comparable between groups over the first 4 days. However, the maximum inferior vena cava (IVC) diameter at admission was significantly larger in the decongestion group than the congestion group (12.6 ± 6.3 vs. 7.6 ± 4.8 mm, p = 0.007). ROC analysis revealed a cut-off of 11 mm for maximum IVC diameter to predict decongestion on day 4 (AUC: 0.73, 95% CI 0.58-0.88). In-hospital mortality was lower in the decongestion group (0% vs. 13%, p = 0.06). In conclusion, in this high-risk severe AS and ADHF population, adding tolvaptan to standard therapy may rapidly improve decompensation if patients have a sufficiently expanded IVC at admission. Maximum IVC diameter could predict successful decongestion with tolvaptan.

The primary objectives were to identify the predictors of new permanent pacemaker implantation in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The secondary objectives were to investigate the temporal changes in permanent pacemaker implantation following TAVI and its impact on long-term prognosis.

Prospective observational cohort study of patients with AS undergoing TAVI.

Single-centre study conducted at a tertiary hospital in Western Norway between 2012 and 2019.

Among 600 consecutive patients with severe AS who were treated with TAVI, 52 patients with permanent pacemaker prior to TAVI were excluded. The remaining 548 patients were included in the present study.

An evaluation of baseline risk factors, 12-lead ECG and echocardiography.

The need for a new pacemaker implantation ≤30 days following TAVI and all-cause death.

The mean age was 80.6±6.7 years, and 50% were males. Among the 548 eligible patients, 173 (31.6%) underwent pacemaker implantation ≤30 days following TAVI, evenly distributed between females and males (29.6% vs 33.6%, p=0.317), with higher implant rates at low-volume phase (2012-2015) and lower implant rates at high-volume phase (2016-2019) (45.8% vs 23.9%, p<0.001). On multivariable analysis, an abnormal electrocardiogram (OR 1.73; 95% CI 1.14 to 2.63, p=0.010), right bundle branch block (OR 2.23; 95% CI 1.09 to 4.59, p=0.028) and atrial fibrillation (OR 1.89; 95% CI 1.24 to 2.88, p=0.003) at baseline were strong predictors of pacemaker implantation. The type of bioprosthesis, but not size, was associated with permanent pacemaker implantation (mechanically expandable valves OR 3.48, 95% CI 2.16 to 5.59; balloon-expandable valves OR 0.07, 95% CI 0.02 to 0.29, both p<0.001)-irrespective of age and sex. During a median follow-up of 60.4 months (range 3-131 months), permanent pacemaker implantation following TAVI was not associated with all-cause mortality (HR 0.89; 95% CI 0.69 to 1.16, p=0.403).

In the current study, the rates of permanent pacemaker implantation following TAVI decreased substantially from the early low-volume phase to the late high-volume phase. An abnormal baseline ECG, right bundle branch block, atrial fibrillation and bioprosthesis selection remained important predictors of permanent pacemaker implantation. Permanent pacemaker implantation following TAVI had no impact on short or long-term survival.

The Regional Committees for Medical and Health Research Ethics (approval number: REK vest 33814/2019) and the Institutional Data Protection Services approved the study protocol. The dissemination of study findings was through peer-reviewed publication, presentation at national and international scientific meetings and conferences.

NCT04417829.

Valvular heart disease is one of the most common cardiovascular diseases today and may result in severe limiting symptoms, a shortened lifespan, and, in some cases, sudden death. It is important to identify significant valve disease because intervention can restore quality of life and in many instances increase longevity. In most patients, the diagnosis of significant valvular heart disease can be made on the basis of a physical examination, yet nearly half of the patients who could benefit from interventions are not being recognized or referred. There have been major improvements in both the diagnosis and treatment of patients with valvular heart disease, with noninvasive echocardiography available to confirm the presence and severity of valve disease, better and more durable surgical procedures, and the advent of catheter-based therapies. There are now national guidelines to aid clinicians in the optimal timing of the intervention, which are presented. However, it is now recognized that the long-standing volume or pressure overload from valve disease can result in incipient ventricular dysfunction even before the onset of symptoms or a drop in ejection fraction; therefore, there is an impetus to recognize and to treat these patients earlier and earlier in the disease natural history. A shared decision-making process should play a key role in the final decision for therapy, outlining the goals and risks of possible intervention coupled with the patient's own needs and expectations.

To compare the overall survival and the risk of all-cause and heart failure-specific hospitalization in nonagenarian patients hospitalized for symptomatic severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) or conservative treatment.

Population-based retrospective cohort study based on healthcare utilization databases of the Italian region of Lombardy. The cohort included all nonagenarians hospitalized for AS between 2017 and 2021, who underwent TAVI within 90 days from first diagnosis or conservative treatment. The association between TAVI and clinical outcomes was assessed through Cox or Fine&Grey regression models. High-dimensional propensity score matching was used to reduce the heterogeneity between groups.

Overall, 16,848 nonagenarians hospitalized for AS were identified. Among these, 320 patients underwent TAVI, of which 193 were matched to as many control patients. The 2-year survival rates were 76.0 % and 37.7 %, respectively, in TAVI and control patients, corresponding to an HR of 0.24 (95 % CI 0.15-0.37). The 2-year cumulative incidence of rehospitalization for heart failure was 11.1 % and 26.5 %, respectively, corresponding to an HR of 0.64 (95 % CI 0.40-0.99).

This study further supports the usefulness of TAVI in nonagenarians, as it showed to improve their survival rate, reduce their risk of rehospitalization, and likely increase their quality of life.

Sustained myocardial hypertrophy or left ventricular hypertrophy (LVH) triggered by pressure overload is strongly linked to adverse cardiovascular outcomes. Here, we investigated the clinical relationship between serum HSP90α (an isoform of HSP90) levels and LVH in patients with hypertension or aortic stenosis (AS) and explored underlying mechanisms in pressure overload mouse model. We built a pressure overload mouse model via transverse aortic constriction (TAC). Compared to controls, elevated serum HSP90α levels were observed in patients with hypertension or AS, and the levels positively correlated with LVH. Similarly, HSP90α levels increased in heart tissues from patients with obstructive hypertrophic cardiomyopathy (HCM), and in mice post-TAC. TAC induced the enhanced cardiac expression and secretion of HSP90α from cardiomyocytes and cardiac fibroblasts. Knockdown of HSP90α or blockade of extracellular HSP90α (eHSP90α) attenuated cardiac hypertrophy and dysfunction by inhibition of β-catenin/TCF7 signaling under pressure overload. Further analysis revealed that eHSP90α interacted with EC1-EC2 region of N-cadherin to activate β-catenin, enhancing the transcription of hypertrophic genes by TCF7, resulting in cardiac hypertrophy and dysfunction under pressure overload. These insights suggest the therapeutic potential of targeting HSP90α-initiated signaling pathway against cardiac hypertrophy and heart failure under pressure overload.

Limited data are available for evaluating the effect of blood glucose on transcatheter aortic valve replacement (TAVR) outcomes in patients with diabetes. We aimed to assess the impact of glucose levels on short-term and long-term adverse outcomes in patients undergoing TAVR.

Data from severe aortic stenosis (AS) patients who underwent TAVR from 2010 to 2022 were collected retrospectively. In total, 615 patients were enrolled in the study: Among the total patient population, 43% had diabetes mellitus (DM), with a mean hemoglobin A1c (HbA1c) level of 7.4 ± 2.5. Within this cohort, 33% were classified as having uncontrolled diabetes, while 17% were considered well-controlled. Diabetic patients were younger (80.7 ± 6.8 vs. 82.0 ± 6.8 years, p = 0.001) and had more cardiovascular risk factors. No significant differences were found in outcomes between the two groups during the twelve-year follow-up. A multivariable logistic regression analysis was conducted on 270 DM patients to examine the impact of blood glucose levels and HbA1c on outcomes such as arrhythmia, stroke, and acute kidney injury (AKI). For arrhythmia, the odds ratio for HbA1c and blood glucose were 1.1039 (p = 0.23), and 0.998 (p = 0.76), indicating no significant associations. In stroke cases, HbA1c had an odds ratio of 1.194 (p = 0.36), while an odds ratio of 1.020 (p = 0.013) for blood glucose indicated a significant association. Notably, for AKI, the odds ratio for HbA1c was 2.304 (p = 0.02), indicating a significant link between higher HbA1c levels and increased AKI risk, with blood glucose levels trending toward significance (odds ratio = 1.0137, p = 0.061).

Diabetic status is a predictor of short-term outcomes following TAVR. Thus, these screening parameters should be included in risk assessment tools for TAVR candidates.

Transcatheter aortic valve implantation (TAVI) has significantly improved in treating aortic valve disease in recent years, particularly in patients at high surgical risk. This case report describes an 80-year-old woman who had severe aortic stenosis previously treated with surgical aortic valve replacement (SAVR) and six years later had a valve-in-valve (ViV) TAVI who developed severe symptomatic restenosis of the bioprosthetic aortic valve five years later of the last procedure. A third valve-in-valve-in-valve (ViViV) TAVI using a 26-mm Sapien 3 valve was performed due to the high surgical risk. The procedure resulted in significant hemodynamic improvement, reducing the transvalvular gradient from 80-90 mmHg to 15-20 mmHg and increasing the effective orifice area from 0.4 cm² to 1.5 cm². The patient's symptoms improved to NYHA Class I. This case highlights the feasibility and safety of ViViV TAVI as a minimally invasive solution for recurrent bioprosthetic valve dysfunction in high-risk patients.

Adverse outcomes from moderate aortic stenosis (AS) may be caused by progression to severe AS or by the effects of comorbidities. In the absence of randomized trial evidence favoring aortic valve replacement (AVR) in patients with moderate AS, phenotyping patients according to risk may assist decision making.

This study sought to identify and validate clusters of moderate AS that may be used to guide patient management.

Unsupervised clustering algorithms were applied to demographics, comorbidities, and echocardiographic parameters in a training data set in patients with moderate AS (n = 2,469). External validation was obtained by assigning the defined clusters to an independent group with moderate AS (n = 1,358). The primary outcome, a composite of cardiac death, heart failure hospitalization, or aortic valve (AV) intervention after 5 years, was assessed between clusters in both data sets.

Four distinct clusters-cardiovascular (CV)-comorbid, low-flow, calcified AV, and low-risk-with significant outcomes (log-rank P < 0.0001 in both data sets) were identified and replicated. The highest risk was in the CV-comorbid cluster (validation HR: 2.00 [95% CI: 1.54-2.59]; P < 0.001). The effect of AVR on cardiac death differed among the clusters. There was a significantly lower rate of outcomes after AVR in the calcified AV cluster (validation HR: 0.21 [95% CI: 0.08-0.57]; P = 0.002), but no significant effect on outcomes in the other 3 clusters. These analyses were limited by the low rate of AVR.

Moderate AS has several phenotypes, and multiple comorbidities are the key drivers of adverse outcomes in patients with moderate AS. Outcomes of patients with noncalcified moderate AS were not altered by AVR in these groups. Careful attention to subgroups of moderate AS may be important to define treatable risk.

Stroke is a feared complication after TAVI. The objective was to assess whether left atrial appendage (LAA) filling-defect (FD) patterns from early and late-phase computed tomography (CT), predict stroke/TIA in patients with severe aortic stenosis.

124 patients with severe aortic stenosis (79.5y, 46.8% females) who underwent CT-Angiography for TAVI-planning were included (66.1% underwent TAVI, 18.6% surgical, 15.3% conservative treatment).CT-image-analysis included: CT-density (HU) from LAA tip-to-base and HU-gradients (I-III), the HU-ratio LAA/aorta, left-atrial-wall-thickness (LAWT) and the periatrial fat attenuation index (FAI).

Stroke/TIA rate was 9.6 %. LAA-HU-gradient was slightly higher in non-stroke patients (p = 0.087). Persisting FDs during the late-phase were associated with stroke (p = 0.047) but not early-phase FDs. Early-phase FDs with HU < 245 (n = 15) were correlated with stroke (p = 0.05). A LAA-HU-gradient > 10HU had 91 % sensitivity and 68 % specificity for prediction of stroke. LAA-HU gradient I had a moderate accuracy (c = 0.592; 95 %CI:0.472-0.711; p = 0.317) for discrimination of stroke during the early phase, which enhanced during the late phase (c = 0.686;95 %CI:0.503-0.868; p = 0.046). Patients with stroke had a higher rate of FDs with HU-progression from early to late phase (>10HU)(p = 0.013), while the ratios LAA/aorta, LAWT, and periatrial-FAI were not different. Among clinical parameters, only age predicted stroke but not CHA2DS2-VASc-score. In multivariate analysis, late-phase FDs (p = 0.059)(OR 5.66: 95 %CI:0.936-34.28) but not early-phase FD were associated with stroke, and none of the major conventional risk factors.

Persisting LAA-filling defects on CT during the late-phase, and early-phase FD with <245HU predict stroke, and a CT-density progression >10HU from early-to-late phase. LAA-FD may improve stroke risk stratification.

Mitral valve repair (MVr) is the gold standard treatment for degenerative mitral regurgitation, yet there is ongoing controversy regarding optimal anti-thrombotic therapy post-MVr. This scoping review aimed to summarise current evidence on the safety and efficacy of anti-thrombotic therapy after MVr, identify knowledge gaps and propose a future study design.

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, the WHO International Clinical Trials Registry Platform and bibliographies of included trials, guidelines and other reviews from inception to 17 September 2024. Randomised controlled trials (RCT) and cohort and case-control studies assessing any anti-thrombotic therapy with any outcomes after MVr were included. Using a predefined collection form, two authors independently extracted data on study characteristics and results were summarised narratively into themes based on the PICO elements.

Of 1296 screened references, we included 11 studies (10 cohort and one non-inferiority RCT). All studies compared vitamin K antagonist (VKA) to an anti-platelet, direct oral anti-coagulant or no anti-thrombotic therapy for median duration of 90 days. Thromboembolic and bleeding event incidences ranged from 0% to 14.3% and 0% to 9.1%, respectively. Seven studies reported no difference in thromboembolic events, and three reported reduced rates with VKA compared with control, while results for bleeding events varied widely. The RCT found edoxaban was non-inferior to warfarin for thromboembolic outcomes, but not for bleeding. Substantial methodological and clinical heterogeneity, high risk of bias and insufficient mitigation of confounders, such as concomitant atrial fibrillation, were prevalent across studies.

Based on this scoping review, existing literature on anti-thrombotic therapy after MVr is inconclusive due to design limitations. We proposed a study design for a pragmatic RCT that addresses prior study limitations and that could provide definitive evidence to guide anti-thrombotic management in MVr patients.

Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We analyzed the National Inpatient Sample data from 2018 to 2022. The International Classification of Diseases-Tenth Revision (ICD-10) codes were used to define the patient cohorts. Propensity score weighting was used to balance patient demographic, hospital-level, and comorbidity data. Results: From 2018 to 2022, there were 383,860 TAVI admissions, among which 1915 (0.50%) had the presence of RHF. Compared to patients without RHF, mortality was higher in patients with RHF (7.57% vs. 1.11%, p < 0.01). Similarly, acute kidney injury (37.10% vs. 8.56%, p < 0.01), respiratory failure (12.79% vs. 1.91%, p < 0.01), and use of mechanical circulatory support (11.48% vs. 0.83%, p < 0.01) was higher in the cohort with RHF. Median length of stay (7 days vs. 2 days, p < 0.01) and hospitalization charges ($257,239 vs. $180,501, p < 0.01) were higher in patients with RHF. Conclusions: In conclusion, we report that RHF is associated with increased mortality risk, complications, and resource utilization in patients undergoing TAVI. Right ventricular function should be a part of the evaluation for TAVI, given significantly elevated risks associated with its presence.

Exercise testing remains underused in patients with aortic stenosis (AS), partly due to concerns about an exercise-induced drop in systolic blood pressure (SBP). We aimed to study the SBP response to exercise in patients with severe symptomatic AS prior to surgery and 1 year postoperatively.

Patients scheduled for aortic valve replacement due to severe symptomatic AS were enrolled at a single centre in a prospective observational cohort study. Maximal cardiopulmonary exercise testing (CPET) was performed on a cycle ergometer at baseline and 1 year postoperatively, using standard termination criteria. The SBP response was categorised according to the last measurements of SBP during exercise, in relation to workload (the SBP/watt-slope) as 'normal' (>0.25 mm Hg/watt), 'flat' (0-0.25 mm Hg/watt) or 'drop' (<0 mm Hg/watt).

45 patients (28 male, 66±9 years, left ventricular ejection fraction 59%±5%, aortic jet velocity 4.6±0.5 m/s) were included, with pairwise comparison available in 31 cases. There were no adverse events. Preoperatively, 4/45 patients were categorised as 'drop', 23 as 'flat' and 18 as 'normal'. There was a change in the distribution of categories from preoperative to postoperative measurements (43% 'normal' vs 74% 'normal', p=0.0046). Maximal SBP and workload-indexed SBP were higher postoperatively than preoperatively (203±26 vs 182±28 mm Hg, p<0.001 and 0.43±0.14 vs 0.29±0.15 mm Hg/watt, p<0.001).

As a drop in SBP was infrequent (<10%) in patients with severe symptomatic AS and no adverse events occurred, our results indicate that CPET may be performed under careful monitoring in AS patients. Postoperatively, the SBP reaction improved, with no patient having a drop in SBP.

NCT02790008.

Background/Objectives: Diffuse myocardial fibrosis and altered deformation are relevant prognostic factors in aortic stenosis (AS) patients. The aim of this exploratory study was to investigate the relationship between myocardial strain, and myocardial extracellular volume (ECV) in patients with severe AS with a photon-counting detector (PCD)-CT. Methods: We retrospectively included 77 patients with severe AS undergoing PCD-CT imaging for transcatheter aortic valve replacement (TAVR) planning between January 2022 and May 2024 with a protocol including a non-contrast cardiac scan, an ECG-gated helical coronary CT angiography (CCTA), and a cardiac late enhancement scan. Myocardial strain was assessed with feature tracking from CCTA and ECV was calculated from spectral cardiac late enhancement scans. Results: Patients with cardiac amyloidosis (n = 4) exhibited significantly higher median mid-myocardial ECV (48.2% versus 25.5%, p = 0.048) but no significant differences in strain values (p > 0.05). Patients with prior myocardial infarction (n = 6) had reduced median global longitudinal strain values (-9.1% versus -21.7%, p < 0.001) but no significant differences in global mid-myocardial ECV (p > 0.05). Significant correlations were identified between the global longitudinal, circumferential, and radial strains and the CT-derived left ventricular ejection fraction (EF) (all, p < 0.001). Patients with low-flow, low-gradient AS and reduced EF exhibited lower median global longitudinal strain values compared with those with high-gradient AS (-15.2% versus -25.8%, p < 0.001). In these patients, the baso-apical mid-myocardial ECV gradient correlated with GLS values (R = 0.28, p = 0.02). Conclusions: In patients undergoing PCD-CT for TAVR planning, ECV and GLS may enable us to detect patients with cardiac amyloidosis and reduced myocardial contractility.

The aim of this study is to identify factors associated with the development of long-term severe tricuspid regurgitation (TR) following mitral valve replacement (MVR).

A retrospective analysis was conducted involving 308 patients who underwent single-valve MVR at Xuzhou Central Hospital between April 2017 and December 2022. Preoperative color Doppler ultrasound indicated that all patients had either no or mild to moderate tricuspid regurgitation. Postoperative follow-up was carried out over several years, and patients were categorized into two groups based on the severity of TR: 258 patients with non-severe TR (observation group) and 50 patients with severe TR (control group). Clinical data, medical history, the performance of tricuspid valvuloplasty during surgery, and echocardiographic parameters before and after the procedure were recorded. Comparative analysis between the two groups was performed, and logistic regression analysis was used to identify factors associated with the long-term development of severe TR post-MVR.

Logistic regression analysis indicated that serum creatinine levels (OR = 1.023, P = 0.026), atrial fibrillation (OR = 2.780, P = 0.040), and a history of permanent pacemaker implantation (OR = 3.029, P = 0.039) were significantly associated with the development of severe TR over time. In contrast, concurrent intraoperative tricuspid valvuloplasty was associated with a reduced risk of TR (OR = 0.315, P = 0.002).

Elevated serum creatinine, atrial fibrillation, and a history of permanent pacemaker implantation were positively associated with the long-term occurrence of severe TR following MVR. In contrast, concurrent intraoperative tricuspid valvuloplasty was found to reduce the likelihood of severe TR development.

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a pivotal intervention for managing severe aortic stenosis in high-risk surgical patients. Objective: This study aimed to evaluate the impacts of procedural factors and patient characteristics on TAVI outcomes, with a focus on survival rates, cardiac mortality, and associated complications. Methods: A retrospective, single-center study involving 224 patients who underwent TAVI at the Lithuanian University of Health Sciences from September 2021 to April 2023 was conducted. Data encompassing demographic characteristics, medical history, procedural specifics, and follow-up outcomes were analyzed. Survival and adverse events were assessed at 30 days, 6 months, and 12 months post-TAVI. Results: The study included 224 patients. The mean age in the non-death group was 80 ± 6.17 years (range, 49-91), while that in the cardiac death group was 81.5 ± 6.14 years (range, 70-94; p = 0.079). Males accounted for 37.7% of the non-death group and 50% of the cardiac death group (p = 0.304). Statistical analyses identified factors significantly associated with mortality and complications. The overall survival rate was 88.8%, with cardiac-related mortality observed in 8% of patients. Increased fluoroscopy time (p < 0.001), a higher contrast volume (p = 0.005), and less improvement in aortic valve velocity post-TAVI (p = 0.031) were significantly associated with cardiac mortality. Advanced age and a reduced left ventricular ejection fraction (<50%) were prominent predictors of adverse outcomes. Patients with non-coronary cusp calcification exhibited lower cardiac mortality (p = 0.005), while mitral valve regurgitation was linked to poorer outcomes (p = 0.015). Logistic regression analysis underscored the incremental risks posed by procedural complexities and comorbidities. Conclusions: Procedural factors such as fluoroscopy duration and contrast volume, along with patient-specific attributes including age, left ventricular function, and valve calcification patterns, critically influence TAVI outcomes. These findings emphasize the need for tailored procedural strategies and patient management protocols to mitigate risks and enhance the efficacy of TAVI interventions.

This study aimed to determine whether artificial intelligence (AI)-based automated assessment of left atrioventricular coupling index (LACI) can provide incremental value above other traditional risk factors for predicting mortality among patients with severe aortic stenosis (AS) undergoing coronary CT angiography (CCTA) before transcatheter aortic valve replacement (TAVR).

This retrospective study evaluated patients with severe AS who underwent CCTA examination before TAVR between September 2014 and December 2020. An AI-prototype software fully automatically calculated left atrial and left ventricular end-diastolic volumes and LACI was defined by the ratio between them. Uni- and multivariate Cox proportional hazard methods were used to identify the predictors of mortality in models adjusting for relevant significant parameters and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score.

A total of 656 patients (77 years [IQR, 71-84 years]; 387 [59.0 ​%] male) were included in the final cohort. The all-cause mortality rate was 21.6 ​% over a median follow-up time of 24 (10-40) months. When adjusting for clinical confounders, LACI ≥43.7 ​% independently predicted mortality (adjusted HR, 1.52, [95 ​% CI: 1.03, 2.22]; p ​= ​0.032). After adjusting for the STS-PROM score in a separate model, LACI ≥43.7 ​% remained an independent prognostic parameter (adjusted HR, 1.47, [95 ​% CI: 1.03-2.08]; p ​= ​0.031). In a sub-analysis of patients with preserved left ventricular ejection fraction, LACI remained a significant predictor (adjusted HR, 1.72 [95 ​% CI: 1.02, 2.89]; p ​= ​0.042).

AI-based fully automated assessment of LACI can be used independently to predict mortality in patients undergoing TAVR, including those with preserved LVEF.