ABSTRACTBackgroundAsymmetric underexpansion of transcatheter heart valves (THVs), as observed on fluoroscopy, may influence prosthesis function or long‐term durability of transcatheter aortic valve implantation (TAVI).AimsThis study aimed to evaluate the effect of stent frame asymmetry on hemodynamic performance and clinical outcomes in ACURATE neo and neo2 THVs.MethodsIn a retrospective registry, the TAVI asymmetry index was defined as the ratio of the THV stent frame diameter. Patients were divided into three groups based on this ratio: a tubular shape, TAVI asymmetry index < 10% (group 1); a tapered shape, a bottom diameter at least 10% greater than the upper diameter (group 2); and a flared shape, an upper diameter at least 10% greater than the bottom diameter (group 3). Impaired THV hemodynamic performance was defined as a mean residual THV gradient ≥ 20 mmHg and/or at least moderate paravalvular regurgitation.ResultsFrom December 2015 to 2023, 585 patients were included (group 1, n = 447; group 2, n = 96; and group 3, n = 47). Compared to group 1, groups 2 and 3 exhibited a higher incidence of impaired THV hemodynamic performance (4.9% vs. 17.5% vs. 11.9%; p < 0.001). There was no significant difference in all‐cause mortality or heart failure hospitalization at 3 years among the three groups (p = 0.787). In multivariable analysis, stent frame asymmetry (groups 2 and 3) was an independent predictor of impaired THV hemodynamic performance.ConclusionsStent frame asymmetry of ACURATE neo and neo2 was associated with impaired THV hemodynamic performance but not with clinical outcomes.

ABSTRACTBackgroundInvasive coronary physiology including fractional flow reserve (FFR), instantaneous wave‐free ratio (iFR), and coronary flow reserve (CFR) are guideline‐endorsed tools to guide the management of coronary artery disease (CAD). Complex factors impact and confound these assessments, and discordance between modalities complicates clinical management. iEquate is a prospective observational trial that combines multi‐modality coronary physiology and optical coherence tomography (OCT) to identify the determinants of pressure‐wire derived myocardial ischemia and iFR‐FFR discordance.MethodsAll patients referred for invasive angiography who met the pre‐selection criteria were screened for inclusion and exclusion criteria. Patients underwent physiological assessment using iFR and FFR, and CFR was performed as indicated. OCT was performed on all suitable lesions. Data were collected on baseline demographics, angiographic results, OCT findings, coronary physiology, and procedural details. Multivariate analysis was performed.ResultsA total of 124 vessels were analyzed from 107 patients. The mean age was 67.6 ( ± 10.8) years, and 23 patients (21.5%) were female. Eighty (74.8%) presented with stable angina, and the most common vessel assessed was the left anterior descending artery (n = 84, 67.7% of patients). The incidence of iFR‐FFR discordance was 20.7%, with 48% of these iFR+FFR−. Calcific plaque was associated with discordance (OR 6.15 [95% CI [1.05−36.13]; p = 0.04), largely with a iFR+FFR− pattern (OR 7.62 [95% CI 0.38−152.15]; p = 0.184). Other morphological features were not predictive of FFR, iFR, or CFR findings. Mean CFR was significantly lower in the iFR+FFR− subgroup compared to FFR+iFR− (mean difference 1.4; p < 0.01).ConclusionsiFR‐FFR discordance is common, and impaired vasodilatory capacity (assessed using CFR) may account for some of these cases. In this study, calcific plaque was associated with discordance, while other OCT‐derived plaque morphological characteristics were not associated with invasive coronary physiology findings. Cross‐sectional plaque eccentricity is associated with lower FFR values.

ABSTRACTIntroductionPatients with aortic aneurysms are at elevated risk of rupture, dissection and death during and after transcatheter aortic valve repair (TAVR), often requiring consideration for endovascular aneurysm repair (EVAR) at the time of TAVR. However, data comparing outcomes of simultaneous versus staged TAVR‐EVAR are limited.MethodsUsing the National Inpatient Sample between the years 2018 and 2021, we compared in‐hospital outcomes of simultaneous and staged TAVR‐EVAR. Patients who underwent both TAVR and EVAR during hospital admission were identified with International Classification of Diseases 10th Revision procedure codes. Patients were stratified by simultaneous (defined as same day) versus staged (defined as different day) procedures. Propensity score matching was done in a 2:1 fashion to account for differences in baseline characteristics, and mixed effects multivariate regression models were used to assess differences in in‐hospital mortality, cost of hospitalization, length of stay, and other procedural complications.ResultsA total of 270 patients underwent simultaneous TAVR‐EVAR, while a total of 70 underwent staged TAVR‐EVAR. After propensity score matching, 98 patients undergoing simultaneous TAVR‐EVAR were matched to 49 patients undergoing staged TAVR‐EVAR. No significant differences in baseline characteristics were observed after matching. In‐hospital mortality between the matched groups was not significantly different (OR 0.67, p = 0.409), however the simultaneous group was associated with shorter length of stay (3 [2.0−11.75] days vs. 14 [13.0−17.0] days, p < 0.001) and less total hospital costs ($77,691 [$65,153−$103,854] vs. $148,617 [$128,339−$217,988]; p < 0.001). The matched simultaneous group was also associated with lower incidence of acute kidney injury (25.5% vs. 65.3%; OR 0.11, p < 0.001), blood transfusions (20.4% vs. 40.8%; OR 0.37, p = 0.01), and access site complications (< 10.2% vs. 49.0%; OR 0.00, p < 0.001).ConclusionSimultaneous TAVR‐EVAR is associated with fewer adverse complications and lower cost of hospitalization without increased in‐hospital mortality, suggesting it is more cost effective than staged TAVR‐EVAR during the same hospital admission.

ABSTRACTBackgroundWe report the first in‐literature animal experiment to validate the intracoronary ECG signal acquired from a coronary wire compared with the direct signal from an epicardial electrode.MethodsAn animal model study was performed in a 40 kg pig. Acute myocardial ischemia was induced by intracoronary balloon inflation for 60 s. Simultaneous ECG recording and PCI guidewire electrical and motion measurements were obtained.ResultsThe first ischemic manifestation was myocardial kinetic disturbances, followed by ST‐elevation. The signals recorded from the PCI guidewire and the epicardial electrode ran simultaneously, from the induction of ischemia to complete recovery of signal.ConclusionThe intracoronary ECG signal acquired from a coronary wire was equivalent to the direct signal received from an epicardial electrode.Trial Registration:ClinicalTrials.gov identifier: NCT04061525.

ABSTRACTTranscatheter aortic valve replacement (TAVR) is a commonly performed procedure for the treatment of severe aortic stenosis. While it is generally considered a low‐risk procedure, one of the rare potentially life‐threatening complications includes aortic dissection. We report the case of a 75‐year‐old immunocompromised female who presented 2 weeks post‐TAVR with persistent and worsening dyspnea, intermittent chest pain, and hypoxia. The patient's symptoms and risk factors increased the suspicion for pulmonary embolism, and initial imaging was supportive of the diagnosis. Management with therapeutic anticoagulation did not resolve the symptoms, and the patient developed acute‐onset anemia. Further investigation revealed an aneurysmal dilation and dissection of the ascending thoracic aorta with pseudoaneurysm causing near‐complete obstruction of the right pulmonary artery. This case highlights the diagnostic challenges of a rare and delayed post‐TAVR complication and describes a unique presentation of aortic dissection. Post‐operative complications should be considered in diagnosis even weeks after the procedure.

ABSTRACTTranscatheter aortic valve replacement (TAVR) is widely used to treat severe aortic stenosis; however, periprocedural stroke remains a significant concern. This systematic review and meta‐analysis evaluate whether the use of cerebral embolic protection devices (CEPDs) during TAVR reduces the risk of stroke and other complications. To conduct a network meta‐analysis of relevant trials to assess the efficacy of CEPDs currently used in TAVR. PubMed, Embase, and Scopus were systematically searched through April 2025 to identify studies comparing TAVR performed with and without CEPDs. Primary outcomes included stroke, all‐cause mortality, major bleeding, and major vascular complications. Data were analyzed using RevMan (Version 5.4.1). A random‐effects model was used for all analyses, applying the Mantel−Haenszel method for dichotomous outcomes, reported as risk ratios with 95% confidence intervals. Funnel plots were used to assess publication bias. Twenty‐four studies (9 randomized controlled trials and 15 observational studies), including a total of 437,487 patients (59,274 with CEPD and 384,213 without), were included in the analysis. The mean patient age was 80 years, and 46.4% were female. Compared to patients undergoing TAVR without protection, those receiving CEPDs had significantly lower risks of stroke (RR = 0.70; 95% CI: 0.60–0.82; p < 0.0001), all‐cause mortality (RR = 0.69; 95% CI: 0.50–0.93; p = 0.02), disabling stroke (RR = 0.44; 95% CI: 0.26–0.75; p = 0.003), acute kidney injury (RR = 0.84; 95% CI: 0.79–0.89; p < 0.00001), and 30‐day readmission (RR = 0.75; 95% CI: 0.60–0.95; p = 0.02). A reduction in major bleeding was also observed (RR = 0.83; 95% CI: 0.59–1.17), although this did not reach statistical significance (p = 0.29). No significant differences were found between groups in terms of major vascular complications, transient ischemic attack (TIA), new pacemaker implantation, or delirium. The use of CEPDs during TAVR is associated with reduced risks of stroke, disabling stroke, acute kidney injury, and 30‐day readmission. However, discrepancies between randomized and observational studies warrant cautious interpretation. Further research is needed to clarify the benefits and evaluate the cost‐effectiveness of CEPD implementation in routine clinical practice.

ABSTRACTWe present a 74‐year‐old female with a history of mechanical aortic and mitral valve implantation and non‐Hodgkin lymphoma. She presented with right sided heart failure due to severe functional tricuspid regurgitation and was treated with transcatheter TricValve bicaval system implantation. However, this was complicated by a paravalvular leak of the inferior vena cava prosthesis. Treatment of the paravalvular leakage was successful with implantation of four Amplatzer Vascular Plugs II.

ABSTRACTBackgroundCoronary artery ectasia (CAE) influences procedural outcomes in the context of ST‐elevation myocardial infarction (STEMI); however, its relationship with atherosclerotic coronary artery disease (ACAD) remains unclear.AimsThis study aimed to compare clinical and procedural characteristics, as well as outcomes, in patients with STEMI and CAE, with or without coexisting ACAD.MethodsOverall, 148 patients with STEMI and ectatic infarct‐related artery who underwent primary percutaneous intervention were included from 2003 to 2021. These patients were stratified based on the presence of atherosclerotic disease into two groups: patients with STEMI and isolated CAE (n = 74) and those with CAE and coexisting ACAD (n = 74).ResultsCompared with patients in the isolated CAE group, those in the CAE and coexisting ACAD groups were older (65 vs. 58.4 year, p = 0.002), with no significant differences in cardiovascular risk factors or initial clinical presentation. Coronary angioplasty was performed more frequently in the CAE with coexisting ACAD group (90.5% vs. 63.7%, p < 0.001), with a higher stenting rate (73.0% vs. 48.6%, p = 0.004) and a trend toward less frequent distal embolization (35.3% vs. 52.9%, p = 0.057). No significant differences were observed between the two groups in troponin or CPK levels, nor in left ventricular ejection fraction at hospital discharge (48 ± 10% vs. 49 ± 10%, p = 0.569). At the 3‐year follow‐up, the overall MACE‐free rate was 85.1%, with no significant difference between the groups (83.8% vs. 78.4%, p = 0.487).ConclusionPatients with STEMI and ectatic related infarct‐related artery who underwent primary PCI demonstrated distinct periprocedural characteristics depending on the presence or absence of coronary atherosclerosis. Further research is needed to determine optimal therapeutic management at discharge.