Transcatheter Valve Research Articles

Modeling of valve-in-valve transcatheter aortic valve implantation after aortic root replacement using a 3-dimensional artificial intelligence algorithm

ObjectiveAortic root replacement requires construction of a composite valve-graft and reimplantation of coronary arteries. This study assessed the feasibility of valve-in-valve transcatheter aortic valve implantation after aortic root replacement. MethodsA retrospective review was conducted on 74 consecutive patients who received a composite valve-graft at a single institution from 2019 to 2021. Forty patients had bioprosthetic valves with adequate postoperative gated computed tomographic angiography scans. Computational simulations of balloon and self-expanding transcatheter valve deployments were performed. The modeled coronary distances were compared with traditional, manually measured valve-to-coronary distances. ResultsThere was a statistically significant difference in the modeled versus manual measurements of valve to coronary distances for all patients regardless of valve type or coronary artery analyzed (P < .05). Most patients are low risk for coronary obstruction per 3-dimensional modeling, including those with a valve-to-coronary distance <4 mm. Only 1 patient (2.5%) was at risk for coronary obstruction for the left coronary artery using a balloon valve. No other valve combination was considered high risk of coronary obstruction. Five patients (12.5%) were at risk for possible valve stent deformation at the outflow, due to angulation at the graft anastomosis. ConclusionsFollowing aortic root replacement, all patients were candidates for valve-in-valve procedure using 1 or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines and balloon-expandable valves may be at higher risk of coronary obstruction.

TAVI transcarotídeo: la técnica paso a paso

Introduction and objectivesTranscatheter aortic valve implantation as a treatment for aortic stenosis is positioned as the therapy of choice for a specific population of patients, which is steadily increasing and is no longer limited to patients with prohibitively high surgical risk. This stems from the advancement and refinement of devices, as well as the development of different access routes. Our goal is to share and standardize the transcarotid access technique, which we have implemented and developed since 2019 with very good results. Method and resultsBetween 01/01/2019 and 31/12/2023, 79 transcatheter valves were implanted via the carotid route (21.43% of the total implants in our center), with no intraoperative mortality and less than 1% mortality during the first month of intervention. The incidence of established strokes in these patients is 0%. ConclusionsWe have adopted the transcarotid route as an equally valid alternative to the transaxillary access. Due to recent changes in patient selection criteria, we believe that the cardiovascular surgeon should have an active role in decision-making and implantation of this type of prosthesis, since many patients have low surgical risk and are consequently susceptible to intervention in case of procedure complications.

Performance of Transcatheter Direct Annuloplasty in Patients With Atrial and Nonatrial Functional Tricuspid Regurgitation

BackgroundA novel echocardiography-based definition of atrial functional tricuspid regurgitation (A-FTR) has shown superior outcomes in patients undergoing conservative treatment or tricuspid valve transcatheter edge-to-edge repair. Its prognostic significance for transcatheter tricuspid valve annuloplasty (TTVA) outcomes is unknown. ObjectivesThis study sought to investigate prognostic, clinical, and technical implications of A-FTR phenotype in patients undergoing TTVA. MethodsThis multicenter study investigated clinical and echocardiographic outcomes up to 1 year in 165 consecutive patients who underwent TTVA for A-FTR (characterized by the absence of tricuspid valve tenting, midventricular right ventricular [RV] dilatation, and impaired left ventricular ejection fraction) and nonatrial functional tricuspid regurgitation (NA-FTR). ResultsA total of 62 A-FTR and 103 NA-FTR patients were identified, with the latter exhibiting more pronounced RV remodeling. Compared to baseline, the tricuspid regurgitation (TR) grade at discharge was significantly reduced (P < 0.001 for both subtypes), and TR ≤II was achieved more frequently in A-FTR (85.2% vs 60.8%; P = 0.001). Baseline TR grade and A-FTR phenotype were independently associated with TR ≤II at discharge and 30 days. In multivariate analyses, A-FTR phenotype was a strong predictor (OR: 5.8; 95% CI: 2.1-16.1; P < 0.001) of TR ≤II at 30 days. At 1 year, functional class had significantly improved compared to baseline (both P < 0.001). One-year mortality was lower in A-FTR (6.5% vs 23.8%; P = 0.011) without significant differences in heart failure hospitalizations (13.3% vs 22.7%; P = 0.188). ConclusionsDirect TTVA effectively reduces TR in both A-FTR, which is a strong and independent predictor of achieving TR ≤II, and NA-FTR. Even though NA-FTR showed more RV remodeling at baseline, both phenotypes experienced similar symptomatic improvement, emphasizing the benefit of TTVA even in advanced disease stages. Additionally, phenotyping was of prognostic relevance in patients undergoing TTVA.

Overview of 2024 FDA Advisory Panel Meeting on the TriClip transcatheter tricuspid valve repair system

Tricuspid regurgitation (TR) is common and associated with significant mortality and morbidity. Because the effectiveness and safety of medical and surgical treatments are limited, there is a significant unmet need for the treatment of this disease. Therefore, there is a growing market for percutaneous devices that offer safer, less invasive, and more effective treatment options in this patient population. On February 13, 2024, the US Food and Drug Administration (FDA) convened a meeting of the Circulatory System Devices Panel to discuss the safety and effectiveness of the TriClip Transcatheter Valve Repair System (Abbott, Santa Clara, CA, USA). Several important points were discussed, including newly published data from the TRILUMINATE Pivotal study, the use of patient-oriented outcomes for device approval, and a discussion about training requirements and rollout plans when approving a breakthrough device. In this manuscript, we summarize the data presented by the sponsor and FDA and describe the deliberations and discussions during the meeting.

Unfolding Mystery of Aortic Transcatheter Valve Doppler Gradient and Clinical Outcomes.

Unfolding Mystery of Aortic Transcatheter Valve Doppler Gradient and Clinical Outcomes.

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Epicardial fat volume is associated with primary coronary slow-flow phenomenon in patients with severe aortic stenosis undergoing transcatheter valve implantation

BackgroundPrimary coronary slow flow (CSF) is defined as delayed opacification of the distal epicardial vasculature during coronary angiography in the absence of relevant coronary artery stenoses. Microvascular disease is thought to be the underlying cause of this pathology. Epicardial fat tissue (EFT) is an active endocrine organ directly surrounding the coronary arteries that provides pro-inflammatory factors to the adjacent tissue by paracrine and vasocrine mechanisms. The aim of the present study was to investigate a potential association between EFT and primary CSF and whether EFT can predict the presence of primary CSF.MethodsBetween 2016 and 2017, n = 88 patients with high-grade aortic stenosis who were planned for transcatheter aortic valve implantation (TAVI) were included in this retrospective study. EFT volume was measured by pre-TAVI computed tomography (CT) using dedicated software. The presence of primary CSF was defined based on the TIMI frame count from the pre-TAVI coronary angiograms.ResultsThirty-nine of 88 TAVI patients had CSF (44.3%). EFT volume was markedly higher in patients with CSF (142 ml [IQR 107–180] vs. 113 ml [IQR 89–147]; p = 0.009) and was strongly associated with the presence of CSF (OR 1.012 [95%CI 1.002–1.021]; p = 0.014). After adjustment, EFT volume was still an independent predictor of CSF (OR 1.016 [95%CI 1.004–1.026]; p = 0.009).ConclusionPrimary CSF was independently associated with increased EFT volume. Further studies are needed to validate this finding and elucidate whether a causal relationship exists.

ROLE OF THE MACHINE LEARNING–DERIVED HYPOTENSION INDEX (HPI) TO CONTAIN INTRAOPERATIVE HYPOTENSION DURING TRANSCATHETER EDGE TO EDGE REPAIR PROCEDURES

Abstract Introduction Percutaneous endovascular valvular interventions can result in profound hemodynamic instability, elevated burden of intraoperative hypotension (IOH) and related postoperative complications: ischemic stroke, acute kidney injury and increased mortality. Machine learning(ML),a branch of Artificial intelligence (AI), can analyze large volumes of data, find associations and allowing predictive rather than reactive interventions. The Hypotension Prediction Index (HPI)a ML derived algorithm,provides a unitless number from 0 to 100, that increases accordingly to the risk of developing a hypotensive event (mean arterial pressure – MAP – &amp;lt; 65 mmHg for more than 1 minute) in the following minutes. The aim of this study is to describe IOH in patients undergoing percutaneous valve repair under general anesthesia treated according to an HPI–based hemodynamic guidance (fig.1). Methods Eligible adult patients undergoing transcatheter valve repair procedures (MitraclipTM, TriclipTM)were included in the study. When HPI value exceeded 85,a proactive individualized treatment protocol to prevent hypotension was provided according to the following modalities (fig. 2). Primary outcome measure was TWA–MAP (time weighted average mean arterial pressure)under the threshold of 65 mmHg. Secondary outcomes were number of patients with at least one hypotensive event, number of events per patient,depth and duration of hypotensive events and area under MAP threshold of 65 mmHg (AUT–MAP &amp;lt; 65). Results Twenty–five consecutive patients were prospectively enrolled and treated. During an average monitoring time per patient of 187 ± 31 minutes, the global burden of hypotension, measured as TWA–MAP &amp;lt; 65 mmHg, was 0.12 [0.02, 0.8] mmHg. Two thirds of the patients(16/25) experienced hypotensive events, with a median number of hypotensive events of 1 [0, 3.25] per patient and about 11% of the time spent &amp;lt; 65 mmHg. Each event lasted 4 [1.7, 8.6] minutes with a MAP of 59 [56, 62] mmHg, leading to a total AUT–MAP &amp;lt; 65 mmHg of 20.3 [3.5, 142.2] mmHg x minutes. The majority of hypotensive events occurred after induction of general anesthesia, while hypotension was rare during the procedure (fig. 3). Conclusions HPI algorithm provides accurate and continuous prediction of impending IOH before its occurrence. Machine learning models,as in the case of HPI, could facilitate the physicians to treat IOH which is a potentially modifiable risk factor for major postoperative complications.

Acute Aortic Dissection After Transcatheter Aortic Valve Replacement

Acute aortic dissection (AAD) is a rare and potentially fatal complication associated with transcatheter aortic valve replacement (TAVR). Owing to the paucity of existing institutional data, we sought to assess the incidence of postimplant AAD in patients who underwent TAVR at a single institution. All patients who underwent TAVR from 2013 to 2022 were retrospectively reviewed to identify those who possessed clinical or radiologic evidence of AAD after TAVR. Follow-up and survival data were retrieved for all included patients. A total of 4,317 patients underwent TAVR, of whom 9 (0.2%) sustained an AAD. These patients had a mean age of 80 years (range 53 to 92), mean Society of Thoracic Surgeons 30-day mortality risk of 5.7% (2.4% to 16.7%), and mean effective aortic valve area of 0.8 cm2 (0.4 to 1.5 cm2). Preoperative maximum aortic diameter was 3.9 cm (2.6 to 4 cm). Of these 9 patients, 6 (67%) showed evidence of Stanford type A dissection, whereas 3 (33%) were diagnosed with Stanford type B dissection. The most common causes of dissection were posterior annular rupture by the transcatheter valve (THV) (44%) and THV embolization or "pop-out" into the ascending aorta (22%). A total of 6 patients (66.7%), comprising 5 type A (55.6%) and 1 type B (11.1%) aortic dissections, died within 30 days of AAD. The median time to follow-up in those surviving TAVR with intraoperative AAD was 1,042 days (range: 648 to 2,666). Surviving patients were managed through thoracic endovascular aortic repair and medical management. In conclusion, in this highly selected cohort of patients, our experience indicates that AAD after TAVR is a rare but often lethal intraprocedural sequela of THV implantation, especially in cases of type A aortic dissection.

Application of Transcatheter Electrosurgery in Structural Heart Interventions: A Report of Three Different Techniques

Transcatheter electrosurgery is a novel technique to traverse or cut tissue, within blood-filled spaces, using alternating current directed by guidewires and catheters. We report the first series of transcatheter electrosurgery procedures in Asia including transcaval access for transcatheter aortic valve implantation, intentional aortic leaflet laceration to mitigate the risk of coronary occlusion in transcatheter aortic valve implantation and intentional laceration of anterior mitral valve leaflet to mitigate the risk of left ventricular outflow tract obstruction. These procedures are potentially valuable in Asian patients because of their smaller body build compared to Caucasians posing a higher risk of coronary or left ventricular outflow tract obstruction during transcatheter valve implantation. There is a need to adopt transcatheter electrosurgery in Asia to treat more surgically inoperable patients, including proper simulation training, bench training and clinical proctorship.

Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis.

Next-day discharge (NDD) outcomes following uncomplicated self-expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non-NDD transcatheter aortic valve replacement with Evolut. Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self-expanding supra-annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non-NDD). Propensity score matching was used to compare risk adjusted 30-day readmission rates and 1-year outcomes in NDD versus non-NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well-matched NDD and non-NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30-day readmission rates (6.3% versus 8.4%; P<0.001) and 1-year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter-defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non-Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter-defibrillator, and previous surgical aortic valve replacement. Most patients undergoing uncomplicated self-expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30-day and 1-year outcomes, including low rates of permanent pacemaker implantation and readmission.

Prevalence and clinical outcome of isolated aortic stenosis: A single-center experience

ABSTRACT Background: There is a paucity of data regarding the prevalence and clinical outcomes of patients with isolated aortic stenosis (AS) in Saudi Arabia. Aim: Study investigates the prevalence AS and the effects of different treatment modalities on patients’ symptoms. Materials and Methods: This retrospective cohort study included patients diagnosed with isolated trileaflet AS between October 2015 and October 2018. Of 2300 patients who presented to our institution with valvular heart disease, 107 (4.7%) had isolated trileaflet AS. Results: The patients’ median age was 76 years (range 67–82). Dyspnea was the most common presenting symptom (n = This 86, 80.4%). The mean aortic valve area was 0.995 ± 0.35 mm2. Six patients (5.6%) had mild, 44 (41.1%) had moderate, and 57 (53.3%) had severe AS. Twenty-three patients with moderate/severe AS underwent surgery (22.8%), 24 patients underwent transcatheter valve intervention (TAVI) (23.8%), and 54 patients received medical treatment (53.5%). Marked symptom improvement was observed in patients who had surgery (n = 20, 86.96%), TAVI (n = 18, 75%), and medical treatment (n = 11, 18.33%) (P &lt; 0.001). The factors affecting symptom improvement were surgery (odds ratio [OR] 21.97 [95% confidence interval (CI): 4.79–100.7]; P &lt; 0.001) and TAVI (OR 9.27 [95% CI: 2.38–36.08]; P = 0.001). Conclusions: A prevalence of 4.7% was found for isolated trileaflet AS in patients who presented to our institution with valvular heart disease. Symptoms improved in patients who received interventional approaches compared with those who received medical management. Medical management should be strictly reserved for patients who cannot tolerate surgical or transcatheter aortic valve replacement.

E-42 | Prevalence of Cardiorenal Syndrome among Admission Cases undergoing Transcatheter Valve Procedures and its Association with Hospital Outcomes

E-42 | Prevalence of Cardiorenal Syndrome among Admission Cases undergoing Transcatheter Valve Procedures and its Association with Hospital Outcomes

Long-term outcomes in patients with bicuspid valve stenosis and aortic dilation undergoing transcatheter valve implantation

BackgroundTo date, whether ascending aorta dilation (AAD) should be considered a contraindication for transcatheter aortic valve replacement (TAVR) remains a topic of debate.. ObjectiveThe study investigated the clinical outcome of TAVR in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by AAD. MethodsWe included patients with BAV-AS who underwent TAVR between 2012 and 2019. We collected patient perioperative clinical data., tracked clinical outcomes for over four years post-TAVR, and obtained echocardiography images one year postoperatively. The Kaplan-Meier method was employed for analyzing both unadjusted and adjusted survival data, which was compared using the log-rank test. COX regression and nomograms were used to assess the impact of AAD on post-TAVR clinical outcomes in patients with aortic stenosis (AS), with all-cause mortality as the primary clinical endpoint. ResultsA total of 111 BAV patients were included in this study. Long-term follow-up showed an increased mortality risk in patients with BAV-AAD (adjusted Kaplan–Meier analysis: P = .02/0.001). Cox correlation analysis indicated that age (OR = 1.137; P = .034), AAD (OR = 3.51; P = .038), and postoperative left ventricular pressure (LVSP) (OR: 0.959; P = .044) were predictive factors for mortality more than four years after TAVR in patients with BAV. The area under the curve of the Nomogram predicting long-term survival for the training set of patients based on the above metrics was 0.845 (95% CI: 0.696–0.994). Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion (0.29 [0–0.34] vs. -1 [−3.3–1] mm/month, P = .001) and a smaller proportion of AA diameter reduction (7.1% vs. 53.7%, P = .001) in patients who died. ConclusionsPatients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality, and clinical prediction models, including AAD age and postoperative LVSP, may predict long-term patient survival. Condensed abstractThe study investigated the clinical outcome of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by ascending aorta dilation (AAD). Patients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality. AAD, age and postoperative LVSP, may predict long-term patient survival. Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion and a smaller proportion of AA diameter reduction in patients who died. A high postoperative AAD expansion rate may indicate an adverse clinical outcome. Surgery regimens for tolerable BAV-AADs and can be considered as a treatment option.

Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves in a large real-world registry

BackgroundPermanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry. MethodsPatients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure. ResultsFrom July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus. ConclusionFrom 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.

Failed bioprosthetic tricuspid valve replacement treated with transcatheter valve for valve repair

Tricuspid bioprosthetic valve failure may lead to right-sided heart failure and is traditionally managed with surgical valve replacement. However, the substantial mortality risk associated with reoperation for failed tricuspid bioprosthesis prompts the need for less invasive alternatives. Transcatheter valve-in-valve (TViV) implantation presents a promising minimally invasive option for patients with failing bioprosthetic valves. This case involves a 32-year-old man with a history of recurrent failed bioprosthetic tricuspid valves who underwent successful percutaneous TViV implantation using a 29 mm Edwards Sapien S3 valve, resulting in marked clinical and hemodynamic improvement. This case contributes essential insights to the limited literature on TViV in the tricuspid position, particularly in patients with complex surgical histories. The high procedural success rate and substantial improvement in valve function underscore the potential of TViV as an effective alternative to surgical replacement for failed tricuspid bioprosthetic valves. Keywords: Transcatheter tricuspid valve replacement; tricuspid valve-in-valve; bioprosthetic tricuspid valve; tricuspid valve stenosis

Off-Label Use of Balloon-Expandable Transcatheter Valves to Treat Pure Aortic Regurgitation

Transcatheter aortic valve implantation (TAVI) in native pure aortic regurgitation (AR) with off-label use of balloon expandable valves (BEV) has been reported. However, there are scant data regarding optimal oversizing and its safety and our study assessed BEV oversizing and outcomes of TAVI. Thirteen consecutive tricuspid aortic valve patients undergoing transfemoral TAVIs for pure AR with Sapien BEV at our centre between 2019 and 2023 (69.2% males, mean age 80.8 years, STS 4.0%) were divided into small annulus group (≤618mm2, SA) where ≥20% oversizing is achievable based on published data on BEV overexpansion, and larger annulus group (LA, >618mm2). Overexpansion and actual oversizing were measured on post-procedural CT scan. Technical success was 92.3% with one valve embolization in LA group. The post-procedural CT showed a mean 28.3% oversizing, significantly higher in SA (31.2%) then in LA group (19.4%), p= 0.0092. Oversizing ≥20% was achieved in 100% SA vs 33.3% LA patients (p=0.046). In conclusion, TAVI in pure AR with oversized Sapien BEV showed good procedural and short-term outcomes when ≥20% oversizing was predictably achievable.

Simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction: initial experience.

Simultaneous transcatheter mitral valve in valve (VIV) replacement and aortic valve replacement experience is limited. We report our initial experience with simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction. A total of 8 patients had simultaneous transcatheter heart valve implants for severe mitral bioprosthesis failure (VIV), with a second valve procedure that included native aortic regurgitation (n = 3) or degenerated bioprostheses in the aortic position (n = 5). All patients were treated with a self-expandable J-valve transcatheter valve, using the transapical approach. The mean age of the patients was 73.1 ± 6.2years. The mean Society of Thoracic Surgeons score was 13.8 ± 6.3%. Device success was 100% according to Valve Academic Research Consortium-2 criteria. No other procedure-associated complications occurred, including left ventricular outflow tract obstruction and valve migration. The mean hospital lengths of stay after the procedure were 11.5 ± 8.0days. No deaths occurred at 30days. At a median follow-up period of 28.7 ± 22.3months, no patients died. All patients were in New York Heart Association functional classes I-II. Echocardiographic parameters at follow-up showed a normofunctioning J valve in the mitral position and a mean max mitral flow velocity of 2.0 ± 0.5m/s; the J valve in the aortic position was also normofunctioning, and the mean max aortic flow velocity was 2.3 ± 0.5m/s. Simultaneous transapical transcatheter aortic and mitral valve replacement using the self-expandable J valve appears to be a feasible and effective alternative to redo surgery.

Clinical characteristics and outcomes of alcohol septal ablation in the era of transcatheter valve interventions.

The clinical efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) have been well-established; however, less is known about outcomes in patients undergoing preemptive ASA before transcatheter mitral valve replacement (TMVR). The goal of this study is to characterize the procedural characteristics and examine the clinical outcomes of ASA in both HCM and pre-TMVR. This retrospective study compared procedural characteristics and outcomes in patient who underwent ASA for HCM and TMVR. In total, 137 patients were included, 86 in the HCM group and 51 in the TMVR group. The intraventricular septal thickness (mean 1.8 vs. 1.2 cm; p < 0.0001) and the pre-ASA LVOT gradient (73.6 vs. 33.8 mmHg; p ≤ 0.001) were higher in the HCM group vs the TMVR group. The mean volume of ethanol injected was higher (mean 2.4 vs. 1.7 cc; p < 0.0001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (99.2 ± 83.37 mm2 vs. 196.5 ± 114.55 mm2; p = <0.0001). The HCM group had a greater reduction in the LVOT gradient after ASA vs the TMVR group (49.3 vs. 18 mmHg; p = 0.0040). The primary composite endpoint was higher in the TMVR group versus the HCM group (50.9% vs. 25.6%; p = 0.0404) and had a higher incidence of new permanent pacemaker (PPM) (25.5% vs. 18.6%; p = 0.3402). The TMVR group had a higher rate of all-cause mortality (9.8% vs. 1.2%; p = 0.0268). Preemptive ASA before TMVR was performed in patients with higher degree of clinical comorbidities, and correspondingly is associated with worse short-term clinical outcomes in comparison to ASA for HCM patients. ASA before TMVR enabled percutaneous mitral interventions in a small but significant minority of patients that would have otherwise been excluded. The degree of LVOT and neoLVOT area increase is significant and predictable.

Improved Hemodynamics With Self-Expanding Compared to Balloon-Expandable Transcatheter Aortic Valve Implantation in Small Annulus Patients: A Propensity-Matched Analysis

Patients with small aortic annuli (SAA) pose a challenge in patients undergoing aortic valve replacement because of the potential for prosthesis-patient mismatch (PPM). This study aimed to compare the clinical and hemodynamic outcomes of self-expandable valve (SEV) versus balloon-expandable valve (BEV) transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and SAA. All patients who underwent TAVI for severe native aortic stenosis with a SAA between January 2018 and December 2022 were retrospectively included in the study from a single center. Propensity score matching was performed to balance the baseline characteristics. Bioprosthesis valve dysfunction was based on modified Valve Academic Research Consortium 3 criteria. A total of 1,170 TAVI procedures were performed between 2018 and 2022. After applying the exclusion criteria, 332 patients reported a SAA at computed tomography scan, and the matching created 109 balanced pairs. Echocardiographic data at discharge showed higher mean transvalvular gradients (p <0.001), higher grades of mitral regurgitation (p = 0.029), and lower ejection fraction (p <0.043) in BEVs than SEVs. At follow-up, significant differences favoring the SEV group regarding bioprosthesis valve dysfunction were observed (p = 0.002), especially in terms of severe PPM (p = 0.046) and at least moderate structural valve deterioration (p = 0.040). In conclusion, TAVI in patients with SAA using a BEV was associated with lower valve areas, higher mean pressure gradients, and PPM (including severe) than a SEV. Short- and midterm all-cause and cardiac-related mortality did not differ between the 2 groups. Future randomized studies with extended follow-ups are warranted to validate these outcomes.