Undergoing Transcatheter Aortic Valve Replacement Research Articles

Transcatheter Aortic Valve Implantation by Valve Type in Women With Small Annuli

Historically, women with aortic stenosis have experienced worse outcomes and inadequate recognition compared to men, being both underdiagnosed and undertreated, while also facing underrepresentation in clinical trials. To determine whether women with small aortic annuli undergoing transcatheter aortic valve replacement have better clinical and hemodynamic outcomes with a self-expanding valve (SEV) or balloon-expandable valve (BEV). The Small Annuli Randomized to Evolut or SAPIEN Trial (SMART) was a large-scale randomized clinical trial focusing on patients with small aortic annuli undergoing transcatheter aortic valve replacement, randomized to receive SEVs or BEVs and included 716 patients treated at 83 centers in Canada, Europe, Israel, and the US from April 2021 to October 2022. This prespecified secondary analysis reports clinical and hemodynamic findings for all 621 women enrolled in SMART. Data for this report were analyzed from February to April 2024. Transcatheter aortic valve replacement with an SEV or a BEV. The composite coprimary clinical end point comprised death, disabling stroke, or heart failure-related rehospitalization. The coprimary valve function end point was the incidence of bioprosthetic valve dysfunction, both assessed through 12 months. Secondary end points included the incidence of moderate or severe prosthesis-patient mismatch. A total of 621 women (mean [SD] age, 80.2 [6.2] years; 312 randomized to the SEV group and 309 to the BEV group) were included in the present analysis. At 12 months, there were no significant differences in the coprimary clinical end point between the SEV and BEV groups (9.4% vs 11.8%, absolute risk difference -2.3%; 95% CI -7.2 to 2.5, P = .35). However, SEV implantation was associated with less bioprosthetic valve dysfunction (8.4% vs 41.8%; absolute risk difference, -33.4%; 95% CI, -40.4 to -26.4; P < .001). SEV implantation resulted in lower aortic valve gradients and larger effective orifice areas at 30 days and 12 months and less mild or greater aortic regurgitation at 12 months compared to BEV implantation. Prosthesis-patient mismatch was significantly lower with SEVs, regardless of the definition used and adjustment for body mass index. Use of SEVs was associated with better quality of life outcomes as assessed by the Valve Academic Research Consortium-3 ordinal quality of life measure. Among women with severe symptomatic aortic stenosis and small aortic annuli undergoing transcatheter aortic valve replacement, the use of SEVs, compared to BEVs, resulted in similar clinical outcomes and a markedly reduced incidence of bioprosthetic valve dysfunction through 12 months, including a lower risk of prosthesis-patient mismatch and better 12-month quality of life. ClinicalTrials.gov Identifier: NCT04722250.

Novel Insights into Non-Invasive Diagnostic Techniques for Cardiac Amyloidosis: A Critical Review

Cardiac amyloidosis (CA) is a cardiac storage disease caused by the progressive extracellular deposition of misfolded proteins in the myocardium. Despite the increasing interest in this pathology, it remains an underdiagnosed condition. Non-invasive diagnostic techniques play a central role in the suspicion and detection of CA, also thanks to the continuous scientific and technological advances in these tools. The 12-lead electrocardiography is an inexpensive and reproducible test with a diagnostic accuracy that, in some cases, exceeds that of imaging techniques, as recent studies have shown. Echocardiography is the first-line imaging modality, although none of its parameters are pathognomonic. According to the 2023 ESC Guidelines, a left ventricular wall thickness ≥ 12 mm is mandatory for the suspicion of CA, making this technique crucial. Cardiac magnetic resonance provides high-resolution images associated with tissue characterization. The use of contrast and non-contrast sequences enhances the diagnostic power of this imaging modality. Nuclear imaging techniques, including bone scintigraphy and positron emission tomography, allow the detection of amyloid deposition in the heart, and their role is also central in assessing the prognosis and response to therapy. The role of computed tomography was recently evaluated by several studies, above in population affected by aortic stenosis undergoing transcatheter aortic valve replacement, with promising results. Finally, machine learning and artificial intelligence-derived algorithms are gaining ground in this scenario and provide the basis for future research. Understanding the new insights into non-invasive diagnostic techniques is critical to better diagnose and manage patients with CA and improve their survival.

Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review.

Cerebrovascular events (CVEs) are a dreaded complication of transcatheter aortic valve replacement (TAVR). They are associated with significant mortality, morbidity, and reduced quality of life and impose a significant burden to health care systems. Although the rates of clinical stroke have reduced since the advent of TAVR, it remains an important complication, particularly as TAVR is increasingly utilized. CVE may occur at the time of the TAVR, as a direct consequence of the procedure, or may occur later, related to thrombosis of the prosthetic valve, atrial fibrillation, and other comorbidities. Imaging of the brain has revealed a high prevalence of subclinical cerebral infarcts (68%-98%) associated with the TAVR procedure. Although their clinical significance has not been fully established, clinically evident CVE ranges between 3% and 5% in patients considered at high operative risk to between 1% and 3% in low operative risk patients. Periprocedural CVEs are largely the result of embolization of the thrombus and tissue derived from the valve, vasculature, or myocardium. Cerebral embolic protection devices have been studied in multiple trials, with some evidence supporting a reduction in new cerebral lesion volume, number, and potentially disabling strokes. However, thus far, there is no robust evidence that they reduce the overall stroke rate. The number and severity of comorbidities, in particular, new-onset atrial fibrillation, are associated with CVEs. Valve thrombosis diagnosed using computed tomography as areas of hypoattenuated leaflet thickening has been identified in 10% to 15% of patients. This is a dynamic process associated with an increase in CVEs, but that resolves with anticoagulation or sometimes without it. Routine use of anticoagulation compared with a single antiplatelet agent is associated with an increased risk of bleeding, without any additional alleviation in risk of thromboembolism. Future studies to improve risk stratification could facilitate the tailoring of preventive therapies to patients at high risk of CVE, who stand to gain the most benefit.

Initial Findings Concerning the Latest Self-expandable Evolut FX Valve: A Report Using OCEAN-TAVI Registry Data

Data concerning the clinical effect of the latest-generation self-expandable transcatheter heart valve (Evolut FX) remain limited. We aimed to assess the in-hospital outcomes of 3 bioprosthetic valves (Evolut EPO, PRO+, and FX). We analyzed data from a Japanese multicenter registry involving 634 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) with Evolut FX up until October 2023. Patients who underwent TAVR with Evolut EPO between 2018 and 2020 (n = 1128), and those with Evolut EPO+ between 2020 and 2023 (n = 1696) served as control groups. Exclusion criteria comprised patients on dialysis, with a history of infective endocarditis, or with insufficient data. Unmatched comparisons among the 3 valves were conducted, followed by a propensity score (PS)-matched comparison between Evolut EPO+ and FX. In the unmatched cohort, among the Evolut EPO, PRO+, and FX groups, all vascular complications (7.8% vs. 5.2% vs. 4.5%, respectively; p < 0.01) and new pacemaker implantation (PMI) rates (11.2% vs. 6.1% vs. 7.7%, respectively; p < 0.01) differed significantly. In the PS-matched analysis, the rate of all bleeding events was significantly higher in the Evolut EPO+ group (11.0%) than in the FX group (7.0%) (p = 0.02), while all vascular complications (4.6% vs. 4.6%, respectively; p = 1.00) and new PMI (5.9% vs. 7.6%, respectively; p = 0.28) rates were comparable. The incidence of stroke in the FX group was approximately half that of the EP+ group (3.7% vs. 1.9%, p = 0.095) without statistical significance. In conclusion, compared with Evolut EPO+, Evolut FX was associated with a lower incidence of in-hospital bleeding complications and may reduce an in-hospital stroke incidence.

TCT-137 Outcomes of Patients With Bicuspid Aortic Valve Undergoing Transcatheter Aortic Valve Replacement Using the Navitor Self-Expanding Valve: Results From an International Multicenter Registry

TCT-137 Outcomes of Patients With Bicuspid Aortic Valve Undergoing Transcatheter Aortic Valve Replacement Using the Navitor Self-Expanding Valve: Results From an International Multicenter Registry

TCT-826 A Validated Risk Model for Acute Kidney Injury Prediction in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the STS/ACC National Cardiovascular Data Registry–Transcatheter Valve Therapy Registry

TCT-826 A Validated Risk Model for Acute Kidney Injury Prediction in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the STS/ACC National Cardiovascular Data Registry–Transcatheter Valve Therapy Registry

TCT-879 Perioperative and In-Hospital Outcomes of Dilated Cardiomyopathy in Patients Undergoing Transcatheter Aortic Valve Replacement: A Large Cross-Sectional Study Using National Inpatient Sample

TCT-879 Perioperative and In-Hospital Outcomes of Dilated Cardiomyopathy in Patients Undergoing Transcatheter Aortic Valve Replacement: A Large Cross-Sectional Study Using National Inpatient Sample

TCT-898 Comparison of Procedural Characteristics Between Use of the Savvy Wire for Simultaneous Ventricular Pacing, Aortic Valve Delivery and Hemodynamic Assessment to Conventional Transvenous Ventricular Pacing and Valve Delivery in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-898 Comparison of Procedural Characteristics Between Use of the Savvy Wire for Simultaneous Ventricular Pacing, Aortic Valve Delivery and Hemodynamic Assessment to Conventional Transvenous Ventricular Pacing and Valve Delivery in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-184 Comparative Outcomes of SGLT2 Inhibitors in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-184 Comparative Outcomes of SGLT2 Inhibitors in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-122 Perioperative and In-Hospital Outcomes of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the National Inpatient Sample 2016-2021

TCT-122 Perioperative and In-Hospital Outcomes of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the National Inpatient Sample 2016-2021

TCT-881 Factors Associated With Readmission for Patients Undergoing Transcatheter Aortic Valve Replacement With Concurrent Congestive Heart Failure: An Analysis of the National Readmissions Database

TCT-881 Factors Associated With Readmission for Patients Undergoing Transcatheter Aortic Valve Replacement With Concurrent Congestive Heart Failure: An Analysis of the National Readmissions Database

TCT-848 Prospective Evaluation of Neurocognition in Patients Undergoing Transcatheter Aortic Valve Replacement: Periprocedural Changes and Predictors of Improvement

TCT-848 Prospective Evaluation of Neurocognition in Patients Undergoing Transcatheter Aortic Valve Replacement: Periprocedural Changes and Predictors of Improvement

TCT-838 Clinical Futility in Patients With Active Malignancy Undergoing Transcatheter Aortic Valve Replacement After Multidisciplinary Heart Team Decision

TCT-838 Clinical Futility in Patients With Active Malignancy Undergoing Transcatheter Aortic Valve Replacement After Multidisciplinary Heart Team Decision

TCT-143 A Validated Risk Model for Acute Kidney Injury Prediction in Patients Undergoing Transcatheter Aortic Valve Replacement Insights From the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry: Transcatheter Valve Therapy Registry

TCT-143 A Validated Risk Model for Acute Kidney Injury Prediction in Patients Undergoing Transcatheter Aortic Valve Replacement Insights From the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry: Transcatheter Valve Therapy Registry

TCT-599 The Prognostic Role of a Novel Computational Approach Assessing Microcirculatory Resistance Based on a Single Angiographic View in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-599 The Prognostic Role of a Novel Computational Approach Assessing Microcirculatory Resistance Based on a Single Angiographic View in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-858 Aortic Valve Calcification Volume and Prognosis in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-858 Aortic Valve Calcification Volume and Prognosis in Patients Undergoing Transcatheter Aortic Valve Replacement

Association between triglyceride-glucose index and all-cause mortality in patients underwent transcatheter aortic valve replacement

BackgroundsThe prognosis of the triglyceride-glucose (TyG) index, a validated surrogate marker for insulin resistance, in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains unknown.MethodsThis study consecutively enrolled patients diagnosed with severe AS who underwent TAVR in a Chinese tertiary hospital from March 2013 to September 2023. Participants were stratified based on the TyG index cut-off value. Cox proportional hazards regression models were utilized to explore the association between the TyG index and all-cause mortality, including an assessment of interactions between the TyG index and various covariates on mortality outcomes.ResultsAmong 1045 patients (mean age 74.7 years, 58.2% male), there was 134 all-cause mortality, resulting in a crude mortality rate of 64.3 per 1000 person-years. Adjusting for age, sex, body mass index, smoking, hypertension, diabetes mellitus, bicuspid aortic valve, atrial fibrillation, Society of Thoracic Surgeons (STS) score, and left ventricular ejection fraction, a per-unit increase in the TyG index was associated with a 41% higher all-cause mortality risk (HR 1.41, 95% CI 1.03–1.93, p = 0.030). Notably, the relationship between the TyG index and all-cause mortality was significantly modified by age (pinteraction = 0.027), sex (pinteraction = 0.007), hypertension (pinteraction = 0.030), and STS score (pinteraction = 0.002).ConclusionsA higher TyG index is significantly associated with an increased risk of all-cause mortality in AS patients after TAVR. These results underscore the importance of considering the TyG index in the prognostic evaluation of AS patients following TAVR.

Eight-Year Outcomes of Patients With Reduced Left Ventricular Ejection Fraction Who Underwent Transcatheter Aortic Valve Replacement With a Self-Expanding Bioprosthesis

Conflicting results have been reported regarding the relationship between impaired left ventricular ejection fraction (LVEF) and adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) and long-term clinical data are lacking.The aims of this study were to investigate the long-term outcomes of patients with reduced LVEF undergoing TAVRData deriving from patients undergoing TAVR between 2007 and 2017 in 13 Italian centers were prospectively collected. Patients were stratified in those with normal LVEF and reduced LVEF. The latter was further classified according to ischemic or non-ischemic etiology. The primary endpoint was a composite of all-cause death and re-hospitalizations, the secondary endpoints were the isolated composers of the primary one and cardiac death. Overall, 2626 patients were included in the analysis, 68.1% with NLVEF and 31.9% with reduced LVEF. At eight years, reduced LVEF was significantly associated with the primary endpoint (adj. HR 1.17 95% CI 1.06-1.29). Consistent findings were evident for the composite endpoint. No differences in these trends were found at 30 days landmark analyses. Compared to non-ischemic etiology, ischemic reduced LVEF was associated with an increased risk of cardiac death (adj. HR 1.43 95% CI 1.02-2.02). In conclusion, patients with reduced LVEF undergoing TAVR are exposed to a progressively increased risk of death and re-hospitalizations even at very long-term follow-up.

Prognostic Value of Shock Index Creatinine in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Introduction: Shock index (SI) and its derivatives have been reported to have prognostic value in various cardiovascular diseases. This study aims to ascertain the utility of shock index creatinine (SIC) in predicting mid-term mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods: We conducted a retrospective analysis of 555 patients with severe AS who underwent TAVR from April 2016 to March 2023. SIC was calculated as (SI × 100) – estimated creatinine clearance (CCr). The primary endpoint was all-cause mortality during the follow-up period, and secondary endpoints included in-hospital complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. Patients were stratified into two groups based on the optimal cutoff value determined by the receiver-operating characteristic (ROC) curve. Cox regression analysis was employed to identify independent predictors of all-cause mortality. Additionally, restricted cubic spline (RCS) was deployed to illustrate the relationship between SIC and mortality risk. The predictive performance of risk scores was evaluated using the area under the ROC curve (AUC). Results: Over a mean follow-up period of 21.5 months, there were 51 cases of all-cause mortality. Patients with a high SIC, identified by a cutoff of 16.5, exhibited a significantly higher cumulative all-cause mortality compared to those with a low SIC (18.3% vs. 5.2%, p < 0.001; adjusted HR = 2.188; 95% CI 1.103–4.341, p = 0.025). Patients with a high SIC were older (p = 0.002) and exhibited a higher prevalence of frailty (p < 0.001). Furthermore, they exhibited a heightened probability of moderate or severe mitral regurgitation (p < 0.001), tricuspid regurgitation (p < 0.001), and pulmonary hypertension (p < 0.001) compared to those with a low SIC. In terms of perioperative complications, acute kidney injury (10.1% vs. 3.9%, p = 0.008) and bleeding (13.6% vs. 6.7%, p = 0.014) were more prevalent in patients with a high SIC. The RCS demonstrated a positive correlation between SIC and all-cause mortality rate. Furthermore, incorporating high SIC into the STS score improved its predictive value for 1-year all-cause mortality (AUC: 0.731 vs. 0.649, p = 0.01). Conclusion: Patients with a high SIC are more likely to experience frailty and cardiac damage and exhibit an increased in-hospital and mid-term mortality rate. SIC may provide additional information for risk stratification of patients undergoing TAVR.

Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.