Clinical outcomes in women and men with raphe-type bicuspid aortic valve stenosis undergoing transcatheter aortic valve replacement.

Background: There is paucity of data regarding sex-related differences among patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR).

Methods: The AD-HOC was an observational, retrospective, investigator-initiated registry enrolling consecutive patients with Sievers type 1 BAV stenosis who underwent TAVR at 24 international centers from 2016 to 2023. The primary endpoint was major adverse events (MAEs), including death, neurologic events and heart failure hospitalization.

High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry.

Background: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).

Objective: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.

Methods: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled.

Comparison between severe R-L and R-NC raphe-type bicuspid aortic valve stenosis treated with TAVI: insights from the international AD HOC Registry.

Background: Sievers type 1 bicuspid aortic valve (BAV) stenosis presents unique challenges for trans-catheter aortic valve implantation (TAVI), particularly when calcified raphe is present. The impact of raphe localization on TAVI outcomes remains unclear.

Objectives: This study aimed to compare procedural and clinical outcomes in patients with right-left (R-L) and right-non coronary (R-NC) raphe-type BAV treated with TAVI.

Intravascular imaging for percutaneous coronary intervention on bifurcation and unprotected left main lesions: a systematic review and meta-analysis.

Background: The efficacy of intravascular imaging (IVI) guidance for percutaneous coronary intervention (PCI) represents a contemporary hot topic. PCI in patients with bifurcation coronary lesions and unprotected left main lesions offers specific challenges that, theoretically, may particularly benefit from IVI.

Objective: To compare the clinical outcomes between IVI and angiography guidance for PCI in bifurcation and unprotected left main lesions.

Cancer-Therapy-Related Cardiac Dysfunction: Latest Advances in Prevention and Treatment.

The increasing efficacy of cancer therapies has significantly improved survival rates, but it has also highlighted the prevalence of cancer-therapy-related cardiac dysfunction (CTRCD). This review provides a comprehensive overview of the identification, monitoring, and management of CTRCD, a condition resulting from several treatments, such as anthracyclines, HER2-targeted therapies, target therapies, and radiotherapy. The paper includes a discussion of the mechanisms of CTRCD associated with various cancer treatments.

Fractional flow reserve or OCT to guide management of complex and noncomplex angiographically intermediate coronary stenosis.

Introduction And Objectives: The management of patients with coronary artery disease can benefit from devices that improve functional or anatomical evaluation. This study aimed to compare the efficacy of optical coherence tomography (OCT) and fractional flow reserve (FFR) guidance for managing vessels with angiographically intermediate coronary lesions according to angiographic lesion complexity.

Methods: The FORZA trial (NCT01824030) was a randomized trial comparing the use of OCT or FFR for revascularization decisions and percutaneous coronary intervention optimization in patients with angiographically intermediate coronary lesions.

Comparison of Stent Geometry Achieved by Different Side-Branch Ballooning Techniques For Bifurcation Provisional Stenting: The CRABBIS Trial.

Background: Stepwise provisional stenting is the most adopted approach for percutaneous coronary interventions (PCIs) in bifurcation lesions. During these procedures, the side branch (SB) may deserve treatment, but the best ballooning technique is still undetermined.

Objectives: The study sought to compare the stent configurations obtained by 2 SB ballooning sequences after main vessel (MV) stent implantation: the proximal optimization technique + kissing balloon inflation + final proximal optimization technique (PKP) vs the proximal optimization technique + isolated side branch dilation + final proximal optimization technique (PSP).

Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience.

Background: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized.

Femoral Large Bore Sheath Management: How to Prevent Vascular Complications From Vessel Puncture to Sheath Removal.

Transfemoral access is nowadays required for an increasing number of percutaneous procedures, such as structural heart interventions, mechanical circulatory support, and interventional electrophysiology/pacing. Despite technological advancements and improved techniques, these devices necessitate large-bore (≥12 French) arterial/venous sheaths, posing a significant risk of bleeding and vascular complications, whose occurrence has been related to an increase in morbidity and mortality. Therefore, optimizing large-bore vascular access management is crucial in endovascular interventions.

Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients.

Background: Patients experiencing non-ST segment elevation acute-coronary-syndromes (NSTE-ACS) often present with multivessel-coronary-artery-disease (MVD). An immediate complete multivessel revascularization (MVR) - within the index hospitalization - may be considered the default therapeutic strategy, although its risk-to-benefit profile has not been definitively established through dedicated clinical trials.

Methods: A systematic review and meta-analysis, adhering to MOOSE and PRISMA guidelines, was conducted to assess studies comparing immediate MVR versus a conservative culprit-only revascularization (COR) in NSTE-ACS with MVD.

Anatomical Annulus Predictors of New Permanent Pacemaker Implantation Risk After Balloon-Expandable Transcatheter Aortic Valve Implantation.

New-generation transcatheter heart valves have significantly improved technical success and procedural safety of transcatheter aortic valve implantation (TAVI) procedures; however, the incidence of permanent pacemaker implantation (PPI) remains a concern. This study aimed to assess the role of anatomic annulus features in determining periprocedural conduction disturbances leading to new PPI after TAVI using the last-generation Edwards SAPIEN balloon-expandable valves. In the context of a prospective single-center registry, we integrated the clinical and procedural predictors of PPI with anatomic data derived from multislice computed tomography.

Heart failure management guided by remote multiparameter monitoring: A meta-analysis.

Background: Several implant-based remote monitoring strategies are currently tested to optimize heart failure (HF) management by anticipating clinical decompensation and preventing hospitalization. Among these solutions, the modern implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been equipped with sensors allowing continuous monitoring of multiple preclinical markers of worsening HF, including factors of autonomic adaptation, patient activity, and intrathoracic impedance.

Objectives: We aimed to assess whether implant-based multiparameter remote monitoring strategy for guided HF management improves clinical outcomes when compared to standard clinical care.

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge.

Background Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real-world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event. Methods and Results A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number/type of treatments prescribed at discharge.

Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot.

Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called "milking effect" at coronary angiography. As coronary blood flow occurs primarily during diastole, the clinical relevance of MB is heterogeneous, being usually considered an asymptomatic bystander.