CT assessment of right heart anatomy across tricuspid regurgitation severity grades: implications for transcatheter interventions.

Purpose: A five-grade severity scheme has been introduced for echocardiographic grading of tricuspid regurgitation (TR). Although higher TR grades have been associated with worse prognosis, it is unknown whether they can help determining patient eligibility for transcatheter tricuspid valve interventions (TTVI) and correspond to different anatomical phenotypes. The aim of our study was to investigate the relationship between TR severity and tricuspid valve (TV) anatomy and determine the screening failure rate for TTVI.

Early Outcomes of Real-World Transcatheter Tricuspid Valve Replacement.

Background: Transcatheter tricuspid valve replacement (TTVR) has been recently approved for the treatment of patients with severe tricuspid regurgitation (TR). Real-world evidence regarding the commercial use of TTVR is lacking.

Objectives: The aim of this study was to investigate the real-world safety and efficacy of the EVOQUE TTVR system in patients with severe TR treated at 12 experienced heart valve centers in 5 European countries.

Impact of Noncoaxial Transcatheter Aortic Valve Implantation on Clinical Outcomes.

Background: Noncoaxial placement of transcatheter heart valves (THVs) relative to the native aortic annulus is occasionally detected on fluoroscopy after transcatheter aortic valve replacement (TAVR).

Objectives: This study aimed to evaluate the impact of noncoaxial TAVR deployment on clinical outcomes.

Methods: We retrospectively evaluated consecutive patients undergoing transfemoral TAVR in the Bern transcatheter aortic valve implantation registry.

Optimal Oversizing With the New-Generation Evolut (PRO/PRO+/FX) Self-Expanding Valves: A Multicenter Study.

Background: Paravalvular leaks (PVLs) after transcatheter aortic valve replacement have a significant prognostic impact, and valve oversizing, particularly with self-expanding valves, may prevent postprocedural PVL occurrence. Recent iterations of the Evolut valve system are intended to reduce PVL, but the effects of oversizing with such valves on PVL are largely unknown. We aimed to assess, in a real-world contemporary setting, the impact of Evolut valve oversizing on PVL after transcatheter aortic valve replacement.

Vascular Complications in Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices.

Background: Vascular complications (VCs) remain a major concern after transcatheter aortic valve replacement (TAVR). However, their occurrence in patients treated with newer generation devices has been scarcely studied. Therefore, the aim of this study was to determine the incidence, management, predictors, and clinical impact of VCs in patients undergoing TAVR with contemporary devices.

Optimizing the management of tricuspid regurgitation: an update on current treatment strategies and perspectives.

Introduction: Tricuspid regurgitation (TR) is a prevalent condition and is independently associated with high morbidity and mortality rates. Despite its prognostic impact, TR remains undertreated, with patients often referred at late stages when medical therapy is ineffective and surgical intervention high risk. Emerging transcatheter therapies offer a promising alternative for safer and effective management of this elderly patient population with numerous comorbidities.

Transapical Mitral Valve Implantation After Closure of Posterior Mitral Annulus Cavity With a Nitinol Occluder.

Mitral valve infective endocarditis involves a mitral annular abscess in approximately 15% of cases, and surgery is the treatment of choice for this scenario. An 80-year-old comorbid man with eradicated infective endocarditis had an emptied abscess cavity of the posterior mitral valve annulus (with left ventricular-left atrial connections) and had severe paravalvular and coexistent relevant transvalvular mitral regurgitation. He was not a surgical candidate.

Transapical Transcatheter Mitral Valve Replacement After Failed Transcatheter Edge-to-Edge Repair: A Multicenter Experience.

Background: Management of recurrent mitral regurgitation (MR) or relevant iatrogenic mitral valve (MV) stenosis after mitral transcatheter edge-to-edge repair (M-TEER) emerges as an increasingly relevant clinical issue. Surgery after M-TEER is associated with higher morbidity and mortality. Electrosurgical leaflet laceration and stabilization of the implant (ELASTA-Clip) followed by transcatheter mitral valve replacement (TMVR) is an innovative, less-invasive treatment option for patients with TEER failure.

Polymer-free versus biodegradable-polymer drug-eluting stent in patients undergoing percutaneous coronary intervention: an assessor-blind, non-inferiority, randomised controlled trial.

Background: Few data are available on polymer-free drug-eluting stents in patients undergoing percutaneous coronary intervention (PCI).

Aims: We aimed to determine the efficacy and safety of a polymer-free amphilimus-eluting stent (AES), using a reservoir-based technology for drug delivery, compared with a biodegradable-polymer everolimus-eluting stent (EES).

Methods: This was a randomised, investigator-initiated, assessor-blind, non-inferiority trial conducted at 14 hospitals in Italy (ClinicalTrials.

Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices.

Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.

Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves.

Management of Intraventricular Gradient in Patients With Aortic Stenosis.

In patients with severe left ventricle hypertrophy and aortic stenosis, the presence of intraventricular gradient should always be investigated. Its prompt recognition enables a precise diagnosis and safe treatment of both conditions. We report 2 cases demonstrating a successful and novel approach to this clinical situation.

Changes and prognostic impact of noninvasive myocardial work indices in patients undergoing transcatheter aortic valve implantation.

Purpose: The prognostic significance of noninvasive myocardial work (MW) indices in patients undergoing transcatheter aortic valve implantation (TAVI) has not been adequately examined.

Methods: We retrospectively selected 88 consecutive patients (mean age 79.9 ± 6.

Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup.

Introduction And Objectives: In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup.

Methods: This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease.

Optimal oversizing in transcatheter aortic valve replacement with the self-expanding Evolut valve system.

Objectives: Valve oversizing has been associated with reduced paravalvular leaks (PVL) and valve migration risk. However, no optimal cut-off oversizing value has been defined for the Evolut system (Medtronic). The aim of this study was to assess the relationship between the degree of oversizing and moderate-to-severe PVL and determine the optimal oversizing cut-off value.

Renin-angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry.

Objectives: Arterial hypertension is associated with the triggering of the renin-angiotensin system, leading to left ventricle fibrosis and worse cardiovascular outcomes. In this study, patients with comorbid arterial hypertension and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) were selected from the EffecTAVI registry to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on cardiovascular mortality.

Methods: We enrolled 327 patients undergoing TAVI from the EffecTAVI registry.

Echocardiographic Evaluation of Aortic Stenosis: A Comprehensive Review.

Echocardiography represents the most important diagnostic tool in the evaluation of aortic stenosis. The echocardiographic assessment of its severity should always be performed through a standardized and stepwise approach in order to achieve a comprehensive evaluation. The latest technical innovations in the field of echocardiography have improved diagnostic accuracy, guaranteeing a better and more detailed evaluation of aortic valve anatomy.