Transcatheter aortic valve implantation in pure aortic regurgitation: one-year outcomes of the AURORA trial.

Background: Transcatheter aortic valve implantation (TAVI) in pure aortic regurgitation (AR) remains challenging because of inadequate anchoring forces. Traditional approaches, which rely solely on virtual annulus oversizing, have demonstrated limited success. We propose a novel anatomical classification system and dual-anchoring theory to optimise the TAVI strategy in patients with pure AR.

Prognostic significance of mitral annular calcification assessed by computed tomography for transcatheter edge-to-edge repair outcomes.

Background: Mitral annular calcification (MAC) presents challenges for transcatheter edge-to-edge repair (TEER). Limited data exist on how the anatomical features of MAC, assessed by computed tomography (CT), may be associated with TEER outcomes.

Aims: We sought to examine the association between CT features of MAC and clinical outcomes after TEER at 3 years.

Transcatheter Tricuspid Valve Replacement for Recurrent Tricuspid Regurgitation After Tricuspid Transcatheter Edge-to-Edge Repair.

Background: It is currently unknown whether tricuspid valve replacement with EVOQUE is feasible after tricuspid transcatheter edge-to-edge repair.

Case Summary: An 81-year-old patient with a complex history of multivalvular heart disease, previously treated with surgical and catheter approaches, presented to our center with symptomatic recurrent tricuspid regurgitation despite maximally tolerated medical therapy and previous tricuspid transcatheter edge-to-edge repair (T-TEER) with 2 TriClips. A multidisciplinary heart team determined that patient was high-risk for tricuspid surgery due to age, comorbidities, and previous sternotomy.

Prosthesis-Patient Mismatch in Young and Low-Risk Patients After Newer Generation Balloon-Expandable Transcatheter Aortic Valve Replacement.

Background: The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.

Objectives: The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.

Methods: From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves.

Roadmap analysis for coronary artery stenosis detection and percutaneous coronary intervention prediction in cardiac CT for transcatheter aortic valve replacement.

Background: The new artificial intelligence-based software, Roadmap (HeartFlow), may assist in evaluating coronary artery stenosis during cardiac computed tomography (CT) for transcatheter aortic valve replacement (TAVR).

Methods: Consecutive TAVR candidates who underwent both cardiac CT angiography (CTA) and invasive coronary angiography were enrolled. We evaluated the ability of three methods to predict obstructive coronary artery disease (CAD), defined as ≥50 ​% stenosis on quantitative coronary angiography (QCA), and the need for percutaneous coronary intervention (PCI) within one year: Roadmap, clinician CT specialists with Roadmap, and CT specialists alone.

Epidemiology of Valvular Heart Disease in Asia Pacific Region.

Valvular heart disease poses a significant health burden in the Asia-Pacific region, with its epidemiology varying widely across countries caused by diverse socioeconomic and health care situations. Rheumatic heart disease remains prevalent, especially in low- to middle-income areas, while degenerative valvular diseases are emerging in developed regions caused by an aging population. Significant disparities in access to health care and intervention result in variable clinical outcomes.

Prognostic implications and predictive factors of subclinical leaflet thrombosis following valve-in-valve transcatheter aortic valve implantation.

Background: Subclinical leaflet thrombosis, as indicated by hypoattenuated leaflet thickening (HALT) on computed tomography (CT) imaging, remains a major concern owing to its potential impact on valve function and patient outcomes.

Aims: We aimed to evaluate the association between HALT and clinical outcomes in patients undergoing valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) with balloon-expandable valves and to identify predictors of leaflet thrombosis.

Methods: Consecutive patients who underwent ViV TAVI with balloon-expandable valves at the Cedars-Sinai Medical Center were retrospectively analysed.

Thrombus characterisation and evolution of hypoattenuating leaflet thickening after transcatheter aortic valve implantation.

Background: Quantifying hypoattenuating leaflet thickening (HALT) on computed tomography angiography (CTA) may provide insights into its clinical implications and guide decisions on oral anticoagulation therapy following transcatheter aortic valve implantation (TAVI).

Aims: We sought to assess the association between quantitative CTA features of HALT and its evolution over time in a real-world cohort after TAVI.

Methods: Among 612 patients who underwent CTA 30 days post-TAVI with balloon-expandable bioprostheses, HALT was detected in 118 (19%).

Management of complications after valvular interventions.

Transcatheter valve interventions have transformed the outcomes of patients with valvular heart disease who are at high risk for surgery. With the increasing utilisation and expansion of transcatheter valve interventions, it is of utmost importance to be familiar with their potential complications and their subsequent management, especially given the relative infrequency of many of these issues in contemporary practice. Herein, we present a state-of-the-art review article focusing on the complications, their prevention, and treatment following transcatheter aortic valve implantation, mitral transcatheter edge-to-edge repair, and transcatheter mitral valve replacement.

The randomized controlled trial to compare temporary permanent pacemaker vs temporary pacemaker in patients with conduction block after transcatheter aortic valve replacement: Rationale and design of the RECOVER trial.

Rationale: Current guidelines and expert consensus recommend different time thresholds of temporary pacemaker (TM) indwelling in patients with conduction block after transcatheter aortic valve replacement (TAVR). Accordingly, this lack of clinical evidence and effective strategies has resulted in extensive variations in permanent pacemaker (PPM) implantation patterns, potentially leading to over-early PPM implantation. The use of a temporary permanent pacemaker (TPPM), which involves an active fixation pacing lead and an external pulse generator secured to the skin surface, may be effective and safe in these patients.

Best Practices for Imaging of Transcatheter Valve Failure: An Update From the Heart Valve Collaboratory.

This updated Heart Valve Collaboratory framework addresses the growing concern for transcatheter valve failure (TVF) following transcatheter aortic valve replacement (TAVR). With the increasing volume of redo-TAV and surgical TAV explantation, there is a critical need for standardized pathways and protocols for evaluating TVF using echocardiography and cardiac computed tomography (CT) angiography. This document clarifies prior definitions of bioprosthetic valve deterioration and bioprosthetic valve failure in a practical, imaging directed context for TAVR.

Age-Related Outcomes of Valve-in-Valve Transcatheter Aortic Valve Replacement for Structural Valve Deterioration.

Background: Valve-in-valve transcatheter aortic valve replacement (TAVR) is a recognized alternative for treating the structural valve deterioration of bioprosthetic valves. Recent guidelines and trials have expanded the indications for TAVR to include younger patients with structural valve deterioration. In this study, we aimed to examine the outcomes of valve-in-valve TAVR across different age groups to understand the age-related clinical outcomes of treating structural valve deterioration following surgical aortic valve replacement and TAVR.

Impact of Balloon-Expandable TAVR Valve Deformation and Calcium Distribution on Outcomes in Bicuspid Aortic Valve.

Background: Research on the role of transcatheter heart valve (THV) deformation and calcium distribution in patients with bicuspid aortic valves (BAVs) undergoing transcatheter aortic valve replacement (TAVR) remains limited.

Objectives: The aim of this study was to evaluate the impact of THV deformation on clinical outcomes in individuals with BAVs undergoing TAVR and the influence of calcium on these outcomes.

Methods: In total, 229 consecutive patients with BAVs who underwent TAVR with balloon-expandable valves and had computed tomography (CT) performed 30 days post-TAVR were analyzed.

Quantification of Aortic Valve Fibrotic and Calcific Tissue from CTA: Prospective Comparison with Histology.

Background Quantifying the fibrotic and calcific composition of the aortic valve at CT angiography (CTA) can be useful for assessing disease severity and outcomes of patients with aortic stenosis (AS); however, it has not yet been validated against quantitative histologic findings. Purpose To compare quantification of aortic valve fibrotic and calcific tissue composition at CTA versus histologic examination. Materials and Methods This prospective study included patients who underwent CTA before either surgical aortic valve replacement for AS or orthotopic heart transplant (controls) at two centers between January 2022 and April 2023.

Permanent pacemaker reduction using temporary-permanent pacemaker as a 1-month bridge after transcatheter aortic valve replacement: a prospective, multicentre, single-arm, observational study.

Background: The permanent pacemaker (PPM) implantation and pacemaker dependency rates after transcatheter aortic valve replacement (TAVR) are highly variable as some of the conduction disturbances are reversible. It remains poorly investigated how to optimise temporary pacing in these patients. This study aimed to explore the potential reduction in the PPM implantation rate using temporary-permanent pacemaker (TPPM) as a 1-month bridge.

Two-Year Clinical Outcomes of Staged Transcatheter Mitral Edge-to-Edge Repair After Transcatheter Aortic Valve Replacement.

Residual significant mitral regurgitation (MR) can increase the risk of adverse events after transcatheter aortic valve replacement (TAVR). The clinical benefits of staged transcatheter edge-to-edge repair (TEER) after TAVR remain underexplored. This study aimed to investigate the clinical outcomes of staged TEER for residual significant MR after TAVR.