Ticagrelor Paradox: Systematic Review and Network Meta-Analysis.

Background: Based on the landmark PLATO (Platelet Inhibition and Patient Outcomes) and TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction) trials, current guidelines recommend ticagrelor and prasugrel over clopidogrel for acute coronary syndrome. However, subsequent studies have failed to replicate the reported benefits of ticagrelor, raising concerns about the validity of the PLATO trial's findings.

Methods: Randomized trials published until January 2025 were searched on PubMed and Embase and included if they compared 2 of the 3 standard dual antiplatelet therapies: 12 months aspirin plus clopidogrel, prasugrel, or ticagrelor.

Sex Differences in Safety and Efficacy of Dual Antiplatelet Therapy Strategies for Patients With Acute Coronary Syndromes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Sex-specific evidence on de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention in patients with acute coronary syndromes (ACS) remains limited. Females are often under-represented in randomized controlled trials (RCTs) and sex-based subgroup analysis in RCTs yield conflicting results. We searched PubMed and EMBASE in September 2024 for RCTs that investigated DAPT strategies for patients with ACS.

Vitamin K Antagonists Versus Direct Oral Anticoagulation After Transcatheter Mitral Valve Replacement.

Optimal anticoagulation strategies after transcatheter mitral valve replacement (TMVR) remain unknown with no randomized trial data. Current practices for anticoagulation after TMVR vary widely as a result. We aimed to compare clinical outcomes between vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) after transcatheter mitral valve replacement (TMVR) at our institution.

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: Updated Meta-Analysis.

Long-term data are essential for selection between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement in low-risk aortic stenosis (AS) patients. Given the recent randomized controlled trials (RCTs) and mid-term outcomes from existing trials, a reappraisal of the current literature is necessary. We systematically identified RCTs comparing TAVR and SAVR in low risk AS patients.

Impact of Sex and Age on Trends of Mortality From Infective Endocarditis in High-Income Countries.

Background: Characteristics of infective endocarditis vary by age and sex.

Objectives: The aim of the study was to identify how age and sex impact mortality due to infective endocarditis in high-income countries.

Methods: The World Health Organization mortality database was analyzed to determine trends in mortality from infective endocarditis in the United Kingdom, Germany, France, Italy, Japan, Australia, the United States, and Canada between 2000 and 2021.

BASILICA or snorkel stenting to prevent or treat coronary obstruction: Multicenter international COBRA-TAVR registry.

Coronary obstruction is a rare but life-threatening complication following transcatheter aortic valve replacement (TAVR). Comparative analysis between snorkel stenting and BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction) remain limited. We analyzed 122 patients from the COBRA registry, including 68 who underwent BASILICA and 54 who received snorkel stents.

Long-Term Outcomes Following Catheter-Based Therapies in Older Adults With Acute Pulmonary Embolism.

Background: Despite the increasing use of catheter-based therapies (CBTs) for acute pulmonary embolism (PE), evidence is limited regarding the long-term outcome.

Objectives: We aimed to investigate the efficacy of CBT for high- and intermediate-risk PE in older adults.

Methods: We included Medicare fee-for-service beneficiaries aged 65 to 99 years admitted for PE from 2017 to 2020 and compared in-hospital and long-term outcomes between patients treated with and without CBT.

Outcomes of isolated tricuspid replacement versus repair among older patients with tricuspid regurgitation in the United States.

Objective: Evidence is limited regarding early-term outcomes after isolated tricuspid operations for tricuspid regurgitation (TR). We compared the early-term outcomes after isolated tricuspid valve replacement versus repair using the contemporary data.

Methods: We analyzed the national data on Medicare beneficiaries aged ≥65 years who underwent isolated tricuspid valve replacement or repair for TR between January 2016 and December 2020.

Mechanical Thrombectomy vs Catheter-Directed Thrombolysis for High-Risk Pulmonary Embolism: A Target Trial Emulation.

Background: Evidence is limited regarding the comparative effectiveness and safety of mechanical thrombectomy (MT) vs catheter-directed thrombolysis (CDT) for high-risk pulmonary embolism (PE).

Objectives: This observational study aimed to compare the outcomes of older adults with high-risk PE treated with MT vs CDT using a target trial emulation framework.

Methods: We included Medicare fee-for-service beneficiaries aged 65 to 99 years admitted with high-risk PE (defined by cardiac arrest, shock, and vasopressor use) who underwent MT/CDT from 2017 to 2020.

How to avoid transcatheter aortic valve replacement explant as the second valve procedure: image assessment for the index transcatheter aortic valve replacement.

The management of severe aortic stenosis (AS) has evolved significantly, with a shift toward shared decision-making regarding the choice of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). This shift necessitates careful consideration of long-term valve durability, as both TAVR and SAVR with bioprosthetic valves offer limited durability, potentially requiring reoperation later in life. While mechanical valves and the Ross procedure offer lifelong durability, patient preferences, including avoidance of anticoagulation, often dominate the discussion.

Transcatheter versus surgical aortic valve replacement in low- to intermediate-risk patients: a meta-analysis of reconstructed time-to-event data.

Background: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for severe symptomatic aortic stenosis (AS), including low-risk patients. We aimed to update a systematic review and conduct a meta-analysis of reconstructed time-to-event data from randomized control trials (RCTs) in low-/intermediate-risk patients.

Methods: Systematic searches were performed in PubMed, EMBASE, Cochrane CENTRAL, and specific websites up to November 2023, for RCTs.

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.

Outcomes of Suction Debulking and Surgery in Patients With Isolated Tricuspid Valve Endocarditis.

Objective: Percutaneous vegetation debulking has been reported to treat tricuspid valve infective endocarditis (TVIE), but data on feasibility compared with conventional surgical strategies are limited. We aimed to compare short-term outcomes of suction debulking with partial venovenous bypass to conventional open surgery in this population.

Methods: This was a single-center, retrospective study that included all patients with isolated TVIE who underwent suction debulking with partial venovenous bypass or tricuspid valve surgery between January 2010 and December 2022.

Valvular Heart Disease-Related Mortality Between Middle- and High-Income Countries During 2000 to 2019.

Background: Valvular heart disease (VHD) management has evolved rapidly in recent decades, but disparities in health care access persist among countries with varying socioeconomic backgrounds.

Objectives: The purpose of this study was to investigate global mortality trends from VHD and assess the difference between middle- and high-income countries.

Methods: We obtained mortality data from the World Health Organization Mortality Database for VHD and its subgroups (rheumatic valvular disease [RVD], infective endocarditis [IE], aortic stenosis [AS], and mitral regurgitation [MR]) from 2000 to 2019.

Clinical Characteristics and Outcomes of Patients Undergoing 3 Aortic Valve Interventions: The THIRD Multicenter Registry.

Background: Lifetime treatment of aortic valve disease is a matter of increasing debate. Although the risks of a second aortic valve intervention are recognized, little attention has been given to the challenges of a third.

Objectives: This study delves into the clinical characteristics, indications, and outcomes of patients undergoing 3 aortic valve interventions.

Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Network Meta-Analysis.

Background: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, most but not all randomized trials have reported that complete revascularization (CR) offers advantages over culprit vessel-only revascularization. In addition, the optimal timing and assessment methods for CR remain undetermined.

Objectives: The purpose of this study was to identify the optimal revascularization strategy in patients with STEMI and multivessel disease, using a network meta-analysis of randomized controlled trials.

Long-term outcomes with medical therapy, transcatheter repair, or surgery for isolated tricuspid regurgitation: a systematic review and network meta-analysis.

Background: Several transcatheter tricuspid valve (TV) repair devices for tricuspid regurgitation (TR) have emerged. However, few studies have compared transcatheter TV repair with medical therapy (MT) alone or isolated TV surgery.

Methods: PubMed and EMBASE were searched in February 2024.

Impacts of Hospital Volume and Patient-Hospital Distances on Outcomes of Older Adults Receiving Percutaneous Microaxial Ventricular Assist Devices for Cardiogenic Shock.

Background: Percutaneous microaxial ventricular assist devices (pVADs) have the potential to reduce mortality of patients with cardiogenic shock (CS). However, the association between the distribution of pVAD-performing centers and outcomes of CS has not been explored.

Methods: This observational study included Medicare fee-for-service beneficiaries aged 65 to 99 years treated with pVAD for CS from 2016 to 2020.

The use of pulmonary artery catheter and clinical outcomes in older adults with cardiogenic shock.

Background: Evidence is lacking regarding the benefits of pulmonary artery catheter (PAC) for cardiogenic shock (CS).

Methods: We analyzed the data on Medicare fee-for-service beneficiaries aged 65-99 admitted with CS from 2016 to 2020 to compare outcomes of patients monitored with versus without PAC. We implemented propensity score matching weight (PSMW) analysis with hospital fixed effects (effectively comparing outcomes within the same hospital) and quasi-experimental instrumental variable (IV) analysis (accounting for potential unmeasured confounders) with the probability of using PAC for CS in the previous year as the instrument.

Transcatheter Pulmonary Valve Replacement in Middle and Late Adulthood.

Transcatheter pulmonary valve replacement (TPVR) is now frequently performed in patients with adult congenital heart disease. As the life expectancy of the population with adult congenital heart disease continues to improve, more patients will require pulmonary valve intervention. This study details the short-term and midterm clinical outcomes of patients aged ≥40 years who underwent TPVR.

Can We Six It? Double BASILICA Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve.

Coronary artery obstruction is an uncommon yet devastating complication of transcatheter aortic valve replacement (TAVR) and may necessitate leaflet modification. A 38-year-old man presented to our center with quadricuspid aortic valve with severe aortic regurgitation. Double leaflet modification was performed with the Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) technique prior to TAVR, creating 6 leaflets from 4.