Tricuspid valve replacement outcomes by baseline tricuspid regurgitation severity: the TRISCEND II trial.

Background And Aims: The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy versus medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity.

Methods: The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR and randomised 2:1 to TTVR (n=267) or control (n=133).

Mid-Term Outcomes of Balloon-Expandable Aortic Valve-in-Valve Replacement in the United States.

Background: Aortic valve-in-valve (AViV) replacement for is approved for patients with degenerated surgical valves at high or prohibitive surgical risk, mostly on the basis of small series with short-term follow-up.

Objectives: The aim of this study was to analyze the outcomes of AViV therapy using contemporary balloon-expandable valves (BEVs) in a large series with mid-term outcomes.

Methods: BEV AViV patients (June 2015 to December 2023) in the Society for Thoracic Surgeons (STS)/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were propensity matched to native transcatheter aortic valve replacement (TAVR) patients.

SESAME technique: septal scoring along the midline endocardium.

Background: The management of interventricular septal hypertrophy is an area of rapidly increasing interest, spurred by continued challenges with transcatheter mitral valve replacement (TMVR) and the management of obstructive hypertrophic cardiomyopathy (oHCM).

Aims: We sought to evaluate the reproducibility of septal scoring along the midline endocardium (SESAME), a novel transcatheter intervention designed to replicate surgical myotomy.

Methods: This single-centre, retrospective review included all patients who underwent the SESAME procedure at the University of Washington from January 2022 to September 2024.

Clinical Outcomes for Closure of Iatrogenic Atrial Septal Defects Following Transseptal SAPIEN Mitral Valve-in-Valve Procedures.

Background: Iatrogenic atrial septal defects (iASD) are created during transseptal (TS) mitral valve-in-valve (MViV) implantation to facilitate access. Although most iASD remain untreated, the outcomes of closing iASD during TS MViV are unclear. This study evaluates outcomes of concomitant iASD closure during TS MViV.

Novel Use of MitraClip for Treatment of Severe Aortic Regurgitation.

A 33-year-old man with unrepaired tetralogy of Fallot, Eisenmenger syndrome, and torrential aortic regurgitation secondary to previous endocarditis (now sterilized) presented to a local hospital with recurrent decompensated heart failure. Gated computed tomography demonstrated no calcification and an annulus area of 1328 mm. The patient's anatomy included an overriding aorta and a large ventriculoseptal defect, allowing for antegrade delivery of a MitraClip NT, which was successfully implanted between the right and noncoronary cusps.

Impact of systematic intravascular imaging on the outcomes of complex and higher-risk percutaneous coronary intervention.

Background: Intravascular imaging (IVI) improves the outcomes of percutaneous coronary intervention (PCI). However, the benefit of a systematic approach versus an already higher usage rate remains unclear. This study investigates the short-term impact of systematic IVI utilization during PCI in a complex higher-risk interventional PCI (CHIP-PCI) center.

Impact of social determinants of health in patients undergoing percutaneous coronary intervention.

Background: Social determinants of health (SDOH) influence the outcomes of patients undergoing cardiovascular procedures. The area deprivation index (ADI) is a multidimensional tool designed to evaluate SDOH at the census block level, which has received limited study in cardiology. This study evaluated the impact of the ADI on short-term clinical outcomes after percutaneous coronary intervention (PCI).

Predicting Mortality and Periprocedural Adverse Events in Patients Undergoing Complex and Higher Risk Percutaneous Coronary Intervention.

Background: The estimation of periprocedural risk in patients undergoing complex and higher risk percutaneous coronary intervention (CHIP-PCI) is challenging. In this study we aimed to compare the performance of 3 different risk-scoring systems---National Cardiovascular Data Registry (NCDR) CathPCI, British Cardiovascular Intervention Society (BCIS)-CHIP, and Blue Cross Blue Shield of Michigan Cardiovascular Consortium 2 (BMC2)---in predicting mortality and major adverse cardiac and cerebrovascular events (MACCEs) in a population of patients undergoing CHIP-PCI at a specialized centre.

Methods: The primary endpoints of this study were in-hospital mortality and MACCE.

5-Year Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients.

Background: The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients with Aortic Stenosis) trial compared SAPIEN 3 transcatheter aortic valve replacement (TAVR) to surgery in low-risk patients with symptomatic, severe aortic stenosis. Echocardiographic outcomes at 5 years are unknown.

Objectives: This study sought to compare 5-year echocardiographic results of TAVR and surgery in the PARTNER 3 trial.

Measure Twice, Clip Once: Real-Time Assessment of Transcatheter Mitral Valve Edge-to-Edge Repair Stability.

Transcatheter edge-to-edge repair of the mitral valve is a commonly accepted therapeutic alternative for a subset of patients with symptomatic mitral regurgitation. Societal guidelines focus on the screening of patients to identify suitable candidates and evaluation of postprocedural results, including residual regurgitation and transvalvular gradient. We present a case with excellent immediate reduction of mitral regurgitation by transcatheter edge-to-edge repair, but subsequent development of single leaflet detachment that may have been prevented by intraprocedural quantitative echocardiographic assessments.

Risk of acute kidney injury after percutaneous coronary intervention with plaque modification.

Background: The use of plaque modification techniques during percutaneous coronary interventions (PCI) has increased. However, these procedures are linked to higher contrast volume and hypotensive episodes, which are risk factors for acute kidney injury (AKI). This study examined the effects of various plaque modification techniques on AKI after PCI.

Use of a Bare Metal Dissection Stent to Manage Aortic Embolization of a Self-Expanding Valve.

Background: This paper describes a case of prosthesis embolization during transcatheter aortic valve replacement (TAVR) that was managed with a novel percutaneous strategy.

Case Summary: A 77-year-old man with severe trileaflet aortic valve stenosis underwent TAVR with a 29-mm Evolut FX. The valve embolized to the ascending aorta shortly after its release.

A Novel Protocol for Contrast-Free Transcatheter Aortic Valve Replacement Evaluation and Implantation.

Background: We aimed to develop a transcatheter aortic valve replacement (TAVR) sizing algorithm and implantation method to facilitate safe and effective TAVR without contrast use in patients with severe chronic kidney disease (CKD) who do not yet require renal replacement therapy. Patients with CKD are a challenging patient subset to treat using standard TAVR care pathways which most usually require the use of iodinated contrast media both during gated computed tomography (CT) angiography sizing, and valve deployment. Iodinated contrast exposure may worsen kidney function in a dose-dependent fashion, and may result in a need for renal replacement therapy.

Transcatheter Mitral Valve Replacement Using Annular Reduction by Cinching With TEER in the Commissure (ARCTIC).

Background: Mitral annular calcification with valve dysfunction remains a challenging syndrome. Operative risk is high, and available transcatheter therapies are limited.

Methods: This study describes our initial experience with a novel procedure to address large mitral annuli when no surgical or trial-based transcatheter mitral valve replacement device is available.

Transcatheter Myotomy for Hypertrophic Obstructive Cardiomyopathy.

Purpose Of Review: To describe the emerging role of transcatheter septal myotomy in the treatment of hypertrophic obstructive cardiomyopathy.

Recent Findings: Transcatheter septal myotomy was developed to address risk of LVOT obstruction during TMVR, however it has been performed in patients with LVOT obstruction related to hypertrophic cardiomyopathy, in whom it improves symptoms, reduces LVOT gradients, and is associated with low incidence of procedural complications. Transcatheter myotomy is a novel approach to address LVOT obstruction related to hypertrophic cardiomyopathy in patients who are not favorable surgical candidates.

5-Year Outcomes of Anterior Mitral Leaflet Laceration to Prevent Outflow Obstruction.

Background: Left ventricular outflow tract (LVOT) obstruction is a common, often fatal complication of transcatheter mitral valve replacement (TMVR). Laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) was safe and effective at preventing LVOT obstruction at 30 days in the National Heart, Lung, and Blood Institute LAMPOON trial.

Objectives: The authors report the 5-year outcomes of intentional anterior mitral leaflet laceration before SAPIEN 3 TMVR, in patients at risk of LVOT obstruction.