Feasibility, Efficacy, and Safety of the Mitral Annulo-TRIpsy in eXtreme Risk Patients.

Background: Severe calcific mitral stenosis is common and therapeutically challenging. Intravascular lithotripsy (IVL) can facilitate percutaneous balloon mitral valvuloplasty in patients not amenable to conventional therapies. We describe a modified technique using larger IVL balloons to ensure maximal annular contact and delivery of ultrasonic shockwaves to restore mitral leaflet pliability and reduce transvalvular gradients without the need for noncompliant valvuloplasty balloons.

Predicting the Surge in Valve-in-Valve Volume: A Comparative Study of Japan and the United States.

Background: Understanding trends in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) utilization is essential for predicting valve-in-valve (ViV) TAVR usage, a viable option for failed bioprosthetic valves that presents a promising avenue for lifetime management of aortic stenosis.

Objectives: This study aimed to predict and compare the future annual ViV volume in the United States and Japan based on past and current TAVR/SAVR utilization under some underlying assumptions.

Methods: We developed a MATLAB-based Monte Carlo model engine to simulate the lifespan of bioprosthetic TAVR and SAVR valves.

Early U.S. Commercial Experience With a Novel Transcatheter Edge-to-Edge Repair System: Insights From Real-World Data.

Background: The PASCAL Precision transcatheter valve repair system provides a new option for treating prohibitive surgical risk patients with significant, symptomatic degenerative mitral regurgitation (DMR).

Objectives: The authors report early U.S.

Balloon-Assisted Leaflet Laceration to Prevent Coronary Obstruction During TAVR: Step-by-Step Modified UNICORN.

Objectives: Coronary obstruction (CO) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Undermining iatrogenic coronary obstruction with radiofrequency needle (UNICORN) has been recently described as a novel strategy to prevent CO during TAVR. We describe here the step-by-step technique of a modified version of UNICORN.

Staging Aortic Stenosis Based on Cardiac Damage: A New Tool for Risk Prediction, Clinical Decision-Making, and Trial Design.

Staging based on extra-valvular cardiac damage is an intuitive approach to categorizing patients with aortic stenosis (AS) that is easily applied using widely available echocardiographic tools. As discussed in this review, it has been shown to be a powerful tool for risk stratification that complements conventional approaches. The original and most widely used framework identifies stage 0 when there is AS without additional cardiac damage; stage 1 when there is left ventricular damage (hypertrophy, systolic or diastolic dysfunction with evidence of elevated filling pressures); stage 2 when there is mitral dysfunction (moderate or greater mitral regurgitation, typically secondary) or left atrial abnormalities (left atrial enlargement or atrial fibrillation); stage 3 when there is pulmonary hypertension and/or moderate or greater tricuspid regurgitation (typically secondary); and stage 4 when there is moderate or greater right ventricular dysfunction.

Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation In Valvular Cardiogenic Shock.

Background: Treatment of valvular cardiogenic shock (VCS) is challenging as the options for mechanical cardiocirculatory support are limited. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) is a mechanical cardiocirculatory support strategy that provides cardiocirculatory support and simultaneous left ventricular unloading, compared to traditional VA-ECMO.

Methods: This is a single-center retrospective analysis of patients with VCS who underwent LAVA-ECMO between 2018 and 2023.

A Comprehensive Review of Left Atrial Venoarterial Extracorporeal Membrane Oxygenation.

Cardiogenic shock (CS) in patients with structural heart disease (SHD) and severe valvular abnormalities poses unique challenges to traditional mechanical circulatory support (MCS) strategies, such as intra-aortic balloon pumps and ventricular assist devices. These devices may fail to address the complex interplay between ventricular unloading and systemic perfusion. Left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) incorporating left atrial (LA) drainage into the ECMO circuit to reduce left ventricular (LV) preload, mitigate pulmonary congestion, and maintain systemic perfusion.

Acute Valve Syndrome in Aortic Stenosis.

Background: To describe the impact of clinical presentation among patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).

Methods: We analyzed a real-world dataset including patients from 29 US hospitals (egnite Database, egnite). Patients over 18 years old with moderate or greater AS undergoing AVR were included.

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.

Early aortic valve replacement versus conservative management in asymptomatic severe aortic stenosis: Meta-analysis of time-to-event data of randomized controlled trials.

Background: Current guidelines recommend aortic valve replacement (AVR) for symptomatic patients with severe aortic stenosis (AS), but the optimal timing for intervention in asymptomatic patients is still debated. Recent randomized controlled trials (RCTs) have offered new insights, prompting a reevaluation of the potential benefits of early AVR.

Methods: A systematic review and pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data of RCTs published by November 2024 was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.

The Staging of Cardiac Damage for Aortic Stenosis: A Review.

The advent and success of transcatheter aortic valve replacement (TAVR) for the treatment of severe, symptomatic aortic stenosis (AS) has sparked a renewed interest in the disease process associated with the valve disorder. While it is evident that untreated AS is fatal, the progressive and cumulative effects of AS on the heart have only recently been studied in a widespread fashion, after the initial pivotal TAVR trials in the United States. From these data, a novel staging system has been developed to characterize the extent of cardiac damage caused by AS.

Health Care Cost and Resource Utilization After Aortic Valve Replacement According to the Extent of Cardiac Damage.

Background: The extent of cardiac damage has been shown to be associated with increased mortality, repeat hospitalization, and decreased quality of life after aortic valve replacement (AVR). However, the association between the extent of cardiac damage at the time of AVR and health care costs and resource utilization has never been described.

Methods: The Optum de-identified Market Clarity database was used to identify patients with aortic stenosis treated with AVR between 2016 and 2022.

Orbital atherectomy versus balloon angioplasty before drug-eluting stent implantation in severely calcified lesions eligible for both treatment strategies (ECLIPSE): a multicentre, open-label, randomised trial.

Background: Coronary artery calcification is common among patients undergoing percutaneous coronary intervention (PCI), and severe coronary artery lesion calcification is associated with increased procedural complexity, stent under-expansion, and high rates of intraprocedural complications and out-of-hospital adverse events. Whether calcium ablation before stent implantation can mitigate these adverse events is not currently established. We aimed to prospectively compare orbital atherectomy with a balloon angioplasty-based strategy before stent implantation for the treatment of severely calcified coronary lesions.

Cardiac Biomarkers in Patients With Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY TAVR Trial.

Background: The EARLY TAVR trial (Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis) demonstrated that early transcatheter aortic valve replacement (TAVR) intervention was superior to clinical surveillance with delayed TAVR in patients with asymptomatic severe aortic stenosis. Cardiac biomarkers are associated with maladaptive remodeling, symptom onset, and worse outcomes after TAVR. Whether elevated biomarkers identify asymptomatic patients more likely to benefit from early intervention is unknown.

Predicting Treatment of Bioprosthetic Aortic Valve Failure in the United States: A Proposed Model.

•Transcatheter aortic valve replacement (TAVR) is the dominant treatment for aortic stenosis; the need to treat TAVR failure is increasing.•TAVR valve-in-valve (ViV) is predicted to reach ∼42,000 procedures by 2035.•TAVR ViV will represent ∼15% of all TAVR performed by 2035.

Transcatheter Mitral Valve Replacement With Atrial Fixation for Treatment of Atrial Functional Mitral Regurgitation.

Background: Many patients with atrial functional mitral regurgitation are not suitable candidates for surgery or transcatheter repair. For transcatheter mitral valve replacement, a common contraindication is the risk of left ventricular outflow tract obstruction, particularly in patients with atrial functional mitral regurgitation, who have characteristically small left ventricles. Herein, we examine the outcomes of transcatheter mitral valve replacement using the AltaValve system, which employs atrial fixation thus minimizing left ventricular outflow tract obstruction risk.

Late Clinical Outcomes of Balloon-Expandable Valves in Small Annuli: Results From the PARTNER Trials.

Background: Short-term clinical outcomes after transcatheter aortic valve replacement (TAVR) are similar in individuals with small or large annuli. The longer term impact of prosthesis-patient mismatch (PPM) and mean gradient (MG) post-TAVR in these patients remains controversial.

Objectives: The aim of this study was to investigate 5-year outcomes in patients with small vs large annuli.

The reversibility of cardiac damage after transcatheter aortic valve implantation and short-term outcomes in a real-world setting.

Aims: This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI), and to investigate the prognostic value of cardiac damage stage evolution.

Methods And Results: Patients with severe aortic stenosis (AS) undergoing TAVI were retrospectively analysed. A five-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI.

Five- Year Outcomes in Low-Risk Patients Undergoing Surgery in the PARTNER 3 Trial.

Background: Surgery remains an important treatment for low-risk patients with severe symptomatic aortic stenosis (AS). This study evaluated 5-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized Placement of Aortic Transcatheter Valves (PARTNER) 3 trial.

Methods: In the PARTNER 3 trial, 454 patients underwent surgery for severe, symptomatic, trileaflet AS and were followed up for 5 years.

Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis: A Systematic Review and Meta-Analysis.

Background: Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction.

Objectives: The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS.

Methods: Studies were quantitatively assessed in a meta-analysis using random-effects modeling.