Sex-specific outcomes after transcatheter or surgical treatment of aortic valve stenosis: the DEDICATE-DZHK6 trial.

Background And Aims: Aortic stenosis may be managed differently in women and men, but evidence remains limited. Sex-specific characteristics and outcomes of low- to intermediate-risk patients assigned to transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) from the DEDICATE-DZHK6 trial are described.

Methods: The DEDICATE-DZHK6 trial demonstrated non-inferiority for the primary outcome of all-cause death or stroke at 1 year.

Invasive and Echocardiographic Mean Transvalvular Pressure Gradients of Different Transcatheter Aortic Valve Prostheses.

This study aimed to assess the effectiveness and clinical relevance of intraprocedural invasive measurements-specifically intraprocedural mean pressure gradients (IC MPGs) and diastolic delta (DD)-in comparison with echocardiography for evaluating transcatheter heart valve (THV) performance across different prosthesis types. Particular attention was paid to comparing outcomes between balloon-expandable (BE) and self-expandable (SE) valves, with further stratification by aortic annulus size. A retrospective analysis was performed on 926 patients who underwent transcatheter aortic valve replacements (TAVRs) between 2012 and 2021.

Peri-interventional Anesthesia Strategies for Transcatheter Aortic Valve Implantation: A Multicenter, Randomized, Controlled, Non-inferiority Trial.

Background: Minimalist treatment strategies for transcatheter aortic valve implantation (TAVI) have been widely adopted due to continued procedural evolution, but large randomized trials are lacking. The DOUBLE-CHOICE trial evaluated safety and efficacy of a minimalist approach (MA) compared with standard of care (SoC) for transfemoral TAVI.

Methods: In this investigator-initiated, 2x2 factorial, open-label, randomized, multicenter, non-inferiority trial, patients with symptomatic aortic stenosis were included at 10 German sites.

Short- and Long-Term Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Patients With Chronic Lung Disease: An Analysis From the German Aortic Valve Registry.

Objectives: Data from the German Aortic Valve Registry (GARY) were analysed to determine whether there are differences between patients with and without chronic lung disease (CLD) undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) and whether TAVI or SAVR is more beneficial in patients with preexisting CLD.

Methods: Follow-up data from GARY registry patients treated from 2014 to 2015 and from 2018 to 2019 were incorporated in the analysis. Demographic results for each of the 2 treatment modalities were evaluated, and patients with and without CLD were compared.

The Evolving Risk of Infective Endocarditis After Transcatheter Aortic Valve Implantation.

Objectives: Despite increased use of transcatheter aortic valve implantation (TAVI) in older adults with severe aortic stenosis, contemporary data on infective endocarditis (IE)-an infrequent but serious complication-are lacking. This study addresses this gap in knowledge.

Methods: We analysed 280 073 Medicare beneficiaries who underwent TAVI between 2013 and 2022.

Understanding Aortic Stenosis and Transcatheter Aortic Valve Replacement in Women.

The impact of sex on the baseline characteristics, morphology, and clinical presentation of degenerative aortic stenosis (AS) is well-documented but remains poorly understood. Unlike valve surgery, for which patients have been predominantly male, percutaneous treatment of AS has shown balanced representation of both sexes, with women demonstrating greater benefit from transfemoral aortic valve replacement compared to surgical treatment. This review explores sex-specific differences in the epidemiology, pathophysiology, diagnostic challenges, treatment approaches, and clinical outcomes of degenerative AS.

Percutaneous Cannulation for Minimally Invasive Heart Valve Surgery: Results from a Multicenter Registry.

Objective: To avoid potential groin incision associated complications and further streamline surgery percutaneous femoral cannulation using different vascular closure devices (VCDs) has emerged to establish cardiopulmonary bypass during minimally invasive heart valve surgery (HVS).

Design: The Percutaneous peRipheral cannulatiOn for Minimally InvaSive heart valve surgEry (PROMISE) multicentre registry included patients, receiving percutaneous vascular access site (VAS) closure during minimally invasive HVS. Retrospective analyses were performed to evaluate major and minor VAS-related complications of plug- (group 1) vs suture-based (group 2) systems according to modified Valve Academic Research Consortium (VARC) 3 criteria (ie, retrograde dissection, vascular injury, conversion to surgical cut-down, or vascular intervention).

Aortic Valve Replacement in Women: A Pooled Analysis of the RHEIA and PARTNER 3 Trials.

Background: In women with severe aortic stenosis, there are limited data regarding outcome differences following transcatheter (TAVR) vs surgical aortic valve replacement (SAVR).

Objectives: The authors sought to examine outcomes of TAVR vs SAVR in a patient-level pooled analysis of women in the RHEIA and PARTNER 3 trials.

Methods: Patients in both trials were randomly allocated to a balloon-expandable SAPIEN 3/Ultra valve or to surgical bioprostheses.

Predictors of pacemaker implantation in aortic regurgitation patients treated with a dedicated transcatheter heart valve.

Background: The JenaValve Trilogy System (JVTS) is the only dedicated transcatheter heart valve system approved for treating patients with aortic regurgitation (AR). Recently, several studies have revealed high rates of permanent pacemaker implantation (PPI) exceeding 20% in patients with AR.

Aims: The aim of this study was to evaluate the incidence and risk factors for new PPI after transcatheter aortic valve implantation (TAVI) with the JVTS.

Procedural and Clinical Outcomes According to Ultrasound-Guided Access in TAVI: A Propensity-Matched Comparative Subanalysis From the PULSE Registry.

Background: Access-related vascular and bleeding complications during transcatheter aortic valve implantation (TAVI) are associated with significant morbidity and mortality. Ultrasound-guided (USG) puncture may reduce the incidence of these adverse events, particularly in large-bore arterial access. However, large-scale data on this approach are limited, and it has not yet been fully implemented into standard clinical practice.

Phenotypic clustering analysis of patients rejected for mitral valve interventions: implications for future transcatheter technologies.

Aims: Although several treatment options are available for patients with severe mitral regurgitation (MR), a significant proportion of patients remain ineligible for any mitral valve (MV) intervention. We aimed to analyse the phenotypic characteristics of surgical high-risk patients ineligible for MV interventions using an unsupervised phenotypic clustering approach.

Methods And Results: Between 2014 and 2022, the CHOICE-MI registry included 984 patients with MR undergoing screening for transcatheter MV replacement at 33 international sites.

Long-term outcome of bail-out ViV-TAVI at index procedure.

Objective: This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI).

Methods: We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality.

Transcatheter vs. surgical aortic valve replacement in women: the RHEIA trial.

Background And Aims: Although women with severe symptomatic aortic stenosis have more complications than men when undergoing surgical valve replacement, they are under-represented in clinical trials. The Randomized researcH in womEn all comers wIth Aortic stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) vs. surgery in women.

Gender differences in the presentation and management of patients with severe aortic stenosis at specialist versus primary/secondary care centres: A sub-analysis of the IMPULSE enhanced registry.

Background: Management and treatment of severe aortic stenosis (AS) may differ considerably in European countries. To investigate these differences in France, Germany, and the UK, the IMPULSE enhanced registry was established. Previous data revealed differences in how patients were managed in specialist (hub) versus primary/secondary care (satellite) centres.

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.

A propensity-matched comparison of plug- versus suture-based vascular closure after TAVI.

Background: Vascular access site complications are associated with increased morbidity and mortality after transcatheter aortic valve implantation (TAVI). Current results comparing strategies with plug- (P-VCD; MANTA) and suture-based vascular closure devices (S-VCD; Perclose ProGlide) remain inconsistent.

Aims: It was our aim to assess the incidence of access-related vascular complications after P-VCD or S-VCD strategies after transfemoral TAVI.

Initial Multicenter Experience With a Novel Self-Expanding TAVR System in Patients With Aortic Valve Stenosis.

Background: As transcatheter aortic valve replacement is performed increasingly in younger, low-risk patients, the need for commissural alignment and coronary access has increased. Design elements of the JenaValve Trilogy (JVT) transcatheter heart valve (THV) ensure both.

Objectives: This study sought to evaluate the outcome of patients with aortic stenosis (AS) treated with this novel transfemoral, self-expanding THV.

Femoral or Radial Secondary Access in TAVR: A Subanalysis From the Multicenter PULSE Registry.

Background: Transradial secondary access (TR-SA) may serve as an alternative to the traditional femoral secondary access (TF-SA) for pigtail placement in transcatheter aortic valve replacement (TAVR).

Objectives: The aim of this study was to assess the incidence of secondary access-related vascular complications after TR-SA or TF-SA in TAVR.

Methods: The PULSE (Plug or sUture based vascuLar cloSurE after TAVR) registry retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVR at 10 heart centers from 2016 to 2021.

Built-in selection or confounder bias? Dynamic Landmarking in matched propensity score analyses.

Background: Propensity score matching has become a popular method for estimating causal treatment effects in non-randomized studies. However, for time-to-event outcomes, the estimation of hazard ratios based on propensity scores can be challenging if omitted or unobserved covariates are present. Not accounting for such covariates could lead to treatment estimates, differing from the estimate of interest.

The influence of lipoprotein(a) on aortic valve calcification in patients undergoing transcatheter aortic valve replacement.

Background: Elevated levels of lipoprotein(a) (Lp[a]) have been recognized as substantial risk factors for cardiovascular disease and aortic stenosis (AS). However, the specific role of Lp(a) in promoting aortic valve calcification (AVC) and influencing mortality in elderly, multimorbid patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear and warrants further investigation.

Methods: A retrospective analysis was conducted on all consecutive patients who underwent TAVR between August 2019 and June 2020 at our clinic.

Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement.

Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.

Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.

Sex-related disparities in aortic stenosis from disease awareness to treatment: a state-of-the-art review.

This state-of-the-art review aimed to synthesize evidence from various sex-stratified studies on aortic stenosis (AS), focusing on the difference in clinical presentation, anatomical characteristics, pathophysiology, and management of AS. In comparison to men, women with AS are present at later stages, are older, more symptomatic, frailer, and exhibit higher operative risk [Society of Thoracic Surgeons (STS) score]. Women tend to have smaller aortic valve (AV) areas and left ventricular (LV) outflow tract, leading to lower stroke volumes (SVs) than men and have a higher prevalence of paradoxical, low-flow, low-gradient AS.