Percutaneous Coronary Intervention for Acute Coronary Syndrome in Young Adults on Dialysis: Insights from Houston Methodist Young ACS-PCI Registry.

AMI and coronary intervention in patients undergoing dialysis are associated with poor survival outcomes. Despite a downward trend in the overall incidence of MI, the incidence among young adults is on the rise. This is a retrospective study including patients from the Houston Methodist Young ACS-PCI registry.

Ideal Navitor Implant Depth for Redo-TAVR Feasibility and Coronary Access: A CT Simulation Study.

Background: The impact of implant depth of the Abbott Navitor intra-annular, self-expanding valve on redo-transcatheter aortic valve replacement (TAVR) feasibility is unknown.

Objectives: The authors sought to determine the feasibility of redo-TAVR and coronary access with Edwards Sapien 3 (S3) valve after initial Navitor valve, based on various implant depths on computed tomography (CT) simulation.

Methods: Using 2050 pre-TAVR CTs of patients with native aortic stenosis, initial Navitor TAVR simulations were done at 3 implant depths (0 mm, 3 mm, and 5 mm), with frame expansion assumed at native annular dimensions and commissural alignment not achievable.

Thrombectomy during Percutaneous Coronary Intervention in Patients With St Elevation Myocardial Infarction.

Adjunctive thrombectomy during percutaneous coronary intervention (PCI) involves the mechanical removal of thrombus prior to balloon inflation and stent deployment .This has been a topic of ongoing debate in the management of ST-elevation myocardial infarction (STEMI), with prior studies yielding mixed outcomes. In this retrospective cohort study utilizing the TriNetX network, we analyzed data from hospitalized STEMI patients who underwent PCI between January 1, 2016, and December 31, 2023, stratifying them based on the use of adjunctive thrombectomy.

Innovations in TAVR: The Latest in Device Technology.

Aortic stenosis is the most prevalent valvular disease globally. Transcatheter aortic valve replacement (TAVR) has become a well-established treatment for aortic stenosis, offering outcomes comparable to surgical aortic valve replacement (SAVR). Its use has expanded to include younger, lower-risk patients and those with more complex anatomies.

Stent Frame Deformation of Self-Expanding Transcatheter Heart Valves in Bicuspid Aortic Stenosis and Impact on Valve Performance.

Aims: To evaluate stent frame expansion and ellipticity of the Evolut™ transcatheter heart valve (THV) and its subsequent impact on valve performance in patients with bicuspid aortic stenosis (AS) using pre- and post-procedural cardiac computed tomography (CT). In transcatheter aortic valve implantation (TAVI) for native bicuspid AS, concerns arise regarding the risk for reduced stent frame expansion and increased ellipticity compared with valves implanted in tricuspid AS. The implications of stent frame under-expansion and eccentricity on THV performance remain unclear.

CT and Fluoroscopic Analyses of Valve Expansion in Redo-TAVR: A First-in-Human Report.

Background: Redo transcatheter aortic valve replacement (TAVR) for transcatheter aortic valve (TAV) failure is becoming increasingly common. Although short-term outcomes appear favorable, no imaging after redo-TAVR has been performed to evaluate frame expansion and geometry.

Objectives: The authors report a first-in-human experience using multidetector computed tomography (MDCT) and fluoroscopy to evaluate valve frame expansion and geometry of both index and second TAVs.

Aortic Stenosis and Mitral Regurgitation: Takeaways From the Heart Valve Collaboratory Workshop on Multivalvular Disease.

The management of multivalvular disease presents increasing challenges in clinical practice caused by complex hemodynamic interactions and limited guideline-based recommendations. As part of the inaugural collaboration between JACC and the Heart Valve Collaboratory (HVC), this paper synthesizes key insights from the 2024 HVC workshop focused on concomitant aortic stenosis + mitral regurgitation. The document outlines the burden of disease, limitations of current surgical and transcatheter approaches, and variability in clinical decision-making caused by gaps in evidence.

Mitral valve surgery after failed transcatheter intervention for mitral regurgitation: surgical techniques, challenges and outcomes.

Objectives: This review article aims to examine the surgical approach to patients with failed mitral transcatheter edge-to-edge repair (M-TEER), focusing on operative challenges, decision-making and contemporary outcome data. Technical considerations, including device removal and the management of complex mitral valve (MV) anatomy, are discussed.

Methods: We performed a comprehensive literature review and gathered the experience from high-volume centres in the surgical management of failed M-TEER.

Risk of Coronary Obstruction in Redo-Transcatheter Aortic Valve Replacement Between Bicuspid and Tricuspid Aortic Valves.

Background: Transcatheter aortic valve replacement (TAVR) is approved across all risk profiles, including patients with bicuspid aortic valves. These patients are generally younger, with a higher chance of reintervention.

Objectives: The aim of this study was to compare the feasibility of redo transcatheter aortic valve (TAV) between bicuspid and tricuspid aortic valves.

The current state of redo transcatheter aortic valve replacement (TAVR) and limitations: why TAVR explant is important as the valve reintervention strategy.

The rise of transcatheter aortic valve replacement (TAVR) over the past two decades has substantially changed the lifetime management of patients with aortic valve disease. As the indications for TAVR expand to include younger and lower-risk patients, the proportion of patients who subsequently require reintervention for failed transcatheter heart valves (THVs) will increase. The two primary options for reintervention are redo TAVR and TAVR explant followed by surgical aortic valve replacement (SAVR).

Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry.

Background: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied.

Objectives: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER.

Methods: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER.

Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020.

•Study design: Utilized the National Readmission Database from 2018-2020. The study included patients over 18 years of age who underwent transcatheter edge-to-edge repair and analyzed readmission for mitral valve (MV) surgery within 180 days.•Readmission rate: Only 1.

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.

Young adults with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the Houston Methodist Young ACS-PCI Registry.

Background: Limited data exist on the risk profile and prognosis of young patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This study sheds light on the burden of cardiovascular risk factors and outcomes in this population.

Methods: The Houston Methodist Young ACS-PCI registry is a retrospective analysis of young adults (18 to 50 years) undergoing PCI for ACS between 2010 and 2022.

Meta-Analysis of Dedicated vs Off-Label Transcatheter Devices for Native Aortic Regurgitation.

Background: Transcatheter aortic valve replacement (TAVR) for high surgical risk patients with severe native aortic regurgitation (AR) presents unique challenges. Dedicated devices such as the JenaValve (JenaValve Technology) and J-Valve (JC Medical Inc) show promising results in addressing these challenges.

Objectives: This study compares the safety and efficacy of dedicated vs off-label devices among high surgical risk patients with pure native AR.

Outcomes of mitral transcatheter edge-to-edge repair in patients with mitral annular calcification: A meta-analysis.

Background: The impact of mitral annular calcification (MAC) on the clinical outcomes of patients undergoing mitral transcatheter edge-to-edge repair (MTEER) remains unclear. This meta-analysis aims to evaluate the clinical outcomes of MTEER among patients with moderate to severe MAC compared to those with mild or no MAC.

Methods: We systematically searched PubMed, EMBASE, and Cochrane CENTRAL databases through March 31st, 2024, comparing clinical outcomes of MTEER among patients with moderate/severe (MAC+) versus no/mild MAC (MAC-).

A Comprehensive Evaluation of the NAVITOR Transcatheter Aortic Valve Replacement System.

Transcatheter aortic valve replacement (TAVR) has undergone significant advancements in the last two decades, expanding its indications and refining transcatheter heart valve (THV) and delivery system designs to improve procedural success and patient outcomes. This review focuses on the Navitor™ valve, a third-generation intra-annular Portico™ valve (Abbott Structural Heart, St Paul, MN, USA) designed to address TAVR complications, particularly paravalvular leak (PVL). We present an overview of the Navitor™ system, comparing it to the first-generation Portico™ THV in terms of THV design, key iterations and clinical outcomes.