Early safety after TAVR according to VARC-3 criteria: incidence, predictors, and clinical impact.

Introduction And Objectives: The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria.

Methods: We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR.

Transcatheter aortic valve replacement in aortic stenosis patients with New York Heart Association functional class III or IV.

Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).

Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs.

Novel cardiac CT method for identifying the atrioventricular conduction axis by anatomic landmarks.

Background: Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy.

Objective: Cardiac structures visible with clinical imaging have been demonstrated to correlate with variability in the conduction system course. We aimed to standardize and assess the reproducibility of predicting the location of the atrioventricular conduction axis by cardiac computed tomography.

Prospective Validation of a Pre-Specified Algorithm for the Management of Conduction Disturbances Following Transcatheter Aortic Valve Replacement. The PROMOTE Study.

Background: There is a large variability regarding the management of conduction disturbances (CDs) after TAVR.

Objectives: To validate a pre-specified algorithm for managing CDs in patients undergoing TAVR.

Methods: Prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR.

Percutaneous Atrial Septostomy in Adult Patients on Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock: A Canadian Single-Center Experience.

Patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop left ventricular (LV) distension and pulmonary edema due to an increased LV afterload. A balloon atrial septostomy (BAS) is a technique used to alleviate LV pressure and facilitate left atrial decompression. While primarily performed in pediatric populations, this procedure's feasibility in adult patients is less studied.

Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices.

Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in aortic stenosis patients. However, the factors associated with poorer outcomes among AF patients in contemporary TAVR practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.

Methods: Multicenter study including consecutive patients with a history of AF, evaluating the clinical outcomes and predictors of mortality, and HF-related hospitalization, who underwent TAVR with newer-generation devices using balloon or self-expandable valves.

Impact of intensive versus nonintensive antithrombotic treatment on device-related thrombus after left atrial appendage closure.

Introduction And Objectives: The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.

Methods: This study included patients who underwent successful LAAC in 9 centers.

Conduction Disturbances After Transcatheter Aortic Valve Replacement: An Update on Epidemiology, Preventive Strategies, and Management.

Conduction disturbances (CDs) are common after transcatheter aortic valve replacement. Continuous improvements in preprocedural planification, implant techniques, and device design have markedly reduced periprocedural complications. However, CDs rate remains in the double-digit range.

Transcatheter Interventions in Adults With Fontan Palliation.

The Fontan circuit is associated with chronically elevated systemic venous pressures and decreased cardiac output, often leading to circuit failure. Managing Fontan circuit failure is complex and requires multiple therapeutic options. Transcatheter interventions have emerged as a reliable approach.

Validation of the Valve Academic Research Consortium High Bleeding Risk Definition in Patients Undergoing TAVR.

The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk (HBR) in patients undergoing transcatheter aortic valve replacement (TAVR). The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale TAVR population. Multicenter study including 10,449 patients undergoing TAVR.

Von Willebrand Factor Activity Association With Outcomes After Transcatheter Edge-to-Edge Mitral Valve Repair.

Background: Residual mitral regurgitation (MR) is associated with worse outcomes after transcatheter edge-to-edge mitral valve repair (TEER). Shear stress induced by MR leads to altered von Willebrand factor activity (vWF:Act) and increased closure time with adenosine diphosphate (CT-ADP).

Objectives: The purpose of this study was to investigate the use of CT-ADP to monitor MR during TEER and the association between the vWF, residual MR, and clinical events post-TEER.

A Novel Echocardiographic Parameter to Confirm Low-Gradient Aortic Stenosis Severity.

Background: In patients with low-gradient (LG) aortic stenosis (AS), confirming disease severity and indication of intervention often requires dobutamine stress echocardiography (DSE) or aortic valve calcium scoring by computed tomography. We hypothesized that the mean transvalvular pressure gradient to effective orifice area ratio (MG/EOA, in mm Hg/cm) measured during rest echocardiography identifies true-severe AS (TSAS) and is associated with clinical outcomes in patients with low-flow, LG-AS.

Objectives: The purpose of this study was to evaluate the diagnostic and prognostic value of MG/EOA ratio.

Thrombocytopenia after transcatheter aortic valve implantation.

Introduction And Objectives: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.

Methods: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *10/L.

Treatment of Transcatheter Aortic Valve Thrombosis: JACC Review Topic of the Week.

Transcatheter aortic valve (TAV) thrombosis may manifest as subclinical leaflet thrombosis (SLT) and clinical valve thrombosis. SLT is relatively common (10%-20%) after transcatheter aortic valve replacement, but clinical implications are uncertain. Clinical valve thrombosis is rare (1.

Antithrombotic therapy for transcatheter structural heart intervention.

Percutaneous transcatheter structural heart interventions have considerably expanded within the last two decades, improving clinical outcomes and quality of life versus guideline-directed medical therapy for patients frequently ineligible for surgical treatment. Transcatheter structural heart interventions comprise valve implantation or repair and also occlusions of the patent foramen ovale, atrial septal defects and left atrial appendage. These procedures expose structural devices to arterial or venous blood flow with various rheological conditions leading to potential thrombotic complications and embolisation.