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July 24, 2026E. Nolan Beckett, MD · Editor
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TODAYJACC. Case reports

Cryoextraction for Airway Bleeding After Valve-in-Valve Procedure.

BACKGROUND: Hemoptysis after percutaneous valve implantation is a rare but life-threatening complication. CASE SUMMARY: An 84-year-old woman with prior mechanical aortic and biological tricuspid valve replacements presented with tricuspid stenosis and regurgitation. A transcatheter valve-in-valve procedure using a 24.5-mm Myval was performed successfully. However, she developed severe hemoptysis, hypoxia, and ventilation difficulties shortly after the procedure. Flexible bron

1 min readBy E. Nolan Beckett, MDRead full story →
From the Editor
Edwards Lifesciences posted Q2 sales up 12.5% year-over-year with raised full-year guidance driven by TAVR and TMTT franchises. The clinical evidence released alongside that growth interrogates selection, not devices. A 2528-patient international M-TEER registry confirms that preprocedural NYHA IV independently predicts 2-year mortality (HR 1.75) even after effective MR reduction, and an infective endocarditis review of TAVR and M-TEER devices confirms that we still lack standardized management for a complication with rising absolute numbers. The market rewarded volume; the literature interrogated selection. That gap is where the case for earlier referral and disciplined patient triage tightens. NYHA IV at time of M-TEER for primary MR carries a 31.8% vs 21.1% 2-year mortality despite comparable procedural success — waiting until class IV is too late (Structural Heart). Venus Medtech completed enrollment in its self-expanding TAVR pivotal trial, adding another platform to a crowded self-expanding field (MassDevice). A radiology-led review of preprocedural CT for redo TAVR crystallizes the growing TAV-in-TAV planning burden as younger patients outlive their index THVs (Radiology: Cardiothoracic Imaging). GLP-1 RA add-on therapy was associated with broad post-cardiac-surgery mortality reduction; SGLT2i benefit was confined to HF/CKD subgroups with a renal signal at 600 days in unselected patients (Cardiology in Review). A critical appraisal of a recent SAVR survival prediction model flags omission of frailty and lack of external validation — lifetime-management decisions still lack rigorous risk tools (GTCS). What to watch: Boston Scientific Q2 earnings on July 29 — TriClip trajectory and any commentary on ACURATE neo2 following its US commercial pause will move the tricuspid and self-expanding TAVR narratives.
E. Nolan Beckett, MD · Editor
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The Valve Wire Weekly — 2026-07-25

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Aortic Valve (TAVR/TAVI)

40 articles

Edwards' 13.6% Q2 TAVR sales growth and Venus Medtech's completed self-expanding pivotal enrollment reflect a market expanding faster than durability data can validate. Three technique-focused papers signal where operators are spending their cognitive load: a Radiology: Cardiothoracic Imaging review on preprocedural CT for redo TAVR, a European Cardiology review of BASILICA, and a Future Cardiology review of direct TAVI vs predilatation. All three are downstream consequences of the ESC 2025 lifetime-management mandate: coronary access, valve-in-valve feasibility, and commissural alignment must be planned at the index procedure.

ESC 2025 still recommends SAVR for patients under 70 with low surgical risk (Class I); ACC/AHA 2020 holds the line at under 65. A critical appraisal in GTCS notes that current SAVR survival prediction tools lack frailty variables and external validation — so lifetime-management decisions are being made without adequate risk stratification on either side of the ledger. The direct-TAVI review supports selective, anatomy-driven predilatation over routine BAV, particularly for bicuspid anatomy, severe calcification, or horizontal aorta. A separate JACC Case Reports case of post-valve-in-valve hemoptysis rescued by bronchoscopic cryoextraction is a reminder that complications from redo transcatheter work are entering new territory.

View all 40 Aortic Valve articles →

Surgical vs Transcatheter

4 articles

No direct head-to-head trials today. A critical appraisal in General Thoracic and Cardiovascular Surgery targets a recent SAVR survival prediction model for lacking frailty variables, external validation, and decision curve analysis — a methodological critique that applies equally to most TAVR risk tools in current use. Lifetime-management decisions are being made on both sides with underpowered risk stratification. The qualitative study of post-TAVI cardiac rehabilitation participation (n=11, single-center, non-randomized) surfaces a related asymmetry: prehab and CR access is a poorly measured determinant of TAVR outcomes that does not appear in any comparison with SAVR.

Research2026 Jul

Infective Endocarditis of Transcatheter Aortic Valve Replacement and Transcatheter Edge-to-Edge Repair Devices.

JACC. Advances— Aoun J, Kharsa C, Desai P, Zeid KA, Goel SS et al.

Infective endocarditis following transcatheter aortic valve replacement and mitral valve transcatheter edge-to-edge repair poses a significant clinical challenge, necessitating a multidisciplinary approach for timely diagnosis and appropriate management that may include surgical intervention for patients of less than prohibitive risk. Although advances in imaging modalities, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography, show promise in enhancing diagnostic accuracy, standardized guidelines for management are lacking, especially regarding the appropriateness of antimicrobial suppression therapy. Future research should focus on refining diagnostic criteria, optimizing therapeutic strategies, and improving patient outcomes in these populations.

Research2026 Jul 23

A critical appraisal of "A novel survival prediction model after isolated surgical aortic valve replacement in the transcatheter aortic valve replacement era".

General thoracic and cardiovascular surgery— Akhtar I, Javaid MH

Maeda et al. recently proposed a model to predict long-term survival after isolated surgical aortic valve replacement (SAVR) in the transcatheter aortic valve replacement (TAVR) era. While the model shows encouraging discrimination and calibration, several methodological and clinical limitations may restrict its broader applicability. The authors selected the final six-variable model primarily on the basis of maximal five-year C-statistic, without formal sample size justification or contemporary shrinkage-based criteria. Validation was restricted to internal resampling within the same registry, limiting evidence for transportability. Important prognostic domains, notably frailty and key anatomical and comorbidity variables, were not incorporated, and performance was not directly compared with established risk scores. Reporting only partially aligns with modern prediction model guidelines and omits decision curve analysis, leaving clinical utility uncertain. Overall, the model represents a valuable step but requires methodological refinement and external validation before guiding lifetime management between SAVR and TAVR.EBM Rating: Level V evidence. The article represents expert opinion derived from the author's clinical experience and interpretation of existing literature, without original experimental, randomized, controlled, cohort, or comparative analytic data.

Research2026 Jul 23

Differential Effects of GLP-1 Receptor Agonist and SGLT2 Inhibitor Add-on Therapy on Outcomes Following Cardiac Surgery: A Propensity Score-Matched Analysis.

Cardiology in review— Biswas S, Wahba A, Srivastava Y, Kumar K, Chintagumpala V et al.

Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2is) reduce cardiovascular events in nonsurgical populations, yet their comparative effects as combination versus monotherapy after cardiac surgery remain unknown. Using the TriNetX US Collaborative Network (115 million patients, 67 healthcare organizations), we conducted a retrospective propensity score-matched cohort study of adults undergoing coronary artery bypass grafting or open valve surgery between January 2018 and January 2026, excluding transcatheter aortic valve replacement. Two prespecified analyses compared combination therapy (GLP-1 RA plus SGLT2i) with each monotherapy. One-to-one nearest-neighbor matching (caliper 0.1) balanced age, sex, race, ethnicity, comorbidities, and glycemic control. The primary outcome was all-cause mortality at 365 days, with prespecified subgroup analyses by heart failure (HF) and chronic kidney disease (CKD) status and sensitivity analyses at 180 and 600 days. After matching, Analysis 1 (combination vs GLP-1 RA monotherapy) included 6974 patients, and Analysis 2 (combination vs SGLT2i monotherapy) included 12,682 patients. Combination therapy was not associated with reduced mortality versus GLP-1 RA monotherapy overall (HR, 0.93; P = 0.587) but was associated with lower mortality versus SGLT2i monotherapy (HR, 0.60; P < 0.001), along with lower atrial fibrillation and major adverse cardiovascular events. The Analysis 1 mortality benefit emerged only in HF and CKD subgroups, with an acute kidney injury signal at 600 days. GLP-1 RA add-on therapy was associated with broad mortality reduction after cardiac surgery, whereas SGLT2i add-on benefit was confined to patients with HF or CKD, with potential renal risk in unselected patients. Prospective trials are warranted.

Research2026 Aug

The Role of Preprocedural CT in Redo Transcatheter Aortic Valve Replacement: A Radiologist's Perspective.

Radiology. Cardiothoracic imaging— Jukema RA, Levene E, Khoo JK, Bugis R, Haugan D et al.

As transcatheter aortic valve replacement (TAVR) has become a viable option across all surgical risk levels, younger patients are anticipated to outlive the durability of their index transcatheter heart valve (THV). When a THV fails, cardiac CT is an important tool to assess the mechanism of THV failure and aids in the differentiation between structural and nonstructural THV dysfunction mechanisms. After the identification of the index THV dysfunction mechanism, CT guides the sizing and selection of the new THV type. While the principles of preprocedural redo TAVR (often called TAV-in-TAV) CT assessment overlap with those for patients undergoing TAVR of surgical bioprosthetic valves, the assessment is different in several ways. These differences are primarily related to the need to evaluate the characteristics of the index THV and the degree of commissural and coronary alignment achieved during the index TAVR procedure, which affect the selection of the type and size of the new THV and determine the risks of coronary obstruction and impeded future coronary access, as well as the potential for leaflet modification. Keywords: Applications-CT, CT Angiography, Transcatheter Aortic Valve Implantation/Replacement, TAVI/TAVR Supplemental material is available for this article. ©RSNA, 2026.

Mitral Valve (Repair & Replacement)

1 article

[NOTABLE] Waiting until NYHA IV to refer primary MR patients for M-TEER erases much of the intervention's mortality benefit. In a 2528-patient international registry across 27 sites (2009–2023), Structural Heart reports that NYHA IV patients had comparable procedural success (residual MR ≤1+ in 66.7% vs 64.6%) and rehospitalization rates, but 2-year all-cause mortality of 31.8% versus 21.1% (HR 1.75, 95% CI 1.32–2.31, p<0.001). Registry data, not randomized; wide temporal span across device generations — those limitations acknowledged, the signal is consistent with two decades of surgical PMR literature: advanced symptoms and end-organ decompensation predict outcomes independent of what you do to the valve.

ESC 2025 upgraded early MV repair in asymptomatic severe PMR with preserved LV to Class I when 3 or more risk factors are present (AF, SPAP >50 mmHg, LA dilation, ≥moderate TR); ACC/AHA 2020 holds at Class IIa. This registry cuts in favor of the ESC position: by NYHA IV, transcatheter rescue underperforms. TEER remains Class IIa for PMR at high surgical risk in both guidelines — this registry doesn't change that indication, but it argues for earlier referral, whether the destination is surgery or TEER.

Research2026 Aug

Preprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation.

Structural heart : the journal of the Heart Team— Koell B, Plewe LX, Ludwig S, Weimann J, Patel D et al.

BACKGROUND: In patients with primary mitral regurgitation (MR) (PMR), advanced symptoms classified as New York Heart Association (NYHA) class IV are typically driven by valve deterioration. Transcatheter edge-to-edge repair (mitral valve transcatheter edge-to-edge repair [M-TEER]) reliably achieves effective reduction of mitral regurgitation in high-risk patients. However, whether or not preprocedural NYHA class IV continues to predict outcomes after successful MR reduction remains unclear. METHODS: The Outcomes of Patients tReated wIth Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation Registry includes PMR patients undergoing M-TEER at 27 international sites between 2009 and 2023. Clinical outcomes were compared between patients in NYHA class IV and those in NYHA class II/III. RESULTS: A total of 2528 patients were included (median age 82 years [interquartile range (IQR) 76-85], 45.9% female), and 19.7% presented in NYHA class IV. Baseline left ventricular ejection fraction and right ventricular function did not differ significantly between groups. Procedural success (residual MR ≤ 1+: 66.7% vs. 64.6%, p = 0.55) and 2-year rehospitalization rates (17.9% vs. 20.4%, log-rank p = 0.78) were comparable. In contrast, 2-year all-cause mortality was higher in NYHA class IV patients (31.8% vs. 21.1%, log-rank p < 0.0001). Multivariable Cox regression confirmed preprocedural NYHA class IV as an independent predictor of mortality (hazard ratio [HR] 1.75; 95% CI 1.32-2.31; p < 0.001). CONCLUSIONS: In PMR, preprocedural NYHA class IV remains an independent predictor of all-cause mortality after effective MR reduction with M-TEER, despite comparable postprocedural results.

Tricuspid Valve (Repair & Replacement)

1 article

No new tricuspid clinical data today. The ESC 2025 Class IIa endorsement of transcatheter TV treatment reframes how Edwards' TMTT revenue growth should be read: US reimbursement expansion will follow, and the TRISCEND II 30-day mortality of 3.1% in the STS/ACC TVT Registry sets the real-world bar. ESC 2025 simultaneously upgraded TV surgery for symptomatic severe primary TR to Class I — up from ACC/AHA 2020's IIa. No head-to-head data exists comparing repair versus replacement or surgical versus transcatheter approaches, and isolated TV surgery outcomes remain heavily contingent on timing of referral.

Research2026 Jul 23

Cryoextraction for Airway Bleeding After Valve-in-Valve Procedure.

JACC. Case reports— Bretones Del Pino T, Alcalde Martínez VF, Sánchez Gila J, García Orta R, Caballero Vázquez A et al.

BACKGROUND: Hemoptysis after percutaneous valve implantation is a rare but life-threatening complication. CASE SUMMARY: An 84-year-old woman with prior mechanical aortic and biological tricuspid valve replacements presented with tricuspid stenosis and regurgitation. A transcatheter valve-in-valve procedure using a 24.5-mm Myval was performed successfully. However, she developed severe hemoptysis, hypoxia, and ventilation difficulties shortly after the procedure. Flexible bronchoscopy with cryoprobe-assisted clot extraction was performed, removing large obstructive clots from the bronchi. A second cryoextraction was necessary 72 hours later. The patient improved rapidly, was extubated, and was discharged in stable condition after 7 days. DISCUSSION: Cryoextraction is commonly used for tumor-related airway bleeding and foreign body removal, but its application in postvalve implantation hemoptysis is novel. This case highlights its lifesaving role. TAKE-HOME MESSAGE: Cryoextraction can be a safe and effective alternative when conventional bleeding control methods fail after valve implantation.

Regulatory & Policy

5 articles

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