Parallel Septal Balloon Occlusion for Acute Right-to-Left Shunt During Mitral Transcatheter Edge-to-Edge Repair.

Mitral Regurgitation after TAVR: Sex Differences and Low-Flow Low-Gradient Aortic Stenosis.

BACKGROUND: Moderate or severe mitral regurgitation (MR) is common in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR). OBJECTIVES: The objectives of the study was to help define the prevalence and prognosis of persistent MR post-TAVR, particularly in women and in low-flow low-gradient (LFLG) AS. METHODS: In this single-center, observational study, 344 consecutive TAVR patients with severe AS and moderate or greater MR pre-TAVR were identified. Patients were stratified by AS subtype (classic vs LFLG). Factors associated with MR improvement to mild or less were evaluated using multivariable logistic regression. Survival was analyzed with Cox proportional hazards models adjusted for clinical and echocardiographic covariates. RESULTS: The mean age was 81.9 years, 48.5% were females, and 45.1% had LFLG AS. MR improved by ≥1 grade in 62.8% and to mild or less in 52.9% of patients, with similar rates in classic vs LFLG AS. On multivariable analysis, severe (vs moderate) baseline MR, hypertension, and female sex were independently associated with lower odds of MR improvement to mild or less. In LFLG AS, female sex and severe MR remained significant predictors of persistent MR, whereas a higher pre-TAVR aortic valve mean gradient was associated with improved MR. Residual severe MR was associated with increased mortality, driven by those with LFLG AS. CONCLUSIONS: More than half of TAVR patients with moderate or severe MR experience MR improvement post-TAVR. Women and those with severe MR are less likely to have a significant improvement in MR. Patients with LFLG AS and persistent moderate or severe MR have worse survival post-TAVR.

Transcatheter Aortic Valve Replacement TAVR Market Forecast to 2035: Low-Risk Patient Expansion Drives Growth - News and Statistics - IndexBox

Transcatheter Aortic Valve Replacement TAVR Market Forecast to 2035: Low-Risk Patient Expansion Drives Growth - News and Statistics  IndexBox

Edwards Lifesciences stock heads into the open after a weaker session - AD HOC NEWS

Edwards Lifesciences stock heads into the open after a weaker session  AD HOC NEWS

Apollo Hospitals Performs Zero-Contrast TAVR In Kidney Transplant Recipient - BW Healthcare World

Apollo Hospitals Performs Zero-Contrast TAVR In Kidney Transplant Recipient  BW Healthcare World

Semaglutide is improving the heart health of millions—but how? Experts are stumped - Cardiovascular Business

Semaglutide is improving the heart health of millions—but how? Experts are stumped  Cardiovascular Business

Transcatheter aortic valve-in-valve implantation for residual prosthetic valve dysfunction and paravalvular leak after healed Enterococcus faecalis prosthetic valve endocarditis: a case report.

BACKGROUND: Prosthetic valve endocarditis (PVE) is associated with substantial morbidity and mortality, particularly when complicated by severe prosthetic valve dysfunction and paravalvular leak. Although redo surgery remains the standard treatment, some patients may be unsuitable for surgical intervention because of prohibitive operative risk. CASE SUMMARY: A 64-year-old man with previous surgical bioprosthetic aortic valve replacement had a history of Enterococcus faecalis PVE and received targeted antimicrobial therapy. Following targeted antimicrobial therapy with documented microbiological control, he presented with cardiogenic shock due to severe residual prosthetic valve dysfunction, including severe prosthetic stenosis, severe central transprosthetic regurgitation, and severe paravalvular leak. Given his prohibitive surgical risk, the multidisciplinary Heart Team selected transfemoral valve-in-valve transcatheter aortic valve implantation as a rescue strategy. The procedure resulted in marked haemodynamic improvement with only mild residual regurgitation. At 1-year follow-up, the patient remained clinically stable with a well-functioning prosthetic valve and no evidence of recurrent infection. DISCUSSION: This case demonstrates that valve-in-valve transcatheter implantation may be considered as a rescue option in carefully selected patients with controlled prosthetic valve endocarditis and residual prosthetic valve dysfunction who are unsuitable for redo surgery. Multimodality imaging and multidisciplinary Heart Team evaluation are essential for individualized decision-making in this challenging clinical scenario.

Twenty-five years of the

OBJECTIVE: To analyze research trends and key contributors in The Journal of Thoracic and Cardiovascular Surgery over 25 years (2000-2024) using bibliometric methods. METHODS: A total of 9190 articles from Web of Science were analyzed using CiteSpace, VOSviewer, and Bibliometrix to assess publication trends, citation metrics, author/institution/country contributions, co-citation networks, and keyword co-occurrence. RESULTS: Annual publications increased from 329 (2000) to 659 (2014), then stabilized at an average of 319 ± 32 (2015-2024). Impact factor peaked at 6.44 in 2021. The United States led with 4695 publications, followed by Japan and Canada. Harvard University topped institutional output (662 publications), whereas Blackstone EH was the most influential author (h-index: 65). The 20 most-cited articles were predominantly clinical studies focused on surgical techniques and outcomes. Co-citation analysis identified aortic surgery, cardiac valve surgery, and coronary artery surgery as major domains. Citation burst analysis revealed transcatheter aortic valve replacement as the most dynamic recent frontier, with Mack MJ and Popma JJ showing strongest citation bursts. Cardiac surgery was the most frequent key word (300 occurrences), followed by non-small cell lung cancer and coronary artery bypass. Recent emerging terms include acute kidney injury, coronavirus disease, and surgical aortic valve replacement. CONCLUSIONS: This 25-year bibliometric analysis reveals The Journal of Thoracic and Cardiovascular Surgery as a leading platform for cardiothoracic surgery research with sustained growth and increasing scholarly impact. The field demonstrates strong North American institutional dominance, with transcatheter aortic valve replacement emerging as the primary research frontier. Future directions should emphasize international collaboration, research in low- and middle-income regions, transcatheter technologies, and translational research integration.

Long-term outcomes of transcatheter mitral valve repair in patients with cancer: a systematic review and meta-analysis.

Surgical and transcatheter mitral valve interventions are the mainstay of treatment for mitral regurgitation (MR). Their impact in patients with cancer has recently gained attention in observational studies but remains poorly characterized. We performed a systematic review and meta-analysis to evaluate outcomes of mitral valve interventions, with particular focus on M-TEER, in patients with active or prior cancer. PubMed and Scopus were systematically searched according to the PRISMA 2020 Statement. This systematic review was prospectively registered in PROSPERO (CRD420261368392). Studies reporting outcomes of transcatheter or surgical mitral valve interventions in patients with cancer were eligible. The primary outcome was all-cause mortality. Secondary outcomes included short-term mortality, procedural success, heart failure worsening or hospitalization, and reintervention. Hazard ratios (HRs) were pooled using random-effects models when appropriate. When HRs were not directly available, they were reconstructed according to established methods for time-to-event data synthesis. Eight observational studies met the inclusion criteria. Seven studies evaluated M-TEER, accounting for the vast majority of patients included in the quantitative analyses (1522 patients with cancer and 4716 controls), whereas only one study assessed surgical mitral valve intervention. In the pooled analysis of M-TEER studies, cancer was associated with a significantly higher risk of all-cause mortality during follow-up (HR 1.72, 95% CI 1.03-2.90; I2 = 74.8%). This association remained consistent across prespecified subgroup and sensitivity analyses. No significant differences were observed in 30-day mortality or procedural success between patients with and without cancer. Data on heart failure outcomes and reintervention were insufficient for quantitative synthesis. This study provides a quantitative synthesis of available evidence regarding long-term outcomes after M-TEER in patients with cancer. Patients with cancer undergoing M-TEER have higher long-term mortality than those without cancer, despite similar procedural success and short-term outcomes. These findings suggest the observed excess mortality occurs in patients with cancer but the available evidence does not establish the factors responsible for this association, which could be mediated by frailty, CV comorbidity, treatment-related comorbidity mitral regurgitation (MR) characteristics, or other residual confounders. Of note, studies comparing matched cohorts found a non-significant difference in HR for long-term mortality. Current evidence is limited by observational data and residual confounding. Prospective cardio-oncology studies are needed to improve patient selection and identify individuals most likely to benefit from transcatheter mitral valve intervention.

Computational fluid dynamics assessment of hemodynamic effects of catheter navigation during transcatheter aortic valve implantation.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a widely adopted, minimally invasive alternative to surgical aortic valve replacement. Despite its clinical success, TAVI can induce hemodynamic complications, which can be investigated using computational fluid dynamics (CFD). In this study, CFD was applied to evaluate the hemodynamic impact of catheter insertion during the TAVI procedure. METHODS: CFD simulations were conducted in SimVascular to assess blood flow alterations at different stages of catheter insertion, from the iliac access to the ascending aorta, focusing on four critical phases of catheter advancement. Hemodynamic parameters were systematically analyzed across all simulated models. RESULTS: Catheter insertion induced a pronounced local pressure drop and elevated wall shear stress (WSS) at the access-side iliac artery. Outlet flow analysis showed redistribution across branches, with reduced flow on the access side and compensatory increases in the contralateral femoral artery and the other branches. Oscillatory shear index (OSI) and turbulent kinetic energy (TKE) were reduced at the access site, whereas higher OSI and TKE were observed in the contralateral iliac artery. Local hemodynamics and WSS near the catheter tip were found to be sensitive to the catheter's longitudinal position. CONCLUSION: This proof-of-concept study demonstrates that CFD can effectively capture catheter-induced hemodynamic disturbances during TAVI delivery, providing a foundation for patient-specific risk assessment and procedural optimization.

Evolution of Aortic Valve Replacement Across Two Eras: Institutional Changes in Transcatheter and Surgical Practice and Outcomes.

Objectives: Conventionally, the gold standard for aortic valve disease has been surgical aortic valve replacement (SAVR). Advances in transcatheter aortic valve replacement (TAVR) have since produced marked improvements in both outcomes and procedural volume. We sought to characterize this evolution by comparing the earliest and most recent 100 procedures of each modality at a single high-volume institution. Methods: We retrospectively compared four cohorts of 100 consecutive isolated procedures: 100 TAVRs from 2012 (the earliest period of complete and verifiable registry capture) and 100 first-time SAVRs from a contemporaneous period (2011), each versus the 100 most recent procedures of the same modality (TAVR 2024; SAVR 2024-2025). The SAVR cohorts were limited to first-time, isolated replacement; the TAVR cohorts to native-valve procedures. The primary endpoint was the 30-day composite of death or stroke. Secondary endpoints included new permanent pacemaker implantation, paravalvular leak, vascular access route, anesthetic technique, and length of stay. Results: For TAVR, the 30-day composite of death or stroke fell from 10% to 1% (p = 0.010), with fewer in-hospital deaths (6% to 0%; p = 0.029) and less new dialysis (4% to 0%; p = 0.059). A paravalvular leak of at least mild severity fell from 27% to 3% (p < 0.001), with none as moderate or greater in either era. New pacemaker implantation decreased from 15% to 6% (p = 0.056). Within the same comparison, general anesthesia decreased from 100% to 23%, non-transfemoral access from 29% to 2%, median ICU stay from 43 to 0 h, and hospital stay from 6 to 1 day (all p < 0.001). SAVR outcomes remained similar (composite 2% to 0%, p = 0.497; pacemaker 1% to 0%; and paravalvular leak 0% to 4%), while prolonged ventilation (11% to 1%; p = 0.007) and hospital stay (8 to 5 days; p < 0.001) improved. The SAVR population became younger (74 to 64 years; p < 0.001), and isolated first-time surgery was markedly less frequent, requiring 18.9 versus 5.7 months to accrue 100 consecutive cases. Conclusions: In this two-era institutional comparison, recent-era TAVR outcomes were markedly better, while SAVR outcomes remained excellent in both eras within a recent population that was younger and in whom eligible isolated first-time surgery was less frequent. Because the eras differed substantially in patient risk profile, these unadjusted within-modality comparisons describe a real-world redistribution of aortic stenosis care between two increasingly complementary treatments rather than isolating the effect of any single procedural or technological factor.

Parallel Septal Balloon Occlusion for Acute Right-to-Left Shunt During Mitral Transcatheter Edge-to-Edge Repair.

BACKGROUND: Mitral transcatheter edge-to-edge repair (M-TEER) requires large-bore transseptal puncture, creating an iatrogenic atrial septal defect (IASD). Right-to-left shunting across an IASD is rare but can cause significant hypoxemia in high-risk patients. CASE SUMMARY: A 78-year-old man with nonischemic cardiomyopathy and severe mitral and tricuspid regurgitation underwent M-TEER. Profound hypoxemia secondary to acute right-to-left shunt developed immediately after transseptal instrumentation with a large-bore sheath. A compliant sizing balloon was inflated across the septal defect in parallel with the transseptal sheath, restoring oxygenation and allowing safe deployment of the PASCAL (Edwards Lifesciences) valve, with septal closure performed at the end of the procedure. DISCUSSION: This case illustrates a distinctive predeployment presentation of right-to-left IASD shunting and a novel bailout technique that preserves transseptal access without requiring additional venous puncture. TAKE-HOME MESSAGES: Right-to-left IASD shunting should be anticipated in patients with high-risk hemodynamic profiles before transseptal puncture. Parallel balloon septal occlusion represents a practical bridging strategy enabling safe M-TEER completion.

Very Severe, Not Too Severe: Reconsidering LV Dysfunction as a Barrier to Mitral TEER.

High Incidence of Short-term Subsequent Atrial Fibrillation Following Restrictive Filling Mitral Flow Profile in Patients without Structural Heart Disease.

PURPOSE: This study investigated the implications of a restrictive filling (RF) mitral flow profile on the frequency of short-term subsequent atrial fibrillation (AF) in cases without thrombotic conditions during routine transthoracic echocardiography (TTE). METHODS: A TTE database was retrospectively analyzed from 2015 to 2023 (n = 123,210). We enrolled middle-aged and older adults (≥50 years) with RF mitral flow (the ratio of the early to atrial mitral inflow peak velocities [E/A ratio] ≥2), normal sinus rhythm during the TTE study, and a large left atrial (LA) dimension (≥40 mm) excluding those with structural heart disease and depressed left ventricular ejection fraction. Ad hoc analyses of LA emptying fraction (LAEF) and LA longitudinal strain during the reservoir phase (LASr) were performed. We calculated the ratio of LASr to LAEF (LASr/LAEF) for the discrepancy between LAEF and LASr. RESULTS: The cohort comprised 163 cases (0.13%, 163/123,210) recruited from 3788 cases with RF mitral flow profile (3.1%, 3788/123,210). Subsequent AF was frequently confirmed in this cohort (14.7%, 24/163). LAEF ≤25.9% was selected as a predictor (P = 0.023, odds ratio: 5.547) in a logistic model, while LASr/LAEF ≥0.65 was a predictor in another model (P = 0.020, OR: 3.68). CONCLUSIONS: The RF mitral flow profile is rare but may indicate short-term subsequent AF. Among TTE parameters, low LAEF and increased LASr/LAEF were the predictors. Atrial stunning might play a significant role.

Medicare Analysis: Surgical vs Transcatheter Tricuspid Repair

T-TEER for Iatrogenic Tricuspid Regurgitation

Tricuspid TEER Biomechanical Forces

NCT03904147: TRILUMINATE

right heart strain changes after transcatheter tricuspid valve replacement

FDA approves first sirolimus drug-eluting balloon for in-stent restenosis - Cardiovascular Business

FDA approves first sirolimus drug-eluting balloon for in-stent restenosis&nbsp;&nbsp;Cardiovascular Business

JenaValve received FDA approval

Trilogy system approval

FDA approval for its Trilogy system

JenaValve FDA approval: Trilogy system for severe aortic regurgitation