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Aortic — All Articles

428 articles
Research2026 Mar

Clinical Outcomes of the Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women.

JACC. Advances— Bhatti S, Gurmani S, Naz S, Yasmin H, Ahmed S et al.

BACKGROUND: Cardiovascular disease is increasingly recognized as a leading nonobstetric cause of maternal morbidity and mortality worldwide, including low- and middle-income countries. OBJECTIVES: This study evaluated fetomaternal outcomes in women with and without structural heart disease (SHD). METHODS: From a total of 25,000 patients enrolled in the Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women registry between February 2023 and April 2025, 489 pregnancies with SHD were identified and compared with 510 pregnancies without SHD. Adverse fetomaternal outcomes were evaluated in both groups as a composite endpoint, comprising fetal outcomes (preterm delivery, fetal death, or low birth weight) and maternal outcomes (maternal death and pulmonary edema). RESULTS: The SHD cohort had a higher mean maternal age (27.3 ± 5.7 vs 26.1 ± 5.2 years; P = 0.011) compared to the non-SHD cohort. Composite adverse maternal outcomes (3.7% vs 0.4%; P < 0.001), fetal outcomes (29.9% vs 13.3%; P < 0.001), and overall fetomaternal outcomes (30.7% vs 13.3%; P < 0.001) were significantly higher in the SHD compared to the non-SHD cohort. SHD was independently associated with adverse fetomaternal outcomes (adjusted OR: 2.67; 95% CI: 1.93-3.70; P < 0.001). CONCLUSIONS: Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women is the first global study linking subclinical echocardiographic abnormalities in asymptomatic pregnant women to adverse fetomaternal outcomes. In a large cohort of asymptomatic pregnant women, an abnormal echocardiogram was found to be associated with 2- to 4 time as many adverse fetomaternal outcomes compared to a normal echocardiogram. Future studies are needed to evaluate optimal timing of screening, cost-effectiveness, and applicability of broad antenatal screening in higher-income countries.

Research2026 Mar

Long-Term Outcomes After Transcatheter Aortic Valve Replacement in Nonagenarians: Impact of Frailty and Malnutrition.

JACC. Advances— Kobayashi T, Noguchi M, Yamamoto M, Ito J, Kato N et al.

BACKGROUND: The role of transcatheter aortic valve replacement (TAVR) in nonagenarians remains uncertain, especially regarding long-term outcomes and prognostic factors. OBJECTIVES: This study aimed to evaluate long-term outcomes of TAVR in nonagenarians, focusing on cause-specific mortality and the prognostic influence of frailty and malnutrition. METHODS: We analyzed 4,623 patients who underwent transfemoral TAVR in a multicenter Japanese registry, including 700 aged ≥90 years. Outcomes were followed for 5 years. We analyzed all-cause mortality, cause-specific mortality, and the prognostic impact of the Clinical Frailty Scale and Geriatric Nutritional Risk Index. RESULTS: At 5 years, all-cause mortality was higher in patients aged ≥90 years than in those <90 years (53.2% vs37.0%, P < 0.001), primarily due to noncardiovascular deaths such as senility and infections (32.5% vs 19.9%; P < 0.001). Cardiovascular mortality was similar (20.3% vs 17.0%; P = 0.198). Multivariable analysis showed that age ≥90 years was not an independent predictor; frailty and malnutrition were the strongest prognostic factors. A Clinical Frailty Scale-Geriatric Nutritional Risk Index heatmap revealed marked heterogeneity, identifying subgroups of nonagenarians with preserved nutrition and low frailty who achieved favorable long-term survival. CONCLUSIONS: In this large multicenter registry, excess mortality in nonagenarians after TAVR was driven mainly by noncardiovascular causes. Frailty and malnutrition, rather than chronological age, were central determinants of long-term outcomes. These findings emphasize that TAVR candidacy in nonagenarians should be guided on geriatric assessment of frailty and nutrition to identify patients most likely to achieve meaningful survival while avoiding futile interventions.

Research2026 Apr 12

Hemodynamic Improvement With the Double-Tap Technique During Transcatheter Aortic Valve Replacement Using a Pressure-Sensing Guidewire.

JACC. Case reports— Nishimura Y, Tanabe K, Higashino A, Yokozuka M, Horiuchi Y et al.

Postdilatation using the original delivery system balloon at the same filling volume (the double-tap technique) has been proposed to improve balloon-expandable transcatheter heart valve (THV) expansion during transcatheter aortic valve replacement (TAVR); however, its immediate hemodynamic impact remains unclear. Here, we report a case series of 6 consecutive patients who underwent TAVR with balloon-expandable valves in whom the double-tap technique was performed with hemodynamic assessment using a pressure-sensing guidewire. The mean transvalvular pressure gradients and midportion THV diameters were evaluated before and after the double-tap technique. This technique was significantly associated with reduced mean transvalvular pressure gradients (median difference: -6.5 mm Hg; P = 0.036) and increased midportion THV diameter (median difference: 0.8 mm; P = 0.036), whereas paravalvular leak was reduced to trivial or none in all patients, and no cardiovascular death, stroke, or permanent pacemaker implantation occurred at 30 days. The double-tap technique under pressure-sensing guidewire guidance may facilitate safer valve optimization during TAVR.

Research2026 Apr 11

Trilogy Transcatheter Aortic Valve Implantation for Freestyle Graft With Flail Left Coronary Cusp.

JACC. Case reports— Al-Shaibi A, Moroni A, Burns D, Alnasser S, Fam NP

CASE SUMMARY: This clinical vignette describes successful transcatheter aortic valve implantation (TAVI) in a Freestyle graft with a flail left coronary cusp using a 27-mm Trilogy valve (JenaValve Technology). Using a Trilogy valve in cases with a flail cusp raises concerns of insufficient valve sealing and stability; our report demonstrates the feasibility and safety of the procedure with excellent procedural outcomes. TAKE-HOME MESSAGES: TAVI using the Trilogy valve for degenerated Freestyle graft with flail left coronary cusp is feasible, with several advantages over commercially available TAVI platforms. However, additional cases are required to demonstrate its safety and reproducibility.

Research2026 Apr 11

Transcatheter Aortic Valve Implantation in a Massive Aortic Annulus With a Novel Balloon-Expandable Valve.

JACC. Case reports— Al-Shaibi A, Moroni A, Bisleri G, Alnasser S, Fam NP

CASE SUMMARY: This clinical vignette describes successful transcatheter aortic valve implantation (TAVI) in the largest reported annulus (1,040 mm2) using a novel 35-mm balloon-expandable valve. TAVI can be performed off-label in selected patients with a massive aortic annulus using commercially available 29-mm transcatheter aortic valves by adding additional volume; however, this risks paravalvular leak, valve embolism, and damage to bioprosthetic leaflets. TAKE-HOME MESSAGE: TAVI is feasible in patients with a massive aortic annulus measuring >1,000 mm2 using Myval 35-mm balloon-expandable valve with balloon overfilling.

Research2026 Apr 09

Stroke Risk After TAVR: Balloon-Expandable vs Self-Expanding Valves in Community Practice.

JACC. Advances— Kumar S, Elison D, Pershad A, Falluji N

BACKGROUND: Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet contemporary data from community hospital practice are limited. OBJECTIVES: The purpose of this study was to evaluate the association between valve type and the risk of stroke within 1 year after contemporary TAVR in community practice. METHODS: We analyzed patients who underwent TAVR across CommonSpirit Health hospitals from January 2021 to February 2023 using data from the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry. Valve type was categorized as balloon-expandable valves or self-expanding valves (SEV). The primary outcome was stroke within 1 year. Kaplan-Meier methods were used to compare stroke-free survival between valve types. Baseline differences were adjusted using inverse probability of treatment weighting. Independent predictors of stroke were identified using weighted time-to-event models. RESULTS: A total of 6,663 patients underwent TAVR during the study period; 5,445 (81.7%) received balloon-expandable valve, and 1,218 (18.3%) received SEV. More females received a SEV (56.7% vs 37.5%; P < 0.001). The STS risk score (4.5 ± 3.8 vs 4.0 ± 3.5; P < 0.001) was higher in the SEV group. A total of 87 (1.3%) patients experienced stroke within the study period. The primary endpoint of stroke-free survival at 1 year was not different between valve types (log-rank P = 0.448). After inverse probability of treatment weighting adjustment, valve type was not associated with stroke (adjusted HR: 1.54; 95% CI: 0.79-2.68; P = 0.294). Age, lower body mass index, prior stroke, STS risk, and alternative access were associated with stroke. CONCLUSIONS: In this registry of patients receiving TAVR, valve type did not predict stroke at 1 year. The predominant drivers of stroke were clinical variables: age, STS risk, and a history of stroke.

Research2026 Apr 02

Two-Staged Transcatheter Aortic Valve Replacement in Severely Calcified Sinotubular Junction.

JACC. Case reports— Bhat S, Ellingson CJ, Singh J, Eziyi U, Dressler D et al.

OBJECTIVE: Severe sinotubular junction (STJ) calcification presents important challenges during transcatheter aortic valve implantation, including risk of aortic dissection or aortic root rupture and valve malposition. We describe a straightforward and reproducible two-stage balloon inflation technique with a balloon-expandable SAPIEN 3 valve to optimize precision and procedural safety in this difficult setting. TECHNIQUE: Step 1: Initial balloon inflation at 2 mL less than nominal volume to secure annular anchoring and limit radial force on the calcified STJ. Step 2: Balloon advanced 1-2 mm under fluoroscopy toward the inflow and inflated to the full nominal volume, completing valve deployment. PITFALLS: Inadequate anchoring may cause migration or embolization, underestimation of calcification can compromise expansion, and balloon overinflation may cause root injury. CONCLUSION: This staged inflation method anchors the valve, minimizes STJ stress, and provides a simple, reproducible strategy that may improve safety in anatomically complex patients.

Research2025 Dec

Gender Matters: A State-of-the-Art Review of Transcatheter Structural Interventions in Older Women Vs Men.

JACC. Advances— Liu J, Lyubarova R, Riggs J, Chung J, Mehta PK et al.

With rising life expectancy, the population of older adults over the age of 65 is rapidly expanding, with women comprising the majority. Structural heart disease is common in this group, and transcatheter interventions have transformed its management. Optimal outcomes require careful consideration of sex-specific differences. This review examines transcatheter structural heart interventions in older adults with a focus on sex-based outcomes, procedural planning, and current knowledge gaps.

Research2026 Mar 29

Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI): an investigator-initiated, multicentre, open-label, non-inferiority, randomised controlled trial.

Lancet (London, England)— Delewi R, Aarts HM, Broeze GM, Hemelrijk KI, van Ginkel DJ et al.

BACKGROUND: Coronary artery disease is common in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to assess whether deferral of percutaneous coronary intervention (PCI) is non-inferior to routine PCI before TAVI in patients with coronary artery disease. METHODS: In this investigator-initiated, open-label, randomised controlled trial, done at 12 hospitals in the Netherlands, TAVI patients with coronary artery disease were randomly assigned in a 1:1 ratio to deferral of PCI or PCI before TAVI. Randomisation was done by use of a web-based system with random block sizes of 2 and 4, and stratification by presence of coronary artery disease involving proximal left anterior descending artery. The primary endpoint was a composite of all-cause mortality, myocardial infarction, stroke, and major bleeding at 1 year. Non-inferiority testing was done in the intention-to-treat population against the prespecified margin of 11 percentage points. The study is registered with ClinicalTrials.gov (NCT05078619) and long-term follow-up is ongoing. FINDINGS: Between Oct 7, 2021, and Nov 19, 2024, 466 patients were enrolled: 233 were assigned to deferral of PCI and 233 to PCI before TAVI. Median age was 81 years (IQR 78-84), and 166 (36%) of 466 patients were female. The primary endpoint occurred in 56 (24%) of 233 patients in the deferral group as compared with 60 (26%) of 233 patients in the PCI group (rate difference -1·7% [95% CI -9·5 to 6·2]; hazard ratio 0·89 [95% CI 0·62-1·28]; p=0·0008 for non-inferiority; p=0·68 for superiority). INTERPRETATION: In patients with coronary artery disease undergoing TAVI, deferral of PCI was non-inferior to PCI before TAVI for the 1-year composite of all-cause mortality, myocardial infarction, stroke, and major bleeding. These findings suggest that an initial conservative strategy can be appropriate in selected patients, although patient-tailored treatment decisions remain essential. FUNDING: ZonMw.

Research2026 Mar

Structural heart disease screening using artificial intelligence-enabled electrocardiogram and novice handheld cardiac ultrasound: a cost analysis.

European heart journal open— Schlesinger RP, Alexandrino FB, Lee E, Deshmukh AJ, Nkomo VT et al.

AIMS: Early detection of structural heart disease (SHD) improves patient outcomes. However, population-based screening is not recommended due to the lack of accurate and cost-effective tools. We evaluated the costs of artificial intelligence-enabled electrocardiogram (AI-ECG) alone vs. AI-ECG followed by handheld cardiac ultrasound (HCU) for SHD screening. METHODS AND RESULTS: We performed a model-based cost analysis using data from 286 adult patients who underwent ECG and same-day HCU performed by a novice operator. Transthoracic echocardiogram (TTE) was the reference standard. We compared two screening strategies: (i) AI-ECG alone and (ii) a stepwise approach (AI-ECG followed by HCU). We assessed costs per diagnosis of aortic stenosis (AS), increased left ventricular wall thickness (ILVWT), and left ventricular systolic dysfunction (LVSD). Sensitivity analyses were conducted for varying disease prevalence. The stepwise approach decreased the cost per diagnosis of AS from $6386 (AI-ECG alone) to $2746 (57.0% savings), ILVWT from $4448 to $2895 (34.9% savings), and LVSD from $1469 to $1296 (11.8% savings). Overall, the cost per diagnosis for all SHDs combined decreased from $1940 to $1570 (19.1% savings). Sensitivity analysis demonstrated that cost savings were inversely proportional to disease prevalence. Nevertheless, stepwise screening remained cost-saving compared with AI-ECG alone until prevalence exceeded ∼55.9% for AS, 28.9% for ILVWT, 20.7% for LVSD, and 40.8% for all SHDs combined. CONCLUSION: A stepwise screening strategy incorporating HCU after a positive AI-ECG reduces the immediate costs of SHD detection by minimizing unnecessary TTEs. This approach may enhance the feasibility of population-based SHD screening, particularly in lower-prevalence settings.

Research2026 May

Balloon-expandable vs. self-expandable transcatheter aortic valve implantation in bicuspid aortic valve stenosis: a meta-analysis of observational studies.

Indian journal of thoracic and cardiovascular surgery— Maloth AK, Baweja T, Shaikh A, Thapa S, Das S et al.

PURPOSE: If patients with bicuspid aortic valve (BAV) stenosis are high-risk candidates for traditional open-heart surgery, they can be treated with transcatheter aortic valve replacement (TAVR). The purpose of this study is to understand the effects of balloon-expandable valves (BEVs) and self-expandable valves (SEVs) as they are used in TAVR on patients with BAV stenosis. METHODS: We searched the databases PubMed, Embase, Cochrane, and ScienceDirect from their inception until January 2025. An odds ratio (OR) and corresponding 95% confidence interval (CI) were determined for every outcome, with statistical significance at p-value < 0.05. Random-effects models were used for studies with high heterogeneity (I 2 > 50%), and fixed-effects models for low heterogeneity (I 2 ≤ 50%). RESULTS: Nine observational studies were included. There was no significant difference found for the following outcomes: procedural death, 30-day mortality, 1-year all-cause mortality, annulus rupture, acute kidney injury, stroke, and moderate/severe paravalvular leak between BEV and SEV.Still, having a BEV was associated with a lower risk of needing a pacemaker or requiring second valve surgery. CONCLUSION: From this analysis, it seems that BEVs may provide better results than SEVs in terms of reducing the need for a pacemaker and a second valve in patients with BAV stenosis treated with TAVR. The number of deaths and serious complications was about the same for the two valves. Additional randomized controlled trials are needed to study both the lasting effects and the factors that shape these results. PROSPERO ID: CRD420251003387. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-025-02111-6.

Research2026 Apr

Outcomes of transatrial transcatheter mitral valve replacement with a balloon-expandable valve for severe mitral annular calcification.

JTCVS techniques— Curran BF, Juarez Casso FM, Schaff HV, Saran N, Rowse PG et al.

OBJECTIVE: To evaluate operative and midterm outcomes, including 1-, 3-, and 5-year survival, of transatrial transcatheter mitral valve replacement (TA-TMVR) with a balloon-expandable valve for severe mitral annular calcification (MAC). METHODS: We retrospectively reviewed patients with severe MAC who underwent TA-TMVR from 2014 to 2024 using a balloon-expandable prosthesis. RESULTS: Twenty-five patients (68% were female, mean age 75 years) had TA-TMVR for mitral valve disease (92% severe stenosis, 52% moderate-to-severe mitral regurgitation). Previous cardiac surgery was common (48%). Median Society of Thoracic Surgeons Predicted Risk of Operative Mortality was 9% (2%-26%). Most patients were New York Heart Association class III or IV (76%). Preoperative left ventricular ejection fraction was 66%. Concomitant procedures were performed in 68% of cases (aortic valve replacement in 11, septal myectomy in 6, other procedures in 9). A SAPIEN 3 valve was used in 24 patients; most were modified with a felt skirt to improve sealing. Anterior leaflet resection was performed in 24 patients. Operative mortality was 12%. Median length of stay was 14 days. Postoperative left ventricular ejection fraction was 64%, and the mean mitral valve gradient was 5 mm Hg. Paravalvular leak were observed in 6 patients; 3 underwent successful transcatheter closure. One of these patients required a percutaneous valve-in-valve for on-going hemolysis. One-, 3-, and 5-year survival was 68%, 59.5%, and 50.6%, respectively. CONCLUSIONS: TA-TMVR with a balloon-expandable valve is a feasible and durable option for high-risk patients with severe MAC and those requiring concomitant procedures, offering an alternative to conventional surgery in anatomically complex or otherwise-inoperable cases.

Research2026-04-14

Ursolic Acid Inhibits Rotavirus Replication Through Modulation Of Lipid Droplet Homeostasis

Biorxiv— Tohme Chapini, M. J.; Converti, A.; Garcia Samartino, C.; Caruso, B.; Barrera, E. E.; Colombo, M. I....

Rotavirus (RV) replication occurs within viroplasms (VP), which are globular, membrane-less cytosolic inclusions primarily assembled by the viral NSP5 and NSP2 proteins. Among host factors, lipid droplets (LD) are strictly required for VP biogenesis. LD are ubiquitous organelles consisting of a neutral lipid core surrounded by a phospholipid monolayer and associated proteins. Ursolic acid (UA), a pentacyclic triterpenoid widely present in plants and fruits, displays multiple biological activities, including modulation of lipid metabolism, and exhibits antiviral activity against RV, as we have previously demonstrated. Here, we investigated the molecular mechanism underlying the antiviral effect of UA. Using biophysical approaches, we first examined the impact of UA on LD formation, finding that it impairs LD biogenesis, consistent with reduced LD budding from the endoplasmic reticulum. We then employed cell-based assays to assess LD turnover and observed that UA acts as a lipolytic stimulus, leading to a marked reduction in LD abundance. Notably, we found that autophagic pathways contribute to LD degradation in the presence of UA. Finally, molecular dynamics simulations proposed that UA, owing to its intrinsic lipid-partitioning capacity, inserts into the LD phospholipid monolayer, establishing interactions with interdigitated neutral lipids. Together, our results indicate that UA both hampers LD biogenesis and accelerates LD degradation, likely through its association with and destabilization of the LD membrane. This dual effect leads to LD depletion, thereby impairing VP formation and ultimately inhibiting RV replication.

Research2026-04-07

Molecular Identification and Characterization of mobatvirus (Hantaviridae) in Lao PDR

Biorxiv— Vanhnollat, C.; Dimitrova, K.; Vachouaxiong, L.; Audet, J.; Somlor, S.; Medina, S. J.; Bounmany, P.;...

Hantavirids, specifically the members within the genus Orthohantavirus, represent a significant global public health threat, with bat-associated lineages challenging traditional reservoir paradigms. To investigate the genetic diversity of hantavirids in Southeast Asia, we conducted an expanded surveillance program in Lao PDR from May 2023 to October 2025 in bat populations and wild animals from local wet markets. Using molecular screening and deep sequencing to characterize hantavirids from bat populations and wild animals from local wet markets, we identified 20 positive samples across four bat species, recovering coding-complete genomes for multiple novel variants. Phylogenetic analysis confirmed that these viruses form a monophyletic group within Mobatvirus, resolving into two major subclades. The first subclade clustered with Quezon and Robina viruses found in fruit-eating bats. The second subclade further split into two lineages corresponding to Dakrong and Xuan Son viruses, which are associated with trident and leaf-nosed bats, respectively. Despite the strong host specificity observed, the detection of these viruses in a wet market, a critical interface for human-wildlife contact, indicates a potential zoonotic risk. These findings significantly expand the known diversity of mobatviruses in Laos and highlight the urgent need for serological surveillance in at-risk human populations to assess the potential for spillover.

Research2026-04-04

Structure-Guided Design and Dynamic Evaluation of VP4-Targeting siRNAs Against Rotavirus A

Biorxiv— Ahmed, A. N.; Satu, K. J.; Rahman, A. B. Z. N.; Hasan, S. S.; Sakib, M. N.; Hossan, M. E.; Bhattacha...

Rotavirus is a major cause of severe diarrheal disease in children under the age of five, with reduced vaccine effectiveness in low-resource settings causing substantial morbidity and mortality. In the absence of approved antiviral therapeutics, treatment is largely supportive, urging the need for targeted and precision-based interventions. VP4 protein plays an essential role in viral attachment, entry, and infectivity, making it a suitable target for targeted therapy. In this context, RNA interference is a specific method for inhibiting viral gene expression with its efficacy depending on sequence conservation, target accessibility, and compatibility with the RISC-loading machinery. In the present study, an integrative in silico approach was employed to design and evaluate siRNAs targeting conserved regions of the VP4 gene across six geographically diverse countries. Candidate siRNAs were screened using established design rules and regression-based scoring with off-target filtering. Three optimized siRNAs were further assessed through structural modeling, molecular docking, and molecular dynamics simulations to examine interactions with human Dicer, TRBP, and Argonaute-2. Comparative dynamic analyses identified one siRNA with enhanced structural compatibility, reduced conformational fluctuations, and stable interactions with RISC-loading proteins. These findings provide a rational computational basis for VP4-targeted siRNA development, facilitating experimental validation.

Research2026-03-31

Left Ventricular Geometry Improves Prediction of Sex-Specific Post-TAVR Remodeling in Aortic Stenosis

Medrxiv— Goraya, S. A.; Lauwers, P.; Javadikasgari, H.; Rouhollahi, A.; Homaei, A.; Masoumi, S.; Zancanaro, E...

Background: Women with severe aortic stenosis (AS) are diagnosed later and experience poorer outcomes than men, partly because clinical approaches rely on 2D, valve-centric thresholds derived from male-predominant cohorts that underutilize information from 3D left ventricular (LV) geometry. We hypothesize that a sex-specific computational framework integrating statistical shape analysis (SSA) of pre-TAVR CT with machine learning would improve prediction of 1-year LV mass regression (LVMR). Objective: To develop a computational framework leveraging 3D LV geometry and evaluate whether it improves sex-specific prediction of 1-year LVMR after TAVR. Methods: We studied 339 patients with severe AS who underwent TAVR from 2013 to 2020 and had pre-TAVR CT and 1-year post-TAVR echocardiography. LV geometries were segmented into digital twins, and shape modes predictive of LVMR were extracted using SSA and partial least squares. These modes were incorporated into support vector regression models and compared with conventional echocardiographic predictors, including pre-TAVR LVEF, LVMI, and E/A ratio. Performance was assessed using RMSE and R^2. Results: After one year, 65% of patients showed positive LVMR, with median regression of approximately 10%; regression was significant overall and within each sex (p<0.001) and similar between sexes (p=0.99). Predictive shape modes differed by sex (p<0.01), with women showing more localized variation and men broader geometric gradients. Sex-specific shape modes outperformed general modes and clinical metrics, particularly in women (R^2=0.80, RMSE=0.09 vs. R^2=0.59, RMSE=0.13; clinical-only baseline R^2=0.16, RMSE=0.22). In men, sex-specific modes also performed strongly (R^2=0.89, RMSE=0.08). Conclusion: In severe AS, 3D LV geometry predicts post-TAVR reverse remodeling more accurately than conventional metrics and may improve risk stratification, particularly in women.

Research2026-03-30

A Deep Learning-Based Single-View Echocardiographic Analysis for Prediction of Left Ventricular Outflow Tract Obstruction After Transcatheter Aortic Valve Replacement

Medrxiv— Choi, J.-W.; Park, J.; Yoon, Y. E.; Kim, J.; Jeon, J.; Jang, Y.; Lee, S.-A.; Bak, M.; Choi, H.-M.; H...

Aims: Dynamic left ventricular outflow tract obstruction (LVOTO) is a hemodynamically significant complication following transcatheter aortic valve replacement (TAVR) that remains difficult to predict with conventional transthoracic echocardiography (TTE). We examined whether a deep learning (DL) model developed for LVOTO detection in hypertrophic cardiomyopathy (HCM) could predict post-TAVR LVOTO from pre-TAVR TTE in patients with severe aortic stenosis (AS). Methods and Results: In this retrospective study of 302 consecutive patients undergoing TAVR for severe AS, a pre-trained DL model was applied to pre-TAVR TTE to generate a patient-level DL index of LVOTO (DLi-LVOTO; range 0-100). Post-TAVR LVOTO was defined as a peak pressure gradient [&ge;]30 mmHg on follow-up TTE. Logistic regression and receiver operating characteristic analyses assessed the association and discriminative performance of DLi-LVOTO. Pre-TAVR LVOTO was present in 32 patients (10.6%) and post-TAVR LVOTO in 35 (11.6%). Follow-up TTE was performed at a median of 47 days (IQR 37-63) after TAVR, with the majority of TTE (216 of 302, 71.5%) performed within 2 months. DLi-LVOTO was significantly higher in patients with LVOTO at both pre- and post-TAVR TTE (all p<0.001). In multivariable analysis, DLi-LVOTO remained independently associated with post-TAVR LVOTO even after adjusting for conventional TTE parameters and pre-TAVR LVOTO (adjusted OR 1.29, 95% CI 1.06-1.56 per 10-score increase, p=0.011), with an AUROC of 0.78 (95% CI 0.72-0.85). Among patients without pre-TAVR LVOTO, DLi-LVOTO retained independent predictive value (adjusted OR 1.56, 95% CI 1.19-2.06, p=0.001; AUROC 0.84, 95% CI 0.77-0.91). Conclusion: A DL model originally trained in HCM patients independently predicts post-TAVR LVOTO from pre-TAVR TTE, including in patients without pre-existing LVOTO, suggesting it captures hemodynamic features beyond conventional echocardiographic assessment.

Research2026 Mar 31

Digital Determinants of Health: Evaluating the Impact of Information and Communication Technology on Chinese Health Outcomes.

The International journal of health planning and management— Lu ZN, Ren S, Hao Y, Yuan C

BACKGROUND: The new generation of network information technology has become a significant tool to promote public health. The application of information and communication technology (ICT) in the traditional medical industry has changed the medical service model, improved the public medical service system, and provided diversified medical services to the public. OBJECTIVE: This paper discusses the impact of ICT on residents' health, and analyzes the possible heterogeneity impact in different groups and its impact mechanism using the China Family Panel Studies (CFPS) data and a fixed-effects model. METHODS: The ordinary least squares estimation method was adopted to quantitatively identify the impact mechanism of ICT applications on residents' health. Multisource big data were collected, including the CFPS questionnaire (gender, age, marriage status, work status, income level, smoking, sports, and insurance participation), regional economic development, as well as service industry development. The quantitative phase involved conducting in-depth investigation across 25 Chinese provinces. Then, a quantitative analyse-based study empirically tested the effects of internet applications on residents' health by matching macro data and micro survey data. After controlling for these identified factors, the data were tested using ordinary least squares and fixed effect models, with the assistance of STATA version 14 to measure and validate the proposed model. RESULTS: The regression results support the conclusion that ICT can significantly improve residents' health (p < 0.001). After a series of robustness tests through replacing explanatory variables and choosing appropriate exogenous policy shocks, the results still hold. We analyse the possible heterogeneous effects and conclude that the health-promoting effect of ICT is stronger among middle-aged individuals, high-income groups, women, urban residents, unmarried individual, those who engage in sports and non-smokers. CONCLUSIONS: Our study confirms a significant association between ICT applications and residents' health and reveals substantial heterogeneity in this effect. It also provides insights into how to apply internet information to better realise disease surveillance and prevention goals.

Research2026 Mar 30

Impact of the invasively measured flow-gradient pattern on clinical outcomes and ventricular remodeling after transcatheter aortic valve implantation in patients with severe aortic stenosis and preserved ejection fraction.

Clinical research in cardiology : official journal of the German Cardiac Society— Allali A, Abdel-Wahab M, Elbasha K, Kurniadi A, Mankerious N et al.

AIMS: To investigate clinical outcomes and cardiac remodeling according to cardiac magnetic resonance (CMR) of the invasively measured different flow/gradient entities of severe aortic stenosis (AS) with preserved left ventricular ejection fraction (EF) after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: All consecutive patients with preserved EF and severe AS undergoing right heart catheterization and treated with TAVI between 2007 and 2017 were split into four groups: normal-flow high-gradient (NF-HG n = 113, 25.9%); low-flow high-gradient (LF-HG n = 190, 43.6%); normal-flow low-gradient (NF-LG n = 50, 11.5%); and low-flow low-gradient (LF-LG n = 83, 19%). Patients with LF were older (81.9 ± 6 vs. 80.1 ± 6, p = 0.004); had a higher rate of atrial fibrillation (45.8% vs. 27.6%, p < 0.001); and had a higher EuroScore (p = 0.002). Significant improvement of functional status was noted in all four subgroups. However, the benefit at 30 days was more pronounced in HG patients. In CMR, at 6 months, we observed a significant regression of LV mass in NF-HG, LF-HG, and LF-LG but not in NF-LG patients. Patients with HG AS showed a lower rate of all-cause mortality at 5 years follow-up compared to LG AS (42.3% vs. 58%; p = 0.024). No difference in long-term mortality was observed between LF and NF AS (43.6% vs. 50%, p = 0.87). CONCLUSION: In patients with severe AS and preserved EF, patients with all invasively measured flow-gradient entities improved functionally after TAVI. High-gradient AS-regardless of the flow status-showed the most pronounced LV mass regression at 6-month CMR follow-up, had the best clinical improvement, and the lowest 5-year all-cause mortality after TAVI.

Research2026 Mar 27

Hydrophilic Cationic Surface Modification Confers Simultaneous Antibacterial and Antithrombotic Properties to Blood-Contacting Devices.

Acta biomaterialia— Hong Y, Liu J, Wang J, Wang Y, Liu X et al.

The clinical application of blood-contacting medical devices carries lethal risks such as sepsis and vascular embolism, with thrombosis and bacterial infection being core complications that severely threaten device safety. Although cationic surface modification strategies exhibit broad-spectrum antibacterial properties without the risk of bacterial resistance, non-specific adhesion induced by electrostatic effects both diminishes antibacterial efficacy and exacerbates thrombotic risk. Hydrophilic modification techniques are extensively employed in anti-adhesion surface coating research. This study introduces hydrophilic modifications onto cationically modified catheter surfaces, effectively reducing non-specific adhesion to achieve sustained dual antibacterial and anti-thrombotic efficacy. Through redox-initiated radical polymerisation, polyhexamethylene guanidine (PHMG) and the zwitterionic compound 2-methacryloyloxyethyl phosphorylcholine (MPC) were covalently grafted onto the polyurethane (PU) catheter surface. Following in vitro and in vivo antibacterial and blood cell adhesion assays to determine the optimal PHMG-MPC ratio exhibiting concurrent hydrophilicity, potent antibacterial activity, and anti-thrombotic properties, intravascular implantation studies validated its efficacy. In summary, the strategy of surface-modifying PU with PHMG/MPC (PU-PM) resolves issues associated with cationic surface modifications arising from non-specific adhesion. This renders it more suitable for clinical requirements in blood-contacting devices, significantly enhancing its potential for clinical translation. STATEMENT OF SIGNIFICANCE: 1. Through redox-initiated polymerisation, methylacrylamidated polyhexamethylene guanidine (PHMG-MA) and 2-methacryloyloxyethyl phosphatidylcholine (MPC) were covalently bonded to the polyurethane surface, achieving hydrophilic modification of the cationic surface. 2. This synergistic modification strategy achieves functional integration of antibacterial and antithrombotic properties, overcoming the performance limitations imposed by the non-specific adhesion associated with single cationic modification techniques.

Research2026 Mar 26

Design and rationale of the EMPagliflozin after Aortic Valve Replacement (EMPAVR) study: a randomized clinical trial.

American heart journal— Sørensen LM, Reinert MS, Raja AA, de Backer O, Bieliauskas G et al.

INTRODUCTION: Left ventricular (LV) hypertrophy and dysfunction secondary to aortic stenosis (AS) are key components of the disease's underlying pathophysiology. Previous trials suggest that up to 1/3 of patients do not benefit symptomatically after aortic valve replacement (AVR), which could be explained by insufficient LV remodeling. Sodium‒glucose cotransporter-2 (SGLT2) inhibitors are effective in heart failure (HF) and have been shown to improve LV remodeling (change in LV mass). METHODS: The EMPAVR study is an investigator-initiated, randomized, placebo-controlled, and double-blinded trial comparing the effect of empagliflozin to placebo in patients with severe and symptomatic AS undergoing transcatheter aortic valve implantation (TAVI). The primary outcome for the EMPAVR trial is the difference in LV mass indexed to body surface area (measured by cardiac CT) from pre-AVR to 6 months post-AVR. Patients are randomized in a 1:1 ratio to 180 days of treatment. DISCUSSION: To the best of our knowledge, the EMPAVR study is the first placebo-controlled trial investigating the effects of SGLT2 inhibition in patients following TAVI because of AS. The EMPAVR study has the potential to pave the way for treatment of the LV in valvular heart disease and may help patients worldwide and expand our understanding of aortic stenosis. TRIAL REGISTRATION: The EMPAVR study was registered in December 2024 (Clinical Trial Registration number: NCT06171802) before enrollment of the first patient. All patients will provide oral and written informed consent. The EMPAVR study is approved by the Regional Committee on Health Research Ethics and the Danish Medicines Agency.

Research2026 Mar 25

Leadless or Transvenous pacemakers following TAVR: A systematic review and meta-analysis.

Cardiovascular revascularization medicine : including molecular interventions— Suruagy-Motta RFO, Nogueira CFSC, Dexheimer da Silva L, Bertoli ED, Barbosa GLV et al.

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is frequently associated with conduction disturbances and arrhythmias, often requiring permanent pacemaker (PPM) implantation in an elderly, high-bleeding-risk population. Leadless pacemakers (LPMs) reduce pocket and lead-related complications and have demonstrated noninferior safety compared with transvenous pacemakers (TVP) in non-TAVR populations. However, comparative data in the post-TAVR setting are lacking. METHODS: We systematically searched Pubmed, Cochrane, Embase, Web of Sciences and Scopus for studies comparing LPM vs. TVP following TAVR. Random effects models were used to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, device-related complications, re-hospitalization and vascular access site complications. Statistical analysis was performed with R software, version 4.2.3. RESULTS: Six retrospective studies comprising 10,681 patients were included, of whom 874 (7.56%) underwent LPM implantation. Compared with TVP, LPM was associated with a significant reduction in device related complications (RR 0.46; 95% 0.25-0.83; p < 0.011) and vascular access site complications (RR 0.15; 95% CI 0.03-0.68; p = 0.011). There was no significant difference in re-hospitalization (RR 0.82; 95% CI 0.23-3.12; p = 0.76). LPM was associated with a higher risk of all-cause mortality (RR 1.61; 95% CI 1.01-2.57; p = 0.047). CONCLUSIONS: Among these six retrospective studies, LPM use following TAVR was associated with fewer device-related and vascular access complications compared with TVP, albeit with a higher risk of all-cause mortality at 2 years. However, this finding likely reflects a selection bias in non-adjusted baseline characteristics rather than device inferiority. No significant differences were observed in re-hospitalization between the two strategies. Prospective studies are required to confirm or refute these findings.

Research2026 Mar 25

Temporal change in patients with mitral annular calcification after successful aortic valve intervention.

Cardiovascular revascularization medicine : including molecular interventions— Abdul-Kafi O, Chedid M, Ansani T, Nguyen J, Bergstedt S et al.

BACKGROUND: Patients with severe aortic valve stenosis and concomitant mild to moderate mitral stenosis (MS) or mitral regurgitation (MR) from mitral annular calcification (MAC) often undergo aortic valve replacement (AVR) while sparing the mitral valve. This study aimed to analyze the rate of progression of mitral valve disease in patients with MAC undergoing AVR. METHODS: A retrospective cohort study was conducted on 147 patients with MS and/or MR and MAC undergoing AVR at Allina Health in 2012-2022. The rate of progression for MR, MS, left ventricular ejection fraction (LVEF), and survival probability were assessed at a median follow-up of 2.0 (1.24-3.70) years. RESULTS: The mean age was 78 ± 10 years. Most patients were female (66%) with NYHA class III symptoms (70%) prior to AVR, and the majority underwent TAVR (93%). Most patients had MS ranging from trace to moderate range (90%) and MR ranging from trace to moderate range (91%) prior to the procedure. There was no significant change in MS or MR severity, or mortality (p = 0.47) based on MAC severity within the follow up duration. CONCLUSION: Overall, patients with MAC with moderate or less MS and/or MR and aortic stenosis had no significant change in MS or MR severity and no need for mitral valve intervention during 6 years of follow-up after AVR.

Research2026 Mar 24

Safety and efficacy of transcatheter aortic valve replacement for native pure aortic valve regurgitation.

Journal of cardiovascular medicine (Hagerstown, Md.)— Cavalli GG, Vallabini A, Braccio M, Spatuzza P, Alemanni R et al.

AIMS: Transcatheter aortic valve replacement has become the standard of care for high-risk patients with aortic stenosis. Considering the unique procedural challenges posed by native pure aortic regurgitation (NPAR), our aim was to evaluate the early and mid-term results of off-label transcatheter aortic valve replacement (TAVR), investigating the possibility of brief Veno-Arterial extracorporeal membrane oxygenation (VA ECMO) support for most complex procedures. METHODS: We retrospectively enrolled 65 consecutive patients, who underwent TAVR for NPAR because they were deemed ineligible for surgery. Patients with aortic valve calcification or stenosis were excluded. Primary endpoints were technical and device success according to the VARC-3 criteria. Secondary endpoints were clinical efficacy at 1 year and absence of at least moderate paravalvular leak. RESULTS: Patients' mean age was 76.15 ± 8.91. We adopted light sedation and local anesthesia in 60 patients (92.3%). High-risk patients (53.8%) were briefly supported with percutaneous femoro-femoral VA ECMO, allowing safer and more precise valve deployment. One intraprocedural death was recorded (1.5%). Although the overall 30-day mortality was 7.7%, primary composite outcomes were significantly better in the second half of the population (P = 0.023 and P = 0.026). Only one moderate paravalvular leak (1.5%) was detected at 1-month follow-up. Clinical efficacy at 1 year was 76.3%, being available for 38 patients. CONCLUSION: TAVR is still considered an off-label approach for NPAR because of the increased stroke volume and absence of annular and leaflet calcification, which might increase the complication rate. Nonetheless, a standardized approach, with the aid of brief VA ECMO support for complex cases, should be considered a safe and valid option in high-volume centers for inoperable patients.

Research2026 Mar 24

Soft hydrophilic interfaces boost endothelial selectivity of bioactive peptides for long-term vascular graft patency.

Biomaterials— Xiong Y, Hu Y, Pu H, Wang J, Luo R et al.

The surface modification of bioactive molecules is thought to aid endothelial cell adhesion, which is crucial for achieving rapid endothelialization of vascular grafts and thus ensuring long-term patency. However, conventional hydrophilic coatings possess inherent limitations in resisting nonspecific adsorption, making it difficult to maintain selectivity for endothelial cells in complex blood environments. As a result, the deposition of nonspecific proteins and cells on the surface may trigger neointimal hyperplasia and luminal stenosis, ultimately leading to graft failure. This study proposed a soft hydrophilic coating that combines a low elastic modulus with high hydrophilicity and site-specifically grafted the endothelial cell-selective YIGSR peptide via click chemistry. The coating featured a dual physical-chemical antifouling mechanism. Compared to traditional hard hydrophilic coatings, the soft hydrophilic coating showed improved resistance to protein and non-target cell adhesion (such as fibroblasts, smooth muscle cells, and inflammatory cells) in complex biological environments, while maintaining the selective pro-adhesive function of YIGSR peptides for endothelial cells. By specifically interacting with integrin receptors on the endothelial cell surface, the coating facilitated firm endothelial attachment and upregulated vinculin expression, thereby contributing to the formation of a functional endothelium. Notably, in rat and rabbit in vivo small vascular graft replacement models, this coating significantly promoted rapid and functional endothelialization and ensured long-term patency of the grafts. This study provided a new strategy to address the rapid loss of in vivo bioactivity in existing coatings and offered valuable insights for the design of next-generation cardiovascular implants.

Research2026 Mar

Evolution of Clinical Indications for Mitral Valve Transcatheter Edge-to-Edge Repair.

Reviews in cardiovascular medicine— Iglesias-Otero C, Echarte-Morales J, González-Fernández D, Íñiguez-Romo A, Estévez-Loureiro R

Mitral valve transcatheter edge-to-edge repair (M-TEER) has evolved from a highly specialized intervention to an essential treatment option for patients with severe mitral regurgitation (MR) who are unsuitable candidates for surgery. Moreover, current guidelines support the use of M-TEER in both secondary MR and selected cases of primary MR. In addition to these established indications, data from clinical trials and registries indicate that M-TEER is associated with improved short-term outcomes compared with conservative therapy in acute MR after myocardial infarction, and is beneficial in more complex scenarios, such as advanced heart failure, hypertrophic obstructive cardiomyopathy, and mitral annulus calcification. Meanwhile, combined strategies, such as repairing the mitral and tricuspid valves simultaneously, adding M-TEER to transcatheter aortic valve replacement, or performing this procedure alongside left atrial appendage closure, are gaining ground as practical ways to address the broader needs of these high-risk patients. More recently, M-TEER has been used in patients with moderate MR, as this stage is now recognized to be associated with adverse outcomes. Overall, current evidence supports M-TEER as a safe and versatile therapy across an expanding range of clinical scenarios. Nonetheless, ongoing studies will help further clarify long-term outcomes and refine patient selection.

Research2026 Mar

Intelligent Decision Support for Transcatheter Aortic Valve Replacement: Machine Learning Spans From Anatomical Assessment to Dynamic Risk Modeling.

Reviews in cardiovascular medicine— Hu X, Xie P, Li Y

This study aimed to investigate the application of machine learning (ML) in transcatheter aortic valve replacement (TAVR) and to demonstrate that, owing to the unique strengths of ML, this field outperforms conventional approaches in both preoperative assessment and postoperative prediction of TAVR. Nonetheless, TAVR is the preferred treatment option for medium- and high-risk patients with aortic stenosis, a common valvular disease, because of the associated minimally invasive nature and rapid recovery. However, challenges remain in preoperative evaluation and in predicting postoperative complications. Thus, ML technology offers innovative solutions for these challenges. This study provides an overview of current ML applications in TAVR and evaluates the associated benefits in measuring preoperative anatomical parameters and predicting postoperative complications. Indeed, the superiority of ML models for preoperative planning can be assessed by comparing ML model-derived data with measurements from senior and junior observers across various aortic root anatomical parameters. Additionally, this review discusses the challenges of applying ML in TAVR, including data acquisition, privacy protection, and model generalizability. The ongoing advancement of artificial intelligence (AI) technologies, particularly the integration of explainable AI and federated learning, is expected to enhance the accuracy and personalization of preoperative planning and postoperative prediction for TAVR. This progress will facilitate broader application of these technologies, ultimately benefiting a wider patient population.

Research2026 Jun

Characteristics, clinical outcomes and molecular mechanisms associated with severe diastolic dysfunction in aortic stenosis.

Journal of molecular and cellular cardiology plus— Panaou K, Venema CS, van Bergeijk KH, Hadjicharalambous D, Girerd N et al.

OBJECTIVES: We aimed to better understand patient characteristics and pathophysiological mechanisms associated with severe diastolic dysfunction in aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI). BACKGROUND: Patients with severe aortic stenosis often have echocardiographic signs of diastolic dysfunction. However, their characteristics and underlying disease mechanisms remain unclear. METHODS: Untargeted LC-MS lipidomics (1110 lipids) and proteomics (834 proteins) were performed on peri-procedural plasma from 231 TAVI patients. Pre-procedural echocardiography was available in 191 patients. DIABLO (mixOmics, version 6.3.0, R version 4.4.1) was used to integrate lipidomic and proteomic profiles. RESULTS: Median age was 80 years, and 61% were female. In total, 75 (39%) patients had severe diastolic dysfunction. Patients with severe diastolic dysfunction more often had atrial fibrillation, higher plasma NT-proBNP concentrations, and more heart failure hospitalizations and mortality.Multi-omic network analysis identified two major lipid-protein clusters associated with severe diastolic dysfunction. The first showed dysregulation of membrane phospholipids such as cardiolipins (essential for mitochondrial integrity and energy metabolism), and phosphatidylserines (cytoprotective and anti-inflammatory properties). This cluster was associated with cytoskeletal and extracellular matrix remodeling. The second cluster showed high concentrations of acylcarnitines (indicative of metabolic dysfunction), which were associated with extracellular matrix remodeling and inflammatory responses. CONCLUSIONS: In patients with aortic stenosis undergoing TAVI, those with severe diastolic dysfunction showed a disrupted balance of membrane phospholipids and acylcarnitines, suggesting that impaired energy metabolism, cellular and extracellular structural remodeling, and inflammatory responses may underlie the development and progression of diastolic dysfunction and heart failure. CONDENSED ABSTRACT: We investigated clinical features and molecular profiles linked to severe diastolic dysfunction in aortic stenosis patients undergoing TAVI. Untargeted lipidomics (1110 lipids) and proteomics (834 proteins) were performed on peri-procedural plasma from 231 patients. Pre-procedural echocardiography was available in 191 patients. Severe diastolic dysfunction was present in 39% and was associated with atrial fibrillation, higher NT-proBNP, and more heart failure hospitalizations and mortality. Multi-omic integration identified two major lipid-protein clusters. The first was characterized by dysregulated membrane phospholipids, including cardiolipins and phosphatidylserines, linked to cytoskeletal and extracellular matrix remodeling. The other showed elevated acylcarnitines, indicating metabolic dysfunction, and inflammatory activation. These findings suggest that altered energy metabolism, structural remodeling, and inflammation are associated with severe diastolic dysfunction in aortic stenosis.

Research2026 Jan

The Utility of Cerebral Protection Devices in Transcatheter Aortic Valve Replacement: A Systematic Review and Bayesian Meta-analysis.

Journal of the Society for Cardiovascular Angiography & Interventions— Shimoda TM, Sakurai Y, Watanabe M, Fukuhara S, Yokoyama Y et al.

BACKGROUND: Cerebral embolic protection (CEP) devices are designed to reduce procedure-related stroke during transcatheter aortic valve replacement (TAVR). In light of recent randomized controlled trials (RCTs), we performed an updated meta-analysis to evaluate their impact on stroke and mortality. METHODS: We systematically searched PubMed, EMBASE, and Cochrane Central through June 2025 for RCTs comparing TAVR with or without the CEP devices. Outcomes of interest included all stroke, disabling stroke, and all-cause mortality. Data were extracted and pooled using a random-effects frequentist meta-analysis. In addition, a Bayesian meta-analysis was performed with both vague and informative priors to evaluate the probability of a clinically meaningful reduction in stroke. RESULTS: Eight RCTs with 11,632 patients (CEP group = 5969; control group = 5663) were included. We found no difference in all strokes between the groups (risk ratio, 0.92; 95% CI, 0.74-1.15), nor in disabling stroke or all-cause mortality. In the Bayesian meta-analysis for all strokes using a vague prior, posterior probabilities that the risk ratio was <1, <0.9, and <0.67 were 71.9%, 35.6%, and 0.1%, respectively. For disabling stroke, the probabilities were 89.6%, 73.3%, and 12.1%, respectively. With an informative prior, posterior probabilities for all strokes were 95.9%, 39.0%, and 0% and the probabilities for disabling strokes were 98.3%, 73.8%, and 0%, respectively. CONCLUSIONS: CEP devices did not significantly reduce stroke or mortality during TAVR, and the probability of a clinically meaningful benefit was low. Larger studies with extended follow-up are warranted to clarify their role in contemporary practice.

Research2026 Apr 16

Supra-Annular Versus Intra-Annular Devices for Transcatheter Aortic Valve-in-Valve Replacement: The PANDORA International Registry.

Journal of the American Heart Association— Popolo Rubbio A, Sisinni A, Criscione E, Poletti E, Van Mieghem N et al.

BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to younger, lower-risk populations, the need for repeat procedures due to valve degeneration is expected to increase. TAVR-in-TAVR has emerged as a feasible strategy, although outcomes across supra-annular (SAV) and intra-annular (IAV) valve combinations remain unclear. The PANDORA (Supra-Annular Versus Intra-Annular Devices for TAVR-in-TAVR) international registry study assessed safety, hemodynamic performance, and clinical outcomes of TAVR-in-TAVR according to prosthetic configurations. METHODS: From an international multicenter registry (2011-2024), 172 TAVR-in-TAVR cases were identified among ≈30 000 TAVR procedures, with a median interval of 1401 days. Patients were stratified into 4 groups: SAV-IAV (n=32), SAV-SAV (n=29), IAV-SAV (n=74), and IAV-IAV (n=37). RESULTS: CoreValve/Evolut (49.4%) and Edwards SAPIEN (35.5%) were the most frequent index prostheses, whereas the second valve was mainly Edwards SAPIEN (60.5%), followed by Evolut (35.5%) and Myval/Octacor (4.0%). Structural valve deterioration was the leading failure mechanism (77.9%), while nonstructural valve deterioration dysfunction, alone or combined with structural valve deterioration, occurred in 40.7%. Overall Valve Academic Research Consortium 3 technical success was 91.3%, numerically highest in SAV-IAV and IAV-SAV (P=0.090). Thirty-day device success was 68%, also higher in SAV-IAV (75.9%, P=0.301), mainly influenced by elevated residual gradients (≥20 mm Hg in 12.7%) and the 30-day mortality rate (7.3%). At 1 year, the IAV-IAV group showed the numerically lowest freedom from death and heart failure hospitalization (76.1%, P=0.734). Male sex and chronic kidney disease independently predicted death at follow-up. CONCLUSIONS: TAVR-in-TAVR is feasible with generally favorable outcomes, although clinical and procedural profiles vary by the different prosthesis combinations. These findings highlight the need for further studies to refine device selection strategies.

Research2026 Apr 15

Safety and effectiveness of balloon-expandable Myval transcatheter aortic valve implantation: a single-center, real-world evidence from Kazakhstan.

Journal of cardiothoracic surgery— Mussayev A, Alimbayev S, Amanzholova Z, Tanaliyev N, Kali A et al.

BACKGROUND: Untreated aortic stenosis (AS) leads to significant mortality and morbidity. Balloon-expandable Myval transcatheter heart valve (THV) has demonstrated safety and effectiveness for treating severe AS in patients at intermediate or high risk for surgery. This retrospective observational study aimed to analyze the safety and efficacy of Myval THV in AS patients who underwent transcatheter aortic valve implantation (TAVI) at a single-center. METHODS: Data from 100 consecutive patients who underwent transfemoral TAVI for severe symptomatic AS with Myval THV were analyzed. Baseline characteristics including medical history, clinical features, procedural data, laboratory and echocardiographic data, and outcome data at discharge and 30 days were collected retrospectively. Outcomes as defined according to the consensus document of the Valve Academic Research Consortium-3 were determined. RESULTS: Baseline characteristics of 100 patients were: 64% males, mean age: 70.87 ± 7.85 years, mean body mass index: 27.97 ± 4.30 Kg/m2, Society of Thoracic Surgeons risk score: 2.88 ± 2.18% and log EuroSCORE: 3.34 ± 2.82% respectively. Following transfemoral TAVI, mean and peak gradients were reduced (p < 0.001). There was a significant improvement in Vmax 2.50 ± 1.52 m/s (p < 0.0001), left ventricular ejection fraction 50.5 ± 10.64% (p = 0.0003), aortic valve area 1.76 ± 0.52 (p = 0.0013), and indexed aortic valve area 0.92 ± 0.28 (p = 0.0034) at discharge which continued at 30-day follow-up. Nearly 94% of patients were asymptomatic and in the New York Heart Association class I-II, with 22% of patients reduced the degree of mitral regurgitation at 30 days. At discharge, only 4.12% had moderate aortic regurgitation while 73.2% had none. Two patients had stroke while 15 patients had conduction disturbances, which led to the implantation of permanent pacemakers. No death or hospitalization were reported. Life-threatening bleeding and access-related complications did not occur in any patient. The rates of the device and technical success were 95%. CONCLUSION: Real-world data on the use of technologically advanced Myval THV leads to safe and precise orthotopic positioning in TAVI patients, ensuring optimal, large effective orifice area, and normal hemodynamic status.

Research2026 Apr 14

Prognostic value of transaortic flow rate compared with ejection fraction and stroke volume index in low-gradient severe aortic stenosis.

Heart (British Cardiac Society)— Allam M, Villa Etchegoyen C, Alsidawi S, Pathangey G, Sheashaa H et al.

BACKGROUND: In low-gradient severe aortic stenosis (AS), reduced left ventricular ejection fraction (LVEF <50%) is practically used to define low flow and prompt dobutamine stress echocardiography to discern pseudo-severe AS. In patients with preserved LVEF, stroke volume index (SVI) <35 mL/m² is typically used. However, both are volume-based surrogates. Transaortic flow rate (TAFR), calculated as stroke volume divided by left ventricular ejection time, may better reflect true flow. Nonetheless, comparative data between TAFR and established metrics remain limited. We aimed to evaluate the prognostic value of TAFR in symptomatic low-gradient severe AS. METHODS: We retrospectively identified patients with low-gradient severe AS (AVA ≤1 cm2 and peak velocity (Vmax) <4 m/s or mean gradient (MG) <40 mm Hg) who underwent transcatheter aortic valve replacement at Mayo Clinic sites (2017-2023). The primary outcome was 1-year all-cause mortality. Survival was assessed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Among 475 patients included (mean age 85±8 years; 49% women), 242 (51%) had TAFR <220 mL/s, 165 (35%) had EF <50%, and 221 (47%) had SVI <35 mL/m2. Low TAFR was significantly associated with higher 1-year mortality even after stratifying by EF or SVI. In multivariate analysis, TAFR was an independent predictor of mortality (HR 2.38; 95% CI 1.19 to 4.76, p=0.014) after adjusting for reduced LVEF, low SVI, gender, chronic kidney disease and mitral and tricuspid regurgitation. CONCLUSIONS: In patients with symptomatic low-gradient severe AS, low TAFR, not SVI or LVEF, is independently associated with mortality and may offer more accurate measure of flow state for clinical staging.

Research2026 Apr 12

The Impact of Vascular Access Complications in Patients Undergoing Transcatheter Aortic Valve Replacement.

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions— Mesar T, Jackson A, Chachati G, Jacquemyn X, Ahmad D et al.

BACKGROUND: Vascular complications remain a significant concern in transfemoral transcatheter aortic valve replacement (TAVR). AIMS: Determine the incidence of vascular complications following TAVR and evaluate their impact on short- and long-term clinical outcomes. METHODS: We conducted a retrospective observational analysis of patients undergoing transfemoral TAVR at a single institution. Patients were stratified into three groups: Group 0 (no perioperative complications), Group 1 (vascular complications), and Group 2 (non-vascular complications). The primary outcome was early- and late-mortality. Propensity score matching was performed to compare outcomes between Group 0 and Group 1. RESULTS: Among 5230 patients, 4391 (84.0%) were in Group 0, 154 (2.9%) in Group 1, and 685 (13.1%) in Group 2. In Group 1, 36.4% experienced intraoperative bleeding requiring intervention, 27.3% had intraoperative limb ischemia or dissection, and 16.2% required postoperative takeback for limb ischemia. In-hospital mortality was 12/154 (7.8%) in Group 1, compared with 7/4391 (0.2%) in Group 0 and 45/685 (6.6%) in Group 2 (p < 0.001). Thirty-day mortality was 16/154 (10.4%) in Group 1 versus 117/4391 (2.7%) in Group 0 and 70/685 (10.2%) in Group 2 (p < 0.001). Propensity-matched analysis showed Group 1 had fourfold higher 30-day mortality (OR 4.02, 95% CI 1.98-8.18, p < 0.001). One-year mortality was 29/148 (19.6%) for Group 1 compared with 72/592 (12.2%) for Group 0, with 5-year survival similar between groups (Group 1: 51.1%, Group 0: 50.9%, log-rank p = 0.214), while unmatched Group 2 had 43.1% 5-year survival. CONCLUSION: While vascular complications after TAVR are uncommon, they are linked to substantially worse early outcomes, whereas long-term survival among patients who survive the initial postoperative period remains comparable, emphasizing the critical impact during the early phase.

Research2026 Apr 10

Initial Outcomes After Trans-Right Subclavian Transcatheter Aortic Valve Implantation: Analysis of Device Coaxiality.

Circulation reports— Hamada R, Onishi K, Yasuda M, Fujita K, Soejima N et al.

BACKGROUND: Trans-subclavian access transcatheter aortic valve implantation (TAVI), typically from the left side, is feasible. However, right subclavian artery access is technically challenging because of the anatomical orientation, resulting in malalignment of the transcatheter heart valve within the aortic annular plane. METHODS AND RESULTS: We aimed to evaluate procedural outcomes, device-annulus alignment, and clinical efficacy of right trans-subclavian (RtTS) TAVI. Of a consecutive 423 patients who underwent TAVI, 32 cases performed via right and left subclavian access were analyzed. Implanted device depth and angle were analyzed angiographically. The device-annulus angle was measured angiographically. Fifteen of 22 patients were treated with a balloon-expandable valve, and 7 patients received a self-expanding valve, via RtTS. Procedural success was achieved in all cases. Compared with femoral and left subclavian approaches, RtTS led to a significantly larger device-annulus angle (6.0° vs. 8.7°; P<0.05), with deep left coronary cusp implantation (2.4 vs. 4.4 mm; P=0.05). Post-procedural transcatheter heart valve function was comparable across the groups, and no patients had greater than moderate paravalvular leakage. However, the incidence of symptomatic stroke occurred in 2 patients in the RtTS group (9.1%; P=0.21). CONCLUSIONS: RtTS TAVI is a feasible alternative access route, with comparable procedural and clinical outcomes to those of conventional approaches, albeit with a higher risk of stroke.

Research2026 Apr 10

Impact of Preoperative Malnutrition and Sarcopenia on Clinical Outcomes After Transcatheter Aortic Valve Replacement.

Circulation reports— Nakamura K, Taniguchi T, Omori A, Nishi H, Bando G et al.

BACKGROUND: The impact of coexisting malnutrition and sarcopenia on survival after transcatheter aortic valve replacement (TAVR) has not been fully studied. METHODS AND RESULTS: Among 513 consecutive patients undergoing TAVR between February 2014 and June 2023, 340 with available preoperative Geriatric after Nutritional Risk Index (GNRI) and Short Physical Performance Battery (SPPB) data were categorized into 4 groups based on malnutrition (GNRI <98) and sarcopenia (SPPB ≤9) status: malnutrition and sarcopenia (N=98); malnutrition without sarcopenia (N=69); no malnutrition with sarcopenia (N=83); neither malnutrition nor sarcopenia (N=90, reference). The primary outcome measure was all-cause death. Patients with both malnutrition and sarcopenia were older and had a higher prevalence of anemia compared with the reference group. The cumulative 5-year mortality rate was significantly higher in this group. After adjusting for confounders, coexistence of malnutrition and sarcopenia had a significantly higher risk for all-cause death (hazard ratio [HR] 3.15; 95% confidence interval [CI]: 1.68-5.89; P<0.001). In contrast, malnutrition without sarcopenia (HR 1.36; 95% CI 0.64-2.90; P=0.42) and no malnutrition with sarcopenia (HR 1.86; 95% CI 0.92-3.79; P=0.08) were not associated with increased mortality. CONCLUSIONS: The coexistence of malnutrition and sarcopenia significantly increased mortality risk after TAVR, which highlights the importance of integrating both nutritional and sarcopenia assessments into preoperative risk stratification to optimize outcomes in patients undergoing TAVR.

Research2026 Apr 10

Left vs. Normal QRS Axis During Left Bundle Branch Block Induced by Transcatheter Aortic Valve Replacement: 3-Year Outcomes.

Circulation reports— Sasaki K, Kuwata S, Izumo M, Sato Y, Kai T et al.

BACKGROUND: The clinical impact of left QRS axis deviation (LAD) during new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains unclear. METHODS AND RESULTS: This single-center retrospective study analyzed 254 patients who developed new-onset LBBB during hospitalization after TAVR. Clinical and echocardiographic outcomes were compared between patients with LBBB and LAD (LBBBLAD) and those with LBBB and a normal QRS axis (LBBBNA). 96 patients (38%) had LBBBLAD, defined as a QRS axis <-30°. A more leftward preprocedural QRS axis independently predicted LBBBLAD (odds ratio 1.20 per 10° decrement; 95% confidence interval (CI) 1.09-1.33; P<0.01). At 3 years, there were no significant differences between groups in all-cause death (28% vs. 19%; P=0.14), cardiovascular death (6% vs. 5%; P=0.73), or heart failure rehospitalization (18% vs. 10%; P=0.07). However, LBBBLAD was associated with a higher incidence of permanent pacemaker implantation (PPI) for atrioventricular conduction disorder (16% vs. 6%; P=0.02) and remained an independent predictor of PPI (Cox hazard ratio 2.46; 95% CI 1.06-5.73; P=0.04). Echocardiographic measures, including left ventricular ejection fraction, chamber size, and mitral regurgitation severity showed no significant longitudinal differences between groups. CONCLUSIONS: Compared to post-TAVR LBBBNA, post-TAVR LBBBLAD is associated with an increased need for PPI, but not with adverse mortality or heart failure outcomes at 3-year follow-up. Closer and extended rhythm monitoring may be warranted in this subgroup.

Research2026 Apr 10

Contribution of Non-Sustained Ventricular Tachycardia to the Primary Prevention of Sudden Cardiac Death　- Validation of Current Japanese Circulation Society / Japanese Heart Rhythm Society Guideline Recommendations in the Nippon Storm Study.

Circulation journal : official journal of the Japanese Circulation Society— Yasuoka R, Maruyama M, Noda T, Nakazawa G, Nitta T et al.

BACKGROUND: The prognostic significance of non-sustained ventricular tachycardia (NSVT) in Japanese patients receiving implantable cardioverter defibrillators (ICDs) for primary prevention remains unclear. This study aimed to verify the prognostic value of NSVT as recommended in the 2018 Japanese Circulation Society guideline. METHODS AND RESULTS: We analyzed 638 patients with structural heart disease who received an ICD or cardiac resynchronization therapy with defibrillator for primary prevention in the Nippon Storm Study. Analysis 1 (n=429) evaluated the association between NSVT history and predefined endpoints in patients with ischemic heart disease (IHD) or non-ischemic heart disease (non-IHD) and reduced left ventricular ejection fraction. Analysis 2 (n=357) assessed the prognostic impact of NSVT documented by Holter electrocardiography across 2 subgroups: Subgroup 1, IHD and non-IHD; and Subgroup 2, other cardiac diagnoses. Endpoints included appropriate ICD therapy, electrical storm, ventricular fibrillation (VF), shock therapy, and mortality. In Analysis 1, a history of NSVT was not significantly associated with appropriate ICD therapy or other major adverse outcomes. In Analysis 2, Holter-documented NSVT was independently associated only with appropriate ICD therapy (hazard ratio [HR] 1.82; 95% confidence interval 1.04-3.18; P=0.035). This association was significant in Subgroup 2, but not in Subgroup 1. CONCLUSIONS: NSVT was modestly associated (HR 1.82) with appropriate ICD therapy but not with VF or mortality, suggesting reconsideration of its clinical role.

Research2026 Apr 10

THOC6 deficiency leads to Cardiomyopathy by Reducing Myocardial Contractile Proteins in Cardiomyocytes.

Experimental cell research— Yuan W, Jiang Z, Li F, Chen H, Zhang X et al.

BACKGROUND: The THOC6 protein is an essential part of the THO complex. Biallelic loss-of-function variants in the THOC6 gene are linked to Beaulieu-Boycott-Innes syndrome (BBIS; OMIM 613680). Although research predominantly focuses on THOC6's involvement in neurodevelopmental disorders, approximately 80% of BBIS patients present with cardiac anomalies, including structural heart disease, cardiomyopathy, and arrhythmia. Despite this, the connection between THOC6 expression and cardiac development remains underexplored. This study firstly investigates THOC6's role in heart development. METHODS AND RESULTS: This study we firstly utilized CRISPR/Cas9 to knock out THOC6 in H9C2 cardiomyocytes, revealing a reduction in cell proliferation and an increase in apoptosis. With RNA sequencing (RNA-seq) analysis we found abundant gene changes after THOC6 knockout (KO) in H9C2, which associated with hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and dilated cardiomyopathy. Protein-protein interaction analysis and experimental validation indicated that THOC6 regulates the expression of type I collagen (COL1A1, COL1A2) and cytoskeletal protein (Cardiac α actin 1) in cardiomyocytes. Subsequently, we generated a THOC6 knockout cell lines in human induced pluripotent stem cells (hiPSCs) derived from a healthy individual using CRISPR/Cas9 technology. THOC6 knockout (KO) in hiPSCs-derived cardiomyocytes (hiPSC-CMs) led to the early manifestation of hypertrophic cardiomyopathy and dilated cardiomyopathy phenotypic characteristics, including disrupted sarcomeric organization. Notably, THOC6 KO hiPSC-CMs demonstrated a significant decreased in COL1A2 and β-tubulin expression levels. CONCLUSION: THOC6 may influence cardiac development by regulating myocardial contractile proteins, primarily type I collagen, cardiac α actin 1 and β-tubulin.

Research2026 Apr 09

Stereotactic Arrhythmia Radioablation: An Emerging Technique for the Treatment of Ventricular Tachycardia.

Cardiology in review— Comuzzi A, Candelora A, Madaffari A, Angheben C, Maines M et al.

Ventricular tachycardia (VT) in patients with structural heart disease is a significant cause of both morbidity and mortality. Current treatment options for VT include the implantation of implantable cardioverter-defibrillators, anti-arrhythmic medications, and catheter ablation. Although implantable cardioverter-defibrillators can terminate arrhythmias by delivering shocks, they do not address the underlying cause and may even contribute to recurrence or cause discomfort for the patient. Anti-arrhythmic drugs may reduce the frequency of VT episodes but are often associated with various side effects. Catheter ablation can effectively eliminate the arrhythmogenic substrate, but it is an invasive procedure and not always successful. Recent studies have investigated stereotactic arrhythmia radioablation as a potential alternative, offering a less invasive, effective, and well-tolerated treatment by using photons, protons, and carbon ions to target and destroy arrhythmic tissue externally. This review aims to examine the current evidence and potential clinical applications of stereotactic arrhythmia radioablation.

Research2026 Apr 09

Lactation Safety in Peripartum Cardiomyopathy.

Cardiology in review— Khalid H, Kim A, Lau T, Parikh MA, Ramasubbu K et al.

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure that occurs toward the end of pregnancy or in the months following delivery. It is characterized by left ventricular systolic dysfunction in women without preexisting structural heart disease. Despite increasing recognition, the pathophysiology of PPCM remains incompletely understood. Accumulating experimental and clinical evidence supports a central role for hormonal dysregulation in disease development, particularly involving prolactin (PRL). During late pregnancy and the postpartum period, heightened oxidative stress promotes cleavage of full-length PRL into a 16-kDa fragment with potent antiangiogenic, proinflammatory, and proapoptotic properties. While total circulating PRL levels are elevated in PPCM, it is the generation of the 16-kDa PRL fragment, rather than absolute PRL concentration, that appears to be most strongly linked to disease severity and progression. The recognition of this mechanism has provided a framework for targeted therapeutic strategies. As many women choose to breastfeed, there are concerns about the safety of breastfeeding in PPCM. This review summarizes the experimental and clinical evidence related to elevated PRL levels, particularly the cleaved 16-kDa PRL fragment's contribution to disease development, with emphasis on lactation safety in PPCM.

Research2026 Apr 08

Early safety and efficacy of intra-annular versus supra-annular self-expanding transcatheter heart valves.

Clinical research in cardiology : official journal of the German Cardiac Society— Mattig I, Romero Dorta E, Kösters L, Fietz AK, Schulze D et al.

BACKGROUND: Comparative data on safety and efficacy of intra- and supra-annular self-expanding heart valves (THV) for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) is scarce. The FIRE TAVI study compared procedural in-hospital and mid-term outcomes of the intra-annular Navitor THV and the supra-annular Evolut PRO THV. METHODS: The retrospective, multicenter study enrolled patients with severe AS who underwent TAVI using Navitor or Evolut PRO. The primary composite safety endpoint included all-cause mortality, myocardial infarction, disabling stroke, life-threatening bleeding, major vascular complication, or acute kidney injury requiring dialysis until discharge. Secondary endpoints comprised pacemaker implantation, paravalvular leakage (PVL), and mean transvalvular gradient. Mortality was assessed 381 ± 308 days after TAVI. Multivariable regression analysis was used for endpoint comparison of both THVs. RESULTS: Then, 269 patients after Navitor and 272 patients after Evolut PRO implantation were enrolled. There was no significant risk difference regarding the adjusted primary safety endpoint (OR 0.97 [95% CI 0.50-1.89]) and rate of pacemaker implantation (OR 1.13 [95% CI 0.67-1.90]). The pressure gradient was comparable between both groups (Navitor 7.0 [4.0-10.0] mmHg vs. Evolut PRO 6.0 [2.0-10.0] mmHg, mean difference - 0.32 [95% CI -0.97-0.32]). Navitor showed a lower frequency of more than mild PVL (0.8% vs. 3.5%, p = 0.032). Mortality was similar (HR 1.04 [95% CI 0.66-1.63]). CONCLUSION: The implantation of the intra-annular Navitor and the supra-annular Evolut PRO was safe, with severe adverse events occurring at similar rates until discharge. The risk of moderate or severe PVL was lower with Navitor; mid-term mortality was comparable in both groups.

Research2026 Apr 07

A Nitric Oxide-Releasing Zwitterionic Glycocalyx-Mimetic Hydrogel Armored Bioprosthetic Valve with Integrated Antithrombotic, Endothelialization-Promoting, and Immunomodulatory Capacities.

Acta biomaterialia— Zheng C, Wei B, Huang X, Chen L, Wang Y

The global prevalence of heart valve disease (HVD) is currently increasing with the population ages, and heart valve replacement surgery is considered as the definitive treatment for HVD. Bioprosthetic heart valves (BHVs) are widely implanted with the development of transcatheter heart valve replacement. Nonetheless, BHVs are prone to degeneration within 10-15 years due to the inherent drawbacks including thrombosis, poor endothelialization, inflammation, and calcification. Herein, a nitric oxide-releasing zwitterionic glycocalyx-mimetic hydrogel armored bioprosthetic valve (AHS-P) was engineered. Zwitterionic glycocalyx-mimetic hydrogel surface was uniformly welded on the BHV by photo-induced polymerization, which markedly enhanced the hydrophilicity and biocompatibility of BHV, effectively resisting the adhesion of plasma proteins and platelets, and inhibiting thrombosis. With the introduction of L-arginine on glycocalyx-mimetic hydrogel, nitric oxide (NO) was intracellularly generated from the dynamically released L-Arg by the iNOS to regulate the immune responses, and the growth and adhesion of endothelial cells (HUVECs) was also facilitated by activating the RhoA-ROCK and PI3K/AKT/mTOR signaling pathways. The immune-inflammatory reactions on AHS-P were also modulated, with downregulated TNF-α and M1 macrophages and upregulated IL-10 and M2 macrophages, creating an immune-balancing microenvironment for enhanced biocompatibility. Furthermore, rat subcutaneous implantation showed that the calcification degree of AHS-P was markedly reduced. Collectively, the engineered BHV (AHS-P) demonstrated enhanced antithrombosis, anticalcification, endothelialization and immunoregulation performances, offering a new way to extend the service life of BHVs. STATEMENT OF SIGNIFICANCE: This work developed a nitric oxide-releasing zwitterionic glycocalyx-mimetic hydrogel-coated BHV to overcome key limitations such as thrombosis, poor endothelialization, inflammation, and calcification-issues associated with the cytotoxic xenogeneic collagenous matrix of BHVs. Zwitterionic glycocalyx-mimetic hydrogel was welded on BHVs to shield the matrix, resist the thrombosis and calcification, and serve as the scaffold for endothelialization. L-Arg was then incorporated to enable NO release, promoting endothelial cell adhesion and growth via RhoA-ROCK and PI3K/AKT/mTOR pathway activation. The immune-inflammatory reactions on BHVs were also downregulated. This work synergistically improved the antithrombosis, anticalcification, endothelialization and immunoregulation performances of BHVs, offering a promising strategy to extend BHV longevity.

Research2026 Apr 07

Left atrial functional recovery precedes volumetric reverse remodeling after TAVI by speckle tracking echocardiography.

Scientific reports— Li G, Liu N, Sun W, Xu K, Wang B et al.

The temporal sequence of left atrial (LA) functional and structural remodeling after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) remains inadequately characterized. We aimed to evaluate the mid-term changes in LA mechanics and volume using speckle-tracking echocardiography (STE). In this prospective observational study, 162 patients with severe AS undergoing TAVI were enrolled. Echocardiography was performed at baseline, 1, 6, and 12 months post-procedure. LA reservoir strain (LASr), conduit strain (LAScd), and pump strain (LASct) were measured by STE. LA volumes and the LA volume index (LAVI) were also assessed. LA strain parameters (LASr, LAScd, LASct) improved significantly at 1 month post-TAVI (all P < 0.05) and continued to improve through 12 months. LAVI also decreased significantly at 1 month (34.3 ± 6.6 ml/m² to 28.5 ± 5.9 ml/m², P < 0.05). However, the absolute LA volumes (LAVmax and LAVmin) showed significant reduction only at 6 months post-TAVI (P < 0.05). After TAVI, LA functional improvement, assessed by STE, occurs early and with greater magnitude than volumetric changes. While LAVI decreases promptly-likely reflecting early hemodynamic unloading-reductions in absolute LA volumes are delayed. STE-derived LA strain serves as a sensitive early marker of LA adaptation following relief of outflow obstruction.

Research2026 Apr 07

Sex-specific utility of pulmonary artery metrics in predicting pulmonary hypertension and survival after TAVI: insights from advanced CT imaging.

Insights into imaging— Boxhammer E, Hammerer M, Schörghofer N, Clodi N, Prinz E et al.

OBJECTIVE: Pulmonary hypertension (PH) significantly affects outcomes after transcatheter aortic valve implantation (TAVI), with sex-specific differences indicating the need for tailored strategies. This study investigated the predictive value of CT-derived main pulmonary artery (MPA) dimensions and ratios, focusing on diagnostic accuracy and prognostic relevance in male and female TAVI patients. MATERIALS AND METHODS: A retrospective analysis of 526 patients (263 male, 263 female) undergoing TAVI was performed. PH was defined echocardiographically according to European Society of Cardiology (ESC) guidelines. Pre-procedural CT measurements of MPA, ascending aorta (AA), and derived ratios (e.g., MPA/AA) were analyzed. Sex-specific cut-offs were determined using area under the receiver operating characteristic (AUROC) analyses and validated with survival curves and Cox regression. RESULTS: MPA and its ratios outperformed right and left pulmonary artery metrics in detecting PH. Overall cut-offs were MPA ≥ 29.5 mm and MPA/AA ≥ 0.76. In men, elevated MPA or MPA/AA showed strong associations with PH, whereas in women, higher cut-offs (MPA ≥ 30.0 mm; MPA/AA ≥ 0.86) were less diagnostically useful. Importantly, the MPA/AA ratio predicted long-term survival only in men (hazard ratio (HR) = 1.857, p = 0.006), underlining its limited prognostic role in females. CONCLUSION: CT-derived pulmonary artery metrics are valuable for predicting PH and survival in male TAVI patients. Incorporating the MPA/AA ratio into clinical practice may improve risk stratification in men, while limited diagnostic utility in women highlights the need for alternative markers. Sex-specific approaches should be pursued to optimize outcomes across all PH etiologies. CRITICAL RELEVANCE STATEMENT: CT-derived pulmonary artery metrics reliably predict PH and long-term survival after TAVI, particularly in men, emphasizing their diagnostic and prognostic value while underscoring the need for sex-specific thresholds and alternative markers in women. KEY POINTS: PH impacts TAVI outcomes, yet sex-specific radiological predictors remain insufficiently investigated. The pulmonary artery to AA ratio predicted survival in men but showed no prognostic value for women. Implementing sex-specific imaging assessments improves risk stratification in men, highlighting the need for distinct diagnostic strategies for women.

Research2026 Apr 07

Impact of Extravalvular Remodeling on Wearable Smartwatch-Recorded Physical Activity in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis.

Journal of the American Heart Association— Androshchuk V, Long E, Chehab O, Wilcox J, McDonaugh B et al.

BACKGROUND: Wearable smartwatches enable objective quantification of physical activity. This study evaluated the association of extravalvular cardiac damage in aortic stenosis with smartwatch-recorded physical activity before and after transcatheter aortic valve implantation (TAVI). METHODS: Patients with severe symptomatic aortic stenosis were dichotomized into cardiac damage stages 0 to 2 (left-heart dysfunction) and stages 3 to 4 (pulmonary/right-heart dysfunction) by echocardiography. All patients received a Fitbit smartwatch for 7 days of continuous monitoring before transcatheter aortic valve implantation and at 6-month follow-up. Regression models determined significant predictors of total daily step count and moderate to vigorous physical activity (MVPA). RESULTS: Within the study cohort (stages 0-2: 43 [50.6%]; stages 3-4: 42 [49.4%]), all patients showed significant improvement in physical activity from baseline to follow-up (all P<0.001). Patients in stages 3 to 4 had significantly lower total daily step count and MVPA at baseline and follow-up, as well as a smaller improvement in MVPA (all P<0.05). Relative to stages 0 to 2, stages 3 to 4 were significantly associated with lower step count and MVPA at baseline (step count: β=-1453.8 [95% CI, -2351.3 to -554.2], P=0.002; MVPA: β=-12.9 [95% CI, -24.3 to -1.5], P=0.027) and follow-up (step count: β=-1438.1 [95% CI, -2453.9 to -422.3], P=0.006; MVPA: β=-27.4 [95% CI, -47.7 to -7.1], P=0.009), as well as less improvement in MVPA (β=-14.5 [95% CI, -28.4 to -0.48], P=0.043) after transcatheter aortic valve implantation. CONCLUSIONS: The extent of cardiac damage before transcatheter aortic valve implantation has an important impact on physical activity, both at baseline and following intervention. Future studies should examine whether smartwatch-measured activity predicts death across cardiac damage stages and whether cardiac rehabilitation improves outcomes in aortic stenosis with advanced remodeling.

Research2026 Apr 05

Dynamic Changes in Circulating Osteogenic Progenitor Cells Following TAVI: Implications for Vascular Remodeling-EPC and EPC-OCN Dynamics After TAVI.

Journal of clinical medicine— Schoenfeld L, Codner P, Abitbol M, Cohen B, Leshem Lev D et al.

Background: The prevalence of severe aortic stenosis (AS) is increasing, in accordance with a longer life expectancy. Aortic valve calcification is a multifactorial pathological process involving a complex interplay between different types of regenerative cellular and genetic factors. Among these cells, endothelial progenitor cells (EPCs) and their osteoblastic phenotype subpopulation (EPC-OCNs) have been implicated in vascular remodeling and disease progression. Objectives: To assess longitudinal changes in EPC and EPC-OCN levels in patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI). Methods: In this prospective observational study, 65 patients with severe AS undergoing TAVI were enrolled. Circulating EPC and EPC-OCN levels were quantified by flow cytometry before the procedure, at 4 ± 1 days, and at 90 ± 29 days after TAVI. EPCs were defined by expression of CD133, CD34, and VEGFR-2. Results: Circulating EPC levels remained unchanged throughout the follow-up. In contrast, circulating EPC-OCNs increased significantly over time. Specifically, CD133+/VEGFR-2+/OCN+ cells rose from 2.50% to 6.25%, CD34+/VEGFR-2+/OCN+ from 2.04% to 4.05%, and VEGFR-2+/OCN+ from 1.46% to 3.01% (all p < 0.01). This suggests an osteogenic response to TAVI, while classical endothelial repair mechanisms were not systemically activated. Conclusions: EPC-OCNs increased significantly following TAVI, possibly reflecting ongoing tissue remodeling or calcification processes. In contrast, the stability of classical EPCs levels suggests limited systemic endothelial regeneration. These observations underscore the potential role of EPC-OCNs as markers or modulators of pre- and post-TAVI vascular remodeling.

Research2026 Apr 05

Early reversal of cardiac remodeling in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement.

Journal of cardiothoracic surgery— Wang S, Tan K, Gao X, Zhang L, Liu C et al.

OBJECTIVE: New-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR) is an independent predictor of long-term cardiovascular mortality in patients. The aim of this study is to evaluate the impact of new-onset LBBB on early cardiac reverse remodeling and clinical outcomes after TAVR. METHODS: A retrospective analysis was performed on 101 patients who underwent successful TAVR for severe aortic stenosis between March 2021 and October 2024 at our institution. Echocardiographic variables indicative of cardiac remodeling were analysed preoperatively and at one and six months after TAVR. Furthermore, the clinical outcomes of the patients were monitored during the follow-up period. RESULT: Of the 101 patients who underwent TAVR, 28 (27.7%) had new-onset LBBB. Transcatheter heart valve(THV) implantation depth was an influential factor for new LBBB, which was more prevalent in patients with thinner interventricular septal thickness preoperatively. At the six-month follow-up, the new-LBBB group showed an increase in left ventricular diameter and left ventricular mass index and a reduction in left ventricular ejection fraction compared with the preoperative period. Mitral regurgitation in the no-LBBB group was significantly reduced at 1 month postoperatively. In contrast, mitral regurgitation in new-LBBB group was reduced at one month postoperatively, but worsened at six months.There was no significant difference in rehospitalization rates within 6 months postoperatively between patients with or without LBBB. CONCLUSIONS: New-onset persistent LBBB after TAVR did not affect short-term rehospitalization, but may adversely affect early postoperative reversal of cardiac remodeling.

Research2026 Apr 04

Discrepancy Between Invasive and Echocardiographic Transvalvular Gradients After TAVI Procedure: A Review of the Literature.

Journal of clinical medicine— Afendoulis D, Vlachakis PK, Tsiamis N, Tsakirian F, Tountas C et al.

Background/Objectives: Transcatheter aortic valve implantation (TAVI) has become an established treatment for patients with severe aortic stenosis. The accurate post-procedural assessment of transvalvular gradients is essential for evaluating procedural success and long-term prognosis. However, significant discrepancies have been reported between gradients measured invasively and those derived by Doppler echocardiography. This systematic review aims to summarize the current evidence comparing invasive and echocardiographic gradient measurements after TAVI. Methods: A comprehensive literature search was conducted of the PubMed database from inception to 8 November 2025 using the keywords: "TAVI/TAVR," "invasive versus echocardiographic gradient," and related terms. Studies were included if they compared invasive and Doppler-derived aortic valve gradients following TAVI. Out of 44 identified articles, 12 studies met the inclusion criteria and were analyzed. Results: Across all the included studies, the echocardiography-derived mean gradients were consistently 4-7 mmHg higher than those obtained invasively, reflecting physiologic rather than procedural discordance. The difference was more pronounced in balloon-expandable and small-diameter valves and in patients with high-flow states. Invasive gradients were independently associated with mortality and major adverse cardiovascular events (MACEs) in multiple studies. An invasive mean gradient ≤ 10 mmHg immediately post-TAVI was repeatedly identified as the threshold for optimal procedural success and improved long-term outcomes. Conclusions: Doppler echocardiography systematically overestimates transvalvular gradients after TAVI. While both modalities remain valuable, an invasive hemodynamic assessment provides the most reliable evaluation of immediate procedural success and long-term prognosis. Echocardiographic gradients should be interpreted relative to the baseline invasive measurement to avoid overdiagnosis of prosthetic dysfunction and ensure appropriate clinical management.

Research2026 Apr 04

Advancing aortic stenosis assessment: Validation of fluid-structure interaction models against 4D flow MRI data.

The Journal of physiology— Zingaro A, Burba I, Oks D, Fontana M, Samaniego C et al.

Systematic in vivo validations of computational models of the aortic valve (AV) remain scarce, despite successful validation against in vitro data. Utilizing a combination of computed tomography and 4D flow magnetic resonance imaging data, we developed patient-specific fluid-structure interaction models of the AV immersed in the aorta for five patients in the pre-transcatheter AV replacement configuration. Our computational models are subjected to rigorous validation against 4D flow measurements. Our results demonstrate the models' capacity to accurately replicate flow dynamics. In addition, we illustrate how computational models can serve as valuable cross-checks to reduce noise and erratic behaviour of in vivo data. Crucially, our validated models enable the measurement of additional critical quantities essential for a comprehensive understanding of aortic stenosis (AS) and its treatments: we compute the blood residence time, enhancing precision and personalization in assessing the probability of thrombus formation within the aorta. This study represents a significant step towards integrating in silico technologies into real clinical contexts, providing a robust framework for improving AS diagnosis and the design of next-generation AV bioprostheses. KEY POINTS: Patient-specific fluid-structure interaction computational models of the aortic valve are developed for five patients in pre-transcatheter aortic valve replacement configuration. A synergistic approach involving in silico models and in vivo data is utilized, including computed tomography and 4D flow magnetic resonance imaging. A patient-specific calibration strategy is introduced to identify the aortic valve Young's modulus, leveraging in vivo flow-derived metrics in combination with patient-specific valve and aortic geometries. The computational models are validated against in vivo 4D flow measurements, demonstrating their ability to replicate flow dynamics accurately. The potential of computational models to cross-check and reduce noise in in vivo data is highlighted, providing additional critical physiological quantities for comprehensive aortic stenosis assessment, such as blood residence time, important for thrombus formation evaluation.

Research2026 Apr 04

Hemostatic Sponge With Excellent Wet Tissue Adhesion Performance for Anticoagulant-Associated and Unsuturable Visceral Hemorrhage Management.

Advanced healthcare materials— Li Y, Gao Y, Jiang N, Liu L, Li H et al.

The management of uncontrolled hemorrhage in anticoagulant-associated patients and visceral trauma necessitates hemostatic agents that operate independently of classical coagulation pathways. Herein, we report a gelatin sponge patch by one-sided coating with N-hydroxysuccinimide (NHS) ester-functionalized poly (acrylic acid-co-N-succinimidyl acrylate) (PANS), which acts by formation of covalent and hydrogen bonding cross-links between polymer, blood proteins, gelatin, and tissue to seal the wound site and prevent hemorrhage during surgery. PANS exhibits robust lap-shear strength of up to 114.4 ± 8.7 kPa, enabling the PANS-GS composite to achieve effective wet-tissue adhesion, while macroporosity is preserved for rapid blood absorption. This dual-function design allows simultaneous physical sealing and platelet enrichment with reduced dependence on fibrin-mediated coagulation pathways. In rat hepatic laceration and femoral artery injury models, the composite sponge demonstrates superior hemostatic efficacy, with significant reductions in bleeding time and blood loss compared to clinically used sponges in both non-heparinized and systemically heparinized subjects. Critically, biocompatibility assessments reveal minimal cytotoxicity and hemolysis, while histopathological analysis indicates no significant increase in inflammatory response compared with commercial gelatin sponge. These results establish a coagulation-independent hemostatic strategy that integrates strong wet adhesion with preserved porosity, offering promise for managing anticoagulant-associated bleeding, visceral trauma, and complex battlefield injuries.

Research2026 Apr 03

Transcatheter aortic valve replacement at metropolitan teaching hospitals among patients with heart failure.

Current problems in cardiology— Dixit S, Anamika F, Ramphul K, Firos JRB, Aneja A

INTRODUCTION: Heart failure is highly prevalent among patients undergoing transcatheter aortic valve replacement (TAVR). Prior literature well documents an increased risk of readmission in heart failure patients undergoing TAVR; however, data comparing clinical outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in this population remain limited. METHODS: We conducted a retrospective analysis using the National Readmissions Database (NRD) from 2016 to 2022. Patients undergoing TAVR at metropolitan teaching hospitals were identified and stratified into two cohorts: HFrEF and HFpEF. The primary outcome was the 30-day all-cause readmission rate. Secondary outcomes included in-hospital complications and all-cause in-hospital mortality. RESULTS: Among 120,199 patients undergoing TAVR, 16.25% had HFrEF and 83.75% had HFpEF. The HFrEF cohort had higher baseline comorbidities, including peripheral vascular disease, prior myocardial infarction, and chronic kidney disease. After adjusting for baseline comorbidities, the HFrEF cohort experienced higher rates of in-hospital complications, including mechanical circulatory support, cardiogenic shock, acute heart failure, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, acute myocardial infarction, valvular complications, mechanical ventilation, intubation, and acute kidney injury, as well as higher in-hospital mortality. The 30-day all-cause readmission rate among survivors was also higher in the HFrEF cohort (11.29% vs. 9.74%; HR: 1.142, 95% CI: 1.127-1.156; p<0.001). CONCLUSION: HFrEF was associated with worse in-hospital and early post-discharge outcomes following TAVR compared with HFpEF. Further studies are warranted to identify targeted strategies to mitigate risk in this high-risk population.

Research2026 Apr 03

Cardiac rehabilitation after transcatheter aortic valve implantation before, during and after the COVID-19 pandemic: a whole-population study.

Heart (British Cardiac Society)— Braver J, Marwick TH, Nolan J, Petitjean C, Wood AM

BACKGROUND: Evidence on cardiac rehabilitation (CR) after transcatheter aortic valve implantation (TAVI) is limited. We examined CR participation across England before, during and after the COVID-19 pandemic, and its association with clinical outcomes. METHODS: This retrospective cohort study used whole-population electronic health records to evaluate characteristics and outcomes of all TAVI recipients in England (2018-2023), stratified by CR participation. The primary outcome was unplanned all-cause rehospitalisation. Secondary outcomes included all-cause mortality, heart failure (HF) rehospitalisation and non-cardiovascular rehospitalisation. Follow-up was up to 5 years, with a minimum of 12 months. Multivariable models adjusted for demographics, clinical factors and procedural complications. RESULTS: Among 24 925 TAVI recipients (56% male, mean age 81 years and 95% white ethnicity), only 1090 (4.4%) attended CR. CR rates dropped during the first COVID-19 lockdown (1.57 per 10 000 person-days) and recovered post pandemic (3.24). HF rehospitalisation rates per 10 000 person-days were similar between CR and non-CR groups (1.05 vs 1.02), while all-cause (4.49 vs 4.72), non-cardiovascular rehospitalisation (4.53 vs 4.82) and mortality rates (3.61 vs 3.84) were slightly lower among CR participants. After adjustment, CR was associated with lower risk of all-cause (HR 0.88, 95% CI 0.79 to 0.98; p=0.019) and non-cardiovascular rehospitalisation (HR 0.84, 95% CI 0.76 to 0.94; p=0.002); however, there was no evidence of an association between CR and HF rehospitalisation (HR 0.94, 95% CI 0.75 to 1.19; p=0.607) or mortality (HR 0.95, 95% CI 0.84 to 1.07; p=0.383). CONCLUSION: CR after TAVI declined during the first COVID-19 lockdown but rebounded quickly. CR was associated with lower all-cause and non-cardiovascular rehospitalisation but was not associated with lower HF rehospitalisation or mortality. More research is needed to confirm these clinical findings.

Research2026 Apr 03

Utility of guide catheter extension and intravascular ultrasound to facilitate transcatheter device closure of aortic paravalvular leak.

BMJ case reports— Brailsford B, Kite TA, Smith WHT

Paravalvular leak (PVL) refers to the retrograde flow of blood through a channel between an implanted valve prosthesis and native cardiac tissue, due to the absence of an appropriate seal. Most PVLs are haemodynamically non-significant; however, large leaks can present with symptoms of heart failure and/or haemolysis, with impact on quality of life. In many patients, re-operation is associated with high risk and alternative treatments using transcatheter closure techniques have been applied. We present the case of a septuagenarian male who underwent aortic PVL closure facilitated by use of a guide catheter extension and intravascular ultrasound. This report illustrates that these adjunctive techniques, more commonly used in coronary angioplasty procedures, can be used to enable complex PVL closure.

Research2026 Apr 03

Periprocedural evaluation of patients with BAV stenosis undergoing TAVR: a machine learning-based study.

Open heart— Mao Y, Chen Y, Zhai M, Jin P, Li W et al.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has increasingly emerged as one of the primary treatments for patients with severe bicuspid aortic valve (BAV) stenosis. Nevertheless, these patients encounter multiple procedural challenges. OBJECTIVE: To develop a machine learning (ML) model for assessing the risk of periprocedural adverse events (PAEs) in TAVR population with BAV. METHODS: This multicentre study retrospectively enrolled 1266 patients with BAV stenosis. Clinical characteristics and imaging data of the patients were collected, and an ML prediction model was developed. PAE was collectively defined as all-cause death, disabling stroke, life-threatening haemorrhage, acute kidney injury (≥stage 3), major vascular complications, valve-related dysfunction necessitating reoperation and other major complications that occurred prior to discharge. RESULTS: The average age was 72.6±6.3 years, and 58.3% (n=738) of male. In the derivation dataset, five predictive factors were identified: Type 0 BAV, aortic root calcification volume, horizontal aorta, annular ellipticity and previous atrial fibrillation. A robust risk scoring model was thereby established (area under the curve=0.801 95% CI 0.768 to 0.832). A graded relationship was observed between the quartiles of the score and PAE (0.6%, 1.7%, 3.2% and 9.6%; overall p<0.001). A nomogram was constructed to enable calculation of individual scores and the corresponding PAE probabilities. Additionally, similar results were observed in the validation dataset. CONCLUSIONS: The ML model developed in this study could predict the PAEs occurrence of TAVR in patients with BAV stenosis. This is conducive to individualised procedural planning and in-hospital management.

Research2026 Apr 02

Impact of Supranormal LVEF After TAVI: Behavior, Mortality, and Cardiac Structure.

Journal of clinical medicine— Sigala XS, Martínez E, Blanco CO, Pozo E, Marcos-Alberca P et al.

Background/Objectives: Left ventricular ejection fraction (LVEF) typically improves after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (SAS). However, the clinical significance and prognosis of patients presenting with supranormal LVEF (≥65%) remain poorly defined. This study aims to describe LVEF behavior, its relationship with mortality, and its effect on cardiac structure in this specific subgroup. Methods: A retrospective observational study was conducted at Hospital Clínico San Carlos (2008-2019), including SAS patients with pre-procedural supranormal LVEF. Patients were classified into two groups: those whose LVEF normalized (55-65%) and those whose LVEF remained supranormal. Demographic, clinical, and echocardiographic variables were collected at baseline and one-year follow-up. The primary endpoint was all-cause mortality at two years. Results: Out of 101 analyzed patients (mean age 82.8 years, 71.2% women), 71 (70.3%) experienced LVEF normalization at one year. Two-year mortality was 10% in the normalized group and 9.8% in the non-variable group, showing no significant difference. Regarding geometric characteristics, a trend toward left ventricular mass regression was observed only in the LVEF-normalized group (Delta -10; p = 0.062 vs. -8.4; p = 0.197). History of bleeding was the only variable showing a trend toward worse prognosis (p = 0.064). Conclusions: LVEF behavior one year after TAVI in patients with baseline supranormal function tends toward normalization. This change is not associated with differences in two-year mortality but is linked to a trend toward beneficial reverse cardiac remodeling.

Research2026 Apr 02

Preprocedural Systemic Immune-Inflammation Index as a marker of risk for major adverse cardiac events and stroke after transcatheter aortic valve implantation.

Clinical research in cardiology : official journal of the German Cardiac Society— Syryca F, Krefting J, Pellegrini C, Rheude T, Mayr NP et al.

BACKGROUND: The Systemic Immune-Inflammation Index (SII), calculated as neutrophils × platelets / lymphocytes, reflects the interplay between systemic inflammation and immune status. Its prognostic relevance in patients undergoing transcatheter aortic valve implantation (TAVI) remains poorly understood. AIM: To evaluate the prognostic significance of preprocedural SII in patients undergoing TAVI. METHODS: This retrospective cohort study included 1822 patients undergoing TAVI for severe aortic stenosis between 2014 and 2023 at two TAVI centers in Germany. Patients were divided into derivation and validation cohorts. Preprocedural SII was calculated from differential blood counts. In the derivation cohort, patients were stratified into tertiles based on preprocedural SII. Using receiver operating characteristics (ROC) analysis an optimized cut-off value for the validation cohort was identified to stratify patients into high- and low-risk groups. A generalized linear model (GLM) was used to identify clinical predictors of SII. RESULTS: In the derivation cohort, multivariate analysis showed that SII was independently associated with both major adverse cardiovascular events (MACE) (hazard ration [HR]: 1.0001 [1.00001; 1.00002], p = 0.020) and stroke (HR: 1.0003 [1.00002; 1.00004], p < 0.001). In the GLM, SII positively correlated with age (p = 0.013) and C-reactive protein (p < 0.001), and inversely with mean aortic gradient (p = 0.022) and hemoglobin (p = 0.011). In the external validation cohort, high risk patients (cut-off > 1204) showed an increased risk for one-year all-cause mortality (HR: 2.19 [1.59; 3.02], p < 0.001). CONCLUSION: Higher preprocedural SII was independently associated with increase rates of MACE and stroke at one-year following TAVI. A SII cut-off of 1204 effectively stratifies patients into high- and low-risk groups and may provide additional value for preprocedural risk stratification.

Research2026 Apr 01

Acute Pulmonary Congestion Secondary to Left Ventricular Outflow Tract Obstruction Following Transcatheter Aortic Valve Implantation in Severe Left Ventricular Hypertrophy: A Case Report.

A&A practice— Yoshiga M, Terada Y, Shimokawa A, Maeda T

Transcatheter aortic valve implantation (TAVI) may be associated with dynamic hemodynamic complications in patients with marked left ventricular hypertrophy. We report a rare case of acute pulmonary congestion caused by TAVI-induced left ventricular outflow tract obstruction with systolic anterior motion, severe mitral regurgitation, and markedly elevated left ventricular end-diastolic pressure. An 88-year-old woman developed severe hypotension and persistent systolic anterior motion immediately after TAVI, with a left ventricular end-diastolic pressure (LVEDP) of 35 mm Hg. Despite transient stabilization, pulmonary congestion occurred after extubation, requiring reintubation. This case underscores the importance of cautious postoperative management in high-risk patients.

Research2026 Apr 01

Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Incidence, Predictors, and Association With Reduced Ischemic Stroke Risk.

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions— Saleh O, Valle NJ, Li S, Mostafa S, Saleh I et al.

BACKGROUND: Development of conduction abnormalities requiring pacing after transcatheter aortic valve replacement (TAVR) is relatively common. The effects of post-TAVR permanent pacemaker (PPM) implantation on mortality, ischemic stroke, and cardiovascular outcomes remain incompletely characterized. AIMS: To evaluate the incidence, predictors, and cardiovascular outcomes of post-TAVR permanent pacemaker implantation, including its association with 1-year ischemic stroke risk. METHODS: Adults undergoing TAVR (2008-2019; n = 1101) were evaluated. Patients with prior PPM (n = 104) and/or valve-in-valve or redo TAVR (n = 11) were excluded. PPM placement was identified post-indexed TAVR admission based on procedure codes, including both in-hospital and post-discharge implantations. Primary outcomes included 1-year mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and ischemic stroke. Multivariate logistic regression was performed to identify independent predictors of 1-year ischemic stroke. RESULTS: Within the TAVR cohort (N = 1101), 158 patients (14.4%) received PPM within 1-year, including 135 (12.3%) in-hospital and 23 post-discharge. PPM was not associated with a significant difference in 1-year mortality (15.8% vs. 14.7%, p = 0.816) or 1-year MACE (20.9% vs. 21.0%, p = 1.000). However, PPM was associated with significantly lower ischemic stroke rate at 1 year (1.3% vs. 4.8%, p = 0.044). In multivariate analysis adjusting for age, sex, and comorbidities, PPM was associated with 77% lower risk of 1-year ischemic stroke (adjusted OR 0.234, 95% CI 0.056-0.977, p = 0.046). Late PPM implantation (> 3 days) was associated with numerically higher 1-year mortality (30.0% vs. 14.3%, p = 0.647) and MACE (36.7% vs. 17.1%, p = 0.119) compared to early implantation, though these outcomes did not reach statistical significance. CONCLUSION: PPM after TAVR was not associated with increased mortality or MACE but was independently associated with significantly lower ischemic stroke risk. Late PPM implantation showed a trend toward worse outcomes. These findings suggest that appropriately indicated PPM may confer cerebrovascular protection, and early implantation when indicated may be preferable. These findings warrant further validation in prospective studies.

Research2026 Apr

Exercise-Induced Left Bundle Branch Block in a Patient With Syncope: A Case Report.

Clinical case reports— Manga A, Vachiat A

Exercise-induced left bundle branch block (EI-LBBB) is a rare phenomenon, particularly in patients without structural heart disease. Its pathophysiology remains poorly understood and there are no defined treatment protocols. We report a 77-year-old man with a history of syncope who developed EI-LBBB during a cardiac stress test, with transient electrocardiographic changes that resolved at rest. Coronary angiography revealed only a mild-moderate (approximately 25%-50%) proximal left anterior descending artery stenosis, and the rest of his cardiac evaluation was unremarkable. The patient was commenced on an aerobic exercise program, and reported symptomatic improvement on follow-up. Although EI-LBBB is often linked to underlying structural heart disease and coronary artery disease, it can occur in patients with normal cardiac structure. This report summarizes an approach to evaluation and follow-up of EI-LBBB and reviews management strategies described in the literature, including exercise training in selected patients.

Research2026 Apr

Heyde-Like Syndrome Manifesting as Massive Gastrointestinal Bleeding After TAVI in an Elderly Patient With Gastric Angiodysplasia.

Clinical case reports— Setoguchi T, Fukamachi D, Matsumoto N, Okumura Y

Gastrointestinal bleeding due to angiodysplasia in elderly patients with severe aortic stenosis may be overlooked outside of cardiology. Clinicians should remain vigilant, especially in TAVI candidates presenting with unexplained anemia, as early recognition can significantly impact management and outcomes.

Research2026 Apr

Clinical Utility of Urinary Liver-Type Fatty Acid-Binding Protein Measured via Point-of-Care Testing in Acute Kidney Injury After Transcatheter Aortic Valve Implantation.

Nephrology (Carlton, Vic.)— Obata Y, Kamijo-Ikemori A, Shimmi S, Ohata K, Sugaya T et al.

AIM: This study evaluated the clinical usefulness of urinary liver-type fatty acid-binding protein (L-FABP) measured via point-of-care testing (POCT) based on immunochromatography for the early prediction of acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI). METHODS: This retrospective observational study was conducted at a single-centre university hospital and included 186 patients who underwent TAVI. The onset of AKI was defined according to the Acute Kidney Injury Network classification. Urine samples were collected preoperatively, immediately after surgery, 4 h postoperatively and on postoperative days 1, 2 and 3 to measure urinary L-FABP using POCT. RESULTS: Of the 186 patients who underwent TAVI, 24 (12.9%) developed AKI postoperatively. Patients with AKI exhibited a decreased left ventricular ejection fraction, the co-occurrence of both hypertension and advanced-stage chronic kidney disease and a longer hospital stay. During the observational period, patients with AKI were found to have significantly higher urinary L-FABP levels than those without. Preoperative urinary L-FABP showed the highest predictive performance for AKI onset, with an area under the receiver operating characteristic curve of 0.74 (cutoff value, 4.24 ng/mL; sensitivity, 0.61; specificity, 0.82; diagnostic accuracy, 0.79). Elevated urinary L-FABP levels above the cutoff value in the early phase of the perioperative period independently predicted AKI onset after adjusting for ejection fraction and the presence of renal dysfunction in the multivariable logistic regression analysis. CONCLUSION: This study indicated for the first time that urinary L-FABP levels measured via POCT were independently associated with the development of AKI following TAVI, indicating potential utility for early risk assessment.

Research2026

Glabrol-an impurity in licorice extract-causes toxicity in muscle, bone, and immune tissues through activation of the AP-1 signaling pathway.

Frontiers in pharmacology— Jiang C, Feng X, Qi M, Wu S, Wang Q et al.

Licorice (Glycyrrhiza genus) is a traditional medicinal herb that has also been widely used in the food and cosmetic industries, leading to widespread human exposure. Currently, many components have been identified as active ingredients in licorice; however, the toxic impurities and quality markers still require further investigation. Glabrol has been identified as a potentially toxic component in glabridin (an extract from licorice). In this study, we sought to evaluate the toxicity of glabrol in commercial licorice extracts and investigated the toxicological mechanism. The content of glabrol and the acute toxicity in ten commercial licorice extracts from different vendors were quantified using HPLC. The toxicity was further verified in zebrafish, cells in vitro and mammals in vivo mouse models. For the in vivo experiments, C57BL/6 mice received daily oral gavage of licorice extracts with (Sample C: 319.23 μg/g) o low (Sample B: 1.54 μg/g) glabrol content for 7 days. Locomotion was assessed via Open Field Test and Elevated Plus Maze, followed by blood and organ collection for pathological and biochemical analyses. To investigate the toxicological mechanism of glabrol, RNA - seq was performed on zebrafish embryos exposed to glabrol. Morphological and histopathological evaluations in zebrafish treated with the glabrol standard were carried out using phalloidin staining, transmission electron microscopy, and alizarin red staining. Our results indicated that glabrol was detected in all tested commercial licorice extracts, and its content showed a significant positive correlation with toxicity in cells and zebrafish. In mice, licorice extracts with higher glabrol levels led to low survival rates, hypoactivity, acute liver and kidney injury, and significantly elevated plasma inflammatory cytokines. Transcriptomic and mechanistic studies revealed that glabrol disrupted AP-1 signaling pathways and may impair myo-fiber organization, osteoclast differentiation, and inflammatory responses. This study establishes glabrol as a prevalent risk-associated impurity in licorice extracts and reveals that its toxicity is mediated via the AP-1 signaling pathway.

Research2026

Fecal microbiota transplantation for intestinal rehabilitation after GI bleeding and perforation post-cardiac transplant: a case report.

Frontiers in medicine— Peng Y, Hu Q, Gao C

Gastrointestinal complications present a critical challenge following heart transplantation. These issues often stem from multifactorial mechanisms, including immunosuppressive therapy and physiological stress, which compromise mucosal defenses. We report a case of a 53-year-old heart transplant recipient who developed severe gastrointestinal bleeding and perforation due to stress ulcers. Following embolization therapy, the clinical course was further complicated by secondary intestinal cicatricial obstruction, necessitating effective intestinal rehabilitation. To address the resulting malabsorption and facilitate recovery while maintaining immunosuppressive stability, fecal microbiota transplantation (FMT) was employed to restore gut microbiota diversity. This intervention successfully promoted intestinal functional recovery. This case offers a practical reference for managing complex post-transplant gastrointestinal complications, highlighting the therapeutic potential of FMT.

Research2026

Safety and efficacy of completely transthoracic echocardiography guided leadless pacemaker implantation assisted by Panna guide wire: initial clinical experience.

Frontiers in cardiovascular medicine— Guo Q, Luo Z, Guo Y, Guo J, Liu C et al.

BACKGROUND AND OBJECTIVE: Conventional leadless pacemaker (LP) implantation relies on fluoroscopy, exposing patients and operators to ionizing radiation and contrast-related risks. Transthoracic echocardiography (TTE) is a radiation-free alternative, but complete TTE-guided LP implantation remains challenging due to poor ultrasound visibility of interventional devices. This study evaluated the short-term safety, technical feasibility, and procedural efficiency of completely TTE-guided LP implantation assisted by the ultrasound-optimized Panna guidewire. METHODS: This study utilized a prospectively protocolized, single-arm design for the TTE-guided cohort, with a retrospective comparative analysis against a historical fluoroscopy-guided control group. All safety and efficacy endpoints were formally predefined prior to patient enrollment. A total of 32 consecutive patients with LP implantation indications were screened during the study period (July 2024-July 2025), and 10 eligible patients underwent fluoroscopy/contrast-free, TTE-guided LP implantation using the Panna guidewire. Preoperative TTE acoustic window grading was performed, and standardized protocols (semi-quantitative "gooseneck" sign assessment, TTE-guided tug test) were applied during the procedure. A historical control group of 44 fluoroscopy-guided LP patients (January 2020-December 2023) was included, with propensity score overlap weighting-based comparative statistical analyses performed to balance baseline covariates and assess between-group differences. Procedural feasibility, short-term safety, pacing parameters, and skin-to-skin procedural duration were evaluated intraoperatively and during follow-up. RESULTS: All 10 patients had optimal TTE acoustic windows (Grade 1). Procedural success was 100%, with no adverse events (median follow-up: 4.7 months) and stable device performance. Sensitivity analysis showed the TTE technique's effectiveness was not affected by operator experience. Compared with 44 propensity score-weighted controls, TTE-guided implantation had slightly longer but comparable procedural duration (62.78 ± 13.05 vs. 60.5 ± 19.1 min, P > 0.05) and comparable efficiency, eliminating radiation/contrast-related risks for high-risk patients (e.g., CKD, radiation sensitivity). Long-term follow-up (12/24 months) is ongoing per schedule. CONCLUSIONS: This preliminary experience demonstrates the short-term safety and technical feasibility of completely TTE-guided LP implantation assisted by the Panna guidewire, which eliminates radiation/contrast risks while matching fluoroscopy-guided efficiency. As a hypothesis-generating proof-of-concept study (small sample, incomplete long-term follow-up), these findings require validation in larger multicenter registries (n ≥ 50) with ≥24-month follow-up to confirm long-term safety and generalizability.

Research2026

Sodium-glucose cotransporter-2 inhibitor use is associated with reduced acute kidney injury after transcatheter aortic valve implantation.

Frontiers in cardiovascular medicine— Keskin B, Hakgor A, Khidolda Y, Dursun A, Akhundova A et al.

BACKGROUND: Acute kidney injury (AKI) remains a clinically relevant complication after transcatheter aortic valve implantation (TAVI). Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated nephroprotective effects in chronic kidney disease (CKD); however, TAVI-specific data are limited. METHODS: We analyzed a single-center registry of consecutive patients who underwent transfemoral TAVI for aortic stenosis between January 2015 and December 2025. After exclusions, 532 patients were included (SGLT-2i users, n = 112; non-users, n = 420). The primary endpoint was post-procedural AKI. Secondary outcomes were need for hemodialysis and in-hospital mortality. Propensity score matching (PSM) was performed (1:1), yielding 110 matched pairs. RESULTS: In the overall cohort, AKI occurred more frequently in SGLT-2i non-users than users (16.0% vs. 4.5%, p < 0.001), along with a higher requirement for hemodialysis (6.0% vs. 0.9%, p = 0.025). In the CKD subgroup, non-users had higher AKI (35.0% vs. 4.5%, p < 0.001) and hemodialysis rates (15.0% vs. 0.0%, p = 0.005), whereas outcomes were similar in the non-CKD subgroup. In the PSM cohort, non-users had higher AKI (20.0% vs. 4.5%, p < 0.001), hemodialysis (7.3% vs. 0.9%, p = 0.035), and in-hospital mortality (10.0% vs. 1.8%, p = 0.019). In the PSM CKD subgroup, non-users demonstrated markedly higher AKI (43.2% vs. 4.5%, p < 0.001), hemodialysis requirement (13.6% vs. 0.0%, p = 0.026), and in-hospital mortality (20.5% vs. 2.3%, p = 0.015), while non-CKD subgroup showed comparable outcomes. In multivariable analysis, SGLT-2i use independently predicted lower AKI risk in both the overall and matched cohorts. CONCLUSIONS: SGLT-2i use was associated with reduced AKI after TAVI, particularly in patients with CKD, and remained significant after propensity matching and multivariable adjustment.

Research2026

Recurrent Ventricular Tachycardia in a Young Adult-Imaging and Genetic Evidence of

Case reports in cardiology— Gomez LE, Martinenghi N, Ortiz-Genga M, Tejeira MS, Buonfiglio P et al.

BACKGROUND: Ventricular tachycardia (VT) may represent the first manifestation of inherited cardiomyopathies, particularly in young patients without overt structural heart disease. Arrhythmogenic cardiomyopathy (ACM) is an inherited myocardial disorder characterized by ventricular arrhythmias, fibrofatty myocardial replacement, and an increased risk of sudden cardiac death. Pathogenic variants in the desmoplakin (DSP) gene have been increasingly associated with left-dominant or biventricular forms of ACM and inflammatory "hot phases" of myocardial injury. CASE PRESENTATION: We report the case of a 37-year-old male presenting with sustained monomorphic VT with right ventricular outflow tract morphology requiring synchronized electrical cardioversion. Electrocardiography in sinus rhythm demonstrated low-voltage limb leads and T-wave inversion in V1-V3. Echocardiography showed mildly reduced right ventricular function with dyskinesia of the RV free wall (TAPSE 17 mm, RV S ' 10 cm/s). Cardiac magnetic resonance revealed mild RV dilation and subepicardial late gadolinium enhancement in the lateral left ventricular wall with mild pericardial involvement, consistent with an ACM-related inflammatory phenotype. An implantable cardioverter defibrillator was implanted for secondary prevention. Genetic testing identified a heterozygous pathogenic DSP frameshift variant (c.1009_1010dup; p.Leu338Serfs36∗), confirming the diagnosis of DSP-related ACM. CONCLUSION: This case highlights the importance of integrating electrocardiography, multimodality imaging, and genetic testing in the evaluation of VT in young adults. Identification of a pathogenic DSP variant confirmed the diagnosis of ACM and has important implications for arrhythmic risk stratification and family screening.

Research2026

BMPR2 affects valve development via ECM-receptor interaction in zebrafish.

Frontiers in cell and developmental biology— Shi Y, Huang Y, Xia Y, Li Y, Wang Y et al.

Abnormal cardiac valve development may lead to functional impairment in adulthood. BMPR2, a highly conserved receptor of the BMP family, exists in two subtypes (bmpr2a and bmpr2b) in zebrafish. However, the roles of bmpr2a and bmpr2b in valve development remain unclear. In this study, we generated three bmpr2a/b mutant zebrafish strains, namely, bmpr2a- and bmpr2b-knockout zebrafish (bmpr2a -/- and bmpr2b -/- , respectively) using CRISPR/Cas9 and bmpr2a and bmpr2b double-knockout zebrafish (bmpr2a -/- ;bmpr2b -/- ) according to bmpr2a -/- and bmpr2b -/- hybridization. Using cardiac function assessment (M-mode), we characterized the cardiac developmental phenotypes of the three zebrafish mutant strains. Transcriptomic profiling (RNA-seq) was combined with whole-mount in situ hybridization (WISH) and qRT-PCR to validate gene-expression changes. The results indicated that bmpr2a -/- , bmpr2b -/- , and bmpr2a -/- ;bmpr2b -/- mutant zebrafish strains exhibited valve developmental defects at 52 hours post-fertilization (hpf), followed by cardiac contractile dysfunction. RNA-seq revealed upregulation of cardiac markers (myl9a, myl9b, tnnc1a, cmlc1, myl7, and nppa) and valve-related genes (fn1b, has2, and nfatc1), along with the downregulation of klf2a, as validated by WISH and qRT-PCR. Pathway analysis identified the ECM-receptor interaction as a key regulatory axis of bmpr2a/b-mediated valve development. In this study, we demonstrate that bmpr2a and bmpr2b cooperatively regulate cardiac contractile function and valve development in zebrafish, providing insights into BMPR2-mediated cardiovascular morphogenesis in humans.

Research2026

Geriatric nutritional risk index improves risk scoring for mortality after TAVR compared to established scores.

Frontiers in cardiovascular medicine— Boehm J, Amabile A, Ruge H, Bichler M, Holdenrieder S et al.

BACKGROUND: Risk scoring prior TAVR is based on the EuroSCORE II (European System for Cardiac Operative Risk Evaluation) and the STS-score (Society of Thoracic Surgeons) which are complex, and partly prone to investigator bias. The geriatric nutritional risk index (GNRI) can be calculated by five parameters via publicly available formula (age, height, weight, sex, serum albumin), whereas EuroSCORE II and the STS-score require 21 and 69 variables, respectively. The study compares the efficiency of GNRI in predicting 30-day mortality compared to the EuroSCORE II and the STS-score. Furthermore, GNRI risk classes were analysed in the long-term. METHODS: 3.470 consecutive patients who underwent TAVR between 2010 and 2023 at our institution were analysed. GNRI calculation produces a linear parameter that can be divided in four risk groups. RESULTS: ROC (receiver operating characteristic) curve analysis demonstrated no difference in predicting 30-day mortality between GNRI vs. EuroSCORE II (AUC = 0.72 vs. 0.69, p = 0.3) and GNRI vs. STS-score (AUC = 0.72 vs. 0.72, p = 1.0). The Hosmer-Lemeshow test indicated good calibration for the GNRI model (p = 0.3793). After adjustment for preoperative demographic characteristics, Cox regression analysis for overall survival after TAVR reveals for the major risk group [21 patients; HR = 4.624; CI95%(2.881-7.422); p < 0.0001], the moderate risk group [198 patients (5.7%), HR = 2.201; CI95%[1.821-2.660]; p < 0.0001], and the low risk group [452 patients (13.0%); HR = 1.831; CI95%[1.597-2.1]; p < 0.0001], respectively. CONCLUSIONS: The GNRI is an objective publicly available score that simplifies risk assessment prior TAVR without any loss of precision compared to the EuroSCORE II and the STS-score.

Research2026

The association between geriatric nutritional risk index and mortality risk of patients after transcatheter aortic valve replacement: a meta-analysis.

Frontiers in nutrition— Liu X, Cai Y, Zhang J, Chen S, Cao S

UNLABELLED: Malnutrition is common among older adults undergoing transcatheter aortic valve replacement (TAVR) and may adversely affect postoperative survival. The Geriatric Nutritional Risk Index (GNRI), an objective marker of nutritional status, has been proposed as a prognostic tool. However, results from individual studies remain inconsistent. This meta-analysis aimed to clarify the association between pre-procedural GNRI and mortality after TAVR. A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting categorical comparisons of GNRI (low vs. high) and all-cause mortality after TAVR. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models accounting for the influence of heterogeneity. Thirteen cohort studies involving 9,647 patients were included. The pooled analysis demonstrated that low pre-procedural GNRI was significantly associated with increased all-cause mortality after TAVR (HR = 1.90, 95% CI: 1.60-2.26; I 2 = 43%, p < 0.001). A stronger association was observed in prospective studies as compared to retrospective studies (p for subgroup difference = 0.04). The association remained robust across subgroups stratified by study country, sample size, GNRI cutoffs, analytical models, and follow-up duration. Meta-regression showed no significant influence of age, sex, body mass index, diabetes prevalence, Society of Thoracic Surgeons (STS) score, or follow-up durations on the effect size. In conclusion, lower GNRI prior to TAVR is associated with a higher risk of all-cause mortality, underscoring the prognostic importance of pre-procedural nutritional assessment. GNRI could be considered as a complementary tool for risk stratification in TAVR candidates, while further prospective studies are needed to determine its optimal clinical integration. SYSTEMATIC REVIEW REGISTRATION: The review protocol was prospectively registered in PROSPERO (registration number: CRD420251178097).

Research2026

Impact of TriGUARD 3 on cerebral protection in Chinese patients undergoing transcatheter aortic valve replacement.

Frontiers in cardiovascular medicine— Li Y, Wang B, Zhou S, Zhou Y, Chen M et al.

INTRODUCTION: In China, evidence regarding cerebral embolic protection device (CEPD) use during transcatheter aortic valve replacement (TAVR) for severe aortic stenosis treatment is limited. This study evaluated the TriGUARD 3 (TG3) CEPD performance in patients undergoing TAVR. METHODS: Data from two studies were pooled: the CEPD group was derived from a multicenter TG3 trial in China, whereas the control group was obtained from a single-center registry. All participants underwent transfemoral TAVR and completed pre- and postoperative diffusion-weighted magnetic resonance imaging (DW-MRI). The primary outcome was total cerebral ischemic lesion volume on DW-MRI. RESULTS: No significant difference was observed between groups in total lesion volume {CEPD [n = 62] vs. control [n = 56]; 256.53 [interquartile range (IQR), 44.12-667.99] vs. 271.88 [IQR, 96.10-650.87]; p = 0.456}. Median regression analysis in the overall cohort showed no significant association between CEPD use and total lesion volume (p = 0.181). Nonetheless, among patients with bicuspid aortic valve (BAV) stenosis, the CEPD group demonstrated significantly lower total lesion volume [165.43 (IQR, 32.96-311.13) vs. 309.38 (IQR, 96.10-788.49); p = 0.025], average lesion volume [61.3 (IQR, 23.44-89.65) vs. 93.75 (IQR, 51.73-137.07); p = 0.019], and maximum single-lesion volume [89.65 (IQR, 28.13-174.02) vs. 164.14 (IQR, 75.00-365.08); p = 0.019]. Median regression revealed that CEPD use was significantly associated with reductions in total, average, and maximum single-lesion volumes (median differences: -406.1, -82.2, and -137.6; all p < 0.05), independent of age, sex, hypertension, diabetes, valve type, and pre-dilatation. CONCLUSION: In patients with severe aortic stenosis undergoing transfemoral TAVR, TG3 CEPD did not significantly reduce the total lesion volume on DW-MRI. In the BAV subgroup, an association was observed between device use and reductions in total, average, and maximum single-lesion volumes. This exploratory finding is hypothesis-generating and should be further elucidated in larger randomized studies.

Research2026

Development of a multi-label deep neural network model for predicting immediate paravalvular leakage and new-onset conduction disturbances after transcatheter aortic valve replacement: A retrospective cohort study.

Digital health— Tang RS, Li YM, Bao Y, Zeng JD, Yao YJ et al.

BACKGROUND: Paravalvular leakage (PVL) and conduction disturbances (CDs) are important complications after transcatheter aortic valve replacement (TAVR). While existing risk prediction models predominantly adopt single-complication modeling strategies, overlooking the interrelatedness. OBJECTIVES: We aimed to develop a multi-label prediction model based on deep learning to predict immediate PVL and new-onset CDs post-TAVR simultaneously. METHODS: The study retrospectively included 966 patients who underwent first-time TAVR for aortic stenosis between April 2012 and July 2023 from the Sichuan University TAVR Registry. A deep learning-based model using the optimization algorithm Muex with 79 features and neural network labels for PVL and new-onset CDs immediately after TAVR was developed. The Muex model was validated using the bootstrap method, evaluated by area under the receiver operating characteristic curve (AUROC) and calibration curves, interpreted with Shapley Additive Explanations, and subsequently compared with a neural network model and two traditional multi-label classification models. RESULTS: The dataset included 771 training and 195 testing patients, with 6.63% exhibiting more than mild PVL and 39.6% developing new-onset CDs. The Muex model outperformed the neural network, label powerests, and multi-label k-nearest neighbor in both discrimination (micro-average AUROC: 0.739 vs. 0.705 vs. 0.504 vs. 0.514) and calibration (integrated calibration index [ICI]: 0.012 vs. 0.116 vs. 0.046 vs. 0.051), demonstrating strong performance in predicting both complications simultaneously. CONCLUSION: The study demonstrated that the Muex model is feasible for simultaneously predicting PVL and CDs post-TAVR, excelling in both performance and interpretability, while identifying high-risk patients and inferring patient-specific risk factors to facilitate informed clinical decision-making. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04415047.

Research2026

Aortic stenosis and sleep disordered breathing: The effects of interventional management.

Science progress— Plaitis A, Dimitriadis K, Adamopoulou E, Pyrpyris N, Beneki E et al.

Sleep disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is a common comorbidity of patients with cardiovascular diseases, including heart failure and aortic stenosis (AS). In specific, studies report a high prevalence of SDB among patients with severe AS, ranging from 34% to over 90%. The pathophysiological relationship between SDB and AS is considered to be bidirectional, as both conditions can initiate mechanisms such as circulatory delay, fluid shift theory or inflammation and oxidative stress that further contribute to this interplay. This interaction between SDB and AS raises questions concerning a possible combined therapeutic approach. Indeed, encouraging results have emerged regarding the beneficial effects of transcatheter aortic valve intervention (TAVI) on SDB in patients with AS, with TAVI being associated with a reduction in the prevalence and severity of SDB and improvements of the apnea-hypopnea index (AHI). Thus, the aim of this narrative review is to summarize the evidence linking SDB with AS, emphasizing the combined effects of TAVI on both conditions. The available evidence from observational studies indicates that TAVI is associated with significant reduction in the severity of SDB, particularly central sleep apnea, accompanied by improvements in the AHI and sleep parameters following the intervention, while obstructive events appear less responsive to valvular correction. These findings highlight the close pathophysiological interaction between cardiac hemodynamics and sleep regulation and suggest that treatment of the valvular pathology may provide benefits extending beyond cardiovascular improvement, with important clinical implications for the comprehensive management of these patients.

Research2026

A Case of Hydrophilic Polymer Embolism after Transcatheter Aortic Valve Replacement.

International heart journal— Kobayashi Y, Kawaguchi S, Kitani Y, Minoshima A, Takahashi C et al.

Recently, endovascular catheter-based interventions have become an established therapeutic option for severe valvular heart disease. Although cholesterol crystal embolism is a well-recognized complication of endovascular treatment, the hydrophilic polymer coating of catheter devices may also induce embolic events. Herein, we reported a rare case of hydrophilic polymer embolism (HPE) after transcatheter aortic valve replacement for severe aortic stenosis. At present, there are no specific treatment options for HPE, but early diagnosis and corticosteroid therapy may be effective. This report highlighted the characteristics and successful management of HPE based on a patient we treated and previous literature.

Research2026

LDL receptor-independent mechanisms of proprotein convertase subtilisin/kexin type 9 in cardiovascular pathophysiology.

Frontiers in cardiovascular medicine— Su H, Guo X, Li Q, Yuan X, Wu X et al.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a pivotal regulator of lipid metabolism and a validated therapeutic target in cardiovascular disease (CVD). While its canonical role in mediating low-density lipoprotein receptor (LDLR) degradation underpins its cholesterol-lowering effects, emerging evidence highlights diverse LDLR-independent actions that contribute to cardiovascular pathology. PCSK9 exerts pro-inflammatory, pro-atherosclerotic, pro-thrombotic, and cardiotoxic effects and promotes valvular calcification-thereby influencing vascular, myocardial, and structural heart disease beyond lipid regulation. This review delineates these non-canonical mechanisms, emphasizing PCSK9's roles in vascular inflammation, atherosclerosis, thrombosis, regulated cardiomyocyte death, and calcific aortic valve disease (CAVD). We also address key unresolved questions regarding the "efficacy gap" between pharmacological inhibition and lifelong genetic deficiency and examine the translational implications for next-generation inhibitors, including small molecules, vaccines, and gene-editing therapies. A deeper understanding of PCSK9's pleiotropic functions may inform precision strategies to achieve cardiovascular protection extending beyond LDL-C lowering.

Research2026

Transcatheter aortic valve implantation and gut microbiota: Rationale and design of the 'GUT-TAVI' cohort study.

Science progress— Manti M, Dimitriadis K, Dri E, Mavromoustakou K, Vakka A et al.

ObjectiveAlterations in gut microbiota have been reported in patients with aortic valve stenosis (AVS), yet the impact of haemodynamic restoration following transcatheter aortic valve implantation (TAVI) on microbiota composition remains unclear. This study protocol describes a prospective cohort investigation designed to examine changes in gut microbiota and related metabolic markers after TAVI.Methods'GUT-TAVI' is a single-centre, prospective observational cohort study enrolling 40 adults with severe AVS undergoing TAVI. Stool samples will be collected at two timepoints (1 month to 1 day pre-TAVI and 3 months post-TAVI) for 16S-rRNA sequencing. Serum trimethylamine N-oxide (TMAO), standard biochemical markers, echocardiographic parameters, and dietary adherence scores will also be assessed. The primary endpoint is the change in gut microbiota composition following TAVI. Secondary analyses will examine associations between microbiota changes, haemodynamic parameters, and TMAO levels while accounting for potential confounders.ResultsAs a protocol, no results are yet available. Planned analyses include alpha- and beta-diversity comparisons, multi-variable modelling, sub-group analyses, and sensitivity analyses addressing antibiotic exposure and procedural variability.ConclusionsThis study may provide preliminary insights into how haemodynamic improvement after TAVI is associated with changes in gut microbiota and metabolic function. Findings may help inform future, larger-scale studies investigating the gut-heart axis in cardiovascular diseases.