Medicine › Cardiology and Cardiovascular Medicine

Cardiac Valve Diseases and Treatments

Works Count: 152056

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Description

This cluster of papers focuses on the management and treatment of valvular heart disease, with a particular emphasis on transcatheter and surgical aortic-valve replacement, evaluation of valvular regurgitation using echocardiography, guidelines for prosthetic valve assessment, and the impact of various risk models on outcomes in cardiac surgery.

Keywords

Transcatheter Aortic-Valve Replacement; Surgical Aortic-Valve Replacement; Valvular Regurgitation; Echocardiography Guidelines; Aortic Stenosis; Mitral Regurgitation; Prosthetic Valves Evaluation; Heart Valve Surgery; EuroSCORE; Cardiac Surgery Risk Models

Diseases of the heart

1966-01-01

Charles K. Friedberg

Clinical Factors Associated With Calcific Aortic Valve Disease

1997-03-01

B. Fendley Stewart , David S. Siscovick , Bonnie K. Lind +5 more

Objectives. The aim of this study was to determine the prevalence of aortic sclerosis and stenosis in the elderly and to identify clinical factors associated with degenerative aortic valve disease. … Objectives. The aim of this study was to determine the prevalence of aortic sclerosis and stenosis in the elderly and to identify clinical factors associated with degenerative aortic valve disease. Background. Several lines of evidence suggest that degenerative aortic valve disease is not an inevitable consequence of aging and may be associated with specific clinical factors. Methods. In 5,201 subjects ≥65 years of age enrolled in the Cardiovascular Health Study, the relation between aortic sclerosis or stenosis identified on echocardiography and clinical risk factors for atherosclerosis was evaluated by using stepwise logistic regression analysis. Results. Aortic valve sclerosis was present in 26% and aortic valve stenosis in 2% of the entire study cohort; in subjects ≥75 years of age, sclerosis was present in 37% and stenosis in 2.6%. Independent clinical factors associated with degenerative aortic valve disease included age (twofold increased risk for each 10-year increase in age), male gender (twofold excess risk), present smoking (35% increase in risk) and a history of hypertension (20% increase in risk). Other significant factors included height and high lipoprotein(a) and low density lipoprotein cholesterol levels. Conclusions. Clinical factors associated with aortic sclerosis and stenosis can be identified and are similar to risk factors for atherosclerosis. (J Am Coll Cardiol 1997;29:630–4)

Guidelines on the management of valvular heart disease (version 2012)

2012-08-24

Alec Vahanian , Ottavio Alfieri , Felicita Andreotti +7 more

The ESC/EACTS Guidelines represent the views of the ESC and the EACTS and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals … The ESC/EACTS Guidelines represent the views of the ESC and the EACTS and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to take them fully into account when exercising their clinical judgement.The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient and, where appropriate and necessary, the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

2014-03-04

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice

2009-01-01

Helmut Baumgartner , Judy Hung , Javier Bermejo +7 more

Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies.

1994-08-01

Catherine M Otto , Johanna Kuusisto , Dennis D. Reichenbach +2 more

Nonrheumatic stenosis of trileaflet aortic valves, often termed senile or calcific valvular aortic stenosis, is considered a "degenerative" process, but little is known about the cellular or molecular factors that … Nonrheumatic stenosis of trileaflet aortic valves, often termed senile or calcific valvular aortic stenosis, is considered a "degenerative" process, but little is known about the cellular or molecular factors that mediate its development.To characterize the developing aortic valvular lesion, we performed histological and immunohistochemical studies on Formalin-fixed and methanol-Carnoy's-fixed paraffin-embedded aortic valve leaflets or on frozen sections obtained at autopsy from 27 adults (age, 46 to 82 years) with normal leaflets (n = 6), mild macroscopic leaflet thickening (n = 15), or clinical aortic stenosis (n = 6). Focal areas of thickening ("early lesions") were characterized by (1) subendothelial thickening on the aortic side of the leaflet, between the basement membrane (PAS-positive) and elastic lamina (Verhoeff-van Gieson), (2) the presence of large amounts of intracellular and extracellular neutral lipids (oil red O) and fine, stippled mineralization (von Kossa), and (3) disruption of the basement membrane overlying the lesion. Regions of the fibrosa adjacent to these lesions were characterized by thickening and by protein, lipid, and calcium accumulation. Control valves showed none of these abnormalities. Immunohistochemical studies were performed using monoclonal antibodies directed against macrophages (anti-CD68 or HAM-56), and contractile proteins of smooth muscle cells or myofibroblasts (anti-alpha-actin and HHF-35) or rabbit polyclonal antiserum against T lymphocytes (anti-CD3). In normal valves, scattered macrophages were present in the fibrosa and ventricularis, and occasional muscle actin-positive cells were detected in the proximal portion of the ventricularis near the leaflet base, but no T lymphocytes were found. In contrast, early lesions were characterized by the presence of an inflammatory infiltrate composed of non-foam cell and foam cell macrophages, occasional T cells, and rare alpha-actin-positive cells. In stenotic aortic valves, a similar but more advanced lesion was seen.The early lesion of "degenerative" aortic stenosis is an active inflammatory process with some similarities (lipid deposition, macrophage and T-cell infiltration, and basement membrane disruption) and some dissimilarities (presence of prominent mineralization and small numbers of smooth muscle cells) to atherosclerosis.

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2006-08-01

Robert O. Bonow , Blasé A. Carabello , Kanu Chatterjee +7 more

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5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial

2015-03-15

Michael J. Mack , Martin B. Leon , Craig R. Smith +7 more

Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I

1951-01-01

R Gorlin , S.G. Gorlin

European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease)

2010-04-30

Patrizio Lancellotti , Luís M. Moura , Luc Piérard +7 more

Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The … Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.

Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging

2013-06-03

Patrizio Lancellotti , C Tribouilloy , Andreas Hagendorff +5 more

Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular … Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate the quantification of the regurgitation, assessment of the valve anatomy and function, as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation.

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A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease

2003-06-20

Bernard Iung

Aims To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines. Aims To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines.

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ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article

2003-09-01

Melvin D. Cheitlin , William F. Armstrong , Gerard P. Aurigemma +7 more

Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography

2003-06-30

William A. Zoghbi , Maurice Enriquez‐Sarano , Elyse Foster +7 more

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Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology

2006-06-07

Alec Vahanian , Helmut Baumgartner , Jeroen J. Bax +7 more

of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and … of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

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Burden of valvular heart diseases: a population-based study

2006-08-22

Vuyisile T. Nkomo , Julius M. Gardin , Thomas N. Skelton +3 more

Percutaneous Repair or Surgery for Mitral Regurgitation

2011-04-04

Ted Feldman , Elyse Foster , Donald D. Glower +7 more

Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin … Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet.We randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite end point for efficacy was freedom from death, from surgery for mitral-valve dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months. The primary safety end point was a composite of major adverse events within 30 days.At 12 months, the rates of the primary end point for efficacy were 55% in the percutaneous-repair group and 73% in the surgery group (P=0.007). The respective rates of the components of the primary end point were as follows: death, 6% in each group; surgery for mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral regurgitation, 21% versus 20%. Major adverse events occurred in 15% of patients in the percutaneous-repair group and 48% of patients in the surgery group at 30 days (P<0.001). At 12 months, both groups had improved left ventricular size, New York Heart Association functional class, and quality-of-life measures, as compared with baseline.Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. (Funded by Abbott Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.).

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Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis

2014-03-29

David Adams , Jeffrey J. Popma , Michael J. Reardon +7 more

We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery.We … We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery.We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing.A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke.In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).

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Ischemic Mitral Regurgitation

2001-04-03

Francesco Grigioni , Maurice Enriquez‐Sarano , Kenton J. Zehr +2 more

Myocardial infarction (MI) can directly cause ischemic mitral regurgitation (IMR), which has been touted as an indicator of poor prognosis in acute and early phases after MI. However, in the … Myocardial infarction (MI) can directly cause ischemic mitral regurgitation (IMR), which has been touted as an indicator of poor prognosis in acute and early phases after MI. However, in the chronic post-MI phase, prognostic implications of IMR presence and degree are poorly defined.We analyzed 303 patients with previous (>16 days) Q-wave MI by ECG who underwent transthoracic echocardiography: 194 with IMR quantitatively assessed in routine practice and 109 without IMR matched for baseline age (71+/-11 versus 70+/-9 years, P=0.20), sex, and ejection fraction (EF, 33+/-14% versus 34+/-11%, P=0.14). In IMR patients, regurgitant volume (RVol) and effective regurgitant orifice (ERO) area were 36+/-24 mL/beat and 21+/-12 mm(2), respectively. After 5 years, total mortality and cardiac mortality for patients with IMR (62+/-5% and 50+/-6%, respectively) were higher than for those without IMR (39+/-6% and 30+/-5%, respectively) (both P<0.001). In multivariate analysis, independently of all baseline characteristics, particularly age and EF, the adjusted relative risks of total and cardiac mortality associated with the presence of IMR (1.88, P=0.003 and 1.83, P=0.014, respectively) and quantified degree of IMR defined by RVol >/=30 mL (2.05, P=0.002 and 2.01, P=0.009) and by ERO >/=20 mm(2) (2.23, P=0.003 and 2.38, P=0.004) were high.In the chronic phase after MI, IMR presence is associated with excess mortality independently of baseline characteristics and degree of ventricular dysfunction. The mortality risk is related directly to the degree of IMR as defined by ERO and RVol. Therefore, IMR detection and quantification provide major information for risk stratification and clinical decision making in the chronic post-MI phase.

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients

1999-06-01

F. Roques

Objective: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods: From … Objective: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods: From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis. Results: Mean age (± standard deviation) was 62.5 ± 10.7 (range 17–94 years) and 28% were female. Mean body mass index was 26.3 ± 3.9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identifiable risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P < 0.001), female gender (P < 0.001), serum creatinine (P < 0.001), extracardiac arteriopathy (P < 0.001), chronic airway disease (P < 0.006), severe neurological dysfunction (P < 0.001), previous cardiac surgery (P < 0.001), recent myocardial infarction (P < 0.001), left ventricular ejection fraction (P < 0.001), chronic congestive cardiac failure (P < 0.001), pulmonary hypertension (P < 0.001), active endocarditis (P < 0.001), unstable angina (P < 0.001), procedure urgency (P < 0.001), critical preoperative condition (P < 0.001) ventricular septal rupture (P < 0.002), non-coronary surgery (P < 0.001), thoracic aortic surgery (P < 0.001w). Conclusion: A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk stratification system for the prediction of hospital mortality and the assessment of quality of care.

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Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery

2010-10-20

Martin B. Leon , Craig R. Smith , Michael J. Mack +7 more

Many patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less … Many patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for high-risk patients with aortic stenosis.

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2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2008-09-01

Robert O. Bonow , Blasé A. Carabello , Kanu Chatterjee +7 more

Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients

2011-06-05

Craig R. Smith , Martin B. Leon , Michael J. Mack +7 more

The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not candidates for surgical replacement. However, the two procedures have … The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not candidates for surgical replacement. However, the two procedures have not been compared in a randomized trial involving high-risk patients who are still candidates for surgical replacement.

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Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement

2012-03-26

Susheel Kodali , Mathew Williams , Craig R. Smith +7 more

The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. … The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits.At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation.The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001).A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.).

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Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis

2008-09-03

Anne B. Rossebø , Terje R. Pedersen , Kurt Boman +7 more

Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results.We conducted a randomized, double-blind trial involving 1873 patients with … Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results.We conducted a randomized, double-blind trial involving 1873 patients with mild-to-moderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. The primary outcome was a composite of major cardiovascular events, including death from cardiovascular causes, aortic-valve replacement, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting, percutaneous coronary intervention, and nonhemorrhagic stroke. Secondary outcomes were events related to aortic-valve stenosis and ischemic cardiovascular events.During a median follow-up of 52.2 months, the primary outcome occurred in 333 patients (35.3%) in the simvastatin-ezetimibe group and in 355 patients (38.2%) in the placebo group (hazard ratio in the simvastatin-ezetimibe group, 0.96; 95% confidence interval [CI], 0.83 to 1.12; P=0.59). Aortic-valve replacement was performed in 267 patients (28.3%) in the simvastatin-ezetimibe group and in 278 patients (29.9%) in the placebo group (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P=0.97). Fewer patients had ischemic cardiovascular events in the simvastatin-ezetimibe group (148 patients) than in the placebo group (187 patients) (hazard ratio, 0.78; 95% CI, 0.63 to 0.97; P=0.02), mainly because of the smaller number of patients who underwent coronary-artery bypass grafting. Cancer occurred more frequently in the simvastatin-ezetimibe group (105 vs. 70, P=0.01).Simvastatin and ezetimibe did not reduce the composite outcome of combined aortic-valve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.)

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Guidelines on the management of valvular heart disease (version 2012)

2012-08-26

Alec Vahanian , Ottavio Alfieri , Felicita Andreotti +7 more

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Cardiac valve surgery—the “French correction”

1983-09-01

Alain Carpentier

Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis

2000-08-31

Raphaël Rosenhek , Thomas Binder , Gerold Porenta +5 more

Whether to perform valve replacement in patients with asymptomatic but severe aortic stenosis is controversial. Therefore, we studied the natural history of this condition to identify predictors of outcome.During 1994, … Whether to perform valve replacement in patients with asymptomatic but severe aortic stenosis is controversial. Therefore, we studied the natural history of this condition to identify predictors of outcome.During 1994, we identified 128 consecutive patients with asymptomatic, severe aortic stenosis (59 women and 69 men; mean [+/-SD] age, 60+/-18 years; aortic-jet velocity, 5.0+/-0.6 m per second). The patients were prospectively followed until 1998.Follow-up information was available for 126 patients (98 percent) for a mean of 22+/-18 months. Event-free survival, with the end point defined as death (8 patients) or valve replacement necessitated by the development of symptoms (59 patients), was 67+/-5 percent at one year, 56+/-5 percent at two years, and 33+/-5 percent at four years. Five of the six deaths from cardiac disease were preceded by symptoms. According to multivariate analysis, only the extent of aortic-valve calcification was an independent predictor of outcome, whereas age, sex, and the presence or absence of coronary artery disease, hypertension, diabetes, and hypercholesterolemia were not. Event-free survival for patients with no or mild valvular calcification was 92+/-5 percent at one year, 84+/-8 percent at two years, and 75+/-9 percent at four years, as compared with 60+/-6 percent, 47+/-6 percent, and 20+/-5 percent, respectively, for those with moderate or severe calcification. The rate of progression of stenosis, as reflected by the aortic-jet velocity, was significantly higher in patients who had cardiac events (0.45+/-0.38 m per second per year) than those who did not have cardiac events (0.14+/-0.18 m per second per year, P<0.001), and the rate of progression of stenosis provided useful prognostic information. Of the patients with moderately or severely calcified aortic valves whose aortic-jet velocity increased by 0.3 m per second or more within one year, 79 percent underwent surgery or died within two years of the observed increase.In asymptomatic patients with aortic stenosis, it appears to be relatively safe to delay surgery until symptoms develop. However, outcomes vary widely. The presence of moderate or severe valvular calcification, together with a rapid increase in aortic-jet velocity, identifies patients with a very poor prognosis. These patients should be considered for early valve replacement rather than have surgery delayed until symptoms develop.

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Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

2016-04-02

Martin B. Leon , Craig R. Smith , Michael J. Mack +7 more

Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in … Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients.

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2014-03-04

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients

2017-03-17

Michael J. Reardon , Nicolas M. Van Mieghem , Jeffrey J. Popma +7 more

Although transcatheter aortic-valve replacement (TAVR) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk, less is known about comparative outcomes among … Although transcatheter aortic-valve replacement (TAVR) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk, less is known about comparative outcomes among patients with aortic stenosis who are at intermediate surgical risk.We evaluated the clinical outcomes in intermediate-risk patients with severe, symptomatic aortic stenosis in a randomized trial comparing TAVR (performed with the use of a self-expanding prosthesis) with surgical aortic-valve replacement. The primary end point was a composite of death from any cause or disabling stroke at 24 months in patients undergoing attempted aortic-valve replacement. We used Bayesian analytical methods (with a margin of 0.07) to evaluate the noninferiority of TAVR as compared with surgical valve replacement.A total of 1746 patients underwent randomization at 87 centers. Of these patients, 1660 underwent an attempted TAVR or surgical procedure. The mean (±SD) age of the patients was 79.8±6.2 years, and all were at intermediate risk for surgery (Society of Thoracic Surgeons Predicted Risk of Mortality, 4.5±1.6%). At 24 months, the estimated incidence of the primary end point was 12.6% in the TAVR group and 14.0% in the surgery group (95% credible interval [Bayesian analysis] for difference, -5.2 to 2.3%; posterior probability of noninferiority, >0.999). Surgery was associated with higher rates of acute kidney injury, atrial fibrillation, and transfusion requirements, whereas TAVR had higher rates of residual aortic regurgitation and need for pacemaker implantation. TAVR resulted in lower mean gradients and larger aortic-valve areas than surgery. Structural valve deterioration at 24 months did not occur in either group.TAVR was a noninferior alternative to surgery in patients with severe aortic stenosis at intermediate surgical risk, with a different pattern of adverse events associated with each procedure. (Funded by Medtronic; SURTAVI ClinicalTrials.gov number, NCT01586910 .).

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Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation

2017-03-14

William A. Zoghbi , David Adams , Robert O. Bonow +7 more

The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal

2017-01-01

James L. Gentry , Dermot Phelan , Milind Y. Desai +1 more

This study was designed to evaluate prevalence, determinants, and clinical outcome implications of reduced functional capacity (FC) in patients with organic mitral regurgitation (MR).Evaluation of FC by exercise testing is … This study was designed to evaluate prevalence, determinants, and clinical outcome implications of reduced functional capacity (FC) in patients with organic mitral regurgitation (MR).Evaluation of FC by exercise testing is rarely performed in MR because little is known about the clinical determinants and outcome implications of FC.Cardiopulmonary exercise testing (CPET) was prospectively performed in 134 asymptomatic patients with organic MR to assess FC (peak oxygen consumption [VO2]) simultaneously to Doppler-echocardiographic quantitation of MR (effective regurgitant orifice [ERO]) and left ventricular (LV) systolic and diastolic function.Peak VO2 was 26 +/- 6 ml/kg/min (96 +/- 16% of age-predicted), but varied widely (57% to 145% of predicted) and was markedly reduced (< or =84% of predicted) in 19% of patients. Although ERO of MR was univariately associated with reduced FC (26 vs. 9% with ERO > or =40 vs. <40 mm2), independent determinants of reduced FC were LV diastolic function (higher E/E' ratio, p = 0.006), atrial fibrillation (p = 0.01), and lower forward stroke volume (p = 0.03). Clinical events (death, heart failure, new atrial fibrillation) and clinical events or surgery were more frequent with than without reduced FC (3 years, 36 +/- 14% vs. 13 +/- 4%, p = 0.02; and 66 +/- 11% vs. 29 +/- 5%, p = 0.001, respectively), even adjusting (risk ratios 1.80 and 1.54 respectively, both p < or = 0.03) for age and ERO.In asymptomatic organic MR, FC quantitatively assessed by CPET is unexpectedly markedly reduced in one out of every four to five patients. Reduced FC is independently determined by consequences rather than severity of MR and predicts increased subsequent clinical events. Therefore, CPET frequently reveals functional limitations not detected clinically and is an important tool in managing patients with organic MR.

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2014-03-04

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

2017 ESC/EACTS Guidelines for the management of valvular heart disease

2017-08-26

Helmut Baumgartner , Volkmar Falk , Jeroen J. Bax +7 more

Mathematical support for phonocardiographic signal processing has been developed based on a mathematical model in the form of a periodically correlated stochastic process and a component processing method.On the basis … Mathematical support for phonocardiographic signal processing has been developed based on a mathematical model in the form of a periodically correlated stochastic process and a component processing method.On the basis of mathematical support, algorithmic and software was developed in the Matlab environment for automated systems of computer diagnostics of the functional state of the valves of the human heart when mitral insufficiency is detected.

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Updated Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation

2012-10-01

A. Pieter Kappetein , Stuart J. Head , Philippe Généreux +7 more

Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation

2018-08-27

Jean‐François Obadia , David Messika‐Zeitoun , Guillaume Leurent +7 more

In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes … In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown.We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm2 or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months.At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3% (78 of 152 patients) in the control group (odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53). The rate of death from any cause was 24.3% (37 of 152 patients) in the intervention group and 22.4% (34 of 152 patients) in the control group (hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned hospitalization for heart failure was 48.7% (74 of 152 patients) in the intervention group and 47.4% (72 of 152 patients) in the control group (hazard ratio, 1.13; 95% CI, 0.81 to 1.56).Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. (Funded by the French Ministry of Health and Research National Program and Abbott Vascular; MITRA-FR ClinicalTrials.gov number, NCT01920698 .).

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Transcatheter Mitral-Valve Repair in Patients with Heart Failure

2018-09-23

Gregg W. Stone , JoAnn Lindenfeld , William T. Abraham +7 more

Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes. Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.

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Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography

2018-09-30

Carol Mitchell , Peter S. Rahko , Lori A. Blauwet +7 more

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Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients

2019-03-16

Michael J. Mack , Martin B. Leon , Vinod H. Thourani +7 more

Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There … Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There is insufficient evidence regarding the comparison of the two procedures in patients who are at low risk.

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Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

2019-03-16

Jeffrey J. Popma , G. Michael Deeb , Steven J. Yakubov +7 more

Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in … Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.

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ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2006-08-01

Robert O. Bonow , Blasé A. Carabello , Kanu Chatterjee +7 more

Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis

2002-12-10

Alain Cribier , Hélène Eltchaninoff , Assaf Bash +7 more

Background— The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted … Background— The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was developed. After ex vivo testing and animal implantation studies, the first human implantation was performed in a 57-year-old man with calcific aortic stenosis, cardiogenic shock, subacute leg ischemia, and other associated noncardiac diseases. Valve replacement had been declined for this patient, and balloon valvuloplasty had been performed with nonsustained results. Methods and Results— With the use of an antegrade transseptal approach, the PHV was successfully implanted within the diseased native aortic valve, with accurate and stable PHV positioning, no impairment of the coronary artery blood flow or of the mitral valve function, and a mild paravalvular aortic regurgitation. Immediately and at 48 hours after implantation, valve function was excellent, resulting in marked hemodynamic improvement. Over a follow-up period of 4 months, the valvular function remained satisfactory as assessed by sequential transesophageal echocardiography, and there was no recurrence of heart failure. However, severe noncardiac complications occurred, including a progressive worsening of the leg ischemia, leading to leg amputation with lack of healing, infection, and death 17 weeks after PHV implantation. Conclusions— Nonsurgical implantation of a prosthetic heart valve can be successfully achieved with immediate and midterm hemodynamic and clinical improvement. After further device modifications, additional durability tests, and confirmatory clinical implantations, PHV might become an important therapeutic alternative for the treatment of selected patients with nonsurgical aortic stenosis.

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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2020-12-17

Catherine M Otto , Rick A. Nishimura , Robert O. Bonow +7 more

Aim: This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. … Aim: This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. Methods: A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.

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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2020-12-17

Catherine M Otto , Rick A. Nishimura , Robert O. Bonow +7 more

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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

2020-12-18

Catherine M Otto , Rick A. Nishimura , Robert O. Bonow +7 more

2021 ESC/EACTS Guidelines for the management of valvular heart disease

2021-06-11

Alec Vahanian , Friedhelm Beyersdorf , Fabien Praz +7 more

Guidelines • Guidelines •

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Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)

2012-10-01

A. Pieter Kappetein , Stuart J. Head , Philippe Généreux +7 more

The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more … The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. Two in-person meetings (held in September 2011 in Washington, DC, USA, and in February 2012 in Rotterdam, Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and non-interventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiographic recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavours of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

2014-03-04

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

2017-03-16

Rick A. Nishimura , Catherine M Otto , Robert O. Bonow +7 more

transcatheter aortic valve replacement ◼ tricuspid stenosis ◼ valvular heart disease AHA/ACC GUIDELINE ACC/AHA Task Force Members, see page e1180*Focused Update writing group members are required to recuse themselves from … transcatheter aortic valve replacement ◼ tricuspid stenosis ◼ valvular heart disease AHA/ACC GUIDELINE ACC/AHA Task Force Members, see page e1180*Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.†ACC/AHA Representative.

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Accuracy of 3D Transesophageal Echocardiography in the Quantitative Evaluation of Aortic Regurgitation.

2025-07-20

Manabu Kimura , Masaki Izumo , Yoshihiro J. Akashi +1 more | PubMed

This study evaluated the accuracy of three-dimensional transesophageal echocardiography (3D-TEE) and two-dimensional transesophageal echocardiography (2D-TEE) in assessing aortic regurgitation (AR) severity compared to magnetic resonance imaging (MRI). While three-dimensional transthoracic … This study evaluated the accuracy of three-dimensional transesophageal echocardiography (3D-TEE) and two-dimensional transesophageal echocardiography (2D-TEE) in assessing aortic regurgitation (AR) severity compared to magnetic resonance imaging (MRI). While three-dimensional transthoracic echocardiography (3D-TTE) is commonly used to assess eccentric regurgitant jets, transesophageal echocardiography (TEE) is recommended for detailed valvular evaluation. A retrospective analysis of 24 AR cases compared regurgitant volume (Rvol) measured by 2D-TEE, 3D-TEE, and MRI. Bland-Altman analysis assessed Rvol concordance, while severity grading agreement was analyzed using the Kappa coefficient. Rvol measured by 3D-TEE correlated better with MRI than 2D-TEE. However, 3D-TEE tended to overestimate AR severity. Agreement in severity grading between 3D-TEE and MRI was low (κ = 0.418) but improved significantly (κ = 0.822) after correcting for 3D-TEE overestimation (4.5 mL/beat). 3D-TEE slightly overestimated regurgitant flow but, after correction, showed strong agreement with MRI in AR severity grading. This suggests 3D-TEE is a valuable tool for quantitative AR assessment, with adjustments enhancing accuracy.

The Silent Heart: Unveiling Mitral Stenosis in the Postoperative Period

2025-06-25

Aparna Bagle , R. R. KELKAR | JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Cerebral Embolic Protection during TAVI — The Failed Promise

2025-06-25

Hani Jneid | New England Journal of Medicine

A New Aortic Valve Calcium Scoring Framework for Automatic Calcification Detection in Echocardiography

2025-06-25

Mervenur Çakır , Elif Baykal Kablan , Murat Eki̇nci̇ +1 more | Deleted Journal

Aortic valve calcium scoring is an essential tool for diagnosing, treating, monitoring, and assessing the risk of aortic stenosis. The current gold standard for determining the aortic valve calcium score … Aortic valve calcium scoring is an essential tool for diagnosing, treating, monitoring, and assessing the risk of aortic stenosis. The current gold standard for determining the aortic valve calcium score is computed tomography (CT). However, CT is costly and exposes patients to ionizing radiation, making it less ideal for frequent monitoring. Echocardiography, a safer and more affordable alternative that avoids radiation, is more widely accessible, but its variability between and within experts leads to subjective interpretations. Given these limitations, there is a clear need for an automated, objective method to measure the aortic valve calcium score from echocardiography, which could reduce costs and improve patient safety. In this paper, we first employ the YOLOv5 method to detect the region of interest in the aorta within echocardiography images. Building on this, we propose a novel approach that combines UNet and diffusion model architectures to segment calcified areas within the identified region, forming the foundation for automated aortic valve calcium scoring. This architecture leverages UNet's localization capabilities and the diffusion model's strengths in capturing fine-grained structures, enhancing both segmentation accuracy and consistency. The proposed method achieves 85.08% precision, 80.01% recall, and 71.13% Dice score on a novel dataset comprising 160 echocardiography images from 86 distinct patients. This system enables cardiologists to focus more on critical aspects of diagnosis by providing a faster, more objective, and cost-effective method for aortic valve calcium scoring and eliminating the risk of radiation exposure.

Valvular Endothelial Cell Heterogeneity Reflects Different Pathogenesis of Tricuspid and Bicuspid Aortic Valve Stenosis in Humans

2025-06-25

Adrian T. Brandtner , Alexander Brückner , Wilhelm Röll +3 more | Journal of the American Heart Association

Aorto-Right Atrial Fistula Caused by Subacute Type A Aortic Dissection Six Months After Double Valve Replacement: A Case Report and Literature Review

2025-06-24

Hiroto Yasumura , Goichi Yotsumoto , Yoshihiro Fukumoto +7 more | Cureus

Predictors of Length-of-Stay Among Transcatheter Aortic Valve Replacement Patients Using a Supervised Machine Learning Algorithm

2025-06-24

Gregory Judson , Jeff Luck , Skye Lawrence +6 more | JACC Advances

Development of an <em>Ex Vivo</em> Mitral Valve Evaluation Model Using a Pulsatile Flow Simulator

2025-06-24

Ergida Albrahimi , İbrahim Başar Aka , Mhd Homam Alhaj Ali +3 more | Journal of Visualized Experiments

Feasibility of guiding catheter exchange using extension wire in percutaneous coronary intervention after transcatheter aortic valve replacement

2025-06-24

Makoto Saigan , Masaki Miyasaka , Daishi Tazawa +7 more | Cardiovascular Intervention and Therapeutics

Dapagliflozin wirkt auch nach TAVI bei Herzinsuffizienz

2025-06-24

Peter Overbeck | CardioVasc

One-year Outcomes of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: CONDUCT Registry: A Propensity Score-Matched Comparison

2025-06-24

Michal Droppa , Tobias Geisler , Jan Baan +7 more | Arrhythmia & Electrophysiology Review

Objectives: The occurrence of new conduction abnormalities necessitating permanent pacemaker implantation (PPI) is a complication of transcatheter aortic valve replacement (TAVR). Previous studies have shown inconsistent results about the clinical … Objectives: The occurrence of new conduction abnormalities necessitating permanent pacemaker implantation (PPI) is a complication of transcatheter aortic valve replacement (TAVR). Previous studies have shown inconsistent results about the clinical impact of new PPI after TAVR. Methods: CONDUCT was a prospective observational registry that enrolled 295 patients undergoing TAVR at four European centres. The primary goal of this registry was to compare 1-year clinical outcomes in TAVR patients with or without PPI, using one-to-four propensity score matched (PSM) analysis. It also assessed major adverse cardiac events (MACE) in patients undergoing right ventricular pacing after PPI. Results: Out of 160 PSM patients, 36 underwent PPI and the other 124 had no PPI within 30 days post-TAVR. The median age of the patients was 80 years, with more men (80.6% and 84.7% in patients with and without PPI, respectively) and similar EuroSCORE II and Society of Thoracic Surgeons scores. Patients with PPI had higher diabetes prevalence (p=0.055) and lower left ventricular ejection fraction percentages (p=0.034), but higher systolic pulmonary artery pressure (p=0.013) than those without PPI. However, these differences diminished after PSM. At 1 year, PPI patients had a non-significant but slightly higher incidence of MACE (22.2% versus 13.7%; p=0.216) (HR 1.63; 95% CI [0.72–3.71]) driven by increased heart failure (11.1% versus 2.4%; p=0.046) (HR 5.05; 95% CI [1.09–23.4]). Freedom from all-cause mortality, cardiovascular death, stroke and endocarditis at 1-year follow-up was comparable between groups. Conclusion: Despite a higher incidence of congestive heart failure rehospitalisation in patients undergoing PPI, 1-year clinical outcomes were similar in both groups.

Aortic annulus reconstruction with bovine pericardium during aortic valve replacement for severe calcific aortic stenosis

2025-06-24

Jiaao Li , Tao Yang , Nan Wu +5 more | Journal of Cardiothoracic Surgery

Aortic perforation following percutaneous coronary intervention in a patient with permanent pacemaker: a case report

2025-06-24

TUN WIN NAING , Xiaofang Chen , Yan Wang +1 more | European Heart Journal - Case Reports

Abstract Background Lead perforation is an uncommon complication of permanent pacemaker (PPM) implantation, occurring in 0.1–0.8% of cases (1). Aortic perforation caused by a pacing lead is rare and has … Abstract Background Lead perforation is an uncommon complication of permanent pacemaker (PPM) implantation, occurring in 0.1–0.8% of cases (1). Aortic perforation caused by a pacing lead is rare and has been described only in case reports. Case summary A 70-year-old Chinese man with a medical history of diabetes mellitus and hypertension presented to the hospital with intermittent chest pain of 3 weeks duration. He was diagnosed with chronic coronary syndrome and underwent percutaneous coronary intervention (PCI) to left anterior descending artery (LAD). Two-days post PCI, he developed shock due to cardiac tamponade. A repeat angiogram was unremarkable; however, during thoracotomy, the right atrial pacing lead of a dual-chamber pacemaker, implanted six weeks previously for complete heart block, was found to have perforated the aorta. The patient was discharged in stable condition 20 days after successful repair of the aortic perforation. Discussion Careful analysis of non-specific chest pain is crucial. This case highlights the importance of considering rare sequelae after multiple cardiac procedures, such as PPM and PCI. This case demonstrates the risk of aortic injury from extra-support guides during PCI, particularly near right atrial pacing leads.

Rheumatic Valve Disease Presenting As Mitral Stenosis and Regurgitation

2025-06-24

Nismat Javed , Rosanna Pineda , Vikram Itare +2 more | Cureus

Ex Vivo Assessment of Transcatheter Edge-to-Edge Treatment Performance After Pathology Recurrence in Functional Tricuspid Regurgitation

2025-06-24

Eleonora Salurso , Gianfranco Beniamino Fiore , Riccardo Vismara | Annals of Biomedical Engineering

Management of Acurate Neo 2 Valve Protrusion Into the Left Ventricle

2025-06-24

Giorgio Quadri , Innocenzo Scrocca , Gianmarco Annibali +1 more | Catheterization and Cardiovascular Interventions

ABSTRACT We report the case of an 81‐year‐old woman with severe aortic stenosis and moderate aortic regurgitation who underwent transcatheter aortic valve implantation (TAVR) with an Acurate Neo 2 valve. … ABSTRACT We report the case of an 81‐year‐old woman with severe aortic stenosis and moderate aortic regurgitation who underwent transcatheter aortic valve implantation (TAVR) with an Acurate Neo 2 valve. During the procedure, the valve protruded into the left ventricle, rendering simple retrieval impossible. A novel “balloon‐assisted” technique was successfully employed to centralize and retract the valve into the ascending aorta, allowing for proper deployment without complications. This case highlights a unique complication and its innovative management strategy.

A Guide for Successful Transcatheter Tricuspid Valve Repair With the Triclip

2025-06-23

Craig Basman , Polydoros Kampkatsis , Sung‐Han Yoon +3 more | Catheterization and Cardiovascular Interventions

The use of transcatheter edge-to-edge repair (t-TEER) for tricuspid regurgitation (TR) continues to grow due to its proven clinical results and high safety profile. Yet, because the tricuspid valve is … The use of transcatheter edge-to-edge repair (t-TEER) for tricuspid regurgitation (TR) continues to grow due to its proven clinical results and high safety profile. Yet, because the tricuspid valve is a complex and heterogenous valve, the results of recent landmark t-TEER trials may be difficult to replicate in daily practice as the use of t-TEER expands. Hence, this review is design to review optimal steps and advanced maneuvers for the Triclip (Abbott, MN, Minneapolis), which is the first United States regulatory approved device for t-TEER.

Cardiovascular and Non‐Cardiovascular Complications of Transcatheter Aortic Valve Implantation

2025-06-23

Antonio Padilla‐Serrano , J. Tapias del Pozo , Elena Lorente +1 more | Catheterization and Cardiovascular Interventions

ABSTRACT Degenerative aortic valve stenosis is becoming a more prevalent disease, and transcatheter aortic valve implantation (TAVI) offers a treatment option for patients who are at high surgical risk. This … ABSTRACT Degenerative aortic valve stenosis is becoming a more prevalent disease, and transcatheter aortic valve implantation (TAVI) offers a treatment option for patients who are at high surgical risk. This manuscript reviews cardiovascular and non‐cardiovascular complications associated with TAVI. A search was conducted in PubMed, Scopus, and Web of Science using the terms “transcatheter aortic valve implantation” and each keyword referring to potential complications, with the Boolean operator “AND” used to allow us to obtain documents containing two or more keywords simultaneously. The most frequent cardiovascular complications were hemorrhage and vascular access‐related complications (2.93%−24%), new‐onset left bundle branch block (13.3%−37%), and myocardial injury (95%−100%). Among non‐cardiovascular complications, stroke and subclinical brain injury occurred in 1.6%−5% of cases; acute kidney injury, in 11.7%; and delirium, in 17.8%−23.7%. Described mortality ranges from 1.1% to 4.2%. This narrative review provides a multidimensional perspective of TAVI complications by addressing both cardiovascular and non‐cardiovascular complications. Non‐cardiovascular complications, such as delirium, negatively influence mortality.

Simultaneous <scp>3D</scp> aortic lumen and vessel wall imaging at 0.<scp>55 T</scp> at either systole or diastole

2025-06-23

Matías Paredes , Carlos Castillo‐Passi , Karl Kunze +4 more | Magnetic Resonance in Medicine

To evaluate the feasibility of a novel, non-contrast enhanced, 3D, simultaneous bright-blood, and black-blood sequence (iT2prep-BOOST) for aortic imaging at 0.55 T at either systole or diastole. Simultaneous contrast-free 3D … To evaluate the feasibility of a novel, non-contrast enhanced, 3D, simultaneous bright-blood, and black-blood sequence (iT2prep-BOOST) for aortic imaging at 0.55 T at either systole or diastole. Simultaneous contrast-free 3D aortic lumen and vessel wall imaging at 0.55 T is achieved using the recently introduced iT2prep-BOOST framework that interleaves the acquisition of two bright blood images (with inversion recovery T2 preparation [T2prep-IR] and no preparation). To enable either systolic or diastolic aortic imaging, three T2 preparation pulses were investigated-an adiabatic RF pulse and two Malcolm-Levitt (MLEV) pulses (MLEV4 and MLEV8)-to improve image quality in regions with high flow and susceptibility. The proposed approach was evaluated in phantom, 10 healthy subjects and 3 patients with suspected cardiovascular disease. Bright- and black-blood images resulting from the three different T2 preparation pulses were compared both qualitatively and quantitatively, using a 4-point Likert scale for vessel sharpness and presence of blood artifacts. Additionally, the contrast ratio between the lumen and myocardium was computed. Aortic measurements, including the aortic annulus area at systole and diastole, cusp-commissure measurement at the aortic root level during diastole, and aortic diameter at the ascending aortic level during diastole were also performed. Excellent or good image quality scores were obtained for both bright- and black-blood images with iT2prep-BOOST at 0.55 T with all three preparation pulses. The use of MLEV8 T2 preparation scheme improves systolic image quality, reducing the presence of artifacts with a significant difference (p < 0.05) at the mid descending aorta level. This scheme also increases the contrast ratio between aortic lumen and myocardium, compared to the previously used adiabatic RF T2 preparation. The aortic root diameter and area were consistent with values reported in the literature for healthy subjects at 1.5 T. The feasibility of a novel, non-contrast-enhanced, 3D aortic imaging framework for simultaneous bright-blood and black-blood imaging was demonstrated at 0.55 T for either systole or diastole, with a scan time of 7 min. Good image quality scores and aortic measurements in agreement with literature values at 1.5 T were achieved with the MLEV8 T2 preparation. Studies in a larger cohort of healthy subjects and patients with aortopathies are warranted.

Impact of initial direction of Navitor transcatheter heart valve delivery system on final valve orientation and coronary access

2025-06-23

Hirokazu Miyashita , Tomoki Ochiai , Daisuke Sato +7 more | Cardiovascular Intervention and Therapeutics

Septal myectomy in aortic valve replacement for severe aortic stenosis

2025-06-23

M.A. Fomin , E.P. Evseev , V.A. Ivanov +2 more | Russian Journal of Cardiology and Cardiovascular Surgery

Objective. To analyze the immediate and mid-term results of septal myectomy and aortic valve replacement in patients with severe aortic stenosis. Material and methods. A retro- and prospective analysis included … Objective. To analyze the immediate and mid-term results of septal myectomy and aortic valve replacement in patients with severe aortic stenosis. Material and methods. A retro- and prospective analysis included 148 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm between 2012 and 2022. Age of patients was 63.0 (60; 66) years. The study included 89 (60%) men and 59 (40%) women. There were 88 patients (60%) with heart failure NYHA class III and 48 (32%) ones with class II. Patients were divided into two groups. Both groups did not differ in clinical and echocardiographic characteristics before surgery. In the AVR+SME group, septal myectomy was performed together with aortic valve replacement. Results. Septal myectomy is a safe procedure not increasing perioperative risk and morbidity in early postoperative period. At the same time, septal myectomy provides better hemodynamic characteristics in the left ventricular outflow tract and aortic valve prosthesis. Mean LVOT pressure gradient was 2.3 (1.8; 2.9) and 4.6 (3.1; 6.8) mm Hg, (p< 0.01), mean pressure gradient on the aortic valve prosthesis — 9.6 (6.2;14.5) and 12.8 (8.2;19.0) mm Hg, respectively (p<0.01). Survival, complication and redo surgery rate in mid-term period were similar. Septal myectomy improves the mid-term results of aortic valve prosthesis and promotes more effective reverse myocardial remodeling after surgery. Left ventricular myocardial mass index in a year after surgery was 90.7 (75.9; 106.9) and 118.4 (100.0; 142.2) g/m2 (p<0.01), respectively. Conclusion. Septal myectomy together with aortic valve replacement improves the results of surgical treatment of aortic stenosis in early and mid-term postoperative period.

Surgical treatment of patients with functional mitral regurgitation and aortic valve disease

2025-06-23

I.I. Scopin , М.С. Латышев , P.V. Kakhktsyan +5 more | Russian Journal of Cardiology and Cardiovascular Surgery

Objective. To evaluate the results of surgical treatment in patients with functional mitral regurgitation (FMR) and aortic valve disease. Material and methods. We retrospectively analyzed (median follow-up 61 months) postoperative … Objective. To evaluate the results of surgical treatment in patients with functional mitral regurgitation (FMR) and aortic valve disease. Material and methods. We retrospectively analyzed (median follow-up 61 months) postoperative outcomes in 108 patients with FMR >2 and aortic valve disease. Depending on mitral regurgitation (MR) mechanism, all patients were divided into type I (n=31) and type IIIb (n=77). Each type of mitral dysfunction was analyzed depending on mitral valve (MV) surgery: isolated aortic valve replacement (AVR), suture annuloplasty, remodeling annuloplasty (RA), multicomponent reconstructions with interventions on subvalvular structures. We examined patients before surgery, in early and late postoperative period. Hemodynamic parameters, complications, mortality, freedom from MR >2, effective left ventricular reverse remodeling, quality of life and mortality were studied. Results. In early postoperative period, 1 patient with MR type I died after isolated AVR. There were 2 redo surgeries after isolated AVR and suture annuloplasty. There were no differences in morbidity. Three patients with MR type IIIb died in early postoperative period (2 after isolated AVR and 1 after multicomponent reconstruction). There were no redo surgeries and differences in morbidity (p=0.24). In long-term postoperative period, there were no deaths or redo surgeries among patients with MR type I. Unsatisfactory quality of life was noted by 56% of patients without MV repair and all patients after suture repair. Better quality of life was observed after RA. There was no MR >2 after RA. Effective LV reverse remodeling was achieved in 100% of cases after RA, 74% without intervention and was absent after suture repair. Six patients with MR type IIIb died in long-term period. There were no significant between-group differences (p=0.50). There were 5 redo surgeries (the largest number after isolated AVR due to progression of MR). Unsatisfactory quality of life was detected in 28 patients (6 (60%) after suture repair and 13 (59%) after isolated AVR). MR >2 was absent in all patients after RA with reduction of interpapillary distance and resection of secondary chordae, 14% (n=3) after RA, 50% without intervention and 40% after isolated suture repair. Effective LV reverse remodeling was achieved in 89% of cases after RA with reduction of interpapillary distance, 100% after resection of secondary chordae, 95% after RA, 80% after suture repair and 68% without intervention. Conclusion. RA is advisable in patients with type I FMR ≥2 and aortic valve disease, mitral annulus ≥38 mm and LV EDV ≥200 ml for more predictable long-term results. In type IIIb mitral dysfunction, the indication for surgical intervention is MR ≥2, mitral annulus ≥40 mm, LV EDV ≥250 ml. Multicomponent MV reconstructions with interventions on subvalvular structures or MV replacement is advisable for IPD >35 mm. In case of IPD <35 mm and tethering <8 mm, RA is effective. IPD <35 mm and coaptation depth >8 mm require multicomponent reconstructions with interventions on subvalvular structures or MV replacement.

Selection of optimal aortotomy in various cardiac surgeries

2025-06-23

A.V. Lysenko , G.I. Salagaev , Yu.S. Gilevskaya +1 more | Russian Journal of Cardiology and Cardiovascular Surgery

Valve replacement and homograft remain the “gold standard” for treating patients with severe aortic valve disease. For successful procedure, as well as in correction of left ventricular outflow tract obstruction, … Valve replacement and homograft remain the “gold standard” for treating patients with severe aortic valve disease. For successful procedure, as well as in correction of left ventricular outflow tract obstruction, it is necessary to ensure optimal access and visualization of ascending aorta, aortic valve, interventricular septum and subvalvular structures. The key factor for successful surgery is a thorough understanding of aortic root anatomy and selection of appropriate aortotomy based on surgical plan and structures to be visualized. In this article, we discuss the main anatomical aspects of aortotomy and the most appropriate techniques for different clinical situations.

Anticoagulation Therapy for Atrial Fibrillation After Transcatheter Aortic Valve Replacement: National Database Insights

2025-06-23

Koki Takegawa , Koshiro Kanaoka , Yoshitaka Iwanaga +6 more | Journal of the American Heart Association

Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic stenosis; however, the optimal postoperative anticoagulation therapy for patients with atrial fibrillation (AF) remains controversial. We aimed to … Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic stenosis; however, the optimal postoperative anticoagulation therapy for patients with atrial fibrillation (AF) remains controversial. We aimed to investigate the association between anticoagulant therapy selection and outcomes in patients with AF after TAVR. We retrospectively analyzed patients with AF who underwent TAVR. Patients were divided into 2 groups according to the anticoagulant therapy administered 3 months after the index TAVR (direct oral anticoagulant [DOAC] and vitamin K antagonist [VKA] groups). The primary end points were thromboembolic and major bleeding events after a landmark period of 3 months. We analyzed the association between oral anticoagulants and outcomes using propensity score matching. Among 47 883 patients who underwent TAVR between April 2014 and March 2021, 10 041 had a history of AF and anticoagulant therapy. Of these, 8191 patients were prescribed a DOAC, while 1850 received a VKA. Before matching, the thromboembolic event rate was 2.2 per 100 person-years in the DOAC group and 3.6 per 100 person-years in the VKA group, whereas the bleeding event rates were 7.1 and 10.0 per 100 person-years, respectively. After matching, VKA was associated with higher risks of thromboembolic events (hazard ratio [HR], 1.46 [95% CI, 1.12-1.91]; P=0.004) and bleeding events (HR, 1.21 [95% CI, 1.03-1.42]; P=0.016). DOAC use in patients with AF who undergo TAVR may be preferable to VKA use in a real-world clinical setting.

Mitral Valve Transcatheter Edge‐to‐Edge Repair or Medical Therapy in Systolic Heart Failure: A Meta‐Analysis of Randomized Trials

2025-06-23

Rohin K. Reddy , David Koeckerling , Gregg W. Stone +2 more | Journal of the American Heart Association

Robotic Mitral Valve Replacement With Balloon-Expandable Valve Using Fibrillatory Arrest

2025-06-23

David Zapata , Douglas Anderson , Kevin Ho +3 more | Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery

CT-based evaluation of patient-prosthesis mismatch after transcatheter aortic valve implantation and its influence on outcome

2025-06-23

Ramona Schmitt , N Ressler , Klaus Kaier +7 more | Clinical Research in Cardiology

Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet … Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry. 444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM. Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (p < 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (p < 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (p = 0.033). Stent geometry did not influence the EOA (p > 0.05 each model). EOA did not influence overall survival (p > 0.05 each model). The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.

Atrial functional mitral regurgitation: definition, features, and unknowns

2025-06-23

Frank A. Flachskampf , Ruxandra Beyer , Wolfgang Fehske | Clinical Research in Cardiology

Atrial functional mitral regurgitation (AFMR) is a form of functional mitral regurgitation as yet insufficiently recognized and characterized. The driving cause is atrial, not ventricular dilatation, usually due to long-standing … Atrial functional mitral regurgitation (AFMR) is a form of functional mitral regurgitation as yet insufficiently recognized and characterized. The driving cause is atrial, not ventricular dilatation, usually due to long-standing atrial fibrillation, and often in association with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction. Increase in mitral annular area leads to loss of central coaptation of the leaflets. Because of the normal sized and normally or nearly normally contracting left ventricle, the amount of regurgitation is typically not more than moderate or moderate-to-severe by standard criteria. The time course of AFMR and the relation to symptoms have yet to be elucidated more clearly. There is a large overlap of symptoms and signs between AFMR and heart failure with preserved ejection fraction, making it likely that the role of AFMR in patients with heart failure has been underestimated. This review presents current concepts and published insights into this form of mitral regurgitation.

Fighting time: the critical importance of pre-TAVR mortality risk prediction

2025-06-23

Jasmin Shamekhi , Martin A. Ebert , Ann Lorek +7 more | Clinical Research in Cardiology

Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not … Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations. This study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period. Between January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure). The median waiting time for TAVR was 41 days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29 days. By comparison, 30 day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of ≥ 5 identified high-risk patients with a pre-TAVR mortality rate of 12.6%. The mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.

The heart and the bone

2025-06-23

Caroline Case | Routledge eBooks

Transcatheter Aortic Valve Implantation (TAVI) In Marfan Syndrome with Critical Aortopathy: Safety and Feasibility in the Setting of Dilated Aortic Annuli

2025-06-23

Donaldo Emiliano Silva López , Diego Rodriguez Herrera , Mary Flores +7 more | International Journal of Medical Science and Clinical Research Studies

Marfan syndrome (MFS) is a hereditary connective tissue disorder characterized by cardiovascular manifestations, including aortic root dilation, valvular insufficiency, and an increased risk of aortic dissection. While surgical aortic valve … Marfan syndrome (MFS) is a hereditary connective tissue disorder characterized by cardiovascular manifestations, including aortic root dilation, valvular insufficiency, and an increased risk of aortic dissection. While surgical aortic valve replacement (SAVR) with root reconstruction remains the gold standard for severe aortic valve pathology in MFS, transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative in high-risk or inoperable patients. However, the safety and efficacy of TAVI in MFS patients with critical aortopathy and dilated aortic annuli remain controversial due to concerns regarding annular stability, device anchoring, and long-term durability. This article reviews the existing literature, procedural challenges, and hemodynamic considerations associated with TAVI in this unique patient population, while discussing the potential risks of aortic dissection, paravalvular leak, and valve migration. Further research is warranted to establish standardized selection criteria and optimal device strategies for TAVI in MFS-related aortopathy.

Challenging anatomy in a patient with severe ankylosing spondylitis and aortic stenosis treated with transcatheter aortic valve implantation

2025-06-23

Marcin Misterski , Anna Olasińska‐Wiśniewska , Aleksander Araszkiewicz +5 more | Kardiologia Polska

Emergency Transcatheter Aortic Valve in Sutureless Valve Replacement for Managing Cardiogenic Shock

2025-06-23

Alessandro Comis , Sebastiano Immè , Claudia Tamburino +1 more | Catheterization and Cardiovascular Interventions

ABSTRACT Sutureless aortic bioprosthesis (SBVs) may pose specific challenges to valve‐in‐valve (ViV) implantation, particularly, in the setting of cardiogenic shock which remains challenging and understudied. We report the case of … ABSTRACT Sutureless aortic bioprosthesis (SBVs) may pose specific challenges to valve‐in‐valve (ViV) implantation, particularly, in the setting of cardiogenic shock which remains challenging and understudied. We report the case of a 69‐year‐old man with a SBVs disfunction, presenting with acute decompensated HF. Despite intra‐aortic balloon pump (IABP), clinical deterioration prompted an emergency transcatheter ViV. Computer tomography imaging confirmed procedural feasibility. A self‐expanding Evolut PRO+ valve was deployment followed by post‐dilatation for underexpansion. The procedure restored valve function, and the patient was weaned off IABP. At 30‐day follow‐up, patient was in NYHA class I with complete recovery of left ventricular systolic function. This is the first reported case of emergency ViV for a degenerated sutureless valve. Careful CT planning and device selection are critical. Despite the lack of data in this setting, ViV may represent a safe and effective option for high‐risk patients in cardiogenic shock.

Sex Differences in Newly Diagnosed Severe Aortic Stenosis in British Columbia (B.C.)

2025-06-22

Aishwarya Roshan , Jeffrey Yim , Shamikh Lakhani +7 more | Diseases

Background: Despite its high prevalence, little is known about the effect of sex on the management and outcomes of aortic stenosis (AS). We sought to characterize the effect of sex … Background: Despite its high prevalence, little is known about the effect of sex on the management and outcomes of aortic stenosis (AS). We sought to characterize the effect of sex on the clinical evaluation for and provision of aortic valve replacement (AVR), including surgical (SAVR) and transcatheter aortic valve replacement (TAVR), and the subsequent morbidity and mortality outcomes. Methods: A comprehensive chart review was conducted on all patients with a first diagnosis of severe aortic stenosis (AS) at Vancouver General and University of British Columbia hospitals from 2012 to 2022. Exact chi-square and Kruskal–Wallis tests were used to evaluate the variables of interest. Results: A total of 1794 studies met the inclusion criteria, comprising 782 females (44%) and 1012 males (56%). Females were significantly older than males at the time of the first diagnosis (79 versus 75 years, p < 0.001). Females were significantly less likely to be evaluated by the TAVR clinic or cardiac surgeon or to receive aortic valve intervention (p-value ≤ 0.001). Females were significantly more likely to be rejected for TAVR due to older age (OR 0.23 (0.07, 0.59)), comorbid conditions (OR 0.68 (0.47, 0.97)), and frailty (OR 0.23 (0.07, 0.59)). Females were significantly more likely to be rejected for SAVR on the basis of frailty (OR 0.66 (0.46, 0.94)). Females also had significantly higher rates of 1-year mortality, hospitalization, and heart failure hospitalization compared to males (p-values < 0.05). Conclusions: Our data suggest significant sex-based discrepancies in the management of AS. Females with severe AS are diagnosed later in life and are less likely to be evaluated for valve intervention. They are less likely to receive intervention due to older age, frailty, and multimorbid conditions. Further research is warranted for a more effective identification and follow up of aortic stenosis, as well as timely referral for AVR, where appropriate, especially for females.

Increased Left Ventricular Myocardial Extracellular Volume Assessed by Cardiac Computed Tomography as a Consequence of Aortic Stenosis and Coexisting Cardiovascular Risk Factors

2025-06-22

Adrian Martuszewski , Patrycja Paluszkiewicz , Rafał Poręba +1 more | Journal of Clinical Medicine

Background/Objectives: Extracellular volume (ECV) expansion reflects myocardial fibrosis and may play a role in subjects with severe aortic stenosis (AS) receiving transcatheter aortic valve implantation (TAVI). This study aimed to … Background/Objectives: Extracellular volume (ECV) expansion reflects myocardial fibrosis and may play a role in subjects with severe aortic stenosis (AS) receiving transcatheter aortic valve implantation (TAVI). This study aimed to assess the relationship between cardiovascular risk factors (CVRF), AS severity and left ventricular myocardial ECV measured by cardiac computed tomography (CCT). Methods: 61 patients qualified for TAVI underwent pre-procedural CCT. CVRFs were recorded, including advanced age, male gender, obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, type 2 diabetes, and smoking. The CCT protocol included non-contrast (for aortic valve calcium score, AVCS), angiographic (for vascular access planning), and delayed phases (for left atrial appendage thrombus assessment). ECV was calculated from attenuation values of the interventricular septum and left ventricular cavity assessed in native and delayed phases. Patients were stratified based on the presence/absence of individual CVRFs, median AVCS, and aortic valve area (AVA). Results: Mean ECV was higher in patients with hypertension (28.01% vs. 26.93%, p = 0.03), smokers (28.71% vs. 26.52%, p = 0.01), AVCS ≥ 2975 (28.08% vs. 26.95%, p = 0.02), and AVA < 0.95 cm2 (28.63% vs. 26.53%, p = 0.01). Positive correlations were found between ECV and the number of CVRFs (r = 0.49, p = 0.01), BMI (r = 0.30, p = 0.01), systolic BP (r = 0.31, p = 0.02), and AVCS (r = 0.36, p = 0.01); AVA correlated negatively (r = −0.59, p = 0.01). Regression showed that hypertension, smoking, and smaller AVA were independent predictors of higher ECV. Conclusions: Among TAVI candidates, hypertension, smoking, and more advanced AS are independently associated with increased myocardial ECV on CCT. These findings may reflect subclinical myocardial remodeling and support the added diagnostic value of ECV in pre-TAVI assessment.

Mitral Valve Replacement via Minithoracotomy Versus Conventional Median Sternotomy in Rheumatic Mitral Valve Disease: A Multicenter Retrospective Study

2025-06-21

Hicham Kbiri , Rachid Seddiki , Abdellatif Chlouchi +5 more | Cureus

Background and objectives This study aimed to compare surgical outcomes, early postoperative complications, and midterm recovery in patients with severe rheumatic mitral insufficiency undergoing either minimally invasive cardiac surgery (MICS) … Background and objectives This study aimed to compare surgical outcomes, early postoperative complications, and midterm recovery in patients with severe rheumatic mitral insufficiency undergoing either minimally invasive cardiac surgery (MICS) or mitral valve replacement via conventional median sternotomy (CMS). While CMS remains the standard approach, MICS has emerged as a less invasive option with potential benefits. However, comparative data in resource-limited settings remain scarce. Methods This multicenter retrospective study included 55 adults with severe rheumatic mitral Insufficiency (RMI) who underwent elective mechanical mitral valve replacement between 2020 and 2024 in Morocco. Patients were divided into two groups: 27 received minimally invasive surgery (MICS) via minithoracotomy, and 28 underwent conventional sternotomy (CMS). The primary endpoint was 30-day all-cause mortality. Secondary outcomes included operative times, postoperative complications, intensive care unit (ICU)/hospital stay duration, 12-month functional recovery, valve performance, and event-free survival based on Kaplan-Meier analysis. Results Fifty-five patients underwent mechanical mitral valve replacement: 27 via minimally invasive cardiac surgery (MICS) and 28 via conventional median sternotomy (CMS). The 30-day mortality was similar between groups (3.7% vs 3.6%; p = .99). Compared with CMS, MICS was associated with significantly shorter cardiopulmonary bypass (68.3 vs 87.5 minutes; p < .001) and aortic cross-clamp times (54.7 vs 77.1 minutes; p < .001), reduced postoperative pneumonia (0% vs 10.7%; p = .03), and fewer arrhythmias (7.4% vs 39.3%; p = .04). Hospital stay was shorter in the MICS group (6.2 vs 7.3 days; p = .04), with similar ICU duration. At 12 months, both groups showed preserved left ventricular ejection fraction (60.1% vs 58.2%; p = .22) and comparable event-free survival (>90%), without significant differences in valve-related complications. Conclusions In this multicenter retrospective study, minimally invasive cardiac surgery (MICS) for severe rheumatic mitral insufficiency was associated with fewer early complications, shorter operative and recovery times, and equivalent 12-month outcomes compared with conventional median sternotomy. These findings support MICS as a safe and effective alternative in appropriately selected patients when performed in experienced surgical centers.

Comparative outcomes of Myval versus contemporary transcatheter heart valves: a systematic review and meta-analysis

2025-06-21

Mustafa Bilal Özbay , Serhat Değirmen , Aysenur Gullu +4 more | Cardiovascular Intervention and Therapeutics

Correction: The PREVASC study: Prospective REgistry of Valve disease in Asymptomatic Italian elderly SubjeCts

2025-06-21

Nazario Carrabba , Mattia Alexis Amico , Gherardo Busi +7 more | Aging Clinical and Experimental Research

Hydraulic forces assist left ventricular filling in aortic stenosis and improve after valve replacement in patients with the lowest hydraulic force and otherwise healthiest left ventricles at baseline

2025-06-20

B. G. WATSON , Jonathan Bennett , Nikoo Aziminia +7 more | medRxiv (Cold Spring Harbor Laboratory)

ABSTRACT Background Diastolic dysfunction in the setting of aortic valve replacement (AVR) for aortic stenosis (AS) is incompletely understood. This study aims to to assess the net hydraulic force of … ABSTRACT Background Diastolic dysfunction in the setting of aortic valve replacement (AVR) for aortic stenosis (AS) is incompletely understood. This study aims to to assess the net hydraulic force of left ventricular (LV) filling in participants with severe symptomatic AS undergoing AVR. Methods This single-centre prospective observational cohort study evaluated patients with severe, symptomatic AS undergoing AVR between 2012-2015. Clinical assessment and cardiovascular magnetic resonance (CMR) was completed prior to AVR and 1-year post-operatively. Atrioventricular area difference (AVAD) was used as a surrogate for the hydraulic force of LV filling. AVAD at mid-diastole was measured as the difference between LV short-axis area and left atrial short-axis area. Results In patients with AS (n=110, 54% male, age 71 [64–77] years, aortic valve area 0.74±0.25 cm 2 ), AVAD was positive at baseline (2.8±6.5 cm 2 ) consistent with a net hydraulic force assisting LV filling. While AVAD did not change post-operatively on a group level (p=0.70), an improvement in AVAD was associated univariably with increasing baseline LV ejection fraction, and decreasing baseline AVAD, LV volume, mass, myocardial extracellular volume, and infarct size (p<0.05 for all), and multivariably with baseline decreasing AVAD, LV mass, and age (model adjusted R 2 =0.49, p<0.001). Conclusion In severe AS, hydraulic force contributes to LV filling prior to and following AVR. The greatest improvement in hydraulic force following AVR occurred in those with the lowest baseline hydraulic force, but also with lower age and the absence of otherwise deleterious LV myocardial remodelling, thus supporting the benefits of early intervention.

An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement

2025-06-20

Liliane Zillner , Mirjam G. Wild , Michaela M. Hell +7 more | Journal of Clinical Medicine

Background: The Tendyne™ transcatheter heart valve (THV) system is a promising option for high-risk patients with severe mitral regurgitation (MR) who are ineligible for surgery or transcatheter edge-to-edge repair (TEER). … Background: The Tendyne™ transcatheter heart valve (THV) system is a promising option for high-risk patients with severe mitral regurgitation (MR) who are ineligible for surgery or transcatheter edge-to-edge repair (TEER). As most fatal complications occur within the first 90 days, this study aimed to identify anatomical predictors of in-hospital mortality after transcatheter mitral valve replacement (TMVR). Methods: In this subanalysis of the TENDER registry, data from 110 patients who underwent TMVR across 26 centers between January 2020 and June 2022 were evaluated. Preprocedural imaging parameters were analyzed, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac 4D computed tomography (CT). Results: We identified LVEDDi as a significant predictor of in-hospital mortality (p = 0.022), with lower values in non-survivors (26.42 ± 3.76 mm/m2) than in survivors (30.37 ± 5.58 mm/m2). Both indexed and absolute LVEDDi predicted in-hospital complications (p < 0.001 and p = 0.008). In multivariate analysis, LVEDDi (p = 0.048; OR = 0.856) and STS score (p = 0.038; OR = 1.114) remained independent predictors of in-hospital mortality. In an extended model, only LVEDDi persisted as a significant predictor (p = 0.007), highlighting its robustness. Conclusions: This analysis identified a small LVEDDi as a novel, clinically relevant risk factor in TMVR and showed its added value alongside conventional markers. Its easy calculation supports incorporating LVEDDi thresholds into screening to improve patient selection and outcomes.

Early predictors of aortic valve surgery in patients with significant bicuspid aortic regurgitation without initial surgical indication

2025-06-20

Ha Jeong Lim , Kyu Kim , Seo‐Yeon Gwak +5 more | Heart

Background Bicuspid aortic regurgitation (AR) is common in younger patients who often do not meet guideline-based criteria for aortic valve (AV) surgery at diagnosis. However, identifying early predictors of disease … Background Bicuspid aortic regurgitation (AR) is common in younger patients who often do not meet guideline-based criteria for aortic valve (AV) surgery at diagnosis. However, identifying early predictors of disease progression may aid in risk stratification and surgical timing. Methods From a single-centre registry of 1927 patients with bicuspid AV, we identified 335 patients with moderate or severe AR, excluding those with severe aortic stenosis (AS), endocarditis or other major valvular diseases. Among them, 199 patients (mean age 52±14.0 years; 80% male) did not initially meet the surgical criteria and were included in the final analysis. Clinical data and echocardiographic parameters, including speckle-tracking-derived strain measurements, were analysed. The primary outcome was progression to AV surgery during follow-up. Results Over a mean follow-up of 4.9 years, 41 patients (21%) underwent AV surgery, primarily for symptom onset or left ventricular (LV) enlargement. In multivariable Cox regression, three independent predictors of future surgery were identified: LV mass index ≥113 g/m² (HR 4.49, 95% CI 1.74 to 11.6, p=0.002), left atrial (LA) reservoir strain <28% (HR 3.07, 95% CI 1.40 to 6.74, p=0.005) and concomitant moderate AS (HR 3.19, 95% CI 1.40 to 7.28, p=0.006). Conclusion In patients with significant bicuspid AR who do not initially meet indications for AV surgery, increased LV mass index, impaired LA reservoir strain and concomitant moderate AS are early predictors of surgical progression. These parameters may enhance surveillance strategies and inform earlier surgical referral in selected patients.

60: ‘the magic number of greatness’ in minimally invasive mitral valve repair?

2025-06-20

Volkmar Falk | Heart

Free-breathing cardiovascular magnetic resonance flow quantification can be an alternative to standard breath-holding approach

2025-06-20

Sinsia A. Gao , Odd Bech‐Hanssen , Christina Polte +2 more | Scientific Reports

Abstract Cardiovascular magnetic resonance (CMR) evaluation of valvular heart disease is an important diagnostic tool when echocardiography is inconclusive. Phase contrast flow quantification is usually performed during breath hold (BH), … Abstract Cardiovascular magnetic resonance (CMR) evaluation of valvular heart disease is an important diagnostic tool when echocardiography is inconclusive. Phase contrast flow quantification is usually performed during breath hold (BH), which can be challenging in patients suffering from dyspnea and heart failure. The purpose of the present study is to compare a free-breathing (FB) with the conventional BH approach for flow quantification in the aortic, pulmonary and tricuspid valves in 20 healthy subjects (HS) and 25 patients with tricuspid regurgitation (TR). Aortic (AoFF) and pulmonary forward flow volume (PuFF), and tricuspid inflow volume (TrIF) were evaluated. Mean, standard deviation (SD) and limits of agreement (LoA) were calculated. There were good agreements between phase contrast flow volumes obtained by FB and BH approach. Mean difference ± SD / LoA for AoFF during BH versus FB were 1 ± 6 / -10 to 13 ml. The corresponding for PuFF were 1 ± 6 / -11 to 13 ml, and for TrIF − 3 ± 6 / -15 to 9 ml, respectively. Thus, free-breathing CMR flow acquisition can be an important alternative in the assessment of stroke volume, valvular regurgitant volume and be useful in all patients with difficulties to hold their breath.

Trends in MitraClip Placements and Predictors of 90-Day Heart Failure Rehospitalization: A Nationwide Analysis

2025-06-20

Vivek Joseph Varughese , Vignesh Krishnan Nagesh , Seetharamprasad Madala +6 more | Medical Sciences

Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of … Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016–2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76–79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1–3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82–4.23), pulmonary hypertension (OR 3.96, CI 1.49–5.55), and chronic lung disease (OR 1.91, CI 1.32–2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions.

Implante valvular aórtico percutáneo

2017-01-01

Carlos Giuliani , Matías Sztejfman , Julio Manuel Lewkowicz