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Data on the efficacy of transcatheter edge-to-edge repair (TEER) in patients with cardiogenic shock (CS) are limited.This study investigated the characteristics and outcomes of consecutive patients with significant mitral regurgitation (MR) and CS who underwent TEER.The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was assessed from November 22, 2013, to December 31, 2021. CS was defined as the coding of: 1) CS; 2) inotrope use; or 3) mechanical circulatory support before TEER. Device success was defined as MR reduction of ≥1 grade and a final MR grade ≤2+. The primary outcome was the impact of device success on 1-year mortality or heart failure (HF) readmissions. Cox proportional hazards models were used to report the risk-adjusted association between device success and 1-year outcomes.A total of 3,797 patients met the inclusion criteria. Mean age was 73.0 ± 11.9 years, and 59.5% were male. Mean Society of Thoracic Surgery score (MV repair) was 14.9% ± 15.3%. MR etiology was degenerative (53.4%) and functional (27.5%). Device success was achieved in 3,249 (85.6%) patients given successful achievement of final MR grade ≤2+ (88.2%) and MR reduction ≥1 absolute grade (91.4%). At 1 year after TEER, device success was associated with significantly lower all-cause mortality (34.6% vs 55.5%; adjusted HR: 0.49; 95% CI: 0.41-0.59; P 0.001) and a composite of mortality or HF admissions (29.6% vs 45.2%; adjusted HR: 0.51; 95% CI: 0.42-0.62; P 0.001).Successful MR reduction is achievable in most patients with CS and is associated with significantly lower mortality and HF hospitalization at 1 year. Randomized trials assessing TEER in CS are needed to establish this potential therapeutic approach.

The last decade has witnessed remarkable advances in pharmacological and nonpharmacological strategies for stroke prevention in patients with atrial fibrillation. However, the currently available clinical stroke risk prediction models do not account for key nonclinical factors (arrhythmia burden, left atrial physiology and anatomy, chemical and electrocardiographic markers) and other competing clinical risks. Hence, their ability to identify patients who will derive the most benefit from pharmacological and mechanical risk prevention strategies remain limited. In this paper, the authors review the current and evolving ischemic stroke risk prediction schemes in patients with nonvalvular atrial fibrillation, highlight the strengths and weaknesses of the models, and discuss the unmet needs in this field.

In contemporary procedural laboratories, multiple intricate procedures can be performed in a single day by an individual operator, who faces the need to repeatedly reset emotions to adapt to rapidly changing situations. Likewise, fear and apprehension are inherent to a profession with risk, and it

“Skate to where the puck is going, not where it has been.”—Wayne Gretsky The recent waves of transformational technology in structural heart disease (SHD) interventions will have dramatic effects on interventional cardiology (IC) and will shape the future of the field over the next decade.

Ischemic stroke in patients with atrial fibrillation is associated with substantial morbidity and mortality. The growing epidemic of atrial fibrillation worldwide has raised concerns about the dire need for effective stroke prevention systems in these patients. Fortunately, the last decade has witnessed a plethora of data on novel stroke prevention methods in patients with nonvalvular atrial fibrillation. However, optimal selection and effective implementation of these preventative strategies require an integrative approach that takes into account not only the available clinical data but also the perspective of each of the stakeholders involved (patient, physician, and society). The goal of this review was to discuss the contemporary issues surrounding stroke prevention in atrial fibrillation from the perspective of these 3 major stakeholders.

The last decade has witnessed remarkable advances in pharmacological and nonpharmacological strategies for stroke prevention in patients with atrial fibrillation. However, the currently available clinical stroke risk prediction models do not account for key nonclinical factors (arrhythmia burden, left atrial physiology and anatomy, chemical and electrocardiographic markers) and other competing clinical risks. Hence, their ability to identify patients who will derive the most benefit from pharmacological and mechanical risk prevention strategies remain limited. In this paper, the authors review the current and evolving ischemic stroke risk prediction schemes in patients with nonvalvular atrial fibrillation, highlight the strengths and weaknesses of the models, and discuss the unmet needs in this field.

OBJECTIVES The aim of this study was to determine the safety of eliminating the pre-discharge transthoracic echocardiogram (TTE) on 30-day outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND TTE is utilized before, during, and after TAVR. Post-procedural, pre-discharge TTE assists in assessment of prosthesis function and detection of clinically significant paravalvular leak (PVL) after TAVR. METHODS Patients who underwent TAVR at Mayo Clinic from July 2018 to July 2019 were included in a prospective institutional registry. Patients undergoing TAVR prior to February 2019 received a pre-discharge TTE, while those undergoing TAVR after February 2019 did not. Both cohorts were evaluated with TTE at 30 days post-TAVR. RESULTS A total of 330 consecutive patients were included. Of these, 160 patients (age 81.1 ± 7.6) had routine pre-discharge TTE, while 170 patients (age 78.9 ± 7.5) were dismissed without routine pre-discharge TTE. Mortality at 30 days was similar between the two groups (0% and 1.2%, respectively). One episode of PVL requiring intervention (0.6%) occurred in the pre-discharge TTE group and none in the group without pre-discharge TTE at 30-day follow-up. There was a similar incidence of total composite primary and secondary adverse events between the cohort receiving a pre-discharge TTE and those without (28.1% vs. 25.3%, P = 0.56) at 30 days. The most common event was need for permanent pacemaker or ICD implantation in both groups (13.1% vs. 11.8%, P = 0.71). CONCLUSIONS Elimination of the pre-discharge TTE is safe and associated with comparable 30-day outcomes to routine pre-discharge TTE. These findings have implication for TAVR practice cost-efficiency and health care utilization.

Transcatheter edge-to-edge repair with MitraClip is only approved for treatment of mitral regurgitation (MR), but it is increasingly used to treat concomitant tricuspid regurgitation (TR) due to its association with poor outcomes. The learning curve associated with the challenge of off-label

With the exception of ISAR-REACT 5 trial, majority of randomized trials (RCTs) compared third generation P2Y12 inhibitors (Prasugrel and Ticagrelor) to Clopidogrel. We performed a network meta-analysis comparing Prasugrel to Ticagrelor in patients with acute coronary syndrome (ACS). We included

The association between the acute change in mean direct left atrial (LA) pressure and symptom improvement post MitraClip has been shown. Mean transmitral diastolic Doppler pressure gradient is routinely measured before and after MitraClip deployment and is used in assessing procedural success.

Background Several studies have investigated early readmissions after percutaneous coronary interventions (PCIs). However, studies investigating 30-day readmission following PCI for chronic total occlusion (CTO) are lacking. Methods The National-Readmission-Database (NRD) was queried to identify patients undergoing elective CTO PCI between January 1, 2016 and December 31, 2016. We assessed the incidence, predictors, and cost of 30-day readmissions. Results A total of 30,579 CTO PCIs were identified in the NRD. After excluding patients who had acute myocardial infarction (n = 14,852), the final cohort included 15,907 patients. In this group of patients, 254 patients (1.5%) expired during their index admission and, 1600 patients (10%) had an unplanned readmission within 30 days. Cardiac causes constituted 54.2% of all causes of readmission. During the readmission, 15.8% of patients had coronary angiography , 8.4% underwent PCI, and 0.9% underwent bypass grafting. Independent predictors of 30-day readmission included baseline characteristics [age (OR 0.99, 95%CI 0.98–0.99), female (OR 1.14, 95%CI 1.01–1.28), lung disease (OR 1.36, 95%CI 1.20–1.55), heart failure (OR 1.42, 95%CI 1.24–1.62), anemia (OR 1.30, 95%CI 1.12–1.50), vascular disease (OR 1.18, 95%CI 1.03–1.35), history of stroke (OR 1.50, 95%CI 1.28–1.76) and the presence of a defibrillator (OR 1.68, 95%CI 1.39–2.03)], and procedural complications [acute kidney injury (OR 1.55, 95%CI 1.33–1.80) and gastrointestinal bleeding (OR 1.67, 95%CI 1.03–2.71)]. Conclusions One-tenth of patients undergoing CTO PCI are readmitted within 30-days, mostly for cardiac causes. The majority undergo angiography but revascularization . Certain patient and procedural characteristics independently predicted 30-day readmission.

Frailty in elderly patients is a key determinant of outcomes of patients undergoing major cardiac procedures. Five-meter walk time (5MWT) has been shown to predict mortality risk following surgical aortic valve replacement, but its association with outcomes in patients undergoing transcutaneous

Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce.The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG.This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses.Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p 0.001), acute kidney injury (16% vs. 12.3%; p 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG.In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.

Ischemic stroke in patients with atrial fibrillation is associated with substantial morbidity and mortality. The growing epidemic of atrial fibrillation worldwide has raised concerns about the dire need for effective stroke prevention systems in these patients. Fortunately, the last decade has witnessed a plethora of data on novel stroke prevention methods in patients with nonvalvular atrial fibrillation. However, optimal selection and effective implementation of these preventative strategies require an integrative approach that takes into account not only the available clinical data but also the perspective of each of the stakeholders involved (patient, physician, and society). The goal of this review was to discuss the contemporary issues surrounding stroke prevention in atrial fibrillation from the perspective of these 3 major stakeholders.

Two transcatheter aortic valve systems are currently in use in the United States. These are the balloon-expandable SAPIEN valves (BEV) (Edwards Lifesciences, Irvine, California), and the self-expanding CoreValve system (SEV) (Medtronic, Minneapolis, Minnesota). In this analysis, we used the advanced

Current methods to aggregate the risk factors in patients undergoing transcatheter aortic valve replacement (TAVR) remains imprecise. We used unsupervised machine learning to predict 30-day adverse events including mortality following TAVR. We included data from 228 patients who underwent TAVR at