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BACKGROUND Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF. AIMS The aim of this study was to evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF. METHODS In total, 81 cases of BVF VIV-TAVI (BVF group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control group). RESULTS VARC-2-defined device success was 93% in the BVF group and 68.4% in the control group (p

OBJECTIVE To evaluate the risk for brain lesions in valve in valve (VIV)-transcatheter aortic valve replacement (TAVR) compared to native valve procedures (NV-TAVR). BACKGROUND TAVR is associated with the risk of stroke and a high incidence of brain lesions in diffusion-weighted magnetic resonance imaging (DW-MRI). The risk in VIV procedures is unknown. METHODS Patients were included, if they received a Sapien-3 or an Evolut-R valve for an NV-TAVR or VIV-TAVR and a DW-MRI within 3-5 days after the procedure. RESULTS Two hundred nine patients had NV-TAVR and 41 patients had VIV-TAVR. The VIV group was significantly younger (mean 82.3 vs. 74.7 years old, p

OBJECTIVES To evaluate outcome and its predictors of bioprosthetic valve fracture (BVF) in patients undergoing valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). BACKGROUND BVF is feasible and reduces transvalvular gradients in VIV-TAVR-procedures, but follow-up-data and information on factors influencing the outcome are missing. METHODS The 81 cases of BVF-VIV-TAVR were collected from 14 international centers. RESULTS Predominantly transcatheter heart valve (THV) was implanted first, followed by BVF. VARC-2 defined device success was 93%, most failures were attributed to residual high gradients. Mean gradients decreased from 37��������13���mmHg to 10.8��������5.9���mmHg (p��

AIMS The aim of this study was to determine the impact of tricuspid regurgitation (TR) on mortality after edge-to-edge percutaneous mitral valve repair (PMVR), and also to analyse whether there is a difference in outcome between patients with improvement of TR after PMVR compared to patients without. METHODS AND RESULTS Out of 197 consecutive patients who underwent PMVR, 139 patients with available follow-up (mean 428±386 days) were included in the study. Concomitant moderate/severe TR was present in 58.3% of patients. Kaplan-Meier analysis showed significantly reduced overall survival for patients with moderate/severe TR, compared to patients with none/mild TR (p=0.003). Cox multivariate regression analysis revealed severe TR at baseline as the strongest independent predictor of mortality (HR 4.367, p=0.003). An improvement of the baseline moderate/severe TR was observed in 45.5% of patients at 30-day follow-up. Patients with no improvement of TR after PMVR had a higher midterm mortality compared to patients in whom TR improved (40.5% versus 11.4%, p=0.005). CONCLUSIONS More than half of patients undergoing PMVR have concomitant moderate/severe TR, which is associated with a worse outcome. Among predictors of mortality after edge-to-edge PMVR, severe TR at baseline is the most important. Patients with no improvement of TR at 30 days after PMVR have a significantly higher mortality at follow-up.

Recently published 30-day all-stroke data from PARTNER 3 (SAPIEN vs. surgery) and the EVOLUT LOW RISK trial (Evolut vs. surgery) revealed a lower stroke rate with the balloon-expandable valve (0.6% vs. 3.4%). A head-to-head comparison of both valve types regarding stroke, however, is not available.

Transcatheter aortic valve replacement (TAVR) is associated with the risk of symptomatic or silent cerebral infarcts (CIs). The role of aortic valve calcification on CIs is not well known. The purpose of this study was to investigate the impact of aortic valve complex calcification on CIs in

Subclinical cerebral ischemic lesions are detected by diffusion- weighted magnetic resonance imaging (DW-MRI) in the majority of patients after TAVR which may be associated with impaired short term neurological outcome. The impact of the TAVR device on cerebral ischemic lesions is not well defined.

Objectives The purpose of this study was to analyze the effect of transcatheter aortic valve replacement (TAVR) without versus with prior balloon aortic valvuloplasty (BAV) on the risk of cerebral embolization in patients who receive a balloon-expandable valve. Background Avoiding BAV prior to TAVR may simplify the procedure, but the risk of cerebral embolization is currently unknown. Methods A total of 87 consecutive high surgical-risk patients with no contraindications for diffusion-weighted magnetic resonance imaging (DW-MRI) were enrolled. Thirty-two patients received a balloon-expandable aortic valve with and 55 patients without BAV. The incidence, number, and volume of new ischemic lesions in DW-MRI performed 2 to 7 days after TAVI were evaluated. Results Mean age (83.8 ± 5.2 years vs. 82.9 ± 6.8 years) and sex (43.8% vs. 52.7% male) of the patients with versus without BAV, respectively, as well as other demographic and hemodynamic data were not significantly different between both groups. The procedural success rate was 93.5% with and 98.2% without BAV, and procedure duration and contrast volume were significantly lower without BAV. The incidence of new cerebral ischemic lesions in the total cohort was 66.7%. Compared with patients with BAV, those without BAV had a significantly higher total volume of cerebral ischemic lesions (235.4 ± 331.4 mm3 vs. 89.5 ± 128.2 mm3; p = 0.01). Conclusions The implantation of a balloon-expandable aortic valve without versus with prior BAV, although performed with a shorter procedure time and lower contrast volume, is associated with a significantly higher volume of cerebral ischemic lesions.