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Frailty is common in the elderly and is known to be associated with worse outcomes. Our objective was to evaluate the impact of frailty on outcomes and readmissions after TAVR in the contemporary era. Nationwide readmission database (NRD) from the year 2016 was used to identify TAVR patients and

Coronary access and redo TAVR are important as TAVR expands to younger patients. We evaluate transcatheter valve(THV) deployment orientation on commissural alignment. Pre-TAVR CT and procedural fluoroscopy were analyzed in 828(483 Sapien3, 245 Evolut, 100 ACURATE) TAVR (3/2016-9/2019). Coplanar

The tricuspid valve has historically received less attention than any other cardiac valve with regard to pathophysiology and surgical management. The tricuspid valve is part of a complex functional apparatus that includes the right atrium, right ventricle, and pulmonary circulation. Functional tricuspid regurgitation is the most common tricuspid valve disease and it occurs secondary to dilatation of tricuspid annulus and/or tethering of valve leaflets from right ventricular dilatation and dysfunction. However, recent expansion in the use of right-sided transvenous devices such as pacemakers and implantable defibrillators has been met with a parallel increase in the risk of organic tricuspid disease. Recent data suggest that tricuspid regurgitation is not benign, and many patients will benefit from intervention at the time of left-sided valve surgery, or early in isolated tricuspid valve disease. This review describes the various surgical options and strategies in the treatment of common tricuspid valve diseases. Current American and European guidelines advocate for a more proactive surgical approach in the treatment of tricuspid regurgitation and/or annular dilatation at the time of left-sided valve surgery. Tricuspid annuloplasty is the preferred technique given its superior long-term outcomes. This renewed interest in surgical repair has been ushered by the development of a newer generation of tricuspid annuloplasty rings, as well as technological strides in transcatheter therapies which now extend to include tricuspid pathologies in otherwise inoperable patients with advanced tricuspid disease and cardiomyopathy. Tricuspid disease is not a benign entity. An aggressive approach to surgical management as well as prophylactic interventions are becoming more widely adopted. Aggressive tricuspid surgery however, remains an area of controversy in cardiac surgery, although surgical repair remains the gold standard for functional tricuspid regurgitation with replacement reserved for advanced or organic tricuspid disease. Transcatheter therapy is primarily directed toward non-surgical patients and is not included in this review.

Impact of transcatheter heart valve(THV) selection on prosthesis-patient mismatch(PPM) remains unknown. We aimed to compare incidence of moderate and severe PPM between Sapien3(S3) and EvolutR/Pro(ERP) in a theoretical model. From 10/2015 to 9/2018, standardized effective orifice area(EOA) of 1401

We evaluate the impact of initial deployment orientation of EvolutR/Pro(ERP) on its final orientation and neo-commissure distance from coronaries to assess ability of coronary reaccess. From 4/2018 to 9/2018, C-tab positions of 60 ERP at 3-cusp or cusp-overlapped coplanar fluoroscopic view were co

Transcatheter aortic valve replacement (TAVR) is expanding to younger patients, but the feasibility of TAVR in failing transcatheter aortic valves (TAV) remains unknown. We determine the feasibility of TAV-in-TAV after SAPIEN 3 (S3) TAVR. From October 2015 to April 2019 at 2 centers, 610 S3 TAVRs

Objectives: Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the ‘bridge to recovery'. Methods: We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator. Results: V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury. Conclusions: Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from ‘bridge to recovery' to heart transplantation for the management of this critically ill population.

Left atrial pressure (LAP) and V-wave reduction are markers of successful transcatheter mitral repair but no simple method of continuous monitoring exists. We report our multicenter experience on continuous LAP monitoring during MitraClip repair. From 11/2016 to 8/2017, 74 prohibitive risk patients

Severe aortic stenosis (AS) can adversely affect right ventricular function (RVF). RVF is an important determinant of transcatheter aortic valve replacement (TAVR) outcomes. Immediate changes in echocardiographic parameters of RVF have not been previously reported. We report changes in

Patients with aortic stenosis undergoing TAVR often have mitral disease. Transcatheter mitral valve replacement (TMVR) is a potential option in these patients, but TAVR may affect mitral annular geometry impacting their candidacy for TMVR. We evaluated mitral annular characteristics before and after

Patients with aortic stenosis undergoing TAVR often have severe mitral regurgitation. Some of them are not anatomical candidates for Mitraclip. Transcatheter mitral valve replacement (TMVR) is a promising alternative, but risk left ventricular outflow tract obstruction (LVOTO). Aortomitral annular

Impact of transcatheter valve choice on prosthesis-patient mismatch (PPM) remains unknown. We compared moderate and severe PPM among Edwards Sapien (ES), Medtronic CoreValve (MC) and BostonScientific Lotus (BL) in a theoretical model. From 6/2014 to 9/2017, 471 patients had TAVR for severe native

Annular sizing predicts paravalvular leak (PVL) and new persistent left bundle branch block (pLBBB), but little is known on Left Ventricular Outflow Tract (LVOT) anatomy on TAVR outcomes. We propse an LVOT seal zone to quantify LVOT-Annular mismatch and derive a “non-tubular index (NTI)”, to

Recommended iliofemoral diameter for transfemoral (TF) TAVR with Medtronic CoreValve is >6 mm, but the lowest limit has not been determined. Our study evaluates the feasibility of TF TAVR in patients with small iliofemoral access (