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Pacer wire induced tricuspid regurgitation is not well‐understood. The mechanisms behind pacer wired induced tricuspid regurgitation have not been clearly defined. This clinical vignette sets to identify different technical mechanisms behind cardiac lead induced tricuspid regurgitation to help optimize cardiac lead implantation strategies for future device implantation. [ABSTRACT FROM AUTHOR]

Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) in cardiogenic shock (CS) is a novel mechanical cardiocirculatory support strategy that provides robust cardiocirculatory support and simultaneous left and right atrial venting by way of a multifenestrated transeptal catheter. We performed a single-center retrospective analysis of all patients aged ≥18 years with CS who underwent LAVA-ECMO at a quaternary care institution from 2018 to 2023. Clinical outcomes and prehemodynamics and posthemodynamics were evaluated. A total of 68 patients were analyzed (75% were men, 72% were white, median age of 63 years). The indications for LAVA-ECMO were CS because of myocardial infarction (29.4%), biventricular failure (26.5%), and/or valvular heart disease (26.5%). Trans-septal puncture was guided by intracardiac echocardiography (86.8%) or transesophageal echocardiography (13.2%). Arterial cannulation was performed by way of transcaval access in 25% of the cases. Post-LAVA-ECMO cannulation was associated with substantial improvement in the hemodynamics within 24 hours after cannulation, including reduction in right atrial pressure (absolute mean difference: -5.0 mm Hg, p <0.001), mean pulmonary artery pressure (-9.0 mm Hg, p <0.001), pulmonary capillary wedge pressure (-10.0 mm Hg, p <0.001), and left ventricular end-diastolic pressure (-14.0 mm Hg, p <0.001). Survival to decannulation occurred in 69.1%, whereas the 30-day survival from cannulation was 51.5%. The in-hospital all-cause mortality was 51.5%. Only 5 patients (7.4%) required additional mechanical circulatory support (MCS) (4 Impella, 1 veno-arterio-venous extracorporeal membrane oxygenation). There were no complications related to transeptal placement of the venous ECMO cannula. In conclusion, LAVA-ECMO, an MCS strategy providing biatrial drainage, appears to also provide simultaneous left ventricular venting, as demonstrated by improved invasive hemodynamics. Although the procedure appears safe, with no direct complications to interatrial septal cannulation, postcannulation complications remain high, and further studies are needed to evaluate the full safety profile of LAVA-ECMO compared with alternative MCS strategies., Competing Interests: Declaration of competing interest Mohammad Alqarqaz received research funding from Abiomed. Jennifer Cowger is a consultant for Abbott, Medtronic, CH Biomedical, Procyrion, BioVentrix, CorWave. Khaldoon Alaswad is a consultant for Arrow, Cardiovascular Systems Inc, Teleflex, Abbott, and Boston Scientific. William O'Neill is a consultant for Abbott, Abiomed, Boston Scientific, Edwards Lifesciences (Abbott), and Medtronic. Pedro Villablanca is a consultant for Edwards Lifesciences, Medtronic, Medicure Pharma, and AngioDynamics. Brian O'Neill is a consultant for Edwards Lifesciences, Abbott, Medtronic, Inari, Medicure Pharma, and AngioDynamics. Herbert Aronow is a consultant for Philips. Hassan Nemeh is a consultant for Edwards Lifesciences and Abbott. Tiberio Frisoli is a consultant for Edwards Lifesciences, Abbott, Boston Scientific, and AngioDynamics. Mir Babar Basir is a consultant Abiomed, Boston Scientific, Chiesi, Saranas and Zoll. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Transcatheter aortic valve replacement (TAVR) has undergone rapid expansion, emerging as a viable therapeutic option for low-risk patients in lieu of surgical aortic valve replacement. This paper aims to provide a review of the scientific evidence concerning TAVR in low-risk patients, encompassing both observational and clinical trial data. Furthermore, a substantial proportion of low-risk patients possesses a bicuspid aortic valve, necessitating careful examination of the pertinent anatomic and clinical considerations to TAVR that is highlighted in this review. Additionally, the review expands upon some of the unique challenges associated with alternate access in low-risk patients evaluated for TAVR. Last, this review outlines the pivotal role of a multidisciplinary heart team approach in the execution of all TAVR procedures and the authors' vision of 'minimalist TAVR' as a new era in low-risk TAVR., Competing Interests: Disclosure: The authors have no conflicts of interest to declare., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)