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Carcinoid heart disease (CaHD) poses a unique challenge in the management of patients with neuroendocrine tumours. Transcatheter pulmonary valve replacement (TPVR) has emerged as valuable therapy for patients with congenital heart diseases. However, its potential role in the treatment of patients with CaHD remains underexplored. To describe the 30-day outcomes of TPVR in a contemporary cohort of patients with CaHD. All consecutive patients undergoing TPVR alone or combined with tricuspid transcatheter valve implantation due to CaHD at a single institution between 2022 and 2024 were included. Indications for TPVR included symptomatic pulmonary valvular disease in native or bioprosthetic valves in patients deemed at high surgical risk. Patients had a computed tomography (CT) scan, a transthoracic (TTE) and transesophageal echocardiography (TEE) before interventions. Procedures were performed using general anesthesia, under TEE and fluoroscopy guidance. Follow-up included outpatient visits at 30 days post-procedure. A total of 6 patients were included. Among them, 2 (33%) had prior pulmonary valve replacement, 2 (33%) had undergone tricuspid valve replacement with subsequent native pulmonary valve disease progression, and the last 2 (33%) had no history of cardiac surgery. TPVR was successfully performed in all six patients using the SAPIEN 3 or SAPIEN 3 ultra transcatheter heart valves, without pre-stenting. One patient underwent combined tricuspid and pulmonary valve replacement, and one patient received a second prosthesis in supravalvular position to treat a supravalvular stenosis. No periprocedural death occurred. One patient without immediate complications developed severe disseminated intravascular coagulation and multi-organ failure leading to death 20 days after the procedure, attributed to oncologic evolution. At 30 days, 5 (83%) patients were alive. All patients had no residual pulmonary regurgitation (Fig. 1). TPVR using the SAPIEN 3 THV appears to be a safe and effective intervention for severe pulmonary valve disease in CaHD patients at high risk for surgery. [ABSTRACT FROM AUTHOR]

Transcatheter mitral valve implantation (TMVI) has emerged as an alternative to surgery in high risk patients with failing mitral bioprosthesis or annuloplasties. The presence of an elevated mean gradient > 5 mmHg after the procedure has been defined as an unsuccessful procedure but the impact and outcomes of an elevated mean gradient after TMVI have not been studied. In all, 175 patients undergoing TMVI from 2010 to 2024 were included. Patients were classified in three groups according to mean gradient after the procedure: group 1 < 5 mmHg, group 2 between 5 and 10 mmHg and group 3 ≥ 10 mmHg. The median age was 69 (52.5–80) years. Indications for TMVI were bioprosthesis failure in 131 patients (74.9%) and ring annuloplasty failure in 44 patients (25.1%). 155 (88.6%) patients were in NYHA class III or IV. Fifty patients were in group 1, 111 in group 2 and 14 in group 3, without any difference in baseline characteristics (except for age [ P = 0.02]) or procedural findings. At 30 days, the rates of all-cause mortality (respectively 2.6%, 0% and 0%, P = 0.3), rehospitalization for heart failure (respectively 7,7%, 7.4% and 20%, P = 0.62), paravalvular leak (4.6%, 16.8%, 20%, P = 0.41), LVOT obstruction (respectively 0%, 2.1% and 10%, P = 0.48) or valve thrombosis (respectively 11.6%, 4.2% and 0%, P = 0.48) were similar in the three groups. At a median follow-up of 3 years, 43 patients have died (35 for cardiovascular reasons) with a cumulative rate of all-cause mortality at 1, 2 and 3 years of 18.7%, 19.2% and 25.4% respectively. An elevated mean gradient was associated with increased risk of cardiovascular mortality with a HR of 1.16 (1.03–1.31, P = 0.02, Fig. 1). An improvement of NYHA class was observed in the two groups with mean gradient < 10 mmHg at one month and one year (P < 0.01) compared to baseline without any difference for the group 3. At one year, median systolic pulmonary arterial pressure also significantly improved in group 1 (from 50 mmHg (43–65) in baseline to respectively 45 mmHg (36–55), P < 0.01), in group 2 (from 55 mmHg [45–70] in baseline to 41 mmHg [35–55], P < 0.01]) without improvement in group 3 (from 55 mmHg (50–62) to 51 mmHg (35–58), P = 1). An elevated mean gradient post-TMVI ≥ 10 mmHg was associated with cardiovascular mortality up to 3 years and without significant functional improvement. Further studies with longer follow up are necessary. [ABSTRACT FROM AUTHOR]

Long-term results of transcatheter mitral valve replacement (TMVR) using balloon-expandable valves remain uncertain. This study aims to evaluate the long-term outcomes and durability of bioprosthetic heart valves after TMVR in patients undergoing valve in valve (ViV), valve in ring (ViR) and valve in mitral annular calcification (ViMAC) procedures. All patients undergoing TMVR for bioprosthesis or ring failure or severe annular calcifications in our center were included. A ballon expandable transcatheter aortic valve (SAPIEN XT or SAPIEN 3) was used in all cases. Patients were followed at 3 months, 1 year and yearly thereafter by means of clinical visits or phone contacts. The primary outcome was a combined criteria of death and mitral re-intervention (mitral valve replacement, heart transplantation, TMVR in TMVR). A total of 200 patients underwent TMVR between may 2010 and august 2023, with 121 (60,5%) ViV, 45 (22,5%) ViR and 34 (17%) ViMAC procedures. The median age of the population was 70 years. Over a median follow-up period of 2.6 years [IQR: 0.7–6.7], the composite outcome of death or mitral reintervention occurred in 102 patients: 84 (82%) patients had died, 12 (12%) required mitral surgical replacement, 2 (2%) underwent heart transplantation and 4 (4%) required TMVR in TMVR. This outcome occurred more frequently in the ViR and ViMAC group than in the ViV group (Fig. 1) (P < 0.0001). Regarding echocardiographic findings, there was a significant reduction in mean transmitral valve gradient after the procedure with a median of 6.0 versus 10.3 mmHg before. The mean gradient remained initially stable with a slight increase during the longer follow up period (Fig. 2a). The median gradient was of 7 mmHg at 1.3 and 5 years 8 mmHg at 7 years and 9 mmHg at 9 years. A similar trend was observed with the assessment of the mitral valve area showing a slight decrease over the years. Reoccurrence of higher-grade (3–4+) mitral regurgitation was infrequent at last follow-up (Fig. 2b). This study suggests acceptable long term clinical outcomes and an excellent durability of TMVR using balloon expandable valves. [ABSTRACT FROM AUTHOR]