Search

Severe pure aortic regurgitation (AR) carries a high mortality and morbidity risk, and it is often undertreated because of the inherent surgical risk. Transcatheter heart valves (THVs) have been used off-label in this setting with overall suboptimal results. The dedicated "purpose-built" Jena Valve Trilogy (JVT, JenaValve Technology) showed an encouraging performance, although it has never been compared to other THVs. The aim of our study was to assess the performance of the latest iteration of THVs used off-label in comparison to the purpose-built JVT in inoperable patients with severe AR. We performed a multicenter, retrospective registry with 18 participating centers worldwide collecting data on inoperable patients with severe AR of the native valve. A bicuspid aortic valve was the main exclusion criterion. The primary endpoints were technical and device success, 1-year all-cause mortality, and the composite of 1-year mortality and the heart failure rehospitalization rate. Overall, 256 patients were enrolled. THVs used off-label were used in 168 cases (66%), whereas JVT was used in 88 (34%). JVT had higher technical (81% vs 98%; P < 0.001) and device success rates (73% vs 95%; P < 0.001), primarily driven by significantly lower incidences of THV embolization (15% vs 1.1%; P < 0.001), the need for a second valve (11% vs 1.1%; P = 0.004), and moderate residual AR (10% vs 1.1%; P = 0.007). The permanent pacemaker implantation rate was comparable and elevated for both groups (22% vs 24%; P = 0.70). Finally, no significant difference was observed at the 1-year follow-up in terms of mortality (HR: 0.99; P = 0.980) and the composite endpoint (HR: 1.5; P = 0.355). The JVT platform has a better acute performance than other THVs when used off-label for inoperable patients with severe AR. A longer follow-up is conceivably needed to detect a possible impact on prognosis. [Display omitted] [ABSTRACT FROM AUTHOR]

The Correction Notice from Cardiovascular Diabetology addresses the absence of a graphic abstract in the original article on SGLT2-inhibitors in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. The missing graphic abstract has been included in the updated version of the article. The correction was made by a group of authors listed in the notice, and Springer Nature maintains neutrality regarding jurisdictional claims and institutional affiliations. [Extracted from the article]

Aims: Many patients have a cardiac implantable electronic device (CIED) extracted at the time of heart transplantation. CIED components may be retained after heart transplantation, but their frequency, nature, and clinical significance is uncertain.Methods and results: Consecutive patients that underwent heart transplantation over 10 years from 1 January 2007 until 1 January 2017 were identified from the unit database. Pre- and post-operative chest radiographs were reviewed by two independent observers for the presence of CIED components. Adverse events relating to any retained CIED component were recorded. Two hundred and six patients had a CIED removed at the time of transplantation. Retained CIED components were present in 86 (42%) patients. The most common retained CIED components were suture sleeves and superior vena cava (SVC) coils of dual coil implantable cardioverter-defibrillator (ICD) leads. An SVC coil was retained in 25% of patients that had a dual coil ICD lead. Seven adverse events were associated with CIED removal or retained CIED components, including one fatal event. However, retained CIED components were not associated with reduced long-term survival after heart transplantation.Conclusion: Retained CIED components were seen in 42% of patients that had a CIED prior to transplantation, may be associated with serious adverse events but are not associated with reduced long-term survival. Cardiac surgeons should be aware of all CIED system components and be familiar with techniques for their complete removal at the time of transplantation. [ABSTRACT FROM AUTHOR]

Background: New conduction disturbances are frequent after transcatheter aortic valve implantation (TAVI). Refining our ability to predict high-grade atrioventricular block (AVB) occurring later than 24 hours after the procedure would be useful in order to select patients eligible for early discharge., Aims: This study was designed to identify predictors of high-grade AVB occurring between 24 hours and 30 days after TAVI and to develop and validate a predictive risk score., Methods: We analysed clinical, procedural, and electrocardiographic parameters of 1,290 TAVI patients. Independent predictors of delayed high-grade AVB were used to develop the predictive score, which was then externally validated in a cohort of 936 patients., Results: Implantation of self-expanding valves, greater implantation depth, longer PR interval in preprocedural electrocardiogram (ECG) and greater increase of PR duration in next-day ECG, preprocedural right bundle branch block (RBBB) and new-onset left bundle branch block or RBBB that persisted in next-day ECG were independent predictors of delayed high-grade AVB and were combined to develop the Delayed atrioventricular block Prediction for eArly disChargE (D-PACE) score. The areas under the curve of the score were 0.879 (95% confidence interval [CI]: 0.835-0.923) and 0.799 (95% CI: 0.730-0.868) in the derivation and validation cohorts, respectively. Based on the score, patients can be classified into three risk categories; low-risk patients demonstrated an incidence of delayed AVB of less than 1% and are ideal candidates for next-day discharge., Conclusions: The D-PACE score can be used to stratify TAVI patients according to their risk of delayed high-grade AVB and thereby identify those suitable for next-day discharge.

Coronary artery disease (CAD) and severe aortic stenosis (AS) often coexist. When significant coronary lesions were found in patients undergoing surgical aortic valve replacement, combined coronary artery bypass grafting was the gold standard of treatment. Differently, the management of concomitant CAD in patients who are candidates for transcatheter aortic valve implantation (TAVI) is a matter of debate. In this review, we discuss the evidence and present the current viewpoints regarding the definition and prognostic implications of CAD in patients undergoing TAVI and the potential role and limitations of invasive functional coronary stenosis assessment in severe AS. We present the challenges of percutaneous coronary intervention (PCI) in this setting, including timing of intervention, completeness of revascularization in the context of the complexity of the disease and the risk associated with the PCI procedure itself. Finally, we mention ongoing trials that should provide some long-awaited answers in this field.

Background: Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgical aortic valve replacement for the treatment of symptomatic aortic stenosis. The EuroScore (ES) II, logistic EuroScore (log ES), and the Society of Thoracic Surgeons (STS) score are the most applied scores for surgical risk stratification. However, their predictive value for patients undergoing TAVI is still unclear., Aim: To evaluate the performance of STS, log ES and ES II as predictors of short-term and long-term mortality in patients undergoing TAVI., Methods: Between February 2008 and October 2017, a total of 384 patients underwent transfemoral TAVI at our institution and constituted the study population. Patients were divided into three groups based on the class of risk (low, intermediate, and high) calculated by each score. In-hospital complications, 30-day outcomes, and 5-year outcomes were assessed., Results: In-hospital mortality rate was 2.6% (n = 10). All scores over-estimated the risk of 30-day mortality, especially for the highest risk classes. At the end of follow-up (5 years), STS risk stratification was able to stratify all-cause and cardiovascular (CV) mortality (P<.01 and P=.02, respectively). Patients with intermediate ES II risk showed a lower survival rate (P=.04) while CV deaths did not differ between classes of risk. All-cause mortality and CV mortality curves did not diverge according to the patients' risk profiles derived from log ES., Conclusion: Conventional surgical risk scores are not appropriate to predict 30-day mortality in patients undergoing transfemoral TAVI. STS assessment was the only risk score able to stratify long-term all-cause and CV mortality.

Aims: Many patients have a cardiac implantable electronic device (CIED) extracted at the time of heart transplantation. CIED components may be retained after heart transplantation, but their frequency, nature, and clinical significance is uncertain., Methods and Results: Consecutive patients that underwent heart transplantation over 10 years from 1 January 2007 until 1 January 2017 were identified from the unit database. Pre- and post-operative chest radiographs were reviewed by two independent observers for the presence of CIED components. Adverse events relating to any retained CIED component were recorded. Two hundred and six patients had a CIED removed at the time of transplantation. Retained CIED components were present in 86 (42%) patients. The most common retained CIED components were suture sleeves and superior vena cava (SVC) coils of dual coil implantable cardioverter-defibrillator (ICD) leads. An SVC coil was retained in 25% of patients that had a dual coil ICD lead. Seven adverse events were associated with CIED removal or retained CIED components, including one fatal event. However, retained CIED components were not associated with reduced long-term survival after heart transplantation., Conclusion: Retained CIED components were seen in 42% of patients that had a CIED prior to transplantation, may be associated with serious adverse events but are not associated with reduced long-term survival. Cardiac surgeons should be aware of all CIED system components and be familiar with techniques for their complete removal at the time of transplantation.