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Introduction: Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited., Methods: We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes., Results: Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups., Conclusion: In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients., (© 2022 Wiley Periodicals LLC.)

Background: Preeclampsia is associated with higher in-hospital cardiovascular events and mortality with known disparities by race/ethnicity, but data on the interaction between income and these outcomes remain limited., Objectives: This study investigated racial and socioeconomic disparities in cardiovascular outcomes of preeclampsia at delivery hospitalizations., Methods: We analyzed National Inpatient Sample data using International Classification of Diseases-9th Revision/-10th Revision codes between 2004 and 2019. We identified a total of 2,436,991 delivery hospitalizations with preeclampsia/eclampsia as a primary diagnosis representing White (43.1%), Black (18.4%), Hispanic (18.7%), and Asian or Pacific Islander (A/PI; 3.3%) women. We stratified the population based on median household income (low income, medium income, and high income). Logistic regression and propensity-matched analysis were used for reporting outcomes adjusted for age, hospital region, and baseline comorbidities., Results: Black Hispanic, and A/PI women with preeclampsia had higher in-hospital mortality compared with White women across all groups of income. Hispanic women had lower odds of peripartum cardiomyopathy (PPCM) compared with White women. A significant interaction effect was observed with race/ethnicity and median household income for in-hospital mortality and PPCM with preeclampsia. Furthermore, high-income Black women had higher odds of PPCM, stroke, acute kidney injury, heart failure, cardiac arrhythmia, and venous thromboembolism compared with low-income White women., Conclusions: Women with preeclampsia experience significant racial/ethnic and socioeconomic disparities in inpatient mortality and cardiovascular outcomes at delivery. Across all income groups, Black, Hispanic, and A/PI women experience higher odds of in-hospital mortality compared with White women. Furthermore, high-income Black women had greater odds of many CV complications compared with low-income White women., Competing Interests: Dr Michos has Advisory Board participation for AstraZeneca, Bayer, Boehringer Ingelheim, Esperion Novartis, Novo Nordisk, and Pfizer; and is supported by the Amato Fund for Women’s Cardiovascular Health research at 10.13039/100007880Johns Hopkins University. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN MEDICAL KNOWLEDGE: Preeclampsia is associated with worse outcomes in terms of in-hospital mortality and cardiovascular complications for Black, Hispanic, Asian, or Pacific Islander women compared with White women. Furthermore, there is significant interaction effect of race and ethnicity with income. White women from a higher income group have a lower mortality compared with lower income White women. Notably, high-income Black women had greater odds of many cardiovascular complications compared with low-income White women. A phenomenon of “Hispanic Paradox” was observed where Hispanic women have the lowest prevalence of PPCM across all classes of income. TRANSLATIONAL OUTLOOK: Further studies are needed to clarify the role of health inequities in the context of income and socioeconomic status among women with preeclampsia. Given worsening US trends in maternal morbidity and mortality, urgent efforts are needed to improve maternal cardiovascular health outcomes in all women, but particularly those from lower income groups and those from underrepresented racial and ethnic groups who experience the greatest health disparities., (© 2022 The Authors.)

Introduction: Percutaneous embolectomy using the percutaneous large-bore aspiration embolectomy FlowTriever system (INARI Medical, Irvine, CA, USA) is a promising method for reducing high clot burden in patients with intermediate- to high-risk pulmonary embolism (PE)., Case Description: A 45-year-old woman with intermediate- to high-risk PE underwent percutaneous intervention using the FlowTriever retrieval/aspiration system. After the procedure, she experienced several cardiac arrests from pericardial tamponade and required pericardiocentesis, leading to haemodynamic stabilization., Discussion: To our knowledge, this is the first documented case of the use of the FlowTriever system causing micro-perforation of the right ventricle, resulting in tamponade and cardiac arrest., Conclusion: Percutaneous embolectomy has shown promise results in reducing clot burden and improving haemodynamic stability but has risks and limitations and requires specialized knowledge and training. In addition, more data are required from centres using the FlowTriever system to ensure adequate training and safety., Learning Points: Percutaneous mechanical thrombectomy using the FlowTriever or similar devices can be paramount in reducing morbidity and mortality from an intermediate- to high-risk pulmonary embolism given the immediate improvement in haemodynamics that cannot be achieved by anticoagulation alone.Cardiac micro-perforation is a potential complication of catheter-based embolectomy devices such as FlowTriever and should be suspected in the setting of pericardial effusion following the procedure., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)

Background There is a paucity of data on the feasibility of same-day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non-SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30-day readmission rate for SDD after TAVI was similar to non-SDD TAVI (9.8% versus 8.9%, P =0.31). The cumulative incidence of 30-day readmissions for SDD was higher compared with next-day discharge (log-rank P =0.01) but comparable to second- or third-day discharge (log-rank P =0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non-SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle-branch block, right bundle-branch block, second-degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30-day readmission and complication rates compared with non-SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.

Sickle cell disease is an inherited hemoglobinopathy leading to the synthesis of hemoglobin S. Hemoglobin S results in the formation of abnormal sickle-shaped erythrocytes that lead to hematologic abnormalities such as hemolytic anemia and increased risks of thrombosis. Another particular problem encountered with the disease is pulmonary hypertension. The objective of this narrative review is to discuss the prevalence, pathophysiology mechanisms, diagnostic techniques, treatment options, and prognostic indicators in the setting of sickle cell disease with pulmonary hypertension. Additionally, the review also highlights other advancements that are being investigated. Considering the significant morbidity, mortality, and prevalence of pulmonary hypertension in patients with sickle cell disease, it is important to account for the aforementioned domains in the future guidelines to provide optimal and individualized care to the high-risk individuals as well as reduce the progression of disease, morbidity, and mortality rates., (Copyright © 2021 by S. Karger AG, Basel.)