An 86-year-old female was referred to the Cardiology Department for further treatment due to symptomatic severe aortic stenosis. Given her old age as well as chronic obstructive pulmonary disease, coronary artery disease, hypertension, chronic kidney disease (Stage III), and frailty, the Heart Team recommended transcatheter aortic valve implantation (TAVI). Transfemoral TAVI was smoothly performed with a 26 mm self-expanding valve VenusA (Venus Medtech, Hangzhou, China; self-expanding) using pre-dilatation of 20 mm Z-MED balloon (NuMED, Hopkinton, NY, USA) and post-dilatation of 22 mm Z-MED balloon. However, on the post-implantation aortogram, it was detected that the outflow part of the stent frame seemed to outreach the aortic wall (Video 1), and a transoesophageal echocardiography revealed a Stanford type-A dissection (Video 2), which on computed tomography scan extended to the abdominal aorta without compromising blood flow in the neck vessels or abdominal organs (Figure 1, Video 3). Since the patient was haemodynamic stable and surgical intervention associated with high risk, conservative treatment was undertaken. Under close surveillance, strict heart rate and blood pressure control were maintained with intravenous drugs during index hospitalization and oral medications after discharge. The patient was fortunately alive at 1-year and 2-year follow-up. Computed tomography angiogram at 1-year follow-up showed stable aortic dissection with partial thrombosis inside the false lumen (Figure 2, Supplementary material online, Videos S1 and S2 ).

Evidence for transcatheter aortic valve implantation (TAVI) is scarce among patients with non-calcific aortic stenosis, and it is not known whether aortic valve calcification is associated with new cerebral ischemic lesions (CILs) that are detected by diffusion-weighted magnetic resonance imaging. So, our study enrolled 328 patients who underwent transfemoral TAVI using a self-expanding valve between December 2016 and June 2021 from the TORCH registry (NCT02803294). A total of 34 patients were finally confirmed as non-calcific AS and the remaining 294 patients were included in the calcific AS group. Incidence of new CILs (70.6% vs. 85.7%, p = 0.022), number of lesions (2.0 vs. 3.0, p = 0.010), and lesions volume (105.0 mm³ vs. 200.0 mm³, p = 0.047) was significantly lower in the non-calcific AS group. However, the maximum and average lesion volumes were comparable between two groups. Non-calcific AS was associated with lower risk for developing new CILs by univariate logistic regression analysis [Odds ratio (OR): 0.040, 95% confident interval (CI): 0.18–0.90, p = 0.026] and multivariate analysis (OR: 0.031, 95% CI: 0.13–0.76, p = 0.010). In summary, non-calcific AS patients had a lower risk of developing new cerebral ischemic infarction after TAVI compared to calcific AS patients. However, new ischemic lesions were still found in over 70% of patients.

The Double Perclose ProGlide (Abbott Vascular Devices) is widely adopted device for closing the main arterial access in transfemoral transcatheter aortic valve replacement (TF-TAVR). Previous observational studies have compared the single device vs double device approach, yielding controversial results and highlighting a gap in clinical randomized controlled trials. The authors sought to evaluate the effectiveness and safety of single vs double Perclose ProGlide devices in patients undergoing TF-TAVR. The Single-Closure trial was been launched in 2024 (NCT06173115). It is an investigator-initiated, open-label, multicenter, noninferior, randomized controlled trial designed to compare the clinical outcomes of single vs double Perclose closure devices. Eligible participants include patients over 65 years of age with severe aortic stenosis and indicated for TF-TAVR. These patients are randomly assigned in a 1:1 ratio to either the single Perclose closure group or the double Perclose closure group. The primary endpoint of the trial is the composite of access site or access-related major and minor vascular complications during hospitalization for the index procedure, as defined by the Valve Academic Research Consortium 3 criteria. This trial aims to compare the clinical outcomes of single vs double Perclose closure. Results of this trial may provide valuable insights into the optimal strategy for large-bore vascular closure.

Backgrounds: The risk of brain injury in bicuspid aortic valve (BAV) patients following transcatheter aortic valve replacement (TAVR) is currently unknown. Methods and Results: A total of 204 consecutive severe aortic stenosis patients who underwent TAVR were enrolled. 83 (40.7%) patients were BAV patients and the other 121 patients were tricuspid aortic valve (TAV) patients. All patients received diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline, 2 to 7 days after TAVR. Mean ages (mean ± SD: 75.8 ± 6.7 years vs. 78.9 ± 6.6 years, p = 0.004) and STS scores (6.0 ± 3.7 vs. 7.1 ± 4.2, p = 0.044) of the BAV and TAV patients were significantly different, while the stroke rates (2.4% vs. 1.7%, p = 0.704) were comparable between two groups. BAV patients were associated with higher number of new lesions (5.69 ± 6.22 vs. 3.50 ± 4.16, p = 0.008), total lesion volume [median(interquartile range): 290(70-930) mm ³ vs. 140(35-480) mm ³ , p = 0.008], and the volume per lesion [70.0(45.0-115.0) mm ³ vs. 57.5(24.5-93.0) mm ³ , p = 0.037] in DW-MRI. Moreover, the proportion of patients with lesions larger than 1cm ³ (28.6% vs. 10.9%, p = 0.005) and the number of new lesions in the middle cerebral arteries zone (1.46 ± 2.07 vs. 0.98 ± 1.84, p = 0.039) and intermediate zone between the anterior cerebral and middle cerebral arteries (ACA/MCA) (1.07 ± 1.68 vs. 0.50 ± 1.05, p = 0.007), and between the vertebral artery and basilar artery (VA/BA) (1.01 ± 1.35 vs. 0.77 ± 1.44, p = 0.033) were higher in BAV patients than in TAV patients. Conclusions: BAV patients may encounter more severe brain injuries not only due to greater number of lesions but also due to larger lesion size, especially in the ACA/MCA, MCA and VA/BA lesions zone.