OBJECTIVES: Aortic valve regurgitation (AR) frequently complicates the clinical course after left ventricular assist device (LVAD) implantation. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (SAVR) in this cohort with a mostly high surgical risk profile. The unique challenges in LVAD patients, such as presence of non-calcified aortic valves and annular dilatation, raise concerns about device migration and paravalvular leakage (PVL) leading to missing device success. This study evaluates procedural outcomes and survival rates in LVAD patients who underwent TAVI, emphasizing strategies to enhance device success. METHODS: Between January 2017 and April 2023, 27 LVAD patients with clinically significant AR underwent elective or urgent TAVI at our centre. Primary end-points were procedural success rates, without the need for a second transcatheter heart valve (THV) and postprocedural AR/PVL. Secondary outcomes included survival rates and adverse events. RESULTS: Among the cohort, 14.8% received AR-dedicated TAVI devices, with none requiring a second THV. There was no intraprocedural AR, and 1 patient (25%) had AR > ‘trace’ at discharge. Additionally, 25.9% underwent device landing zone (DLZ) pre-stenting with a standard TAVI device, all without needing a second THV. There was no intraprocedural AR, and none to trace AR at discharge. Among the 59.3% receiving standard TAVI devices, 37.5% required a second THV. In this subgroup, intraprocedural AR > ‘trace’ occurred in 12.5%, decreasing to 6.25% at discharge. In-hospital mortality was 3.7%, and median follow-up survival was 388 days (interquartile range 208–1167 days). CONCLUSIONS: TAVI yields promising procedural outcomes and early survival rates in LVAD patients with AR. Tailored TAVI devices and pre-stenting techniques enhance procedural success. Continued research into these strategies is essential to optimize outcomes in this complex patient cohort.

Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic valve stenosis. Data regarding sex-specific differences in patient-centered endpoints, such as patient-reported outcomes (PROs), and in sociodemographic characteristics are scarce. This study aimed to investigate patient-centered, sex-specific characteristics and their associations with the overall patient outcome, that is, clinical course and PROs in patients undergoing TAVI. This analysis of the TAVI-COMIC randomized controlled trial included 299 patients undergoing TAVI at 2 tertiary care centers. Data were collected for sociodemographic characteristics, PROs, and postprocedural outcomes for up to 90 days. Male patients undergoing TAVI had significantly higher educational attainment with more university degrees (34.2% vs 13.0%, P < 0.001). Female patients were significantly less often in a relationship (29.7% vs 73.3%, P < 0.001). Females reported significantly higher anxiety levels before TAVI (State-Trait Anxiety Inventory: 42 vs 39 points, P < 0.001). Postprocedure, female patients experienced longer hospital stays (8 vs 7 days) and reported greater difficulties with daily activities such as walking (41.7% vs 29.8%), shopping (41.7% vs 27.2%), helplessness (35.7% vs 10.5%), and depression (45.2% vs 25.4%). Female patients were more frequently discharged to a nursing facility (11.6% vs 3.7%). This study highlights significant sex-specific differences in educational and relationship status, anxiety levels, as well as length of hospitalization and PROs following TAVI. Female patients showed higher anxiety and more frequent postprocedural challenges. These findings underscore the need for tailored pre- and post-procedural care to address the distinct needs of male and female TAVI patients.

OBJECTIVES: The growing elderly population contributes to an increasing prevalence of severe degenerative native aortic valve (AV) or mitral valve (MV) disease in combination with bio-prosthetic valve failure of prior implanted (aortic or mitral) bio-prostheses, as well as concomitant failure of both aortic and mitral bio-prosthetic valves. A combined surgical AV and MV replacement carries a markedly higher risk, especially in the redo setting. Transcatheter double-valve implantation (TDVI) is emerging as a promising alternative that may mitigate the risks of redo surgery. The evidence for TDVI is very limited. This study aims to address the current gap in the literature by analysing a large institutional series of single-stage TDVI. METHODS: Single-centre retrospective analysis of all patients (n = 13) undergoing simultaneous transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve implantation (TMVI) from October 2018 until April 2024. Primary end-points were Valve Academic Research Consortium-3 (VARC-3) and Mitral Valve Academic Research Consortium (MVARC) technical success, 30-day device success and early safety (MVARC procedural success). Secondary end-points included echocardiographic TDVI performance, adverse events, symptom change and survival. RESULTS: The median age of patients was 77 years, with 7/13 (53.8%) females. Median EuroSCORE II was 16.9%. All patients presented with structural valve degeneration with severe haemodynamic valve deterioration according to the VARC-3 definition. Procedural outcomes showed 100% technical success. There was absence of 30-day mortality (0%). Thirty-day device success and early safety/MVARC procedural success were 100%. No major adverse events occurred. After TDVI, the median New York Heart Association functional class improved from III to II. CONCLUSIONS: TDVI appears to be a safe and effective alternative to surgical redo double-valve replacement for selected patients. Our findings support the feasibility of TDVI with excellent early outcomes. Further prospective multicentre studies with larger cohorts are needed to validate the long-term effects and to establish TDVI as a guideline consideration.

Background: Aortic valve dysfunction is a rare but relevant long-term complication after orthotopic heart transplantation (HTX). Treatment options include surgical (SAVR) and transcatheter (TAVR) aortic valve replacement, but evidence is limited to the level of case reports. Methods: A total of 2054 patients underwent HTX between 1986 and 2023 at the Deutsches Herzzentrum der Charité, Berlin, Germany, 16 of them underwent aortic valve replacement (SAVR, N = 7; TAVR, N = 9) after HTX. In this case series we report on the outcomes of these 16 patients (age 29-73 years). Results: Isolated aortic valve regurgitation occurs in 5 (31%) patients (TAVR N = 1, SAVR N = 4), while 11 patients (69%) suffer from aortic valve stenosis. Severe pre-procedural heart failure is present in 38% of the patients. Thirty-day mortality is 0%, in-hospital mortality is N = 2 (22%) patients due to sepsis, both patients were severely decompensated prior to TAVR. An uneventful postoperative course occurs in 8 (50%) patients, the patient’s functional status improves in 12 (75%) cases. Conclusion: TAVR is the increasingly preferred treatment for aortic valve dysfunction after heart transplantation, but SAVR is a feasible alternative for individuals who are ineligible for TAVR. Further information is needed on the appropriate procedural timing in these high-risk patients.

Structural deterioration of bioprosthetic mitral valves is a common cause of late valve failure, requiring surgical or transcatheter replacement of the failed prosthesis. In rare cases, hemodynamic compromise may lead to cardiogenic shock, requiring mechanical circulatory support and making treatment particularly challenging. A 76-year-old man with prior bioprosthetic mitral valve replacement presented with cardiogenic shock. A microaxial flow pump was implanted. Echocardiography revealed severe transvalvular mitral regurgitation due to leaflet tear. Because of prohibitive surgical risk, the heart team opted for transcatheter mitral valve-in-valve replacement. The procedure resulted in immediate hemodynamic stabilization and weaning from mechanical support within 24 hours. This case demonstrates the feasibility of transcatheter mitral valve replacement combined with microaxial flow-pump support in cardiogenic shock as a potential rescue therapy in selected patients. Timely transcatheter intervention may be life-saving in cardiogenic shock due to bioprosthetic mitral valve failure.

Objectives: Transcatheter mitral valve implantation (TMVI) is increasingly used in failed bioprostheses and annuloplasty rings as a less invasive alternative to redo-surgery in selected patients, with promising results. This retrospective single-centre study aims to provide additional insight into clinical outcomes and its determinants following TMVI. Methods: Data of all TMVI procedures (n = 88) performed between February 2014 and June 2024 were retrospectively analysed. The primary end-points were 1-year mortality and the Mitral Valve Academic Research Consortium (MVARC) composite end-points. Secondary outcomes included complications and echocardiographic outcomes. Results: Overall, in-hospital, 30-day, and 1-year mortality rates were 6.8%, 5.8%, and 16.5%, respectively. No significant differences were observed between transseptal and transapical approach (20.0 vs 13.2%, P = .439) or between valve-in-valve and valve-in-ring procedure (16.3 vs 18.2%, P = .828). At 1-year follow-up, only one patient presented with mitral regurgitation ≥ grade 2. However, a post-procedural mean pressure gradient (MPG) ≥5 mm Hg was observed in 51 patients (58%). In multivariate analysis, higher post-procedural MPG was associated with increased mortality risk (P = .047; hazard ratio [HR] = 1.23; 95% CI, 1.00-1.51), whereas technical success was associated with reduced mortality risk (P = .014; HR = 0.12; 95% CI, 0.02-0.65). Conclusions: Transcatheter mitral valve implantation provided acceptable mid-term mortality irrespective of procedure type and access route, with excellent technical success. Furthermore, mid-term follow-up showed near-complete elimination of mitral regurgitation. However, a high rate of post-procedural relevant mitral stenosis was observed, which may have an impact on mortality. In the light of the anticipated increase in TMVI procedures, we advocate for larger prospective studies to investigate the long-term determinants of mortality. Clinical trial registration: As this study was retrospective and based on previously collected clinical data, clinical trial registration was not required.