Introduction: Transcatheter aortic valve replacement (TAVR) has become a widely used, comparably efficient and safe alternative to surgical aortic valve replacement (SAVR). Its utilization continues to grow, especially among younger patients. Despite improvements in durability, degeneration and subsequent re-interventions of failed prosthetic valves are still common. Even though valve-in-valve procedures have become more frequent, little is known about the trends over time or about clinical and echocardiographic long-term outcomes. Materials and Methods: Patients who underwent a valve-in-valve procedure between December 2011 and December 2022 in a large tertiary university hospital were analyzed. Primary outcomes were defined as procedural and device successes as well as event-free survival. Secondary analyses between subsets of patients divided by index valve and date of procedure were performed. Results: Among 1407 procedures, 58 (4%) were valve-in-valve interventions, with an increased frequency observed over time. Overall, technical success was achieved in 88% and device success in 85% of patients. Complications were predominantly minor, with similar success rates among TAVR-in-SAVR (TiSAVR) and TAVR-in-TAVR (TiTAVR). Notably, there were significant and lasting improvements in mean echocardiographic gradients at 1 year. Event-free survival was 76% at one month and 69% at one year. Conclusions: Over the last decade, a rising trend of valve-in-valve procedures was observed. Despite an increase in procedures, complications show a contrasting decline with improved technical and device success over time. TiSAVR and TiTAVR showed comparable rates of procedural and device success as well as similar outcomes, highlighting the utility of valve-in-valve procedures in an aging population.

Introduction: Transcatheter aortic valve replacement (TAVR) has become an efficient and safe alternative to surgical aortic valve replacement (SAVR). While severe aortic stenosis as well as severe aortic regurgitation (AR) are known to negatively impact left ventricular ejection fraction (LVEF), prior studies have shown that TAVR can lead to an improvement in LVEF. Thus far, little is known about the prognostic implication of LVEF improvement as a sole predictor of outcomes. Therefore, the aim of this study was to assess the prognostic impact of LVEF impairment before TAVR, as well as early LVEF improvement in patients undergoing TAVR. Materials and Methods: Patients undergoing TAVR in a large tertiary university hospital were consecutively included in a prospective registry. Transthoracic echocardiography (TTE) was performed at baseline, after 1 month and annually thereafter. Significant LVEF improvement was defined as a relative increase of ≥10% in LVEF at 30 days compared to baseline LVEF. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, non-fatal myocardial infarction, stroke, bleeding and unplanned re-interventions of the aortic valve at 5 years. Results: Among 1655 patients who underwent TAVR between September 2011 and April 2024, the LVEF at baseline was available for 1556 patients. Of these, 1031 patients (66.2%) had preserved LVEF at baseline (LVEF ≥ 53%), whereas 303 patients (19.5%) had moderately reduced LVEF (40–52%) and 222 patients (14.3%) had severely reduced LVEF (<40%). Out of the patients with impaired LVEF, 155 (40.4%) patients showed a significant improvement in LVEF ≥10% after 30 days, while 229 (60.6%) patients showed no significant LVEF improvement (<10%). Patients with preserved LVEF at baseline had significantly better mortality outcomes than those with severely reduced LVEF (p < 0.001). LVEF improvement was associated with a survival benefit after 1 year (p = 0.009, HR 2.68, 0.95 CI 1.23–5.85) which diminished after 5 years (p = 0.058), but patients with LVEF improvement showed lower MACE rates at 5 years (p < 0.001). Conclusions: Preserved LVEF before TAVR is an independent predictor for improved outcomes. Additionally, early improvement in LVEF is associated with beneficial outcomes in patients undergoing TAVR.

BACKGROUND: Right heart catheterization plays a pivotal role in the preprocedural evaluation of patients considered for transcatheter tricuspid valve edge-to-edge repair. This study aimed to explore the potential impact of hemodynamic parameters obtained through right heart catheterization on patient-centered outcomes. METHODS: This study represents a subanalysis from the multicenter EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation). Patients with invasive hemodynamic data who underwent isolated transcatheter tricuspid valve edge-to-edge repair for significant tricuspid regurgitation were included. Outcomes of interest were a composite of 2-year all-cause death or hospitalization for heart failure (HFH) and a patient-centered composite of 6-month all-cause mortality, HFH, New York Heart Association class IV/worsening New York Heart Association class compared with baseline. Secondary outcome included postprocedural New York Heart Association class improvement. RESULTS: Seven hundred and eleven patients were included in the analysis. Two-year survival free from death and HFH was 63%. Optimal prognostic thresholds identified for death and HFH at 2 years were: mean pulmonary artery pressure≥32 mm Hg, pulmonary capillary wedge pressure (PCWP)≥20 mm Hg, and pulmonary vascular resistance≥5 wood units (WU). The early patient-centered composite outcome occurred in 25% of cases. PCWP≥20 mm Hg was independently associated with an early clinical deterioration (hazard ratio, 2.77 [95% CI, 1.47–5.28]; P <0.001) and with 2-year death/HFH (hazard ratio, 1.75 [95% CI, 1.03–3.02]; P =0.04). No invasive parameter was associated with residual tricuspid regurgitation ≥3+. New York Heart Association class improved significantly throughout the follow-up ( P <0.001), although patients with elevated mean pulmonary artery pressure ( P =0.04) or PCWP ( P <0.01) experienced less symptomatic benefit. CONCLUSIONS: In patients undergoing transcatheter tricuspid valve edge-to-edge repair, invasive hemodynamics—especially elevated PCWP—are independently associated with early patient-centered outcomes and late adverse clinical events. Despite overall improvement of the functional status and no impact on residual tricuspid regurgitation, patients with higher mean pulmonary artery pressure or PCWP benefit less. These findings support the role of comprehensive right heart catheterization in preprocedural risk stratification. REGISTRATION: URL: https://clinicaltrials.gov ; Unique identifier: NCT06307262.

Background/Objectives: Aortic valve stenosis (AS) is a prevalent cardiovascular condition among elderly patients frequently treated with Transcatheter Aortic Valve Implantation (TAVI). Traditional hemodynamic monitoring during TAVI relies on invasive methods. The ClearSight^® Finger Cuff system offers a non-invasive alternative for continuous hemodynamic monitoring. To compare the reliability and feasibility of non-invasive hemodynamic monitoring with traditional invasive hemodynamic monitoring during TAVI procedures. Methods: In this prospective observational study, patients undergoing elective TAVI were recruited from two tertiary hospitals between March and August 2023. Invasive hemodynamic measurements were obtained using arterial and pigtail catheters, with a subset undergoing right heart catheterization. Non-invasive measurements were captured using the ClearSight^® system. Data on baseline characteristics, procedural details, and 30-day follow-up outcomes were collected. Results: The study cohort comprised 50 patients (median age 82 years (IQR 78.0, 85.8), 50% female). Non-invasive measurements of cardiac output (CO), cardiac index (CI), and stroke volume (SV) were consistently lower than invasive measurements (CO: 4.1 vs. 4.8 L/min, p = 0.03; CI: 2.2 vs. 2.7 L/min/m², p = 0.01, SV: 66 vs. 77 mL, p = 0.25). Non-invasive blood pressure readings were lower than invasive radial and aortic measurements before and after TAVI. Correlation of non- and invasive measurements was low but similar before and after TAVI (Mean percentage error of 52%). Conclusions: The ClearSight^® system provided lower absolute values for all evaluated hemodynamic parameters as well as low correlation compared to traditional methods pre- as well as post-interventional.

International clinical practice guidelines recommend discontinuing sodium-glucose cotransporter-2 inhibitors (SGLT2i) 3-4 days before surgery to prevent euglycemic diabetic ketoacidosis, chiefly on the basis of case reports/series. Whether SGLT2i discontinuation may increase the risk of postoperative cardiovascular complications is unclear. In a secondary analysis of the Basel-PMI (NCT02573532) and PMI-Vital (NCT05866874) prospective cohort studies in major noncardiac surgery, the exposure of interest was continuing, or stopping, SGLT2i in participants receiving chronic SGLT2i therapy. The primary outcome was an ordinal composite of acute heart failure hospitalisation and cardiovascular death within 90 days of surgery, adjusting for prespecified covariates. Secondary outcomes included the incidence of euglycemic diabetic ketoacidosis within 7 days. Among 451 study participants receiving SGLT2i (mean age 72 (range: 47-86) yr; 22% women), 404/451 (89.6%) had diabetes mellitus, and 166/451 (36.9%) had chronic heart failure. SGLT2i were discontinued before surgery in 393/451 (87.1%) participants (39.2% for 1 day, 34.4% for 2 days, 13.5% for ≥3 days). Cardiovascular complications occurred in 1/58 (1.7%) participants who continued SGLT2i, compared with 10/177 (5.7%) stopping for 1 day, 13/155 (8.4%) stopping for 2 days and 7/61 (11.5%) stopping for ≥3 days (P=0.011; adjusted odds ratio: 1.58 [95% confidence interval: 1.08-2.30] per discontinued day). Euglycemic diabetic ketoacidosis occurred in 1/451 participants after SGLT2i discontinuation. Perioperative SGLT2i discontinuation was associated with a substantially increased risk of 90-day cardiac complications. This suggests potential harm in current guideline recommendations; randomised controlled trials are needed to confirm these findings. NCT02573532, NCT05866874.