Transcatheter aortic valves (TAVs) are subject to degeneration and repeat intervention. TAVs are increasingly used in clinical practice, but there is a paucity of data regarding repeat interventions. We sought to describe and compare clinical characteristics and outcomes of TAV in TAV procedures vs. surgical explant procedures after an index transcatheter aortic valve replacement (TAVR) at The Christ Hospital Health Network (Cincinnati, OH) from January 2015 to August 2023. A total of 1314 patients underwent TAVR procedures during the study period. Of these patients, 31 (2.3%) underwent repeat interventions (25 TAV in TAV and 6 surgical explants) and were included. The median [interquartile range] time from index TAVR to a repeat intervention was 5.02 years [1.01-7.12] for TAV in TAV and 2.55 years [1.36-3.20] for surgical explants (p = 0.386). Patients undergoing TAV in TAV were more likely to have structural valve deterioration (60%), whereas patients undergoing surgical explants were more likely to present with infective endocarditis (50%). Major adverse cardiovascular event rates were similar at discharge (20 vs. 17%, p = 1.00). No mortality events were presented in TAVR explant patients. Two strokes presented in TAVR explant patients, 1 at discharge and 1 at 30 days. Repeat interventions are uncommon in the first decade after TAVR. In clinical practice, the mechanism of failure of the TAVR valve is an important determinant of subsequent treatment; most patients with structural valve deterioration receive a TAV in TAV procedure, whereas surgical explants are usually reserved for infective endocarditis.

Aortic regurgitation (AR) is a common complication in patients with left ventricular assist devices (LVAD). However, there is paucity of data regarding the feasibility and safety of transcatheter aortic valve replacement (TAVR) in this population. Hence, we sought to describe the clinical characteristics and outcomes of patients with LVAD and AR who underwent treatment with TAVR at our institution. We included all patients with a LVAD who developed clinically significant AR and received TAVR at The Christ Hospital in Cincinnati, Ohio. Baseline clinical and echocardiographic characteristics were collected, and outcomes were defined using Valve Academic Research Consortium 3 criteria. A total of 7 patients with LVAD were included. The median time from LVAD implantation to TAVR was 3.67 years (IQR, 1.96-4.26 years). The mean age of the patients was 68.6 ± 13.7 years, and the average Society of Thoracic Surgeons score was 6.2 ± 5.2. All patients presented with moderate to severe AR and New York Heart Association functional class III or IV symptoms. All procedures were performed via transfemoral access, with a median procedure time of 149 minutes (IQR, 146-150 minutes). The transcatheter heart valves implanted included commercially available devices—Abbott Navitor (n = 2) and Medtronic Evolut (n = 3)—and dedicated investigational devices for AR—JenaValve Trilogy (n = 1) and J-Valve (n = 1). All patients were discharged alive with no or mild residual AR. There was 1 case of device embolization, which was treated with a second valve, and 1 valve migration treated with snaring and repositioning of the valve. Both complications occurred in patients treated with commercially available self-expanding valves. TAVR for AR in selected patients with LVAD is a feasible therapeutic option that may improve outcomes. Larger studies are necessary to better define procedural risks, optimal patient selection, and the role of TAVR valves specifically designed for AR in this population.

The Small Annuli Randomized to Evolut or SAPIEN Trial showed superior hemodynamics of self-expanding valves (SEVs) over balloon-expandable valves (BEVs) in patients with small aortic annuli (SAA). The long-term clinical implications of these hemodynamic differences are unknown. We conducted an observational cohort study of patients with SAA, defined as an aortic valve annular area ≤430 mm² on cardiac computed tomography, who underwent transcatheter aortic valve replacement using BEV or SEV at a single institution between August 2013 and February 2021. Patients undergoing valve-in-valve procedures or alternative access were excluded. Patient-prosthesis mismatch (PPM) was defined as moderate when indexed effective orifice area of 0.65-0.85 cm²/m² and severe when indexed effective orifice area was <0.65 cm²/m² (or 30 kg/m²). The primary outcome of the study was mortality and major adverse cardiovascular events. A total of 258 patients were included. The majority were female (81%) with intermediate surgical risk (median STS risk score 4.23); 90 patients (35%) received a BEV (median age 80 years [73, 86]) and 168 (65%) received a SEV (81 years [75, 85], p = 0.699). Comorbidities and risk profiles were well balanced between groups. At 30 days post-transcatheter aortic valve replacement, SEV had lower aortic valve mean gradients (8 mmHg [6, 11] vs. BEV 14 mmHg [10, 18], p < 0.001), lower peak velocities (1.86 m/s [1.60, 2.34] vs. BEV 2.52 m/s [2.14, 2.90], p < 0.001), and were less likely to have PPM (SEV 18% vs. BEV 42% (p < 0.001). At 3 years, both groups had similar mortality (SEV 23% vs. BEV 22%, p = 0.875). PPM was not associated with long-term mortality. In patients with SAA, we observed no difference in mortality between SEV and BEV up to 3 years after the index procedure, despite early differences in valve hemodynamics.

Mitral annular calcification (MAC) is a chronic and progressive degenerative process characterized by calcium and lipid deposition of the mitral valve annulus. We sought to describe the natural history of patients with MAC with and without mitral valve dysfunction (MVD). We conducted an observational study of patients with an echocardiogram-based diagnosis of MAC from 2006-2023. Patients were matched by age and sex in a 1:1 ratio to patients without MAC. We collected baseline clinical, echocardiographic, and computed tomography data. The primary end point was all-cause mortality. We also report predictors of mortality in patients with MAC and MVD. We included 15,372 patients in the analysis: 7686 with MAC (median age, 76 years [68-84], 58% women) and 7686 without MAC matched by age and sex. Patients with MAC had higher rates of comorbidities, cardiovascular risk factors, MVD, and multivalvular heart disease (aortic stenosis/regurgitation and tricuspid regurgitation) relative to patients without MAC (all P < .001). Two-year mortality was 14%, 26%, and 21% for patients with MAC and no MVD, MAC with ≥moderate MR, and MAC with ≥moderate MS, respectively (P < .001). Surgical or transcatheter mitral valve interventions in patients with MAC and significant MVD were infrequently performed (n = 136/788, 17.2%). Ten percent of patients with MAC have clinically significant MVD, with mitral regurgitation being more common than mitral stenosis. The presence of MVD is associated with significantly increased mortality in patients with MAC.

In Mexico, breast cancer (BC) is the principal cause of death in women over 30 years old, with an annual mortality rate of 14.61 deaths per a 100,000 population. Chemotherapy, in combination with trastuzumab (TTZ), improves the survival of cancer patients; however, cardiotoxicity (CT) is the principal consequence. CT prevalence occurs between 10% and 30% of patients; however, there are no data about the prevalence of CT in the Mexican population. This study aims to establish the prevalence of CT in patients treated with anti-HER-2 therapy among BC women in southeast Mexico. A retrospective cross-sectional study was carried out from January 2015 to July 2019. The records of 46 patients diagnosed with HER-2-positive BC who attended the Mexican Social Security Institute in the Ambulatory Care Medicine Unit were analyzed. The diagnostic criterion for CT was a decrease in LVEF > 10% from baseline or a final LVEF < 53%. CT prevalence was observed in 19 (41.3%) of women with cancer, with an average decrease in LVEF of 13%. In the population, we found an association between weight, surface area, and the loading dose of TTZ with CT. Nutritional follow-up and the administration of cardioprotective drugs are necessary to recover LVEF and avoid cardiovascular failure in women with BC and survivors.