Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Results: Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014–5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217–3.031], p = 0.01). Conclusions: CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.

Background: Transcatheter heart valve (THV) selection for transcatheter aortic valve implantation (TAVI) is crucial to achieve procedural success. Borderline aortic annulus size (BAAS), which allows a choice between two consecutive valve sizes, is a common challenge during device selection. In the present study, we evaluated TAVI outcomes in patients with BAAS according to THV size selection.Methods: We performed a retrospective study including patients with severe aortic stenosis (AS) and BAAS, measured by multi-detector computed tomography (MDCT), undergoing TAVI with self-expandable (SE) or balloon-expandable (BE) THV from the Israeli multi-center TAVI registry. The aim was to evaluate outcomes of TAVI, mainly paravalvular leak (PVL) and valve hemodynamics, in patients with BAAS (based on MDCT) according to THV sizing selection in between 2 valve sizes. In addition, to investigate the benefit of shifting between different THV types (BE and SE) to avoid valve size selection in BAAS.Results: Out of 2,352 patients with MDCT measurements, 598 patients with BAAS as defined for at least one THV type were included in the study. In BAAS patients treated with SE-THV, larger THV selection was associated with lower rate of PVL, compared to smaller THV (45.3 vs. 64.5%; pv = 0.0038). Regarding BE-THV, larger valve selection was associated with lower post-procedural transvalvular gradients compared to smaller THV (mean gradient: 9.9 ± 3.7 vs. 12.5 ± 7.2 mmHg; p = 0.019). Of note, rates of mortality, left bundle branch block, permanent pacemaker implantation, stroke, annular rupture, and/or coronary occlusion did not differ between groups.Conclusion: BAAS is common among patients undergoing TAVI. Selection of a larger THV in these patients is associated with lower rates of PVL and optimized THV hemodynamics with no effect on procedural complications. Additionally, shift from borderline THV to non-borderline THV modified both THV hemodynamics and post-dilatation rates.

Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is rare. We describe patients referred to a tertiary heart center endocarditis team, with post-TAVR IE complicated by infected ascending aorta false aneurysms. Among 60 patients with post-TAVR IE who were referred to our center between January 2016 and October 2024, 7 (11.7%) patients were complicated by false aneurysm and aortitis. In all cases, self-expanding transcatheter heart valves (THVs), primarily Symetis ACURATE neo, were used. Infected false aneurysm formation mainly at the tip of the THV stabilization arches and aortitis were identified only on cardiac computerized tomography. Five patients underwent surgical explant of the TAVR valve with aortic valve replacement. Interposition graft replacement of the ascending aorta was performed in 4 cases whereas 1 patient underwent aorta patch repair. Mitral valve surgery and coronary artery bypass graph were performed as a concomitant procedure in 2 cases. Two patients were managed conservatively due to extreme surgical risk. One patient died perioperatively, and one patient died during follow-up. Unlike prosthetic valve endocarditis after surgical aortic valve replacement, TAVR-IE may involve the ascending aorta, leading to life-threatening false aneurysm formation at the tip of the THV stabilization arches, where the device was adherent to the aortic wall. This pathology often eludes detection by echocardiography, underscoring the essential role of cardiac computed tomography in diagnosis and surgical planning. Clinicians should maintain a high index of suspicion for this rare but unique life-threatening complication and consider early use of advanced imaging.

Introduction: A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter interventions for atrioventricular (AV) valve dysfunction in patients with ACHD. Methods: We compiled an international collaborative multi-center registry focusing on adult patients with congenital heart disease undergoing transcatheter AV valve interventions (repair or replacement). Included were patients from three international centers who underwent procedures between 2016 and 2022. Demographic, clinical, and procedural data were compiled. Results: Nine patients with ACHD underwent AV valve interventions. The median age was 48 years (IQR (37; 56), 55% women). At baseline, seven patients (78%) were in NYHA functional class III and two (22%) were in NYHA functional class II. The diagnosis of ACHD varied. Three valve interventions were performed on the subpulmonary AV valve and six on the systemic AV valve. The primary valvular pathology was regurgitation (six patients, 78%). Five procedures were valve-in-valve interventions, and four procedures were transcatheter edge-to-edge repair procedures. There were no major complications or peri-procedural complications or peri-procedural mortality. One patient developed a suspected non-obstructive thrombus on the valve that was medically treated. One patient did not improve clinically following the procedure and underwent a heart transplant, one patient died 6 months following the procedure due to a cardiovascular implantable electronic device infection. At one year, six patients were in NYHA functional class I, and one patient was in NYHA functional class III. In conclusion, transcatheter AV heart valve interventions are feasible and safe procedures in carefully selected ACHD patients. These procedures can offer an effective treatment option in these younger patients with high surgical risk.

Background: Preprocedural contrast-enhanced computed tomography (CT) is essential for planning Transcatheter Aortic Valve Implantation (TAVI), but concerns remain regarding contrast-induced (CI) acute kidney injury, especially in patients with chronic kidney disease. This study aimed to evaluate the incidence of CI-acute kidney injury following contrast-enhanced CT performed before TAVI. Methods: CI-acute kidney injury was defined according to the Kidney Disease—Improving Global Outcomes (KDIGO) guidelines. Nonionic, low-osmolality iodinated contrast material was used for all CT studies. The primary outcome was the incidence of CI-acute kidney injury post-CT. Secondary outcomes included the need for renal replacement therapy and the 30-day post-CT mortality rate. Results: Our study included 359 patients. The median age was 81, and 44% were males. Chronic kidney disease was present in 59.3% of patients, and the overall incidence of CI-acute kidney injury occurred in 24 patients (7%), without a significant difference between patients with and without baseline chronic kidney disease (4.8% vs. 8%, respectively; p = 0.331). Three consecutive creatinine tests within a median of 5.8 days showed that acute kidney injury occurred in only six patients (1.7%). No patients required new dialysis initiation within 30 days. Multivariable analysis did not identify baseline chronic kidney disease or IV contrast volume as independent predictors of CI-acute kidney injury. Conclusions: CI-acute kidney injury following pre-TAVI CT is low, even among patients with chronic kidney disease. Most cases were transient and did not require dialysis. Routine avoidance of CT due to chronic kidney disease may not be warranted.