Aortic stenosis (AS) is a progressive form of valvular heart disease most commonly associated with aging, with an exponential increase in prevalence after age 50. While men have historically been considered at higher risk, recent studies highlight a similar prevalence between men and women, with a higher prevalence in elderly women driven by longer life expectancy. Sex-related differences in clinical presentation, anatomy, and pathophysiology influence disease progression, severity assessment, and management. Women are often diagnosed at more advanced stages, exhibiting more pronounced symptoms, typically dyspnea and functional impairment, whereas men more often report chest pain. Women have a smaller body surface area, leading to smaller aortic annuli, left ventricular outflow tracts, aortic roots impacting flow dynamic, and severity grading. Diagnostic challenge contributes to the undertreatment of women. Despite experiencing severe AS, women receive fewer interventions and face delays in treatment. The advent of transcatheter aortic valve implantation (TAVI) improved outcomes, with studies suggesting a potential advantage in women compared to men. However, the anatomical differences, such as smaller annuli and more tortuous vascular access, necessitate tailored procedural approaches. Recognizing these sex-specific differences is essential to optimizing AS management, ensuring timely interventions, and improving patient outcomes. Future strategies should incorporate sex-specific thresholds for diagnosis and treatment while leveraging technological advancements, such as artificial intelligence, for personalized therapeutic decisions.

Background: Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta‐analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction. Methods: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study‐specific results in meta‐analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction. Results: We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta‐analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78–1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (−1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11–1.13). Conclusion: Our meta‐analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465 ; Unique identifier: CRD42024595465.

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. As TAVR continues to evolve, precise pre-procedural planning and imaging have become increasingly critical. While transthoracic echocardiography remains indispensable for assessing the severity of aortic stenosis, cardiac computed tomography angiography (CCTA) has emerged as the benchmark imaging modality for pre-procedural planning for TAVR. CCTA provides detailed anatomical information essential for patient selection, procedural success, and the mitigation of complications. This review aims to equip practitioners with the knowledge to effectively integrate CCTA into the TAVR workflow, ensuring a systematic approach to patient evaluation and procedural planning while addressing future challenges in the field.

A case report describing a novel approach to mechanical coronary thrombectomy using a stent retriever and continuous aspiration.