Right ventricle-pulmonary artery (RV-PA) coupling is prognostically important in valvular heart disease. The authors performed a systematic review and meta-analysis to quantify the association of RV-PA coupling with clinical endpoints after intervention for aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). The primary outcome was all-cause mortality, and the secondary outcome was a composite of major adverse cardiovascular events (MACE). A random-effects model was used to compute pooled effect estimates, and summary receiver-operating characteristic curves identified optimal RV-PA thresholds. In total, 30 interventional studies (N = 12,992) met eligibility criteria, including 14 AS (n = 6,100), 12 MR (n = 5,032), and 4 TR (n = 1,860) studies. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) was the most studied RV-PA coupling index. Reduced TAPSE/PASP was independently associated with all-cause mortality (AS adjusted HR: 1.69 [95% CI: 1.30-2.20]; MR adjusted HR: 1.94 [95% CI: 1.40-2.69]; P < 0.001) and the composite MACE (AS adjusted HR: 1.60 [95% CI: 1.29-2.00]; MR adjusted HR: 2.01 [95% CI: 1.54-2.62]; P < 0.001). There were significant nonlinear associations between TAPSE/PASP and adverse outcomes in AS and MR (P < 0.001). There were insufficient data to estimate a pooled effect-size in TR. Optimal TAPSE/PASP thresholds to predict all-cause mortality were ≤0.51 mm/mm Hg for AS interventions, ≤0.33 mm/mm Hg for MR interventions and ≤0.44 mm/mm Hg for TR interventions. TAPSE/PASP is an independent predictor of outcomes after interventions for AS and MR. The disease-specific TAPSE/PASP cutoffs could be integrated into risk-stratification models to better predict mortality before valve interventions and improve patient selection.

Background/Objectives: Sex-related differences in the presentation and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve (MV) surgery remain unclear. We aimed to identify these differences to inform personalized management. Methods: A total of 143 consecutive patients undergoing surgery for MR between 2017 and 2018 were stratified by sex and assessed for differences in characteristics. We performed 1:1 propensity score matching (PSM) by sex, with baseline characteristics as covariates, yielding 38 comparable pairs which were analyzed for differences in all-cause mortality and post-operative length of stay (LOS). Results: Females (n = 67) were more symptomatic (NYHA Class ≥ 3: 73% vs. 45%, p < 0.001), had higher logistic EuroSCORE (5.5 vs. 3.9, p = 0.006), had more urgent operations (25% vs. 11%, p = 0.020), MV replacements (28% vs. 11%, p = 0.007), and secondary MR (43% vs. 16%, p < 0.001). Females had significantly smaller end-diastolic and end-systolic left ventricular (LV) diameters, though indexed diameters showed no significant differences. After PSM, females had significantly longer LOS (7 days vs. 9 days, p = 0.033) and no differences in long-term mortality (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 0.34–4.76, p = 0.7, median follow-up: 6.67 years). An indexed LV end-systolic diameter (LVESDi) > 19 mm/m² yielded greater specificity (46.0% vs. 26.7%) and comparable sensitivity (69.4% vs. 69.2%) to LVESD > 40 mm. In subgroup analyses, female patients undergoing concomitant tricuspid intervention (HR: 6.80 [1.63–37.92], p < 0.01) or urgent operation (HR: 4.85 [1.08–21.06], p = 0.04) had worse prognoses than males. Conclusions: Females undergoing MV surgery for MR had more symptoms, higher surgical risk, and longer LOS, but similar mortality compared to males. However, concomitant tricuspid intervention and urgent operations were associated with higher mortality. Our results add to the growing body of evidence that current non-indexed LV diameter thresholds may not adequately account for sex differences.

Objective: This study aimed to develop and evaluate a 3-degree-of-freedom (DoF) robotic system for the safe delivery of cardiac sheaths through challenging anatomical structures, including the fossa ovalis and pathways with tight curves. Methods: The robot and its kinematic model were built on a previously proposed single-DoF actuation module and bending model. A sheath delivery strategy (SDS) was developed, combining two control methods: tip position control to approach an optimal entry point and point-constrained control to maintain consistent navigation through this point, minimizing tissue contact. Technical performance was evaluated through trajectory-following and point-crossing tests, followed by feasibility experiments in a simulated scenario. Trials were conducted by three cardiologists using a validated phantom model under fluoroscopic guidance, comparing SDS with joint control (JC) and manual control (MC). Results: Average root mean square errors were 2.10 mm for tip position control and 1.86 mm for point-constrained control. SDS outperformed MC with significantly shorter trajectory lengths and lower root mean square jerk. Compared to JC, SDS reduced sheath-induced movements (an indirect measure of force) and increased retraction success rates at the fossa ovalis. Conclusion: The proposed robotic system reduced tissue wall contact compared to JC and provided smoother, more controlled operations than MC, ensuring safer and more effective delivery through confined pathways. Significance: This work contributes to advancing robotic-assisted cardiac sheath delivery, providing a reliable and safer method for navigating challenging anatomical structures.