Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development of LBBB in patients undergoing TAVI. Methods: This is a prospective single-centre study of patients who have LBBB following elective TAVI procedures. All patients underwent ECGs pre-TAVI, as well as immediately, 6 h, and 24 h post-TAVI. Changes in ECG were compared at 6 and 24 h with the one immediately post TAVI. Results: The study included 115 patients with uncomplicated procedures. The mean age was 81 ± 7 years, with 54% male. A self-expanding valve was used in 67% of patients. Following TAVI, prolongations of PR interval and QRS duration were dynamic and reduced at 6 h. The change in PR interval at 6 and 24 h was comparable [−11 (−20 to 3) vs. −2 (−24 to 16) ms, p = 0.18]. Similarly, there was no statistical difference in the change of QRS duration at 6 and 24 h compared to the ECG immediately post-TAVI [−10 (−40 to −2) vs. −7 (−34 to 0) ms, p = 0.055]. Changes in ECG were also comparable in patients undergoing balloon-expandable and self-expanding valves. Conclusions: The current study supports that 6-hour ECG has the potential to reduce the need for prolonged continuous monitoring post-TAVI. ECG at 6 h can help optimise patient flow and facilitate early discharge. Future studies with larger sample sizes are required to confirm our findings.

Paravalvular leak (PVL) remains an important limitation of transcatheter aortic valve implantation (TAVI), despite major advances in prosthesis design, imaging guidance, and implantation technique. Although the incidence of moderate and severe PVL has substantially declined with newer-generation valves, mild PVL continues to be frequently observed in contemporary practice and is increasingly recognised as clinically relevant. Multiple studies have demonstrated an association between even mild PVL and adverse outcomes, particularly heart failure (HF) hospitalisation, suggesting that conventional grading systems may underestimate its true haemodynamic burden. Beyond simple regurgitant volume, PVL is characterised by eccentric high-velocity flow, turbulence, impaired pressure recovery, and reduced haemodynamic efficiency. These effects may be particularly important in vulnerable phenotypes such as patients with heart failure with preserved ejection fraction (HFpEF), concentric left ventricular hypertrophy, or low-flow states, in whom small regurgitant volumes can result in disproportionate increases in filling pressures and symptomatic deterioration. This review summarises contemporary evidence regarding the prevalence, diagnosis, haemodynamic impact, and clinical consequences of PVL after TAVI. Differences across valve platforms, predictors of PVL, and current management strategies are also discussed. Particular emphasis is placed on the limitations of pressure-based assessment and the need for a patient-specific, flow-oriented approach aligned with contemporary endpoint definitions such as those proposed by VARC-3.

Background: Current guidelines acknowledge that early discharge is not associated with late mortality and that in-hospital length of stay (LOS) of 48–72 h should be considered following successful primary percutaneous coronary intervention (PPCI) in low-risk patients. Recent studies have highlighted the safety of very early discharge after PPCI in highly selected low-risk patients; however, objective tools to guide discharge timing remain limited. The Index of Microcirculatory Resistance (IMR) offers a quantitative assessment of microvascular function and may help identify patients suitable for very early discharge. We aimed to evaluate the feasibility of using IMR to guide very early discharge in patients who underwent uncomplicated PPCI. Study design and objectives: The Safety of Early Discharge Using Index Microcirculatory Resistance in Patients with Acute Myocardial Infarction (SECURE) study is designed to assess the feasibility of using IMR, measured immediately following successful PPCI, to guide early discharge from hospital within 24 h. The SECURE study is a prospective, proof-of-concept, functional non-inferiority, single-centre, randomised, open-label trial to determine if patients with low IMR can be safely discharged when compared to standard discharge policy. The SECURE study will recruit 82 patients with low IMR following successful PPCI. Participants will be 1:1 randomised to either standard discharge timing or very early discharge (within 24 h). The left ventricle ejection fraction will be assessed using cardiac magnetic resonance imaging. A telephone follow-up at 3 months will be arranged. Clinical events are collected as secondary and exploratory safety endpoints. Conclusions: The SECURE study will provide proof-of-concept data about the feasibility of using IMR to guide very early discharge following PPCI. If successful, this study will provide data to plan for a larger study to determine the safety of this personalised approach.

Background and Objectives: Recent studies have focused on evaluating the hemodynamic results in patients undergoing transcatheter aortic valve implantation (TAVI) with small aortic annuli. There is limited data on the incidence, clinical characteristics, and mortality of prosthesis–patient mismatch (PPM) in patients undergoing TAVI with large aortic annuli. Materials and Methods: This is a retrospective analysis of consecutive patients with severe aortic stenosis and large annuli who underwent TAVI at a single UK center. PPM was defined according to the Valve Academic Research Consortium (VARC-3) criteria and identified using echocardiography within 4–6 weeks following TAVI. Measurements were analyzed by an experienced operator who was blinded to the type of valve platform and clinical outcomes. Results: A total of 447 patients were screened, of whom 353 patients were included in the analysis. The incidence of any PPM or severe PPM was 38% and 15% of patients, respectively. Patients with severe PPM were younger, had larger body surface area, and were more likely to receive a balloon-expandable valve (BEV). At a mean follow-up of 35 months, mortality was numerically higher in patients with severe PPM (46% vs. 36%, p = 0.20) but this did not reach statistical significance. Similar mortality rates were observed among patients with or without severe PPM in those who received SEV as well as BEV. There was a differential role of body surface area in mortality in patients who developed severe PPM versus non-severe PPM. Conclusions: Severe PPM was evident in patients with large aortic annuli undergoing TAVI, particularly those who received BEV. Nonetheless, severe PPM did not impact mortality rate at three-year follow-up. Longer-term follow-up may be required to assess the impact of severe PPM on mortality.