Background and Objectives: Patients with impaired left ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI) remain at high risk for adverse outcomes despite successful procedures. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure, but their long-term impact after TAVI is not well established. Materials and Methods: This single-center retrospective study included patients with LVEF < 50% who underwent transfemoral TAVI between January 2015 and September 2025. Patients were stratified according to SGLT2i use. The primary outcome was a composite of all-cause mortality and heart failure (HF) hospitalization requiring intravenous diuretics. Secondary outcomes included all-cause mortality, HF hospitalization, and changes in echocardiographic parameters at 6 months. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for baseline differences. Time-to-event analyses were performed using IPTW-weighted Cox models and adjusted survival curves. Results: The study included 226 patients (78 SGLT2i users, 148 non-users) with a median follow-up of 37 months. After IPTW adjustment, SGLT2i use was associated with a lower rate of the composite outcome (32.8% vs. 50.8%, p = 0.019) and a lower crude long-term mortality (32.8% vs. 47.4%, p = 0.056). Acute kidney injury after TAVI occurred less frequently among SGLT2i users (3.4% vs. 17.4%, p = 0.013). In IPTW-weighted Cox analyses, SGLT2i use was associated with a reduced risk of all-cause mortality (HR 0.57, 95% CI 0.32–0.98) and the composite outcome (HR 0.56, 95% CI 0.33–0.96). SGLT2i users demonstrated greater reductions in left ventricular end-diastolic diameter at 6 months. Conclusions: In patients with impaired LVEF undergoing TAVI, SGLT2 inhibitor therapy was associated with improved long-term survival, better composite outcome-free survival, and lower rates of post-TAVI acute kidney injury. Larger prospective studies are warranted to confirm these findings.

Background: Whether the initial clip type selected during transcatheter edge-to-edge repair (TEER) of the mitral valve—grasping width and arm length—independently influences procedural and echocardiographic outcomes remains uncertain. Methods: We retrospectively analyzed 138 consecutive patients undergoing mitral TEER. The first implanted clip was classified as narrow standard-length (NT), long narrow-arm (XT), or long wide-arm (XTW). Determinants of initial clip selection and its association with procedural success (residual mitral regurgitation [MR] ≤ 1+), post-procedural transmitral gradient, and the need for ≥2 clips were assessed using multivariable logistic and linear regression. Results: Median age was 74.0 (66.0–80.0), 74.5 (66.0–82.5), and 75.0 (70.0–79.0) years, and median LVEF was 35.0% (30.0–50.0), 30.0% (25.0–45.0), and 40.0% (25.0–45.0), for the NT, XT, and XTW groups, respectively; 66% of patients overall were male. An XTW clip was implanted first in 61.6% of patients. XTW selection was independently associated with larger effective regurgitant orifice area, lower LVEF, longer posterior leaflet length, and secondary MR (all p < 0.05), whereas NT selection favored younger age, smaller orifice, and higher LVEF. After adjustment for these factors, no statistically significant independent association was detected between initial clip type and residual MR ≥2+, post-procedural transmitral gradient, or the need for additional clips (all p > 0.05); however, confidence intervals were wide. On univariable analysis, larger left atrial size and moderate-to-severe tricuspid regurgitation were associated with residual MR ≥ 2+, but neither remained significant after multivariable adjustment. Conclusions: Initial clip selection was associated with valve anatomy, LVEF and MR etiology. No statistically significant independent association between initial clip type and procedural or short-term echocardiographic outcomes was detected in this cohort. Given the observational design, confounding by indication, limited sample size and wide confidence intervals, clinically relevant effects cannot be excluded, and these findings do not establish the superiority or equivalence of any clip-selection strategy.

1. The inability of cardiomyocytes to regenerate after scar tissue formation caused by ischemic or non-ischemic injury is a well-recognized phenomenon [1]. Despite significant advances in the manag...