Objective: The long-term durability of transcatheter aortic bioprosthetic valves continues to be a major concern. Standardized criteria of the structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) have recently been defined. Limited studies have evaluated the longterm durability of transcatheter aortic valve implantation (TAVI) according to these new definitions. We aim to analyze the durability of TAVI beyond 5 years and to report the frequency of SVD and BVF. Methods: A total of 89 patients who had undergone TAVI and had theoretically completed at least 5 years after the procedure were included. Either a Medtronic CoreValve or an Edwards SAPIEN XT valve were implanted in the patients. New standardized definitions were used to evaluate SVD and BVF. Results: The mean age of the patients was 78.70 +/- 6.95 years. SVD occured in 4 (4.5%) patients during 6 years of follow-up. Severe SVD was observed in 2 patients (2.2%), and these patients had the New York Heart Association class II symptoms. Both patients with severe SVD also met the criteria of BVF. Moderate SVD was observed in 2 patients (2.2%), and these patients had no valve-related symptoms. Of the 4 SVD cases, 2 were associated with increased mean transaortic gradients, whereas the remaining 2 cases were associated with intraprosthetic aortic regurgitation. All patients with SVD are still alive, and none of them have required aortic valve reintervention. Conclusion: Although first-generation TAVI devices were used, we determined the low rate of SVD and BVF at the 6-year follow-up. It may be suggested that there is no major concern associated with TAVI even with first-generation devices regarding long-term durability.

Background: Despite continuous advancements in diagnostic imaging and targeted antimicrobial protocols for infective endocarditis (IE), global epidemiological data show that both disease burden and incidence continue to rise. This study aimed to evaluate real-world diagnostic and treatment approaches in accordance with the 2023 European Society of Cardiology (ESC) IE Guidelines and to identify independent predictors of mortality in a contemporary patient cohort. Methods: This multicenter, retrospective cohort study analyzed data from 470 consecutive adult patients diagnosed with IE across 27 academic reference centers between 1 September 2023 and 1 June 2025. Patients were managed and adjudicated according to the 2023 ESC diagnostic criteria. Demographic data, clinical characteristics, microbiological profiles, imaging findings, empirical antibiotic therapy patterns, and clinical outcomes were analyzed. Independent predictors of mortality were determined using multivariable Cox proportional hazards regression models. Results: The mean age of the overall study population was 58.08 ± 16.81 years, with a male predominance (60.6%, n = 285). Staphylococcus aureus was the most frequently isolated pathogen (27.9%), with a high proportion of methicillin resistance (38.9%). Hospital-acquired IE was identified in 41.1% of cases. Surgical treatment was performed in 40.6% (n = 191) of the cohort. The 28-day mortality rate was 11.9%, and the overall mortality during follow-up reached 26.4%. Multivariable Cox regression analysis identified hospital-acquired IE (HR = 2.247; 95% CI: 1.216–4.167; p = 0.010) and the presence of major clinical complications (HR = 4.207; 95% CI: 1.556–11.378; p = 0.005) as the strongest independent predictors of mortality. Conclusions: Contemporary infective endocarditis is a highly complex and fatal disease characterized by a prominent healthcare-associated burden and a predominant staphylococcal etiology. The occurrence of major clinical complications and hospital-acquired infections were the primary independent predictors of mortality.

Background: Transcatheter aortic valve implantation (TAVI) is a viable alternative therapeutic approach for patients with severe aortic stenosis (AS), following technological innovations in transcatheter aortic valve systems and advances in clinical expertise, which aim to optimize valve hemodynamics. In this study, we aimed to compare early hemodynamic changes in different types of TAVI valves via two-dimensional echocardiography. Methods: This retrospective observational study examined patients with severe AS who underwent transfemoral TAVI. Patients were classified according to expansion mechanism (self-expanding valves (SEVs) or balloon-expandable valves (BEVs)) and leaflet position relative to the annulus (supra-annular valves (SAVs) or intra-annular valves (IAVs)). The implanted prostheses were Edwards SAPIEN XT valves (ESV, Edwards Lifesciences, Irvine, CA, USA), Medtronic valves (Core Valve-MCV and Evolut R, Medtronic, Minneapolis, MN, USA), Portico valves (St. Jude Medical, Saint Paul, MN, USA), and Myval valves (Meril Life Sciences, Vapi, India). Baseline two-dimensional transthoracic echocardiography (TTE) datasets were compared with post-TAVI measures obtained before discharge. Results: In total (n = 332), 275 (82.8%) patients were treated with SEVs, and 57 (17.2%) were treated with BEVs. In terms of leaflet position, 249 (75%) patients were treated with SAVs, and the remaining 83 (25%) patients were treated with IAVs. Transaortic gradients were comparable between patients treated with SEVs and BEVs. However, patients treated with IAVs exhibited significantly higher aortic maximum gradients (16 [13–21] mmHg vs. 14 [10–20] mmHg, p = 0.019) and mean gradients (9 [7–11] mmHg vs. 8 [5–10] mmHg, p = 0.014) compared to those receiving SAVs. Post-TAVI gradients were also compared based on each TAVI device. Although post-TAVI aortic maximum gradient was comparable among TAVI devices (p = 0.080), aortic mean gradient was significantly different among the valves (p = 0.006). Post hoc analyses demonstrated that the post-TAVI mean gradient was significantly lower in Medtronic CoreValve compared to the Myval (p = 0.013) and Portico (p = 0.030). No significant differences were observed in the frequency of perivalvular leak between the valve groups. Conclusions: We found that post-TAVI transaortic gradients of SEVs and BEVs were comparable; however, SAVs were associated with lower transaortic gradients than those of the IAVs. In addition, the frequency of ≥moderate PVL was comparable between the valve groups.

Background: Penetrating cardiac trauma is rare in adolescents, and late acute coronary syndrome after surgical repair, which narrows left anterior descending artery, is even rarer. Managing ischaemia from late coronary stenosis without underlying atherosclerosis is challenging. Multimodal imaging, including coronary computed tomography and intracoronary imaging, is crucial for guiding treatment. Case summary: An 18-year-old male presented with recurrent chest pain. Two years after surgical repair of a penetrating left ventricular injury, a 12-lead electrocardiogram showed deep, symmetrical T-wave inversions in the anterolateral leads. Coronary angiography revealed a myocardial bridge and a significant stenosis in the mid left anterior descending artery (LAD). After recurrent symptoms, coronary computed tomography angiography demonstrated repair material surrounding the stenotic segment. Myocardial perfusion imaging showed a small fixed defect without reported reversibility. Intravascular ultrasound (IVUS) showed a minimum lumen area of 1.85 mm2 without an atherosclerotic phenotype. Following individualized Heart Team review favoring a percutaneous approach, a drug-eluting stent was implanted; the final minimum stent area was 4.83 mm2. At 1 month, exertional chest pain had markedly improved, biomarkers were normal, and the electrocardiogram was unchanged. Discussion: This case may represent one of the initial documented instances of IVUS-guided percutaneous coronary intervention (PCI) for late LAD compression caused by mechanical factors, following pledget repair for penetrating cardiac trauma in a young patient. Multimodal imaging helped clarify the underlying mechanism of this non-atherosclerotic coronary lesion, and a multidisciplinary Heart Team approach directed the personalized treatment decision.