Alcoholic liver disease is the most prevalent cause of progressive liver disease in Europe. Alcoholic cirrhosis occurs in 8%–20% of cases of alcoholic liver disease. It has significant influence on cardiovascular system and haemodynamics through increased heart rate, cardiac output, decreased systemic vascular resistance, arterial pressure and plasma volume expansion. Cirrhotic cardiomyopathy is characterised by systolic and diastolic dysfunction and electrophysiological abnormalities, if no other underlying cardiac disease is present. It is often unmasked only during pharmacological or physiological stress, when compensatory mechanisms of the heart become insufficient to maintain adequate cardiac output. Low-to-moderate intake of alcohol can be cardioprotective. However, heavy drinking is associated with an increased risk of cardiovascular diseases, such as alcoholic cardiomyopathy, arterial hypertension, atrial arrhythmias as well as haemorrhagic and ischaemic stroke. Alcoholic cardiomyopathy is characterised by dilated left ventricle (LV), increased LV mass, normal or reduced LV wall thickness and systolic dysfunction.

Backgrounds: The vascular closure device (VCD) is a medical device used for achieving hemostasis of vascular access sites greater than 8 Fr. We compared complications after placement of Perclose ProGlide (Abbott Vascular, USA), a percutaneous suture-mediated closure system, with MANTA VCD (Teleflex Vascular, USA), a collagen-based closure device.Methods: This retrospective cohort study analyzed procedures performed between 2016 and 2021. We compared the incidence of bleeding complications according to the Bleeding Academic Research Consortium (BARC) and Valve Academic Research Consortium-3 (VARC-3) criteria. The comparison was made between two cohorts of patients: in the first, vascular access sites were closed with a double Perclose ProGlide system, and in the second with an 18 Fr MANTA VCD.Results: A total of 189 patients were included in the study, out of which 63% were male and 37% were female, with a median age of 79 (72–83) years. All devices were used for femoral arterial access closure. A double Perclose ProGlide was used in 91 (48%) patients, while MANTA VCD was used in 98 patients (52%). The distribution of patients by VARC-3 and BARC bleeding criteria differs between groups (p = 0.017). A significantly higher incidence of VARC 1 (14% vs. 4%; p = 0.020) and BARC 1–2 (14% vs. 4%; p = 0.020) complications in the Perclose ProGlide cohort was observed. VARC 3 (1% vs. 5%; p = 0.213) and BARC 3b (1% vs. 5%; p = 0.213) complications showed higher, but statistically non-significant rates of major bleeding complications in the MANTA VCD cohort. The need for subsequent surgical revision did not show a significant difference between the cohorts (2% vs. 6%; p = 0.281).Conclusion: The Perclose ProGlide cohort was associated with a significantly higher rate of milder complications. MANTA VCD cohort had a higher rate of major bleeding complications, requiring more complex treatment with a potentially larger impact on quality of life.

Transfemoral (TF) access is the safest and guideline-recommended approach for transcatheter aortic valve replacement (TAVR). However, in patients with hostile aortic anatomies, the procedure may carry increased risks of vascular or cerebrovascular complications. The objective of this article is, therefore, to evaluate the safety and efficacy of using the extended-length DrySeal Flex introducer sheath (Gore, USA) for TF-TAVR in high-risk patients with challenging aortic anatomies. We conducted a retrospective, single-center cohort study including all consecutive patients who underwent TF-TAVR with the 65-cm DrySeal sheath between 2021 and 2025. We analyzed the indications for sheath use and the following clinical outcomes: all-cause mortality, stroke, and major vascular complications as defined by Valve Academic Research Consortium-3 criteria. The 65-cm DrySeal sheath was used in 200 patients (median age 80 years; median Society of Thoracic Surgeons score 5.4%) out of 2430 (8.2%) TF-TAVR procedures performed. This approach was selected to address challenges posed by aortic arch calcification (28%), heavily atheromatous or shaggy aorta (20%), acute aortic angulation (26%), tortuosity (36%), and aortic coarctation (8%). In this high-risk cohort, all-cause mortality was 0.5%, stroke occurred in 1.5% (including 0.5% with disabling stroke), and major vascular complications were observed in 1.0%. These outcomes were comparable to those seen in lower-risk patients undergoing TF-TAVR using conventional approaches. In patients with hostile aortic anatomies, the extended-length DrySeal Flex introducer sheath facilitated safe and effective TAV delivery and was associated with a low rate of periprocedural complications, including cerebrovascular events. Its use may help mitigate the risks traditionally associated with hostile aortic anatomies.

Background: Degenerative calcification is the primary mechanism underlying severe aortic stenosis; however, some patients with hemodynamically severe aortic stenosis have low aortic valve calcium scores (AVCS), suggesting heterogeneous disease processes. This study aimed to evaluate the clinical characteristics and outcomes across the spectrum of AVCS. Methods: We performed a retrospective analysis of the AMTRAC (Aortic+Mitral Transcatheter Valve) registry, including 3766 patients with severe aortic stenosis who underwent transcatheter aortic valve implantation across 16 centers mainly in Europe (2013–2024). Patients were stratified into three groups of low, high, or very high based on their AVCS. The primary end point was 3‐year mortality. Secondary end points included periprocedural outcomes (Valve Academic Research Consortium‐3) and posttranscatheter aortic valve implantation hemodynamics. Results: Patients with low AVCS more frequently presented with low‐gradient aortic stenosis and advanced New York Heart Association classes. At 3 years, mortality displayed a bimodal pattern in association with AVCS spectrum: 30.5% in the low, 26.5% in the high, and 31.3% in the very‐high AVCS group ( P <0.05). Paravalvular leak greater than moderate increased with AVCS severity (0.5%, 0.9%, 1.9%, for low, high, and very‐high AVCS, respectively; P <0.01). The risk for stroke and permanent pacemaker implantation were also higher in the very‐high AVCS group compared with the low/high AVCS groups (stroke: 4.1%, 1.4%, 2.4%; permanent pacemaker: 21.2%, 14.7%, 14.2%; for very‐high, low, high, respectively; P <0.05 for both). Conclusions: Low AVCS defines a unique phenotype marked by predominant fibrosis, advanced symptoms, and increased mortality despite fewer procedural complications. In contrast, very‐high AVCS is linked to higher procedural risk, more bicuspid valves, and increased mortality. These insights challenge calcification‐based criteria and support incorporating fibrosis assessment into treatment strategies.