Kenichi Ishizu

Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for severe aortic stenosis. Among patients with left ventricular (LV) systolic dysfunction, recovery of LV function after TAVI is heterogeneous, and reliable tools for pre‐procedural risk stratification and patient counseling remain limited. Aims: We sought to identify simple pre‐procedural predictors of complete LV functional recovery after TAVI and to develop a clinically applicable risk score to support patient counseling and post‐procedural management. Methods: We retrospectively analyzed patients with severe aortic stenosis and baseline LV ejection fraction (LVEF) < 40% enrolled in a large multicenter registry in Japan. The primary outcome was complete LVEF normalization (LVEF > 50%) at 1 year after TAVI. Independent predictors were identified using multivariable logistic regression in a derivation cohort, and an exploratory weighted score was constructed. The score was preliminarily assessed in a separate single‐center cohort. Results: The derivation cohort comprised 177 patients (median age 84 years; 44% women), of whom 94 (53%) achieved LVEF normalization. Lower body mass index (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77–0.95; p = 0.004), higher aortic valve peak velocity (OR 2.45, 95% CI 1.40–4.29; p = 0.002), and smaller LV end‐diastolic diameter (OR 0.93, 95% CI 0.88–0.98; p = 0.020) were independently associated with LVEF normalization. The derived score stratified patients into low‐, intermediate‐, and high‐probability groups (15%, 45%, and 71%, respectively; p < 0.001), with consistent discrimination in the validation cohort. Conclusions: A simple exploratory score incorporating body mass index, transvalvular peak velocity, and LV size was associated with the probability of complete LV functional recovery after TAVI. This pre‐procedural tool may facilitate patient counseling, expectation‐setting, and identification of patients who may require closer heart failure follow‐up after TAVI. It should not be used to determine eligibility for TAVI.

Background and Aims: This study examined the impact of aortic arch atheroma severity on the risk of periprocedural stroke following transcatheter aortic valve implantation (TAVI). Methods and results: We retrospectively evaluated contrast-enhanced computed tomography data of patients who underwent transfemoral-TAVI from May 2016 to March 2024. Aortic arch atheroma was classified into none/mild [maximum plaque thickness (MPT) 5 mm without shaggy morphology), and shaggy (MPT >5 mm with shaggy morphology). The primary outcome measure was periprocedural (30-day) ischaemic stroke following TAVI. Of the 1971 eligible patients, 65 (3.3%) experienced periprocedural ischaemic stroke. Compared with none/mild atheroma, moderate atheroma [adjusted odds ratio (aOR) 2.93; 95% confidence interval (CI), 1.63–5.28; P < .001] and shaggy atheroma (aOR 14.58; 95% CI, 6.67–31.87; P < .001) were independently associated with increased risk of periprocedural stroke. Severe atheroma exhibited a similar trend, albeit without statistical significance (aOR 2.81; 95% CI, 0.92–8.61; P = .07). In the balloon-expandable transcatheter heart valve (BE-THV) cohort, stroke incidence was significantly increased only in the shaggy group (1.1% vs. 2.8% vs. 1.4% vs. 11.9%, P < .001); however, stroke incidence across the atheroma severity groups in the self-expandable THV (SE-THV) cohort demonstrated a stepwise increase (2.8% vs. 8.2% vs. 13.6% vs. 33.3%, P < .001). Conclusions: Aortic arch atheroma severity was associated with an increased risk of periprocedural stroke following transfemoral-TAVI, with the impact being more pronounced in patients treated with SE-THV than in those treated with BE-THV.