Tobias Schmidt

Background: Mitral valve transcatheter edge‐to‐edge repair (M‐TEER) has emerged as a viable therapy option in patients with severe mitral regurgitation and high surgical risk. Although atrial fibrillation is common among patients undergoing M‐TEER, the optimal anticoagulatory treatment after the intervention is unknown. Methods: A single‐center retrospective observational analysis was conducted using data from the M‐TEER registry at the University Hospital Cologne collected from 2019 untill 2021 including patients undergoing M‐TEER between November 2012 and April 2019. Patients with atrial fibrillation receiving consistent anticoagulation following M‐TEER were categorized into a direct oral anticoagulant or a vitamin K antagonist (VKA) group. The primary end point was a composite of ischemic cerebrovascular and bleeding events. Additionally, overall survival was assessed. Results: Among 613 patients undergoing M‐TEER, 206 met the inclusion criteria, with 61 receiving direct oral anticoagulants and 145 receiving VKAs. After a median follow‐up of 833 (interquartile range, 355–1271) days, the incidence of the composite primary end point did not differ between direct oral anticoagulant and VKA groups (hazard ratio [HR], 0.51 [95% CI, 0.23–1.12]; P =0.07). Similarly, rates of ischemic cerebrovascular events and bleeding events were similar between groups. However, the overall mortality rate was higher in the VKA group (HR, 2.56 [95% CI, 1.54–4.26]; P =0.002). In the multivariable analysis, oral anticoagulation with a VKA was an independent predictor for death (adjusted HR, 2.23 [95% CI, 1.08–5.06]; P =0.03). Conclusions: Our findings suggest that direct oral anticoagulants may offer comparable efficacy and safety to VKAs in preventing thromboembolic events following M‐TEER in patients with atrial fibrillation. Further randomized trials are needed to confirm these results and establish optimal anticoagulation strategies in this patient population.

Background: Tricuspid regurgitation (TR) is a disease with significant morbidity and mortality rates. Besides surgery and transcatheter edge-to-edge repair (TEER), transcatheter tricuspid valve replacement has evolved as a possible treatment option in high-risk patients with an unfavourable anatomy for TEER. Case summary: We present a case of an 82-year-old patient with torrential TR due to an annulus dilation and subsequent central gap of >8 mm. Echocardiographic guiding was impeded by the presence of two permanent right ventricular implantable cardioverter-defibrillator (ICD) leads and previous surgical aortic valve implantation and mitral valve reconstruction. An EVOQUE prosthesis (Edwards Lifesciences; Irvine, USA) was successfully implanted without impairment of the ICD function or significant paravalvular leakage. Conclusion: Transcatheter tricuspid valve replacement with the EVOQUE-tricuspid valve replacement system is feasible even in patients with two right ventricular ICD leads and limited echocardiographic visibility.

Background: Besides transcatheter edge-to-edge repair (TEER), there are new interventional treatment options for mitral and tricuspid regurgitation in evaluation, such as a complete replacement of the valve through a prosthesis. Case summary: A 78-year-old previous coronary artery bypass graft-operated patient with symptomatic severe mitral regurgitation and tricuspid regurgitation was sequentially treated by a transfemoral transcatheter mitral and tricuspid valve prosthesis (Cardiovalve; Cardiovalve Ltd, Israel) due to unfavourable mitral valve anatomy. The transcatheter mitral valve implantation (TMVI) was performed first and after progression of the tricuspid regurgitation, a second transcatheter valve prosthesis was implanted in tricuspid position (TTVI) 1.5 years later. Imaging showed a twin look-alike picture of a mitral and tricuspid prosthesis and showing the possibility of a complete transcatheter based replacement of the mitral and tricuspid valve. Discussion: This case shows the possibility of a Cardiovalve prosthesis being used for TMVI and TTVI in a single patient. Especially in TEER ineligible patients, it might be a good treatment option after device approval.

Objective Periinterventional stroke is one of the most feared potential complication, among patients treated with transcatheter aortic valve implantation (TAVI). The purpose of this review was to investigate the incidence of cerebrovascular events and the influence of postinterventional neurologic check-up in patients undergoing TAVI. Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. Three separate electronic searches of the public domains Medline and Clinicaltrials.gov were performed to identify the 30-day incidence of stroke within randomized controlled trials (RCTs) and registries for patients undergoing a TAVI procedure. A meta-analysis was conducted to evaluate the 30-day incidence of stroke within RCTs. Furthermore, we pooled the RCTs in which a scheduled neurological check-up was conducted or not to investigate the effect of this intervention. Results Twenty-three studies including 399,532,491 TAVI patients were included, 6370 from RCTs, 857,833 from cerebral-embolic protection device RCTs and 392,288 were adopted from registries. The mean 30-day incidence of stroke among all reviewed studies was 2.33%. In RCTs evaluating TAVI the pooled stroke incidence was 3.86%, among RCTs focused CEP the incidence was 6.4436% and in registries the incidence was 2.29%. Ten RCTs conducted scheduled neurological check-ups, the incidence in these was 4.03% and among the remaining RCTs it was 2.47%. In the meta-analysis, the pooled 30-day stroke incidence was 3.61% (95% CI 2.57–4.79%). Conclusion This systematic review demonstrates that the stroke incidences following TAVI differ strongly according to the study design and neurological follow-up. Intense neurological testing increases the incidence of a stroke after TAVI. Graphical abstract

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Aims Surgical ventricular reconstruction to remodel, reshape, and reduce ventricular volume is an effective therapy in selected patients with chronic heart failure (HF) of ischaemic aetiology. The BioVentrix Revivent TC System offers efficacy comparable to conventional surgical ventricular reconstruction and is less invasive utilizing micro‐anchor pairs to exclude scarred myocardium on the beating heart. Here, we present 12‐months follow‐up data of an international multicenter study. Methods and results Patients were considered eligible for the procedure when they presented with symptomatic HF [New York Heart Association (NYHA) class ≥II], left ventricular (LV) dilatation and dysfunction caused by myocardial infarction, and akinetic and/or dyskinetic transmural scarred myocardium located in the anteroseptal, anterolateral, and/or apical regions. A total of 89 patients were enrolled and 86 patients were successfully treated (97%). At 12 months, a significant improvement in LV ejection fraction (29 ± 8% vs. 34 ± 9%, P < 0.005) and a reduction of LV volumes was observed (LV end‐systolic and end‐diastolic volume index both decreased: 74 ± 28 mL/m² vs. 54 ± 23 mL/m², P < 0.001; and 106 ± 33 mL/m² vs. 80 ± 26 mL/m², respectively, P < 0.0001). Four patients (4.5%) died in hospital and survival at 12 months was 90.6%. At baseline, 59% of HF patients were in NYHA class III compared with 22% at 12‐month follow‐up. Improvements in quality of life measures (Minnesota Living with Heart Failure Questionnaire 39 vs. 26 points, P < 0.001) and 6‐min walking test distance (363 m vs. 416 m, P = <0.001) were also significant. Conclusions Treatment with the Revivent TC System in patients with symptomatic HF results in significant and sustained reduction of LV volumes and improvement of LV function, symptoms, and quality of life.

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)