Mustafa Gabarin

Background: Aortic valve calcium score (AVCS) is associated with an increased risk of paravalvular leak (PVL) after Transcatheter aortic valve replacement (TAVR). We aimed to evaluate the association between AVCS burden and procedural outcomes, particularly PVL, and to determine whether valve platform performance differs according to calcium burden. Methods: This study included patients with severe aortic stenosis undergoing TAVR with balloon-expandable (Sapien platform) or self-expanding (Evolut and Navitor platforms) valves. The primary endpoint was the rate of any and moderate or greater PVLs according to AVCS burden (p = 0.010), as did moderate or greater PVLs (5% vs. 3%; p = 0.011). In multivariable analysis, both SEV implantation and AVCS ≥ 3000 AU were independent predictors of moderate or greater PVL, while the interaction between AVCS burden and valve platform was not significant. When restricted to contemporary-generation valves, PVL rates were lower overall but remained higher in patients with an AVCS ≥ 3000 AU (4.4% vs. 2.4%; p = 0.001), with smaller differences between valve platforms. Conclusions: A higher AVCS is associated with increased PVLs after TAVR. BEVs showed lower rates of moderate or greater PVLs than SEVs, although no statistically significant interaction between AVCS burden and valve platform was observed. With contemporary-generation valves, overall PVL rates were reduced, and platform differences were attenuated.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) remain underused in routine practice, particularly among women. Aim: This study evaluated gender differences in mortality among patients with T2DM and established atherosclerotic cardiovascular disease (ASCVD) and examined whether disparities in SGLT2i and GLP-1RA dispensing contribute to mortality. Methods: The CARDIAB cohort included 138,397 patients with T2DM and established ASCVD, categorized by gender into male and female groups. The primary endpoint was all-cause mortality, and the secondary outcome was the dispensing rates of SGLT2i and GLP-1RA. Results: Of the 138,397 patients, 40.3% were women and 59.7% were men. The overall dispensing rates of SGLT2i and GLP-1RA were 37.1% and 23.4%, respectively, and were significantly lower among women compared with men for both SGLT2i (27.8% vs. 43.3%; p < 0.001) and GLP-1RA (21.3% vs. 24.9%; p < 0.001). Women exhibited higher mortality rates, as reflected by deaths per 10,000 patient-years (9724 vs. 7744; p < 0.001). However, in multivariable analysis, gender was not an independent predictor of mortality. Notably, the use of cardioprotective medications was strongly associated with reduced mortality, with the greatest benefit observed for SGLT2i (HR 0.307; 95% CI 0.299–0.316; p < 0.001) and GLP-1RA (HR 0.466; 95% CI 0.451–0.482; p < 0.001). Conclusions: Women with T2DM and ASCVD were treated less often with SGLT2i and GLP-1RA, therapies strongly associated with lower mortality. Their higher unadjusted mortality appears to reflect undertreatment rather than sex-related risk. Action is needed to improve the use of these cardioprotective medications, especially in women.

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm‐control strategy for AF. Although the CHA₂DS₂‐VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real‐world multicenter settings.Aim: To evaluate the association between the CHA₂DS₂‐VASc score and both AF recurrence and adverse clinical outcomes following PVI.Methods: We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA₂DS₂‐VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re‐hospitalization, major adverse cardiovascular events (MACE), and all‐cause mortality.Results: AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA₂DS₂‐VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; p < 0.001). Elevated CHA₂DS₂‐VASc scores also correlated with higher MACE and re‐hospitalization rates. No significant difference in all‐cause mortality was observed.Conclusion: The CHA₂DS₂‐VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. This study aims to evaluate the feasibility and clinical outcomes of implementing a TAVI program at a cardiology department without an on-site cardiac surgery department, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center's interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3 and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. Valve types used included Acurate-neo 2 (57 patients, 38%), Sapien-3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak, no elevated post-implantation gradients, and no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: This study demonstrates that the transfemoral TAVI procedure can be safely and effectively performed in a cardiology department without an on-site cardiac surgery unit, provided there is collaboration with a remote surgical center. These findings suggest that expanding TAVI programs to centers without on-site cardiac surgery could increase access to this life-saving treatment for aortic stenosis.