Nikolaos Pyrpyris

The pre-procedural presence of chronic total occlusions (CTO) in patients undergoing transcatheter aortic valve implantation (TAVI) could be a significant predictor of outcomes. This meta-analysis aims to investigate whether CTO presence significantly alters outcomes in TAVI patients. A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After study selection, a random effect meta-analysis was performed. Seven studies with a total of 15,162 patients undergoing TAVI were included. There was no significant difference regarding in-hospital [Relative Risk (RR): 1.13; 95% Confidence Interval (95% CI): 0.82-1.55] and 1-year all-cause mortality (RR: 1.58; 95% CI: 0.71-3.50). Patients with CTO exhibited significantly increased rates of myocardial infarction (RR: 1.27, 95% CI: 1.07-1.51) and reduced rates of new pacemaker implantation (RR: 0.88, 95% CI: 0.79-0.98). No differences were found in cardiogenic shock (RR: 1.18, 95% CI: 0.97-1.44), acute kidney injury (RR: 1.06, 95% CI: 0.88-1.28), vascular complications (RR: 1.10, 95% CI: 0.91-1.33), or bleeding (RR: 1.01, 95% CI: 0.89-1.14). In TAVI patients, pre-procedural unrevascularized CTO presence is not related to short- or mid-term increased mortality. Further studies are needed to identify predictors of adverse events and phenotypes benefiting from revascularization.

Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a cornerstone in the management of severe mitral regurgitation, serving as a robust, low-risk alternative to conventional mitral valve surgery. Although thromboembolic risk remains a critical clinical challenge, that varies significantly across the clinical continuum, from pre-procedural substrates to post-procedural management. This review highlights the role of atrial cardiomyopathy in creating a prothrombotic milieu even prior to intervention, while during the procedure, device time emerges as a potentially dominant independent predictor of embolic burden, marking the periprocedural window as the period of peak hazard. Furthermore, this article addresses the notable disparity between the near-universal presence of subclinical ischemic lesions on magnetic resonance imaging and the infrequent incidence of overt neurological deficits. As the post-procedural phase is considered, we discuss the shift from standardized antithrombotic protocols to individualized strategies and the potential role of concomitant left atrial appendage occlusion. Ultimately, integrating these stage-specific clinical and procedural determinants with emerging technologies—like digital twins and artificial intelligence—represents a promising frontier for mitigating embolic risks, optimizing procedural planning and patient safety in the evolving landscape of mitral valve interventions.

Objective: Aortic stenosis (AS) may complicate cardiogenic shock (CS) or acute decompensated heart failure (ADHF) in a small but significant number of patients. In such cases, urgent treatment is necessary to prevent mortality and adverse outcomes. Transcatheter aortic valve implantation (TAVI) and balloon aortic valvuloplasty (BAV) represent the main treatment options, however, limited studies have compared them directly. Therefore, this systematic review and meta‐analysis aims to synthesize available studies directly comparing urgent TAVI and BAV, in respect to reported outcomes. Methods: We systematically searched MEDLINE/PubMed, Scopus and Web of Science for studies comparing outcomes in patients with CS or ADHF undergoing urgent TAVI or BAV. Followingly, a meta‐analysis of all included studies was performed. Results: A total of six studies, including 21,020 patients (10,597 patients undergoing TAVI and 10,423 patients undergoing BAV) were analyzed. Regarding in‐hospital mortality, it was found to be significantly lower in patients undergoing urgent TAVI, compared to BAV (risk ratio [RR]: 0.53; 95% confidence interval (CI): 0.32−0.87]. Moreover, urgent TAVI was also associated with significantly lower all‐cause mortality at 30‐days follow up (RR 0.51, 95% CI: 0.31−0.84). Conclusion: In this meta‐analysis of observational, retrospective studies including patients undergoing urgent transcatheter interventions for acute AS, TAVI is associated with significantly reduced in‐hospital and 30‐days mortality, in comparison to BAV. More larger studies, reporting extended follow‐up and adverse events' rates, are needed to safely conclude regarding the benefit of urgent interventions in the acute care.

Arterial hypertension is highly prevalent among individuals with chronic kidney disease (CKD), exhibiting a bidirectional association and playing a critical role in the progression of renal dysfunction. CKD affects approximately 10–12% of the global population and is often a common comorbidity in patients with true resistant hypertension. The sympathetic nervous system (SNS) plays a key role in the pathophysiological cascade of CKD-mediated hypertension. Current pharmacological therapies do not directly target SNS overactivity, highlighting the need for alternative approaches. Renal denervation (RDN), an interventional procedure that modulates both afferent and efferent renal nerve signaling, has emerged as a promising strategy for resistant hypertension with multiple pleiotropic benefits. Both preclinical and clinical trial data indicate that RDN is safe, with no significant deterioration of renal function reported in both early-stage CKD and end-stage renal disease (ESRD), as well as effective in reducing both office and ambulatory blood pressure in most studies. This review examines the pathophysiological basis for SNS overactivity in CKD, summarizes preclinical and clinical data on the safety and efficacy of RDN in this population, and discusses ongoing and future trials that may further clarify the role of RDN in CKD management and its long-term impact on renal and cardiovascular outcomes.

Tricuspid regurgitation (TR) is a well-recognized factor contributing to adverse outcomes and mortality. Recent developments in transcatheter valve repair techniques, with the emergence of tricuspid transcatheter edge-to-edge repair (TEER) devices, have altered the treatment algorithm of TR and now offer a safe and feasible alternative for the effective management of the disease and an improvement in patient symptoms. Evidence from large studies and registries showcases the benefit of tricuspid interventions in terms of heart failure hospitalization and quality of life; however, most studies do not report a significant benefit in terms of hard outcomes. Even though longer-term follow-up may be needed to identify such differences, it is important to also identify distinct patient phenotypes that would benefit the most from such interventions, moving from pure anatomical criteria to an overall assessment of the patient’s clinical status. Therefore, the aim of this review is to provide updates on potential moderators of the effect of tricuspid TEER, focusing on novel anatomical criteria, right cardiac function, and renal physiology, in order to guide patient selection and provide an insightful discussion on the optimal patient phenotype for future trial design.