Juri Iwata

Background: Advances in transcatheter aortic valve implantation (TAVI) devices and techniques have been remarkable. Self‐expanding valves (SEVs) possess the technical advantage of reposition (REP); however, research on their clinical impact remains limited. Aims: This study aimed to investigate the impact of REP, including the latest SEVs. Methods: This study included patients who underwent TAVI in Clinic Pasteur, France. The primary endpoint was the composite safety endpoint 30 days after TAVI. Other periprocedural safety outcomes and 1‐year all‐cause mortality were also evaluated. Subgroup analysis was performed to assess the independent risks for REP and early safety. Results: Among 5628 patients, 3235 patients were included in the analysis. The REP group had a significantly younger age and a higher ejection fraction, suggesting lower operative risks. During TAVI, the REP group demonstrated significantly higher contrast volume, longer procedure duration, and fluoroscopic time than the non‐REP group. The early safety and 1‐year mortality were comparable between the groups (78.1% vs. 79.5%, p = 0.324; 5.1% vs. 5.4%, p = 0.668). The multivariate analysis showed that younger age, hemodialysis, aortic valve regurgitation ≥moderate, Navitor, and pre‐dilatation were the independent risks for the need for REP. Regarding the early safety endpoint, previous pacemaker implantation was significantly associated with the achievement of early safety. REP was not associated with the early safety endpoint. Conclusions: The REP technique in SEVs was associated with favorable valve hemodynamic performance, maintaining safety compared to the non‐REP group. However, potential risks of complications exist due to prolonged procedure times and increased contrast volume.

Background: Basal septal hypertrophy (BSH) is commonly encountered in elderly patients undergoing transcatheter aortic valve replacement (TAVR). However, its impact on periprocedural and procedural outcomes remains unclear. Aims: The aim of this study was to evaluate the effect of BSH on periprocedural and postprocedural outcomes in patients undergoing TAVR. Methods: This study included patients with severe aortic stenosis (AS) who underwent TAVR using either balloon‐expandable (BEVs) or self‐expanding valves (SEVs). The primary endpoint was to compare periprocedural interventions and procedural outcomes. Secondary endpoints included subgroup analyses by device generation (new vs. old), valve type (BEVs vs. SEVs), severity of septal hypertrophy, and across study periods. Results: A total of 3261 TAVR patients were included: 1050 had a BSH ≥ 15 mm (HS+ group) and 2211 had a septal thickness < 15 mm (HS– group). Patients in the HS+ group had higher rates of post‐dilatation (25% vs. 21%, p = 0.008), moderate or greater paravalvular leak (PVL) on angiography (2.4% vs. 0.8%, p < 0.001) and echocardiography (5% vs. 3.4%, p = 0.033), and permanent pacemaker (PPM) implantation (18% vs. 14%, p = 0.008). Conversely, HS− patients more often required valve repositioning and a second valve. In subgroup analyses stratified by device generation, the influence of BSH appeared broadly consistent across platforms. Additional Subgroup analysis showed particularly higher rates of post‐dilatation, moderate or greater PVL, and PPM implantation in the SEV HS+ group, whereas mild septal thickening (12–15 mm) had no significant impact compared with marked hypertrophy (≥ 15 mm). Conclusion: In this large cohort of TAVR patients, BSH (≥ 15 mm) was associated with higher rates of post‐dilatation, PVL, and PPM implantation, particularly among those receiving SEVs, while mild septal thickening had no significant impact.

Background: The impact of peridevice leak (PDL) at device implantation on clinical outcomes after percutaneous left atrial appendage closure (LAAC) is unknown. This study aimed to investigate the association between PDL and clinical outcomes after LAAC. Methods: Using data from the OCEAN‐LAAC (Optimized Catheter Valvular Intervention‐Left Atrial Appendage Closure) Japanese multicenter registry, we examined 1397 patients who underwent LAAC between September 2019 and December 2022. The primary outcome was transient ischemic attack, ischemic stroke, or systemic embolism within 2 years of LAAC. Clinical outcomes were compared between patients with and without PDL at device implantation using Fine and Gray multivariable regression analyses and propensity score matching. Additional analyses were performed by categorizing PDL into 2 groups: ≤3 mm and >3 mm but ≤5 mm. Results: Of 1397 patients who underwent LAAC, 84 (6.0%) had PDL, of whom 73 (86.9%) had ≤3 mm PDL. Patients with PDL had a larger left atrium and higher CHADS2 scores than those without PDL. Multivariable analyses showed that PDL was significantly associated with a higher risk of transient ischemic attack, ischemic stroke, or systemic embolism (adjusted subdistribution hazard ratio [sHR], 4.25 [95% CI, 1.91–9.44]; P P =0.016). Propensity score matching analyses revealed consistent findings. Conclusions: PDL was associated with a higher risk of transient ischemic attack, ischemic stroke, or systemic embolism, even PDL ≤3 mm. Therefore, it may be necessary to aim for no PDL as much as possible.