In severe AS, the Anrep effect supports output at high energetic cost. TAVR reverses this state, unloading the heart and reducing mechanical demand without altering ejection fraction. This identifies the Anrep as a clinically relevant load-dependent mechanism in AS and highlights its reversibility post-TAVR.

Background: Patients undergoing transfemoral aortic valve replacement are particularly vulnerable and require a more sophisticated anesthetic therapeutic approach. According to the literature, no study has directly compared general anaesthesia with conscious analgosedation using postoperative infections as the primary endpoint. Methods: Patients undergoing transcatheter aortic valve implantation (TAVI) were analyzed retrospectively. A total of 3313 patients from a large heart center in Western Europe were included in this study. One group received general anaesthesia, and the other group received analgosedation for TAVI. The primary outcome was postinterventional pneumonia; secondary outcomes included myocardial infarction, renal failure, stroke, and 30-day mortality. Propensity score matching using 16 matching criteria yielded over 1000 pairs. Results: No difference was observed in the incidence of postinterventional pneumonia (p = 0.148). The occurrence of myocardial infarction (p = 0.2) and stroke (p = 0.4) also did not differ significantly between the two groups. In contrast, the need for transient renal replacement therapy (p = 0.02) and 30-day mortality (p = 0.02) were lower in the analgosedation group. Conclusions: Regarding postinterventional pneumonia, general anaesthesia can be used as safely as analgosedation during TAVI. However, since renal failure requiring temporary replacement therapy and mortality are both increased with general anaesthesia, analgosedation should be the standard of care for TAVI in high-volume centers. The anesthetic regimen must be determined on an individual basis and discussed during the heart team briefing. The conversion to, or primary use of, general anaesthesia when clinically indicated is safe. Overall, ensuring the continuous presence of a senior consultant anesthetist, specifically trained in cardiac anaesthesia, throughout the procedure is essential.

This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI). We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints. 4555 patients undergoing TAVI were retrospectively included. 231 matched (77:154) patients were analyzed. BViV-TAVI was a rare event (1.9

Background In aortic stenosis (AS), chronic pressure overload of the left ventricle (LV) may sustain an intrinsic, afterload-dependent adaptive response known as the Anrep effect, characterized by increased myocardial contractility and prolonged systolic duration. Whether this response resolves following transcatheter aortic valve replacement (TAVR) remains unknown. Objectives The objective of the study was to determine whether the Anrep is chronically activated in severe AS and acutely reverses after TAVR. Methods We studied 119 patients with high-gradient AS undergoing TAVR. Pressure-volume (PV) loops were analyzed by echocardiography before and 24-hours after intervention. The “Anrep triad”, defined as elevated afterload (LV end-systolic pressure, effective arterial elastance), enhanced contractility (end-systolic elastance, end-systolic volume at 150 mm Hg), and prolonged systolic ejection time, was assessed. Stroke work (SW), potential energy, PV area (PVA), and mechanical efficiency (SW/PVA) quantified LV energetics. Results TAVR reduced afterload (LV end-systolic pressure: 220 vs 143 mm Hg; effective arterial elastance: 2.8 vs 2.0 mm Hg/mL) and contractility (end-systolic elastance: 4.5 vs 2.6 mm Hg/mL; end-systolic volume at 150 mm Hg: 39 vs 53 mL), while shortening systolic duration (systolic ejection time: 390 vs 321 ms) (all P < 0.0001). LV ejection fraction was unchanged (56% vs 56%, P = 0.44). Mechanical workload decreased (SW: 9,017 vs 6,257 mm Hg mL; PVA: 14,261 vs 10,017 mm Hg mL, P < 0.0001), while efficiency was preserved (64% vs 63%, P = 0.101). Conclusions In severe AS, the Anrep effect supports output at high energetic cost. TAVR reverses this state, unloading the heart and reducing mechanical demand without altering ejection fraction. This identifies the Anrep as a clinically relevant load-dependent mechanism in AS and highlights its reversibility post-TAVR.

This pilot study aims to compare advanced and standard haemodynamic monitoring during TAVI in terms of predicting and avoiding hypotension. Intraoperative hypotension influences postoperative outcomes by increasing mortality, renal failure, and cardiac complications. In TAVI (transaortic valve implantation), haemodynamic stability is essential because the patients are usually old and vulnerable. Fifty patients underwent transfemoral TAVI under standard anaesthetic care. Blood pressure was measured invasively, using Edwards Acumen sensors connected to a HemoSphere monitor. The signal was simultaneously fed to anaesthesia monitors. Patients were randomly divided into two groups: in the test group, the Edwards monitor with the HPI (hypotension prediction index) values was available to the anaesthetist, whereas in the control group, the HemoSphere monitor was covered. The primary endpoint of the study was the time-weighted average of intraoperative hypotension, which is calculated from the intensity and duration of hypotension, adjusted for the duration of surgery (TWA65). Secondary endpoints were the cumulative time of hypotensive episodes adjusted for the duration of the procedure (TWAtotal). No difference in intraoperative hypotension in terms of TWA65 between control and intervention group could be detected, the overall duration of intraoperative hypotension was reduced in the intervention group, and the administration of intraoperative volume was higher in the intervention group when compared to controls. The use of HPI during TAVI leads to improved haemodynamic stability, and this is particularly important in these extremely vulnerable patients. Not only is it possible to reduce overall intraoperative hypotension with HPI, but postoperative complications associated with intraoperative hypotension that might occur will also be diminished.

Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI). All patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE. PVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9 Key finding: Take-home message

Abstract Introduction Prosthetic valve endocarditis (PVE) is the most unfavourable complication after any aortic valve replacement. Purpose The aim of this study was to analyse the impact of antibiotic-only and additional surgical therapy in patients with TAVI-PVE and to compare it with the results of patients with PVE after surgical aortic valve replacement (SAVR) regarding survival. Methods All patients who underwent primary isolated aortic valve replacement via SAVR (n=3.447) or TAVI (n=2.269) in our heart center between 01/2012–12/2018 were analysed. The diagnosis of PVE was made using the 2015 modified Duke criteria. Follow-up was performed until 06/2019 (max. 89, mean 34 months) with a follow-up rate of 98% regarding mortality. Results PVE incidence did not differ significantly between SAVR with 4.9 cases per 100 patient-years and TAVI with 2.4 cases per 100 patient-years (p=0.49), although TAVI patients were significantly older (mean 80 vs. 67 years) and had more multimorbidities (STS score mean 5.9 vs. 1.6) (p<0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than TAVI prostheses without polymer (p=0.004). Most common pathogens were staphylococci and enterococci in all PVEs. Antibiotic-only therapy in TAVI-PVE patients resulted in a significantly better 1-year survival compared with additional surgical therapy (90.9% vs. 33.3%; p=0.005) even in 4 patients with an indication for surgery according to ESC guidelines. In SAVR-PVE patients both therapies led to comparable survival (p=0.861). However, SAVR-PVE who were not operated although indication for surgery was given by the guidelines resulted in a significantly worse survival after 1 year (p=0.004). Conclusion TAVI patients did not have a significantly higher risk to develop PVE than SAVR patients despite their older age and greater comorbidities. The 1-year survival of TAVI-PVE patients was significantly higher after antibiotic-only therapy than after additional surgery, even if surgery had been indicated according to guidelines. This new finding is presumably due to the fact that TAVI prostheses do not have a polymeric suture ring. Our results show for the first time that indication for surgery in TAVI-PVE patients should be made carefully. SAVR-PVE patients however benefit from guideline-compliant surgery as in this respect antibiotics-only led to a significantly worse prognosis. This is probably related to the ability of gram-positive cocci to migrate into the polymeric ring and to protect themselves from antibiotic therapy by forming a biofilm. Some of the newer TAVI prostheses contain plastic components which can also be cured often with antibiotic-only but are associated with an increased risk to develop PVE. Funding Acknowledgement Type of funding sources: None.

Abstract Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). Methods and results This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04–1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41–0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. Conclusion The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.

AIMS:Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE).METHODS:Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode.RESULTS:3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE.CONCLUSIONS:In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.

High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43–3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06–2.13], p = 0.0210; 1-yr: HR 1.58[1.21–2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.

Background: Treatment of severely calcified aortic valve stenosis is associated with a higher rate of paravalvular leakage (PVL) and permanent pacemaker implantation (PPI). We hypothesized that the self-expanding transcatheter heart valve (THV) prostheses Evolut Pro (EPro) is comparable to the balloon-expandable Sapien 3 (S3) regarding hemodynamics, PPI, and clinical outcome in these patients. Methods: From 2014 to 2019, all patients with very severe calcification of the aortic valve who received an EPro or an S3 THV were included. Propensity score matching was utilized to create two groups of 170 patients. Results: At discharge, there was significant difference in transvalvular gradients (EPro vs. S3) (dPmean 8.1 vs. 11.1 mmHg, p ≤ 0.001) and indexed effective orifice area (EOAi) (1.1 vs. 0.9, p ≤ 0.001), as well as predicted EOAi (1 vs. 0.9, p ≤ 0.001). Moderate patient prosthesis mismatch (PPM) was significantly lower in the EPro group (17.7% vs. 38%, p ≤ 0.001), as well as severe PPM (2.9% vs. 8.8%, p = 0.03). PPI and the PVL rate as well as stroke, bleeding, vascular complication, and 30-day mortality were comparable. Conclusions: In patients with severely calcified aortic valves, both THVs performed similarly in terms of 30-day mortality, PPI rate, and PVL occurrence. However, patient prothesis mismatch was observed more often in the S3 group, which might be due to the intra-annular design.

Cardiac amyloidosis (CAM), the most common cardiac storage disease is associated with significant changes in left-ventricular (LV) morphology and function. To gain particular insights into LV systolic longitudinal myocardial mechanics we investigated seven parameters derived by speckle-tracking-echocardiography (STE) in patients with confirmed CAM ( n = 59). The results were compared with those of individuals with healthy heart ( n = 150) and another primary myocardial disease with also thickened myocardium and severe diastolic and systolic LV-dysfunction (symptomatic LV-non-compaction-cardiomyopathy, LV-NC, n = 30). In addition to standard echocardiographical measures, the STE-derived data were evaluated and documented utilizing polar-diagrams to obtain overviews of longitudinal myocardial mechanics of the entire LV. Compared with healthy individuals, patients with CAM and LV-NC showed significantly reduced LV-ejection-fraction (EF), global longitudinal systolic peak-strain, strain-rate, and displacement. Pre-systolic stretch-index, post-systolic index, and the EF/global peak-longitudinal-strain-ratio (EF/S) were increased. In contrast to healthy-hearts and the LV-NC group only patients with CAM demonstrated significantly reduced time-to-peak systolic longitudinal strain and time-to-peak strain-rate. Although the level of the segmental values in longitudinal mechanics was significantly different between the groups, comparable intraventricular baso-apical parameter-gradients were found for systolic longitudinal peak-strain and strain-rate, pre-systolic-stretch-index, post-systolic-index, and peak systolic displacement. Compared to ATTR-amyloidosis (ATTR-CAM), patients with AL-amyloidosis (AL-CAM) demonstrated significantly lower end-diastolic and end-systolic LV-volumes, LV-mass-indices, relative apical strain, time-to-peak systolic longitudinal strain, and time-to-peak longitudinal strain-rate. CAM and LV-NC demonstrated altered myocardial mechanics with significantly different STE-derived echocardiographical parameters. ATTR-amyloidosis and AL-amyloidosis had at least significantly different time-to-peak strain, time-to-peak strain-rate and relative apical sparing values.

Background: The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry.Methods: Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients.Results: In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were S. aureus (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, P = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, P = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, P = 0.006, and 18.0 vs. 10.2%; P < 0.001, respectively. In IE cancer patients, predictors of mortality by multivariate analysis were creatinine > 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated).Conclusions: Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.

Little is known about the characteristics of infectious endocarditis (IE) in cancer patients, although their risk may be higher and their presentation non-specific. This study sought to assess the prevalence of cancer in patients with IE in the EURO-ENDO registry and to determine their baseline characteristics, management, outcomes in comparison to cancer-free patients with IE. Data were collected from a prospective cohort of 3085 adult patients enrolled in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on the ESC 2015 diagnostic criteria. Clinical, biological, microbiological and echocardiographic findings, use of other imaging techniques, medical therapy, complications, theoretical indications for surgery, in-hospital mortality, and 1-year mortality were analysed in IE patients with and without cancer. 359 (11.6%) cancer patients with IE were identified and compared with 2726 IE patients without cancer. IE was community-acquired in 225/361 (74.8%), and more often nosocomial (18.6%) in healthcare associated cases. IE was native in 209 (60.4%), prosthetic in 97 (28%) and device-related in 30 (8.7%) patients. Microorganisms involved were Enterococci in 72/303 (23.8%), methicillin-sensitive Staphylococci in 63/303 (20.8%), and Streptococcus gallolyticus in 33/303 (10.9%) patients. IE cancer patients received more long-term cortico-therapy and immunosuppressive treatment compared to cancer free IE patients (9.1% vs. 3.9%, P<0.0001 and 11.7% vs. 2.7%, P<0.0001, respectively). Acute renal failure was the most frequent complication, observed in 25.9% of patients, followed by embolic events (21.7%). Congestive heart failure and cardiogenic shock occurred more frequently in cancer patients (18.1% vs. 13.4%, P=0.016; 10.1% vs. 6.3%, P=0.011, respectively). Cancer IE patients were more frequently treated with amoxicillin (35.8% vs. 26.3%; P=0.0002) and daptomycin (15.2% vs. 10.6%; P=0.0096), but less frequently treated with vancomycin (34.6% vs. 44.9%, P=0.0003). According to the ESC guidelines, theoretical indication for cardiac surgery was not significantly different between groups (65.5% vs. 69.8%, P=0.091), but was effectively less performed when indicated in cancer IE patients during hospitalisation (65.5% vs. 75.0%, P=0.0018). Compared to cancer-free IE patients, in-hospital and 1-year death occurred in 23.4% vs. 16.1%, P=0.006, and 35.7% vs. 23.1%, P<0.001, respectively. Predictors of mortality by multivariate analysis were creatinine >2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). We report the largest contemporary series of patients with IE and cancer. The prevalence of cancer in IE patients is common and associated with a worse outcome. Patients with IE and cancer have different clinical characteristics than the general population and should require a specific management. Type of funding source: Private company. Main funding source(s): Pharmacological.

Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). F-18-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

OBJECTIVES:Transcatheter aortic valve implantation (TAVI) has become standard therapy for aortic stenosis patients with intermediate or high operative risk. Treatment of patients with pre-existing mechanical mitral valve replacement (MVR) is challenging due to possible interference between the TAVI prosthesis and MVR. We present our single-center experience with this special patient cohort. METHODS:A total of 1960 patients underwent TAVI at our institution between 2009 and March 2018; of these, 16 patients had pre-existing mechanical MVR. Device success and adverse events were analyzed according to the Valve Academic Research Consortium (VARC)-2 criteria. Patients were followed for at least 12 months. RESULTS:Mean patient age was 81.5 ± 4.4 years. The patients had a mean logistic EuroScore of 37.1 ± 13.5% and STS score of 7.1 ± 3.2%. Successful valve deployment was achieved in all patients, peri-interventional stroke rate was 0.0%, and permanent pacemaker was implanted in 2 patients (12.5%). Two patients experienced major complications, with blockage of the MVR disc in 1 patient and annulus rupture in 1 patient. Hence, 30-day mortality was 12.5% and 1-year mortality was 25.0%. CONCLUSION:TAVI in patients with mechanical MVR is challenging and requires careful preparation and choice of TAVI device. Repositionable and retrievable devices seem to be a safer option.

We present our single center experience with Medtronic CoreValve and Evolut R regarding procedural outcome and 3 years follow-up in patients with degenerated bioprostheses. From 1645 patients who underwent transfemoral TAVI at our institution between February 2009 and December 2016, 37 patients with degenerated bioprosthesis were treated with Medtronic CoreValve/Evolut R. All data concerning baseline characteristic, procedural outcomes and follow-up were entered into a dedicated database. Mean age was 83.9 ± 4.4 years and patients showed an average logistic EuroSCORE of 33.2 ± 16.7%. Successful ViV deployment was achieved in all cases, a permanent pacemaker was implanted in 16.2%, no periinterventional stroke and no coronary obstruction occurred. Mortality at 30 days was 2.7%, at 1-year follow-up 5.7% and at three years 13.5%. Depending on bioprosthesis size <23 mm versus ≥23 mm echocardiographic mean gradients post implantation were significantly higher in the smaller bioprostheses, 22.8 mmHg ± 9.4 mmHg versus 15.1 ± 7.1,  = 0.013. ViV-TAVI with CoreValve/R is demonstrated to be safe and effective in terms of no coronary obstruction and very low mortality up to 3 years despite slightly higher mean transprosthetic gradients especially in very small bioprostheses.

OBJECTIVES We present our single center experience with Medtronic CoreValve and Evolut R regarding procedural outcome and 3 years follow-up in patients with degenerated bioprostheses. METHODS From 1645 patients who underwent transfemoral TAVI at our institution between February 2009 and December 2016, 37 patients with degenerated bioprosthesis were treated with Medtronic CoreValve/Evolut R. All data concerning baseline characteristic, procedural outcomes and follow-up were entered into a dedicated database. RESULTS Mean age was 83.9 ± 4.4 years and patients showed an average logistic EuroSCORE of 33.2 ± 16.7%. Successful ViV deployment was achieved in all cases, a permanent pacemaker was implanted in 16.2%, no periinterventional stroke and no coronary obstruction occurred. Mortality at 30 days was 2.7%, at 1-year follow-up 5.7% and at three years 13.5%. Depending on bioprosthesis size <23 mm versus ≥23 mm echocardiographic mean gradients post implantation were significantly higher in the smaller bioprostheses, 22.8 mmHg ± 9.4 mmHg versus 15.1 ± 7.1, P = 0.013. CONCLUSION ViV-TAVI with CoreValve/R is demonstrated to be safe and effective in terms of no coronary obstruction and very low mortality up to 3 years despite slightly higher mean transprosthetic gradients especially in very small bioprostheses.

ObjectivesAlthough procedure‐related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure‐related CCDs on systolic and diastolic LV performance and on patient survival after TAVI.Methods and resultsNinety‐five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow‐up were evaluated with respect to procedure‐related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer‐term follow‐up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs −4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): −1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A‐ratio: −0.3 ± 0.6 vs −0.5 ± 0.5, P = .1). Kaplan‐Meier survival analysis revealed no significant differences between the two cohorts (P = .795).ConclusionProcedure‐related conduction abnormalities after TAVI lead to an LBBB‐related dyssynchrony with impairment of LV performance but not of overall survival.