Background: The diagnostic performance of preprocedural CT angiography in detecting coronary artery disease (CAD) in patients scheduled for transcatheter aortic valve implantation (TAVI) has been reported. However, data on predictors of diagnostic inaccuracy are sparse. We sought to investigate clinical characteristics and imaging criteria that predict the inaccurate assessment of coronary artery stenosis based on pre-TAVI-CT. Methods: The patient- and vessel-level analysis of all CT datasets from 192 patients (mean age 82.1 ± 4.8 years; 63.5% female) without known CAD or severe renal dysfunction was performed retrospectively in a blinded fashion. Significant CAD was defined as a CAD-RADS™ 2.0 category ≥ 4 by CT. Invasive coronary angiography (ICA) served as the reference standard for relevant CAD (≥70% luminal diameter stenosis or fractional flow reserve ≤ 0.80). Pertinent clinical characteristics and imaging criteria of all true-positive (n = 71), false-positive (n = 30), false-negative (n = 4), and true-negative patient-level CT diagnoses (n = 87) for relevant stenosis according to ICA were assessed. Results: In the univariate per-patient analysis, the following parameters yielded discriminative power (p < 0.10) regarding inaccurate CAD assessment by pre-TAVI-CT: age, atrial fibrillation, scanner generation, and image quality. Factors independently associated with CT diagnostic inaccuracy were determined using multivariable logistic regression analysis: a younger age (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.80 to 0.94; p < 0.01) and insufficient CT image quality (OR 0.6; CI 0.41 to 0.89; p < 0.01). Conclusions: Our results demonstrate younger age and poor CT image quality to predict less accurate CAD assessments by pre-TAVI-CT in comparison with ICA. Knowledge of these predictors may aid in more efficient coronary artery interpretations based on pre-TAVI-CT.

Importance:The incidence and burden of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) are not known. Nevertheless, North American guidelines state that it is reasonable to administer 60 days of oral anticoagulation to patients with new-onset AF after CABG, a moderate-strength recommendation (class 2a) based on evidence derived from nonrandomized clinical studies. Objective:To test the hypothesis that the incidence of new-onset AF within the first year after CABG is higher than suggested in the current literature and to assess AF burden. Design, Setting, and Participants:A prospective, multicenter cohort study in 2 academic cardiac surgery centers in Germany that involved 198 patients with 3-vessel coronary artery disease or left main disease and no history of arrhythmias who received an insertable cardiac monitor during CABG for long-term continuous electrocardiographic monitoring. Patients were enrolled from November 2019 through November 2023 and were followed up for 1 year. Exposures:Atrial fibrillation detected within a year of continuous monitoring using insertable cardiac monitors implanted during CABG. Main Outcomes and Measures:Cumulative incidence of new-onset AF within a year of surgery. Secondary outcomes were AF burden and clinical outcomes. Results:A total of 1217 patients were assessed, and 1008 were excluded. Of the 198 patients enrolled (173 male [87.4%]; 25 female [12.6%]; mean age, 66 [SD, 9] years), 95 patients developed new-onset AF within the first year after CABG (cumulative incidence, 48%; 95% CI, 41%-55%). The median AF burden during the first year was 0.07% (IQR, 0.02%-0.23%) or 370 minutes. The median AF burden on days 1 through 7 was 3.65% (IQR, 0.95%-9.09%); on days 8 through 30, 0.04% (IQR, 0%-1.21%); and on days 31 through 365, 0% (IQR, 0%-0.0003%), corresponding to 368, 13, and 0 minutes, respectively. After discharge, 3 patients had an AF episode longer than 24 hours. Conclusions and Relevance:Although the incidence of new-onset AF after CABG in this study was higher than previously reported, the AF burden in these patients was very low, especially after 30 days. The very low AF burden questions the current guideline recommendations that long-term oral anticoagulation should be considered in patients with new-onset AF after CABG.

BACKGROUND:The occurrence and clinical impact of transcatheter heart valve midframe underexpansion following transcatheter aortic valve replacement are not well understood. OBJECTIVES:The aim of this study was to evaluate midframe underexpansion among patients treated with the self-expanding ACURATE neo2 device. METHODS:This retrospective analysis included 604 patients (median age 82 years; Q1-Q3: 78-85 years; 61.4% women) from 2 European high-volume centers. Midframe underexpansion was assessed on postimplantation fluoroscopic images and defined as nonparallelism of commissure posts. The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization at 1 year. RESULTS:Midframe underexpansion was identified in 13.9% of patients (84 of 604) and was associated with higher rates of the primary endpoint (33 of 84 [39.3%; 95% CI: 28.8%-50.5%] vs 54 of 520 [10.4%; 95% CI: 7.9%-13.3%]; P < 0.001) and each of its components. Furthermore, midframe underexpansion was independently associated with 1-year all-cause mortality (adjusted HR: 4.07; 95% CI: 2.26-7.33; P < 0.001). The only independent predictor of midframe underexpansion was the absence of postdilatation (adjusted OR: 5.76; 95% CI: 2.60-12.77; P < 0.001). Postdilatation significantly decreased the rate and extent of midframe underexpansion. CONCLUSIONS:In this European cohort of ACURATE neo2 recipients, midframe underexpansion occurred in a minor proportion and was associated with poorer clinical outcomes through 1 year. Postdilatation effectively reduced the rate and extent of midframe underexpansion.

BACKGROUND:The self-expanding aortic valve prosthesis ACURATE neo2 features an extended external sealing skirt aiming to reduce postprocedural paravalvular leak (PVL). There is limited knowledge if PVL can be further reduced by dedicated implantation techniques. We aim to examine predictors of PVL after implantation of the ACURATE neo2 with focus on implantation technique. METHODS:Patients undergoing ACURATE neo2 transcatheter aortic valve replacement (TAVR) at 3 centers were included in a retrospective registry. Patients were analyzed in 2 groups: PVL none/trace and PVL ≥ mild. RESULTS:A total of 901 patients (mean age 81 ± 6 years, 57 % women) were included. On echocardiography before discharge, PVL was graded as none/trace, mild and moderate in 599 (67 %), 291 (32 %) and 6 (1 %), respectively. Implantation depth (OR 0.93 per mm, 95 % CI 0.88-0.99, p = 0.032) and commissural misalignment (>45°; OR 9.6, 95 % CI 1.9-48.6, p = 0.006) significantly predicted PVL ≥ mild. Other, non-modifiable predictors for PVL included LVOT calcification severity (OR 1.98, 95 % CI 1.24-3.16, p = 0.002), larger sinotubular junction diameter and sinus of valsalva diameter (OR 1.08 per mm, 95 % CI 1.02-1.13, p = 0.004 and OR 1.07 per mm, 95 % CI 1.04-1.12, p = 0.003, respectively). CONCLUSIONS:A high implantation and commissural misalignment were associated with PVL ≥ mild after implantation of the ACURATE neo2. These findings may help to guide implantation technique and further improve clinical outcomes.

INTRODUCTION AND OBJECTIVES:It is unknown whether aortic valve calcium volume, as measured by contrast-enhanced computed tomography angiography (angio-CT), is associated with mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to confirm that contrast-enhanced aortic valve calcium correlates with noncontrast-enhanced calcium score and provides useful prognostic information in patients undergoing TAVI. METHODS:This retrospective observational study included patients from 2 high-volume TAVI centers in Germany, all of whom underwent high-quality angio-CT prior to TAVI. Calcium volume in contrast-enhanced angio-CT was calculated using 3Mensio software (Pie Medical, The Netherlands), while the calcium score from noncontrast-enhanced angio-CT was obtained using the Syngo.via (Siemens Healthineers, Germany) workstation to validate contrast-enhanced angio-CT values. Calcium volume was dichotomized using the median based on to sex-specific values from contrast-enhanced angio-CT, and the risk associated with increased calcium volume was determined using Cox proportional hazard regression analysis. RESULTS:We included 3318 TAVI patients. A good correlation was observed between noncontrast-enhanced and contrast-enhanced angio-CT (r2=0.680; P<.001). The median values for sex-specific contrast-enhanced angio-CT calcium volume were 514 mm3 for women and 1025 mm3 for men. Patients with higher calcium volumes showed lower mortality at 1 year (8.8% vs 12.1%; adjusted HR, 0.86; 95%CI, 0.75-0.98; P=.02) compared with those with lower calcium volumes. CONCLUSIONS:Calcium volume in contrast-enhanced angio-CT correlated well with noncontrast-enhanced angio-CT calcium score. Patients with higher calcium volume showed lower mortality at 1 year after TAVI.

New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased rates of adverse events (including mortality and stroke). Its incidence after coronary artery bypass grafting (CABG) is considered to be approximately 30%, and it is believed to be a transient condition. However, studies investigating POAF after CABG fail to provide appropriate data on incidence and arrhythmia patterns due to the use of intermittent rhythm detection strategies. These methods have a low sensitivity as compared with continuous monitoring. Subsequently, studies using these techniques most likely do not identify all patients with arrhythmia and do not adequately demonstrate the long-term incidence of arrhythmia, which in turn may affect its association with adverse events. The Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns (CABG-AF) study (German Clinical Trials Register Number: DRKS00018887) tests the hypothesis that the incidence of AF in the first 12 months after CABG is significantly underestimated. CABG-AF is an investigator-initiated multicenter, prospective, observational study in which 196 patients with no history of arrhythmia who underwent first-time CABG receive an insertable cardiac monitor for continuous postoperative rhythm monitoring. The primary end point of the study is any episode of AF within the first 12 months after surgery. Secondary end points include AF burden, AF density, and the ratio of silent to symptomatic AF episodes. End points will be investigated by automatic and patient-initiated data transfers from the implanted device, by telephone interview of patients, and by follow-up forms sent to patients by mail. The patients will be followed for a planned follow-up of 3 years. In conclusion, the CABG-AF study will provide information on the true incidence of AF after CABG and on the temporal patterns of the arrhythmia.

BACKGROUND: Vascular access site complications are associated with increased morbidity and mortality after transcatheter aortic valve implantation (TAVI). Current results comparing strategies with plug- (P-VCD; MANTA) and suture-based vascular closure devices (S-VCD; Perclose ProGlide) remain inconsistent. AIMS: It was our aim to assess the incidence of access-related vascular complications after P-VCD or S-VCD strategies after transfemoral TAVI. METHODS: The Plug or sUture based vascuLar cloSurE after TAVI (PULSE) registry retrospectively evaluated 10,120 consecutive patients who had undergone transfemoral TAVI at 10 centres from 2016 to 2021. A propensity score was used to match 900 P-VCD patients with 1,800 S-VCD patients in a 1:2 fashion. The primary outcome measures were major and minor access-related vascular complications at the primary access site, adjudicated according to Valve Academic Research Consortium 3 definitions. RESULTS: The median age was 81.8 years, 46.4% of patients were female, and the median European System for Cardiac Operative Risk Evaluation II was 3.50%. In matched P-VCD and S-VCD groups, large-bore access-related complications occurred in 14.9% vs 10.3% (p<0.001; major: 3.6% vs 4.6%; p=0.218; minor: 11.3% vs 5.8%; p<0.001) of patients. Bleeding accounted for most of these complications (9.6% vs 7.2%; p=0.028) and was treated with endovascular balloon inflation (5.4% vs 2.6%; p<0.001), stent implantation (4.7% vs 0.7%; p<0.001) or surgical repair (0.7% vs 1.7%; p=0.03). CONCLUSIONS: P-VCD were associated with higher rates of primary access-related vascular complications, driven by minor complications, compared to S-VCD. Endovascular treatment was more common after P-VCD failure.

Background:Mitral annular calcification (MAC) is a common finding in the elderly that is associated with worse outcomes. It is postulated that MAC is a different form of atherosclerosis. Epicardial fat tissue (EFT) is in close contact with different heart structures and is especially pronounced in the atrioventricular grooves and the area surrounding the atrioventricular valve apparatus. The amount of EFT is associated with the extent of coronary artery disease, including plaque burden and coronary calcification. The aim of this study was to investigate whether EFT is also associated with the extent of MAC. Methods:In this retrospective analysis of n = 543 (53.6% female) consecutive patients with high-grade aortic stenosis, EFT volume and MAC were assessed in the pre-transcatheter aortic valve implantation computed tomography scans. Patients with no/mild MAC and moderate/severe MAC were compared in terms of EFT volume and baseline, procedural, and postprocedural characteristics. Univariate and multivariable regression analyses were performed with MAC as dependent variable. Results:Over one-quarter (n = 154; 28.4%) of the patients had moderate or severe MAC. The EFT volume between those with moderate/severe MAC and those with little or no MAC did not differ significantly: 130 (interquartile range 94-164) cm3 vs. 133 (interquartile range 95-176) cm3; p = 0.704. Accordingly, EFT volume did not predict increased MAC. Female sex, atrial fibrillation, and prior pacemaker implantation were independent predictors of moderate/severe MAC. Conclusions:Increased EFT is not a predictor of MAC, and thus its unfavorable proinflammatory properties do not seem to play a significant role in the development of MAC.

Background Mid-term comparative data for the self-expanding ACURATE neo2 transcatheter heart valve and the balloon-expandable SAPIEN 3 Ultra are lacking. Objectives The aim of this study was to compare 1-year outcomes after transcatheter aortic valve replacement of these 2 valves. Methods A total of 2,106 patients from 3 centers (neo2, n = 1,166; Ultra, n = 940) undergoing transfemoral transcatheter aortic valve replacement were analyzed retrospectively. The primary endpoint was the composite of all-cause mortality, stroke, and rehospitalization at 1 year. Secondary endpoints were the individual components of the primary endpoint at 1 year. To adjust for baseline differences, nearest neighbor propensity score matching was used. Results After matching (702 pairs), baseline characteristics were similar between groups. Device success was more common in the neo2 group (87.5% vs 82.3%; P = 0.007), irrespective of matching. DP mean after the procedure was higher for Ultra (13 mm Hg [Q1-Q3: 10-15 mm Hg] vs 8 mm Hg [Q1-Q3: 6-11] mm Hg; P < 0.001). Rates of paravalvular leakage, device embolization, and multiple valve implantations were more common in the neo2 arm, whereas major cardiac structural complications and major vascular complications occurred more frequently in the Ultra group. All other in-hospital complication rates were similar between the 2 groups. At 1 year, the cumulative incidence of the primary endpoint (14.1% for neo2 vs 14.5% for Ultra; P = 0.819) was similar between the groups. Likewise, the individual components showed no difference between the groups. Conclusions Despite differing immediate results, the outcomes at 1 year, including the composite of all-cause mortality, stroke, or hospitalization, were similar for neo2 and Ultra transcatheter heart valves.

BACKGROUND:Comparative data on transcatheter self-expanding ACURATE neo2 (NEO2) and balloon-expandable SAPIEN 3 Ultra prostheses in technically challenging anatomy of severe aortic valve calcified aortic annuli are scarce. METHODS:A total of 1987 patients with severe native aortic stenosis treated with the self-expanding NEO2 (n=1457) or balloon-expandable SAPIEN 3 Ultra (n=530) from January 2017 to April 2023 were evaluated. The primary end point was procedural outcome according to the Valve Academic Research Consortium 3 definitions. Propensity matching defined 219 pairs with severe calcification (calcium density cutoff, 758 AU/cm2) of the native aortic valve. RESULTS:Technical success (90.4% versus 91.8%; risk difference, 1.4% [95% CI, -4.4 to -7.2]; P=0.737) and device success at 30 days (80.8% versus 75.8%; risk difference, -5.0% [95% CI, -13.2 to 3.1]; P=0.246) were comparable between NEO2 and SAPIEN 3 Ultra. The rate of severe prosthesis-patient mismatch (1.1% versus 10.1%; risk difference, 10.0% [95% CI, 4.0-13.9]; P<0.001) and mean transvalvular gradient ≥20 mm Hg (2.8% versus 14.3%; risk difference, 11.5% [95% CI, 5.8-17.1]; P<0.001) was lower with NEO2. The rate of more-than-mild paravalvular leakage or valve-in-valve due to paravalvular leakage was significantly higher (6.2% versus 0.0%; risk difference, 6.2% [95% CI, -10.1 to -2.7]; P=0.002), and there was a tendency for a higher rate of device embolization or migration (1.8% versus 0.0%; risk difference, -1.8% [95% CI, -4.1 to 0.4]; P=0.123) with NEO2. Multivarate regression revealed no independent impact of transcatheter heart valve selection on device success (odds ratio, 0.93 [95% CI, 0.48-1.77]; P=0.817). CONCLUSIONS:In patients with severely calcified annuli, supraannular implantation of NEO2 showed hemodynamic advantages. Nevertheless, NEO2 was associated with a higher incidence of relevant paravalvular leakage and a numerically higher rate of device embolization than SAPIEN 3 Ultra in this particular patient group.

BACKGROUND:Challenging anatomies and comorbidities have impact on success in transcatheter aortic valve replacement (TAVR). There is controversy whether the extent of the aortic angle (AA) has an impact on procedural outcomes. Matched comparative outcome data of new generation transcatheter heart valves (THVs) in horizontal aorta (HA) are scarce. METHODS:A total of 1582 patients with severe native aortic stenosis (AS) treated with the SAPIEN3 Ultra (Ultra; n = 526) or ACURATE Neo2 (Neo2; n = 1056) THVs from January 2017 to January 2023 were analyzed. Patients with non-horizontal aortas (AA < 51.7°, n = 841) were excluded. The population was matched by 1-to-1 nearest-neighbor matching (Ultra, n = 246; Neo2, n = 246). Clinical and procedural outcome were evaluated according to VARC-3 recommendations. RESULTS:Technical success (93.1% vs. 94.7%, p = 0.572) was high after Ultra and Neo2. Device success (80.5% vs. 89.8%, p = 0.05) was inferior with Ultra. Neo2 reveals superior hemodynamic properties with lower rate of severe prosthesis patient mismatch (12.0% vs. 3.7%, p = 0.001) and elevated gradients ( ≥ $\ge $ 20 mmHg: 11.9% vs. 1.7%, p < 0.001). Ultra showed a lower rate of relevant paravalvular regurgitation ( > $\gt $ mild paravalvular regurgitation or Valve-in-Valve due to paravalvular regurgitation: 0.0% vs. 3.7%, p = 0.004). The rate of procedural bailout maneuvers (0.8% vs. 0.4%, p = 1.000) and thirty-day all-cause mortality (1.3% vs. 2.2%, p = 0.496) was similar. CONCLUSION:Transfemoral TAVR in patients with severe aortic stenosis and HA, using the balloon expandable Sapien3 Ultra and self-expanding ACURATE Neo2 prosthesis, is feasible and safe. Therefore, valve selection between these platforms should be made irrespective of the aortic angle by a team experienced with both valves based on their specific advantages. Large, randomized trials in this sub-group of patients would be necessary to compare long term outcomes.

BACKGROUND: There is a lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (valve-in-valve [ViV]). AIMS: We sought to compare outcomes of using two self-expanding transcatheter heart valve (THV) systems for ViV. METHODS: In this retrospective multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo 2 (ACURATE group) or the Evolut R/PRO/PRO+ (EVOLUT group). The primary outcome measure was technical success according to Valve Academic Research Consortium (VARC)-3. Secondary outcomes were 30-day all-cause mortality, device success (VARC-3), coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM), and aortic regurgitation (AR) >= moderate. Comparisons were made after 1:1 propensity score matching. RESULTS: The study cohort comprised 835 patients from 20 centres (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs EVOLUT 88.9%; p=0.20) and device success (69.7% vs 73.9%; p=0.36) as well as 30-day mortality (2.8% vs 1.6%; p=0.392) were similar between the two groups. The mean gradients and rates of severe PPM, AR >= moderate, or CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with a true inner diameter (ID) >19 mm, whereas a true ID <= 19 mm was associated with higher device success - but not technical success - among Evolut recipients. CONCLUSIONS: ViV TAVI using either ACURATE or Evolut THVs showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with a true ID <= 19 mm, device success was higher when using Evolut.

Die Genese von Aortenvitien ist überwiegend degenerativ im Sinne einer kalzifizierenden Aortenklappenstenose, was mit einer drastischen Reduktion der Prognose einhergeht. Auch die Prävalenz der Aortenklappeninsuffizienz steigt mit zunehmendem Alter. Bei Aortenvitien im Allgemeinen ist eine zeitgerechte Kausaltherapie wichtig. Nach Indikationsstellung hierfür kommt dem Heart-Team eine zentrale Bedeutung bei der Bewertung der Evaluationsergebnisse sowie bei der den Patientenwunsch berücksichtigenden Therapieentscheidung zu. In der Abwägung der Therapiemöglichkeiten spielen gerade bei jüngeren Patientinnen und Patienten Überlegungen zur langfristigen Perspektive eine entscheidende Rolle. Die mit weitem Abstand häufigste Therapie bei Aortenvitien ist das Einbringen einer Klappenprothese, mittlerweile in der Mehrzahl der Fälle als kathetergestützte Implantation (transkatheter Aortenklappenimplantation [TAVI]) einer biologischen Herzklappenprothese. Der offen-chirurgische Aortenklappenersatz (AKE) wird bei jüngeren Patienten mit niedrigem chirurgischem Risiko favorisiert oder dann, wenn eine minimal-invasive TAVI-Prozedur nicht möglich ist. Bei AKE kommen biologische wie auch die am längsten haltbaren mechanischen Prothesentypen zum Einsatz. Rekonstruktive chirurgische Verfahren kommen im Wesentlichen nur bei der Aortenklappeninsuffizienz zur Anwendung. Insbesondere die TAVI, aber auch die chirurgischen Verfahren zur Behandlung von Aortenvitien haben sich in den vergangenen Jahren stark weiterentwickelt. In Bezug auf die TAVI sind hier unter anderem Indikationserweiterungen zu nennen, auf chirurgischer Seite insbesondere minimal-invasive Operationstechniken.

One of the most devastating complications of transcatheter aortic valve replacement (TAVR) is aortic root injury (ARI). However, existing risk analyses are based on early TAVR practice with first generation devices and different sizing approaches. Here we introduce a revised approach for a more contemporary assessment of the risk of ARI. This includes the adjustment of sizing thresholds, a careful consideration of the entire aortic root anatomy to rule out an incongruently small sinotubular junction (STJ), and customized positioning recommendations according to the underlying risk factors.

The ACURATE neo (NEO) transcatheter heart valve and its successor, the ACURATE neo2 (NEO2), are both characterized by a low risk of coronary obstruction (CO), with rates reported to be ≤0.2% in previous registries. 1 Möllmann H Hengstenberg C Hilker M Kerber S Schäfer U Rudolph T Linke A Franz N Kuntze T Nef H Kappert U Walther T Zembala MO Toggweiler S Kim WK. Real-world experience using the ACURATE neo prosthesis: 30-day outcomes of 1,000 patients enrolled in the SAVI TF registry. EuroIntervention. 2018; 13: e1764-e1770 Crossref PubMed Scopus (92) Google Scholar ,2 Pellegrini C Rheude T Renker M Wolf A Wambach JM Alvarez-Covarrubias HA Dörr O Singh P Charitos E Xhepa E Joner M Kim WK. ACURATE neo2 versus SAPIEN 3 Ultra for transcatheter aortic valve implantation. EuroIntervention. 2023; 18: 987-995 Crossref PubMed Scopus (6) Google Scholar The self-expanding design, with a relatively short main stent frame and an upper crown that captures the native leaflets for coronary ostia clearance, are factors contributing to the low risk of CO. 3 Kim WK Hengstenberg C Hilker M Schäfer U Rudolph TK Toggweiler S Rück A Søndergaard L Conradi L Hamm C Walther T Möllmann H CollaboratorsTranscatheter aortic valve implantation with the ACURATE neo valve: indications, procedural aspects and clinical outcomes. EuroIntervention. 2020; 15: e1571-e1579 Crossref PubMed Scopus (20) Google Scholar Factors predictive of CO were reported to be low coronary ostia height (<10 to 12 mm) and/or sinus of Valsalva (SOV) diameter <28 mm. 4 Ribeiro HB Webb JG Makkar RR Cohen MG Kapadia SR Kodali S Tamburino C Barbanti M Chakravarty T Jilaihawi H Paradis JM de Brito Jr, FS Cánovas SJ Cheema AN de Jaegere PP del Valle R Chiam PT Moreno R Pradas G Ruel M Salgado-Fernández J Sarmento-Leite R Toeg HD Velianou JL Zajarias A Babaliaros V Cura F Dager AE Manoharan G Lerakis S Pichard AD Radhakrishnan S Perin MA Dumont E Larose E Pasian SG Nombela-Franco L Urena M Tuzcu EM Leon MB Amat-Santos IJ Leipsic J Rodés-Cabau J Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol. 2013; 62: 1552-1562 Crossref PubMed Scopus (464) Google Scholar However, these data were derived from transcatheter heart valves other than the ACURATE platform, and a systematic assessment of risk factors including aortic root measurements has not yet been carried out for the ACURATE platform.