AbstractBackgroundTranscatheter aortic valve implantation (TAVI) procedures to treat severe aortic stenosis are rising, in line with aging populations and advancements in healthcare access. Economic development correlates with AS mortality rates. Socio-economic status (SES), defined by social and economic factors such as median household income, significantly influences cardiovascular outcomes. This study analyses the impact of SES on TAVI outcomes.MethodsFollowing PRISMA guidelines, a comprehensive search was conducted across PubMed, Medline, Embase, Cochrane,ClinicalTrials.govand Google Scholar, including literature up to August 1, 2024. The search employed keywords related to SES and TAVI. Of 393 identified studies, 127 were selected for full-text review, with ten addressing SES effects post-TAVI. Most studies had a retrospective design.ResultsThe patient cohort comprised 319,557 individuals, (144,583 from low SES backgrounds and 174,974 from high SES backgrounds). The analysis revealed a higher burden of comorbidities in low SES patients. Post-TAVI, lower SES related to increased 30-day mortality, major adverse cardiovascular events and the need for pacemaker implantation, although it did not affect in-hospital mortality or 30-day readmission rates.ConclusionThese findings underscore the substantial socio-economic disparities in TAVI outcomes and highlight the need for specific interventions to improve care for patients from less advantaged backgrounds.Key Learning PointsA.What is already knownLower SES negatively impacts cardiovascular outcomes due to disparities in healthcare access and comorbidities.TAVI is the standard treatment for severe aortic stenosis, especially in elderly patients.SES influences outcomes in cardiovascular procedures, but its impact on TAVI was unclear.B.What this study addsLow SES increases 30-day mortality, MACE, and pacemaker implantation rates after TAVI.SES does not affect in-hospital mortality or 30-day readmissions.Highlights the need for standardized SES metrics in TAVI research.

We report the case of an 85-year-old female with severe aortic stenosis, who was transferred to our centre for transcatheter aortic valve replacement (TAVR) after presenting to her local hospital in acute pulmonary oedema. Computed tomography (CT) demonstrated anomalous coronary arteries, with both the right coronary artery (RCA) and left coronary artery (LCA) arising from the right coronary cusp (RCC). The coronary heights were low for both the RCA and LCA and the simulated valve to coronary (VTC) distances narrow, suggesting high risk of coronary obstruction following TAVR. Further complicating factors were an effaced aortic root, and the presence of a previous mechanical mitral valve 6 mm below the level of the aortic annular plane. In this case we discuss the pre-procedural planning considerations and procedural steps, in this case double chimney stenting from the same aortic cusp, to successfully navigate this unusual and high-risk anatomy.

ABSTRACTBackgroundLimited data exist on the impact of polyvascular disease (PolyVD) on clinical outcomes in female patients undergoing transcatheter aortic valve replacement (TAVR). We therefore sought to investigate clinical outcomes in women with versus without PolyVD undergoing TAVR.MethodsFemale participants from the multicentre Women's International Transcatheter Aortic Valve Implantation (WIN‐TAVI) registry were categorized based on the presence or absence of PolyVD. The PolyVD population was defined as the presence of atherosclerotic disease affecting ≥ 2 arterial systems from coronary, cerebral, or lower limb peripheral vessels, whilst patients with either no atherosclerosis or atherosclerotic disease in one vascular system were included in the non‐PolyVD population. The primary endpoint was the Valve Academic Research Consortium‐2 consensus (VARC‐2) efficacy endpoint at 1 year, whilst secondary endpoints included VARC‐2 safety events, VARC‐2 major bleeding and major vascular complications. Cox regression analysis were computed adjusting for various cofounders.ResultsAmong 996 participants, 543 (54.5%) had PolyVD, while 453 (45.5%) did not. Across the subgroups no differences in age was noted, whilst patients with PolyVD were more likely to have a history of hypercholesterolemia and a previous cardiac surgery. The incidence of the primary endpoint was higher in the PolyVD group (19.4%) compared to the non‐PolyVD group (13.3%, plog‐rank = 0.014), though the difference was attenuated after multivariable adjustments (p = 0.093). Of note, no statistically significant differences concerning incident VARC‐2 safety events, VARC‐2 major bleeding and major vascular complications were noted according to PolyVD status.ConclusionPolyVD is a common comorbidity and is associated with elevated rates of adverse clinical events, but no increase in safety events, vascular complications, or bleeding among women undergoing TAVR.

Aims:Health systems face increasing waiting times for transcatheter aortic valve implantation (TAVI), incurring excess deaths and morbidity. To determine whether remote patient monitoring (RPM) using connected technologies can mitigate these risks by prioritizing patients awaiting TAVI, we aimed to measure the clinical safety and effectiveness of an RPM-based prioritization programme. Methods and results:Prospective observational cohort study of all patients awaiting TAVI at Imperial College Healthcare NHS Trust, London, UK, between 24th April 2023 and 15th November 2023. An RPM pathway was implemented for all patients accepted for TAVI. These patients responded to a weekly symptom questionnaire via web, smartphone RPM platform or telephone monitoring; with rule-based clinical escalation. The primary endpoint was the rate of adverse events (defined as emergency department presentation, unplanned hospitalization, or death), compared with a propensity score-matched (PSM) historical control group. Secondary endpoints included pathway performance characteristics for detection of deterioration. 200 patients met inclusion criteria. Despite growth of the waiting list, responsible for longer waiting times experienced by the RPM group [median 104 days (IQR 61.00-176.00) vs. 75 days (IQR 38.75-118.00)], there was no difference in rates of adverse events between RPM-patients and historical controls (Log rank P = 0.9). The RPM pathway had high sensitivity for prediction of waiting list death (100%). Patients deemed at high-risk of deterioration experienced shorter waiting times to treatment. Conclusion:RPM for patients awaiting TAVI is feasible and may mitigate the adverse effects of longer waiting times through accurate detection of deterioration and by informing prioritization decisions.

Background: The coronary sinus reducer (CSR) has placebo-controlled evidence of angina benefit from two randomised placebo-controlled trials. The characteristics of patients with most to gain from this therapy remain unknown. Research Question: What is the relationship between endocardial to epicardial blood flow ratio at stress and the placebo-controlled angina response to the CSR? Methods: The Coronary Sinus Reducer Objective Impact on Symptoms, MRI Ischaemia and Microvascular Resistance (ORBITA-COSMIC) trial was a randomised, double-blind, placebo-controlled trial of the CSR in patients with angina on the maximum tolerated antianginal medication, myocardial ischaemia, epicardial coronary artery disease and no further options for revascularisation. Patients underwent a quantitative adenosine-stress perfusion cardiac magnetic resonance (CMR) scan and started daily angina reporting on a smartphone application (ORBITA-app) on enrolment to the trial. At the enrolment CMR, myocardial blood flow (MBF) in all 16 myocardial segments was quantified using an automated perfusion quantification sequence, with further stratification into endocardial and epicardial layers. Patients were randomised in the cardiac catheterisation laboratory to CSR or placebo and entered a 6-month period of blinded follow-up prior to a repeat stress CMR and scheduled unblinding. Results: Enrolment quantified perfusion CMR data were available for 48/51 (94.1%) patients randomised in ORBITA-COSMIC, 22 CSR and 26 placebo (median age 67 (IQR 60 to 73), 42/48 (87.5%) male). The median endocardial to epicardial perfusion ratio (EN:EP) of stress MBF in ischaemic myocardial segments was 0.76 (IQR 0.72 to 0.87). The lower the EN:EP stress MBF, the greater the placebo-controlled improvement with CSR. There was strong evidence that a patient with EN:EP stress MBF in the lower quartile at baseline would have greater placebo-controlled benefit in angina episodes with the CSR than a patient in the upper quartile (EN:EP stress MBF 0.72 versus 0.87, OR 1.26, 95% CrI 1.13 to 1.41, probability of interaction>99.9%). Conclusion: EN:EP stress MBF is the first biological variable which has been shown to predict placebo-controlled benefit with the CSR. This may have a role in the selection of patients for treatment.

Limited evidence exists concerning the prognostic impact of baseline left ventricular ejection fraction (LVEF) on outcomes among women undergoing transcatheter aortic valve implantation (TAVI), which we aimed to investigate in the present analysis. Patients from the Women's International Transcatheter Aortic Valve Implantation (WIN-TAVI) registry were categorized according to baseline LVEF into 3 groups: reduced (LVEF <= 40%), mildly reduced (LVEF between 41% and 49%), and preserved (LVEF >= 50%) LVEF. The primary (Valve Academic Research Consortium 2 [VARC-2]) efficacy point was defined as a composite of mortality, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure, or valve-related dysfunction at 1 year. The primary (VARC-2) safety end point included all-cause mortality, stroke, major vascular complication, life-threatening bleeding, stage 2 to 3 acute kidney injury, coronary artery obstruction requiring intervention, or valve-related dysfunction requiring repeated procedures. A Cox regression model was performed using the preserved LVEF group as the reference. Among the 944 patients included, 764 (80.9%) exhibited preserved, 80 (8.5%) had mildly reduced, and 100 (10.6%) had reduced LVEF. The 1-year incidence of VARC-2 efficacy end point was numerically higher in patients with reduced LVEF, albeit not resulting in a significant risk difference. Notably, reduced LVEF was associated with a higher risk of the 1-year VARC-2 safety end point, still significant after adjustment (28.0% vs 19.6%, Hazard Ratio 1.78, 95% Confidence Interval 1.12- 2.82, p = 0.014). These differences were primarily driven by trends toward increased rates of all-cause mortality, cardiovascular mortality, and major vascular complications. Clinical outcomes were similar between patients with mildly reduced and preserved LVEF. In conclusion, when performed in women with reduced LVEF, TAVI was associated with a worse (VARC-2) safety profile at 1-year follow-up. In contrast, patients with mildly reduced LVEF appeared to align more closely with outcomes observed in the preserved LVEF group than with the reduced LVEF group. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND AND AIMS:Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities requiring further investigation to assess prognosis and guide treatment. We evaluated current diagnostic practices across European academic centres in its diagnosis and management, to focus on current gaps in clinical practice. METHODS:Between June and October 2023, we distributed an electronic survey to 42 centres selected from a 2023 list of European Association of Percutaneous Cardiovascular Interventions Hosting Academic Centres, obtaining information on demographics of MINOCA, perceived clinical impact, testing and treatments. RESULTS:The analysis was based on data from 41 centres. According to the survey, MINOCA accounts for approximately 10% of MI cases. Only 38% of the respondents perceived MINOCA as increasing the risk for future major adverse cardiovascular events. Sixty-three percent of centres agreed on the need for further testing after MINOCA diagnosis, and 22% reported proceeding with a comprehensive diagnostic algorithm. Intravascular (51%) and cardiac magnetic resonance imaging (50%) were the most common diagnostic tools used. Coronary plaque disruption was perceived as the most frequent cause based on respondents' opinions. Sixty-nine percent of centres considered 'empiric' therapy acceptable without functional testing. CONCLUSIONS:This survey revealed a significant heterogeneity in the diagnostic approaches to MINOCA in academic European centres, with variable belief of its clinical impact, wide variation in diagnostic algorithms, noteworthy diagnostic inertia, and poor adherence to guideline recommendations. All these point to a pressing need for a unified approach to MINOCA testing and a much closer alignment to guidelines.

Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for severe aortic stenosis across the spectrum of surgical risk cohorts. Subsequently, the dramatic increase in procedural volume worldwide has placed significant financial and logistical pressures on healthcare institutions, particularly regarding hospital length of stay (LOS), which can adversely affect patient flow. In this review article, we discuss different peri-procedural strategies developed to reduce LOS and facilitate early discharge after TAVI.

Background: Frailty has been shown to significantly affect outcomes after transcatheter aortic valve replacement (TAVR). The impact of pre-frailty on TAVR outcomes in women is still unclear. Aim: To assess the impact of pre-frailty and frailty on outcomes in women enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN-TAVI) registry. Materials and methods: WIN-TAVI was a multinational, prospective, observational registry, which enrolled women at intermediate or high preoperative risk undergoing TAVR. Patients included in this registry were divided into three groups, based on the number of fulfilled Fried frailty criteria: non-frail (no criteria, reference group), pre-frail (1-2 criteria) and frail (≥3 criteria). The primary outcome was the Valve Academic Research Consortium (VARC)-2 efficacy endpoint at 1-year after TAVR. The key secondary outcome was VARC-2 safety endpoint. Results: Out of 1,019 patients, 264 (25.9%) were pre-frail and 33 (3.2%) frail. The risk of VARC-2 efficacy endpoint at 1-year was increased in pre-frail (19.7%, HR 1.36, 95% CI 0.98-1.89) and frail (24.2%, HR 1.74, 95% CI 0.85-3.57) as compared to non-frail patients (14.9%, reference group), although it didn’t reach statistical significance. The risk of VARC-2 safety endpoint was significantly higher in pre-frail (25.8%, HR 1.43, 95% CI 1.07-1.91) and frail (42.4%, HR 2.77, 95% CI 1.60-4.80) than in non-frail subjects (19%, reference group); this difference was driven by an excess of major vascular complications and life-threatening or major bleeding in the pre-frail and frail group. In addition, in pre-frail patients hospitalizations for heart failure or valve-related symptoms at 1-year were higher than in non-frail patients. Conclusion: In women at intermediate or high preoperative risk undergoing TAVR, pre-frailty and frailty increased the risk of safety endpoints such as vascular complications and major bleeding.

Abstract Background The expansion in indications for transcatheter aortic valve implantation (TAVI) has fuelled an increase in demand worldwide. Prolonged waiting lists and waiting list mortalities are not infrequent and often arise from limited hospital capacity and infrastructure. Approaches to address this have included procedural modifications – ‘minimalist TAVI’ and more recently the development of pathways to facilitate early discharge post-TAVI, such as same-day discharge (SDD) post-procedure. Purpose This study aims to evaluate the safety and effectiveness of a novel SDD pathway a large volume tertiary referral cardiac centre. Methods A new SDD pathway was established between March 2023 and February 2024 at a large-volume tertiary cardiac centre in UK. All patients accepted for TAVI were screened for SDD suitability based on three factors: 1) availability of adequate social support, (defined as presence of able-bodies adult individual to assist in home recovery), 2) technically suitable for transfemoral approach and 3) presence of previous pacemaker or low risk for conduction abnormalities (defined as no baseline conduction disturbances). Following TAVI, patients were deemed suitable for SDD if they were clinically stable, the procedure was technically successful and there were no procedural complications. Demographic, clinical, procedural and outcome data were collected for all patients enrolled onto the SDD pathway and reasons for non-SDD were identified. Ethical approval was obtained in accordance with local institutional policies. Results From March 2023 to February 2024, 81 out of 305 patients (26.6%) were enrolled onto the SDD pathway (median age 82 years old, 66.7% male, median STS risk score 2.34%). Indications for TAVI were severe native aortic stenosis (74/81, 91.4%), severe native aortic regurgitation (2/81, 2.5%) and severe surgical valve degeneration (5/81, 6.2%). SDD was feasible for 58/81 (71.6%) of patients, with 10/81 (12.3%) discharged the following day and 13/81 (16.0%%) requiring >24 hours hospital admission (Figure 1). Reasons for non-SDD included new conduction abnormality (10/81, 12.3%), vascular complication (6/81, 7.4%), acute stroke (3/81, 3.7%), patient preference (2/81, 2.5%) and haemodynamic instability (2/81, 2.5%). Out of the 58 SDD patients, 25/58 (43.1%) had no previous permanent pacemaker system and in these patients a balloon-expandable valve was selected for 24/25 (96.0%) of patients (Figure 2). Conclusions Patient selection based on the presence of social support at home, low risk of conduction abnormalities or previous pacemaker combined with appropriate valve selection can facilitate a safe and effective SDD post-TAVI programme.

Background The coronary sinus reducer (CSR) is proposed to reduce angina in patients with stable coronary artery disease by improving myocardial perfusion. We aimed to measure its efficacy, compared with placebo, on myocardial ischaemia reduction and symptom improvement. Methods ORBITA-COSMIC was a double-blind, randomised, placebo-controlled trial conducted at six UK hospitals. Patients aged 18 years or older with angina, stable coronary artery disease, ischaemia, and no further options for treatment were eligible. All patients completed a quantitative adenosine-stress perfusion cardiac magnetic resonance scan, symptom and quality-of-life questionnaires, and a treadmill exercise test before entering a 2-week symptom assessment phase, in which patients reported their angina symptoms using a smartphone application (ORBITA-app). Patients were randomly assigned (1:1) to receive either CSR or placebo. Both participants and investigators were masked to study assignment. After the CSR implantation or placebo procedure, patients entered a 6-month blinded follow-up phase in which they reported their daily symptoms in the ORBITA-app. At 6 months, all assessments were repeated. The primary outcome was myocardial blood flow in segments designated ischaemic at enrolment during the adenosine-stress perfusion cardiac magnetic resonance scan. The primary symptom outcome was the number of daily angina episodes. Analysis was done by intention-to-treat and followed Bayesian methodology. The study is registered with ClinicalTrials.gov, NCT04892537, and completed. Findings Between May 26, 2021, and June 28, 2023, 61 patients were enrolled, of whom 51 (44 [86%] male; seven [14%] female) were randomly assigned to either the CSR group (n=25) or the placebo group (n=26). Of these, 50 patients were included in the intention-to-treat analysis (24 in the CSR group and 26 in the placebo group). 454 (57%) of 800 imaged cardiac segments were ischaemic at enrolment, with a median stress myocardial blood flow of 108 mL/min per g (IQR 077-141). Myocardial blood flow in ischaemic segments did not improve with CSR compared with placebo (difference 006 mL/min per g [95% CrI -009 to 020]; Pr(Benefit)=788%). The number of daily angina episodes was reduced with CSR compared with placebo (OR 140 [95% CrI 108 to 183]; Pr(Benefit)=994%). There were two CSR embolisation events in the CSR group, and no acute coronary syndrome events or deaths in either group. Interpretation ORBITA-COSMIC found no evidence that the CSR improved transmural myocardial perfusion, but the CSR did improve angina compared with placebo. These findings provide evidence for the use of CSR as a further antianginal option for patients with stable coronary artery disease. Funding Medical Research Council, Imperial College Healthcare Charity, National Institute for Health and Care Research Imperial Biomedical Research Centre, St Mary's Coronary Flow Trust, British Heart Foundation. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Background/Objectives: Acute ischemic stroke is an uncommon but potentially devastating complication of Transcatheter Aortic Valve Implantation (TAVI). Despite improvements in device technology and procedural techniques, stroke rates have remained stable, with cerebral embolic protection devices demonstrating only limited efficacy to date. Therefore, the management of acute ischemic stroke complicating TAVI (AISCT) remains a key priority. We conducted a systematic review of the management of AISCT and provided multidisciplinary consensus recommendations for optimal management. Methods: PubMed, Google Scholar, and Cochrane databases were searched from inception to October 2023. All the original studies focusing on the treatment of AISCT were included. Non-English language studies, review articles, and studies in pediatric populations were excluded. Consensus recommendations were made by a working group comprising experts in stroke medicine and structural interventional cardiology. Results: A total of 18 studies met the inclusion criteria, including 14 case reports/series and 4 observational studies. No clinical trials were identified. The included case reports and series suggest that tissue-type plasminogen activator (tPA) and mechanical thrombectomy (MT) might be effective strategies for managing AISCT. However, significant bleeding complications were reported in two out of the four patients receiving tPA. Four observational studies also suggest an association between tPA and/or MT and improved functional outcomes and survival compared to conservative management. Higher bleeding rates were reported following tPA. Observational data suggest that there is currently little real-world utilization of either reperfusion strategy. Conclusions: There is an absence of high-quality randomized data to guide clinical decision making in this important area. Observational data suggest reperfusion strategies are associated with improved clinical outcomes once important confounders such as stroke severity have been accounted for. While MT can be recommended as the standard of care in appropriately selected patients, significantly increased rates of bleeding with tPA following large-bore arterial access raise important safety concerns. We present simple clinical guidance for AISCT based on the limited available data. Close multidisciplinary work and patient-specific consideration of ischemic and bleeding risk is essential.

Introduction Patients with isolated tricuspid valve (ITV) disease have a poor prognosis with no consensus on their management. Transcatheter ITV intervention is emerging as a valid option in patients with prohibitive surgical risk. We aimed to analyse the characteristics and clinical outcomes of patients who underwent ITV surgery to inform the clinical decision making in patients undergoing transcatheter ITV intervention and to advance the development of future technologies. Methods Digital databases were searched from inception through to 2022 for studies reporting clinical outcomes on ITV surgeries, namely ITV repair, ITV replacement with a bioprosthetic valve (ITVR-B), or ITV replacement with a mechanical valve (ITVR-M). Overall estimates of treatment effect were calculated with a random-effects model. Results Twenty-seven studies involving 10,478 patients (4,931 ITV repair, 3,821 ITVR-B, 1,713 ITVR-M) were included. Overall, early mortality occurred in 9.0% of patients and did not differ between different ITV surgical approaches. Late mortality was 27.1% at a median follow-up of 3.9 (3.0-6.0) years and was significantly higher for all ITV replacement surgeries (30.2% vs. 24.7%, RR 1.18, 95% CI 1.05-1.31, P=0.004) compared to ITV repair. Late mortality did not differ between ITVR-B and ITVR-M. Early and late clinical outcomes after ITV surgery differed according to the surgery performed. Compared to all ITV replacement surgeries and despite its favourable late mortality outcomes, ITV repair was observed to have a relatively higher risk of cerebrovascular accidents or need for permanent pacemaker implantation in the post-operative period, as well as TV regurgitation recurrence after 1 year. Conclusions Amongst ITV surgeries, ITV repair has favourable long-term mortality compared to ITV replacements. This supports the development and refinement of transcatheter ITV repair approaches in suitable patients. PROSPERO ID: CRD42022371646. Conflict of Interest None

Background: For women undergoing drug-eluting stent (DES) implantation, the individual and combined impact of chronic kidney disease (CKD) and diabetes mellitus (DM) on outcomes is uncertain.Aims: We sought to assess the impact of CKD and DM on prognosis in women after DES implantation.Methods: We pooled patient-level data on women from 26 randomised controlled trials comparing stent types. Women receiving DES were stratified into 4 groups based on CKD (defined as creatine clearance <60 mL/min) and DM status. The primary outcome at 3 years after percutaneous coronary intervention was the composite of all-cause death or myocardial infarction (MI); secondary outcomes included cardiac death, stent thrombosis and target lesion revascularisation.Results: Among 4,269 women, 1,822 (42.7%) had no CKD/DM, 978 (22.9%) had CKD alone, 981 (23.0%) had DM alone, and 488 (11.4%) had both conditions. The risk of all-cause death or MI was not increased in women with CKD alone (adjusted hazard ratio [adj. HR] 1.19, 95% confidence interval [CI]: 0.88-1.61) nor DM alone (adj. HR 1.27, 95% CI: 0.94-1.70), but was significantly higher in women with both conditions (adj. HR 2.64, 95% CI: 1.95-3.56; interaction p-value <0.001). CKD and DM in combination were associated with an increased risk of all secondary outcomes, whereas alone, each condition was only associated with all-cause death and cardiac death.Conclusions: Among women receiving DES, the combined presence of CKD and DM was associated with a higher risk of the composite of death or MI and of any secondary outcome, whereas alone, each condition was associated with an increase in all-cause and cardiac death.

Patients with isolated tricuspid valve (TV) disease have poor prognosis with no consensus on their management. Transcatheter TV intervention is emerging as a valid option in patients with prohibitive surgical risk. We analyzed studies of patients who underwent isolated TV surgery to identify the features associated with successful clinical outcomes. We performed a systematic review and meta-analysis of studies reporting clinical outcomes of isolated surgical TV intervention, namely TV repair, TV replacement with a bioprosthetic valve (TVR-B), or TV replacement with a mechanical valve (TVR-M). Twenty-seven studies involving 10,478 patients (4,931 TV repair, 3,821 TVR-B, and 1,713 TVR-M) were included. Early mortality occurred in 9% and did not differ between TV surgical approaches. Late mortality was 27% at a median follow-up of 4 (3 to 6) years and was significantly higher for all-TVR (30% vs 25%, rate ratio 1.18, 95% confidence interval 1.05 to 1.31, p = 0.004) and TVR-B (28% vs 24%, rate ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02) compared with TV repair. Late mortality did not differ between TVR-B and TVR-M. Across all studies, early complications included bleeding (7.4%), acute kidney injury (18.7%), permanent pacemaker (13.7%), cerebrovascular accidents (1.2%), and infection (8.9%). Late clinical outcomes included reintervention (3.7%), structural valve deterioration (2.4%), valve thrombosis (2.6%), and TV regurgitation recurrence after 1 year (15.0%). In conclusion, in isolated TV surgeries, TV repair has favorable long-term mortality compared with TV replacement. This supports the development and refinement of transcatheter TV repair approaches. Future research is recommended to provide comparative data for various transcatheter TV interventions. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;203:414-426)

Early menopause is associated with an increased risk of cardiovascular diseases, including aortic stenosis (AS). We sought to investigate the prevalence and impact of early menopause on clinical outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) for severe symptomatic AS. Women's International TAVI is a multinational, pro-spective, observational registry of women who underwent TAVI for severe symptomatic AS (n = 1,019). Patients were divided into 2 groups based on age of menopause: early meno-pause (age <= 45 years) and regular menopause (age >45 years). The primary outcome of interest was Valve Academic Research Consortium 2 efficacy end point, a composite of mor-tality, stroke, myocardial infarction, hospitalization for valve-related symptoms, or heart failure or valve-related dysfunction at 1-year follow-up. Of 732 patients with available data on menopause age, 173 (23.6%) were classified as having early menopause. These patients presented for TAVI at a younger age (81.6 +/- 6.9 vs 82.7 +/- 5.9, p = 0.05) and had a signifi-cantly lower Society of Thoracic Surgeons score (6.6 +/- 4.8 vs 8.2 +/- 7.1, p = 0.03) than those with regular menopause. However, the total valve calcium volume was smaller among patients with early versus regular menopause (731.8 +/- 850.9 mm3 vs 807.6 +/- 633.8 mm3, p = 0.002). Other co-morbidities were similar between the 2 groups. At 1-year follow-up, there were no significant differences in clinical outcomes between patients with early versus regular menopause (hazard ratio 1.00, 95% confidence interval 0.61 to 1.63, p = 1.00). In conclusion, despite presenting for TAVI at a younger age, patients with early menopause had a similar risk of adverse events as patients with regular menopause at 1 year after TAVI. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;192:221-227)