Transcatheter aortic valve replacement (TAVR) becomes the leading therapeutic choice for severe aortic stenosis. There is a growing body of knowledge on long-term survival out-comes, but available data from real-world observational studies are scarce. An observational cohort study was conducted on 705 consecutive patients who underwent TAVR at Strasbourg University Hospital between February 2010 and June 2017. We observed the living status (dead or alive) for each study participants by March 2023. The primary end point was to evaluate the all-cause mortality rate beyond 5 years after TAVR, compare the survival outcomes according to valve type, and identify predictors of mortality. Of the 705 study participants, 91.8% of the TAVR procedures were performed through the com-mon femoral artery and 60.6% were treated with a balloon-expandable valve. Over a mean study period of 5.4 +/- 3 years, the all-cause mortality rate was 45.8%. No difference in survival outcomes according to valve type was observed (p = 0.449). All-cause mortality rate was associated with age >= 90 years (hazard ratio [HR] 1.625, 1.109 to 2.380, p = 0.013), female gender (HR 0.228, 0.176 to 0.294, p <0.001), diabetes mellitus (HR 1.356, 1.070 to 1.719, p = 0.012), post-TAVR stroke (HR = 2.867, 1.690 to 4.865, p <0.001), and post-TAVR acute kidney injury (HR 1.977, 1.445 to 2.703, p <0.001). In conclusion, the present real-world large tertiary center experience showed that more than half of patients who underwent TAVR are alive beyond 5 years from procedure's date. All-cause mortality is mainly determined by advanced age and co-morbid conditions, and valve type has no advantage on the survival outcomes. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;207:229-236)

Published data on the size-specific effective orifice area (EOA) of transcatheter heart valves (THVs) remain scarce. Here, we sought to investigate the intra-individual changes in EOA and mean transvalvular aortic gradient (MG) of the Sapien 3 (S3), CoreValve (CV), and Evolut R (EVR) prostheses both at short-term and at 1-year follow-up. The study sample consisted of 260 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI). EOAs and MGs were measured with Doppler echocardiography for the following prostheses: S3 23 mm (n = 74; 28.5%), S3 26 mm (n = 67; 25.8%), S3 29 mm (n = 20; 7.7%), CV 23 mm (n = 2; 0.8%), CV 26 mm (n = 15; 5.8%), CV 29 mm (n = 24; 9.2%), CV 31 mm (n = 9; 3.5%), EVR 26 mm (n = 22; 8.5%), and EVR 29 mm (n = 27; 10.4%). Values were obtained at discharge, 1 month, 6 months, and 1 year from implantation. At discharge, EOAs were larger and MGs lower for larger-size prostheses, regardless of being balloon-expandable or self-expandable. In patients with small aortic annulus size, the hemodynamic performances of CV and EVR prostheses were superior to those of S3. However, we did not observe significant differences in terms of all-cause mortality according to THV type or size. Both balloon-expandable and self-expandable new-generation THVs show excellent hemodynamic performances without evidence of very early valve degeneration.

BACKGROUNDNew-onset conduction abnormalities (CAs) following transcatheter aortic valve replacement (TAVR) are associated with hospital rehospitalization and long-term mortality, but available predictors are sparse. This study sought to determine clinical predictors of new-onset left bundle branch block (LBBB) and new permanent pacemaker (PPM) implantation in patients undergoing TAVR.Methods and Results:We enrolled 290 patients who received SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA; n=217) or Evolut R (Medtronic, Minneapolis, MN, USA; n=73) from a prospective registry at Nouvel Hôpital Civil, Strasbourg, France between September 2014 and February 2018. Of 242 patients without pre-existing LBBB, 114 (47%) experienced new-onset LBBB and/or new PPM implantation. A difference between membranous septal length and implantation depth (∆MSID) was the only predictor of CAs for both types of valves. In the multivariate analysis, PR interval and ∆MSID remained as sole predictors of CAs. The risk for adverse clinical events, including all-cause death, myocardial infarction, stroke, and heart failure hospitalization, was higher for patients with CAs as compared with patients without CAs (hazard ratio: 2.10; 95% confidence interval: 1.26 to 3.57; P=0.004).CONCLUSIONSComputed tomography assessment of membranous septal anatomy and implantation depth predicted CAs after TAVR with new-generation valves. Future studies are required to identify whether adjustment of the implantation depth can reduce the risk of CAs and adverse clinical outcomes.

fragmented QRS complex (fQRS) is a marker of myocardial scarring and has prognostic significance. ST-segment resolution (STR) in STsegment elevation acute myocardial infarction (STEMI) is characteristic of tissue reperfusion. This study investigates the relationship between fQRS and STR in STEMI patients undergoing primary percutaneous coronary intervention (PCI) and determines the predictors of fQRS. we analyzed the electrocardiograms (ECGs) of 256 patients included in a multicenter prospective STEMI-PCI study. fQRS and STsegment resolution were evaluated upon arrival in the ambulance (ECG-amb) and 1 h post-PCI (ECG-post). Major clinical cardiac events were assessed at 30 days and 6 months. fQRS was present in 33 patients (13.6%) on ECG-amb and in 30 patients (12%) on ECG-post. The presence of fQRS at either time was not associated with STR or clinical outcomes. In a multivariable analysis, the independent predictors of fQRS on ECG-amb were female sex (p=0.04), cardiac troponin Ic level at 72 h (p=0.01), TIMI 0-1 flow rate pre-PCI (p=0.002), and inferior STEMI location (p=0.04). Patients with fQRS on ECG-amb presented a larger necrosed mass on cardiac MRI than patients without fQRS (p=0.04). No predictors of fQRS post-PCI were identified. the presence of fQRS at the time of presentation or 1 h after PCI was not associated with STR. However, fQRS was related to enzymatic infarct size, inferior STEMI location, and low TIMI flow rate.

Conclusions: TLR rate at the LCx-ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting.The former also seems to be associated with high TLR at the LAD-ostium.It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.

Cardiac magnetic resonance imaging (MRI) is the gold standard to quantify the infarct size and the extend of microvascular obstruction in ST-elevation myocardial infarction (STEMI). ST-segment resolution (STR) after primary percutaneous intervention (PCI) is currently used to assess the reperfusion quality in the acute phase myocardial infarction. The relation between STR and microvascular obstruction evaluated by MRI is unknown. The aim of this study was to determine the relationship between the ST-segment resolution, the infarct size and the extend of microvascular obstruction. 41 patients undergoing primary PCI for STEMI within 6 hours of symptom onset were prospectively included. ST-segment resolution was evaluated one hour after reperfusion. MRI was performed in all patients. Complete STR was defined as a STR>70%. Mean age of the patients was 54 ± 12 yo, 85 waer males. The percent of infarct size was 18,6 ±16% of the left ventricular volume. Microvascular obstruction was present in 68% of patients. Mean STR was 59 ± 39% and 14 patients (34%) presented complete STR. A large infarct size (> 75th percentile) was associated with anterior localisation and left descending artery obstruction. STR significantly correlated with infarct size measured by MRI (r=-0,38 p=0,026). Incomplete STR (<70%) predicted large infarct size with a sensitivity of 78%, a specificity of 42% and high degree of microvascular obstruction with sensitivity of 80% and specificity of 45%. STR one hour after primary PCI is associated with the level of infarct size and microvascular obstruction in STEMI patients. Incomplete STR after PCI is a strong prognostic marker of large infarct size and high degree of micro vascular obstruction.