A better understanding of dynamic behaviour of transcatheter tricuspid valve therapies in an ex-vivo bench model can significantly help to improve the current treatments and reduce risks to the patients in pre-clinical trials. To create pulse duplicator that simulates the right heart pressure waveforms, in order to investigate the dynamic behaviours of transcatheter tricuspid valve therapies prior to preclinical trials. A double-side piston-cylinder mechanism has been designed. The pistons are driven by a crank mechanism to move simultaneously in same directions. A connector is installed between two cylinders and an artificial tricuspid valve is placed in the middle. Two one-way holes are placed on each side of the tricuspid valve, one side is 'in' only and the other one is 'out' only. Two holes are connected by a U-shape tube. All parts are connected to an intact cycling system, then filling the combined cylinders and tube with water. The pump was able to provide a pulse wave from 0 mmHg to 40 mmHg over two seconds. The pump was able to be reversed and the pressure wave form reduced from 40 mmHg to 0 mmHg. We have successfully developed and tested an ex-vivo right heart simulator, pulse duplicator, bench model for transcatheter tricuspid valve device testing We plan to utilise this to build a foundation for development of the devices of other heart valves investigations.

Current transcatheter therapies for tricuspid regurgitation have limited efficacy and utility. To evaluate the haemodynamic performance of OriValve in an ex-vivo right heart bench model with simulated severe tricuspid regurgitation. A right heart bench model was developed using standard cardiac sheaths for inflow/outflow pressure transducers and PVC conduits with pressure valves for cardiac chambers. A defective tricuspid valve was mounted between an atrial and ventricular chamber. Right ventricular systole was simulated by injecting 100 mL of normal saline over two seconds. With no device inserted, the mean peak V-wave pressure recorded in the atrial chamber was 48±5 mmHg. With OriValve deployed across the defect, the mean peak V-wave pressure recorded in the atrial chamber was 16±2 mmHg. Forward flow pressure waveform through the valve was similar to that seen with no device with peak v-wave in the ventricle at 38±4 mmHg. This study demonstrates the efficacy of OriValve in a bench model with greater than 60% reduction in peak-to-peak V wave pressure. Furthermore, there was preservation of forward flow through the valve with no significant gradient. Further testing is required in ISO standardised heart valve testing systems. OriValve has demonstrated significant reduction in tricuspid regurgitation in an ex-vivo right heart bench model.

A better understanding of dynamic behaviour of transcatheter tricuspid valve therapies in an ex-vivo bench model can significantly help to improve the current treatments and reduce risks to the patients in pre-clinical trials. To recreate physiologic pressure waveforms in a bench right heart simulator for (a) normal tricuspid physiology (b) severe tricuspid regurgitation. Standard transcatheter sheaths used as atrial/ventricular inflow/pressure transducers. PVC conduits used as atrial and ventricular chambers. An electric pump was connected to both conduits to create pulsatile flow. Plastic bands of variable thickness were placed at open ports in both chambers to recreate afterload pressure gradients. A scalpel was used to induce abnormal leaflet coaptation seen in primary/secondary tricuspid regurgitation. With bands with resistance forces 4.4 N and 13.3 N (atrial and ventricular, respectively), and inflow of 100 mL over two seconds, most accurately recreated normal tricuspid physiology baseline pressure is 5 mmHg. The peak normal pressure is 6 mmHg and the severe tricuspid regurgitation pressures is 25 mmHg. A right heart simulator was created and successfully reproduced right atrial pressure waveforms seen in a normal and abnormally functioning tricuspid valve.

Heart block necessitating pacemaker is a known complication of transcatheter aortic valve replacement (TAVR).

Paravalvular leak and vascular injury are known complications of transcatheter aortic valve replacement (TAVR).

Artificial intelligence (AI) is an overarching term that encompasses a set of computational approaches that are trained through generalised learning to autonomously execute specific tasks. AI is a rapidly expanding field in medicine. In particular cardiology, with its high reliance on numerical patient data in decision making, has great potential to benefit from AI. Types of AI, including neural networks and computer vision, can dramatically change the day-to-day workflow of cardiologists, primarily through integration in diagnostic imaging modalities, periprocedural planning, electronic health record analysis and patient monitoring. Healthcare systems will undoubtedly become more automated and shift to more AI-driven methods to improve efficiency and reduce cost. Patients in the end will benefit from these changes with improved diagnostic accuracy, better tailored treatments resulting in a greater quality and quantity of life. In this article, we will describe some of the fundamental principles underlying AI that physicians should have an understanding of, along with current clinical applications.

Valve selection is the most critical clinical decision made during transcatheter aortic valve replacement (TAVR) work-up.

Aortic stenosis (AS) of moderate or greater severity has an estimated prevalence of 5% in people older than 65 years. Survival is poor after onset of symptoms, and surgical aortic valve replacement was the gold-standard treatment for decades. However, more than one-third of patients with symptomatic AS were untreated due to high surgical risk, exposing a clinical need for a less invasive therapy for aortic valve stenosis. The PARTNER trials were pivotal in presenting robust evidence for the safety, feasibility, and efficacy of transcatheter aortic valve replacement in the management of AS and paved the way for clinical use worldwide.

A 36-year-old female underwent left lower lobectomy with left atrial and left upper pulmonary vein (LUPV) reconstruction with a bovine pericardial patch for an intrathoracic pheochromocytoma. Postoperatively, she developed shortness of breath and transesophageal echocardiography demonstrated LUPV stenosis with increased velocities. Computed tomography angiogram of the chest revealed LUPV stenosis at the left atrium ostium with an area of 39 mm 2 . Under angiographic and echocardiographic guidance, a 10 × 19 mm Omnilink Elite uncovered stent was deployed in the LUPV ostia. While reported following left atrial ablation, pulmonary vein stenting can be successful in a pulmonary vein surgically reconstructed with bovine pericardium.

We present our single centre retrospective cohort study of transcatheter pulmonary valve implantation (TPVI) using the Medtronic Melody vs Edwards Sapien valves. We analysed 27 consecutive cases of TPVI between 2007 and 2019. We compared baseline characteristics, procedural data and outcomes between the Melody vs Sapien cohorts. The Melody valve was used in 18 (66%) cases, this group had fewer males (50% vs 89%) and smaller conduit diameters (22.1mm vs 25mm). The primary underlying pulmonary pathology was stenosis in both groups (50% vs 56%). Preoperative echocardiographic peak pulmonary gradients were higher in the melody group (64.9mmHg vs 47.6mmHg). There was similar preoperative ≥2 pulmonary regurgitation in both groups (33% vs 56%). The median implant valve size was smaller in the Melody group (20.3mm vs 24.7mm). Pre-stenting was higher in the Melody group (94% vs 22%). Procedural fluoroscopic time was longer in the Sapien group (47.5mins vs 32.8mins). Procedural success was similar between groups (89% vs 100%). Follow-up was longer for the Melody group (54.6 vs 18.6 months). On the latest echocardiogram there was a similar pulmonary gradient (22.8mmHg vs 28.7mmHg) and ≥2 PR (1 vs 0). There was an increase in infective endocarditis in the Melody group (2 vs 0). One Melody patient required a re-do procedure and one Sapien case was complicated by valve embolisation. Our study highlights that both Melody and Sapien TPVI have high procedural success rates and similar favourable outcomes.

We present our single centre retrospective cohort study of transcatheter pulmonary valve implantation (TPVI) using the Medtronic Melody vs Edwards Sapien valve. We analysed 27 consecutive cases of TPVI between 2007 and 2019. We compared baseline characteristics, procedural data and outcomes between the Melody vs Sapien cohorts. The Melody valve was used in 18 (66%) cases, this group had fewer males (50% vs 89%) and smaller conduit diameters (22.1mm vs 25mm). The primary underlying pulmonary pathology was stenosis in both groups (50% vs 56%). Preoperative echocardiographic peak pulmonary gradients were higher in the melody group (64.9mmHg vs 47.6mmHg). There was similar preoperative ≥2 pulmonary regurgitation in both groups (33% vs 56%). The median implant valve size was smaller in the Melody group (20.3mm vs 24.7mm) and pre-stenting was higher (94% vs 22%). Procedural fluoroscopic time was longer in the Sapien group (47.5mins vs 32.8mins). Procedural success was similar between groups (89% vs 100%). Follow-up was longer for the Melody group (54.6 vs 18.6 months). On the latest echocardiogram there was a similar pulmonary gradient (22.8mmHg vs 28.7mmHg) and ≥2 PR (1 vs 0). There was an increase in infective endocarditis in the Melody group (2 vs 0). One Melody patient required a re-do procedure and one Sapien case was complicated by valve embolisation. Our study highlights that both Melody and Sapien TPVI have high procedural success and favourable outcomes but more infective endocarditis in the Melody group.

Purpose of the Review Moderate or severe aortic regurgitation (AR) occurs in 0.5% of the population and typically peaks in the fourth to sixth decade of life. A significant proportion of patients have prohibitive surgical risk and are therefore treated medically with pharmacological management of heart failure and no definitive treatment of the underlying valvular pathology. Recent Findings Transcatheter aortic valve replacement (TAVR) has been used in an off-label setting to treat AR to attempt to reduce mortality and improve quality of life with varying levels of success. New-generation TAVR devices currently used in AS have demonstrated safety and feasibility when used in patients with AR. Novel TAVR devices dedicated for use in AR are being developed and early studies demonstrate promising results. Ongoing studies with larger clinical trials and novel methods of device anchoring are required, which if positive, will in turn lead to commercial approval and reimbursement, eventually making TAVR ready for use in AR.

Transcatheter mitral valve-in-valve (TMVIV) for failed bioprosthetic valves is an emerging alternative to surgical re-operation in high risk patients. In this systematic review, we assessed the outcomes of mitral valve-in-valve replacement. Methods: A thorough computer-based search was performed using 4 major databases. We included studies utilising TMVIV replacement in failed bioprosthetic valves, mitral ring repairs and mitral clips. The 30-day and outcome of all-cause mortality, stroke, major bleeding and reintervention was analysed. Results: Seventeen observational studies were included in the analysis which comprised of 558 patients (437 bioprosthetic mitral valves, 110 mitral rings and 11 mitral clips). The mean age was 75 years with 39% of patients being male. 42.7% (238 patients) had New York Heart Association class 3 or 4 symptoms. The mean Society of Thoracic Surgeons score was 12.5%. Mean preoperative left ventricular ejection fraction was 55.5%. Patients with underlying mitral valve disease included 13.1% (73 patients) with mitral stenosis, 28% (158 patients) with mitral regurgitation and 10% (58 patients) with mixed mitral disease. Overall analysis demonstrated a low 30-day all-cause mortality of 2.5%. The rates of stroke and bleeding were also low at 0.7% (4 patients) and 6.8% (38 patients) respectively. 2.7% (16 patients) required reintervention with 0.4% (2 patients) needing surgical replacement and 0.4% (2 patients) with further valve-in-valve procedure. Conclusion: TMVIV is a safe and feasible option in patients with failed mitral valve prosthesis who are high surgical risk for re-operations.

To produce a high quality article for physicians that reviews the current literature pertaining to NOAC's, in particular, their use in clinical practice, known drug interactions and side effect profile. Medline, Cochrane and PubMed databases were searched for the most recent and clinically sound articles pertaining apixaban, rivaroxaban and dabigatran. Researchers found the trials for each of these NOAC's to be sound and have results that can be translated into clinical practice.

Background Three-dimensional (3D) printing of cardiac fistulae allows for immediate understanding of their complex courses and anatomical relations. Models can be used to improve patient understanding, enhance the consenting process, facilitate communication between multidisciplinary staff at heart team meetings, and help plan surgical or percutaneous interventions. Case summary We report four cases where 3D printed models were used as an adjunct with traditional measures in treating patients with complex cardiac fistulae. Discussion In our cases, overall patient understanding was improved, staff at heart team meetings were more aware of anatomical anomalies and perioperatively planning saw adjustments made that may have ultimately benefited patient outcome. Our cases highlight the additional benefit that 3D printed models can play when treating patients with complex cardiac fistulae.

Introduction: Graft failure is associated with poorer short-term and long-term prognostic outcomes, and higher complication and hospital readmission rates.

Case: An 81-year-old man was referred to this institution with New York Heart Association Class III dyspnoea. Echocardiography revealed severe aortic stenosis with normal left ventricular function. Coronary angiography revealed a heavily calcified, severe distal left main coronary artery (LMCA) stenosis, which did not extend into the left anterior descending (LAD) or left circumflex artery (LCx). Femoral access was contraindicated, due to the presence of an infrarenal abdominal aortic aneurysm. Percutaneous aortic balloon valvuloplasty and coronary intervention were subsequently performed via 9-Fr sheath in the right brachial artery accessed through surgical cutdown.

A 57-year-old Australian man was retrieved to The Prince Charles Hospital from the Asia-Pacific region after a complicated anterior ST-elevation myocardial infarction (STEMI). During a routine primary percutaneous coronary intervention (PCI) for an occluded proximal left anterior descending (LAD) artery, a large amount of air was injected to the left coronary system.

Objective: Predictors of balloon rupture during percutaneous balloon aortic valvuloplasty (PBAV) have not been quantified.

Mitral regurgitation (MR) is a valvular heart disease associated with significant morbidity and mortality. Transcatheter mitral valve intervention (TMVI) repairs or replaces the mitral valve through small arterial and venous entry sites and so avoids risks associated with open heart surgery. Transcatheter devices targeting components of the mitral apparatus are being developed to repair or replace it. Numerous challenges remain including developing more adaptable devices and correction of multiple components of the mitral annulus to attain durable results. The mitral valve apparatus is a complex structure and understanding of the mechanisms of MR is essential in the development of TMVI. There will likely be a complementary role between surgery and TMVI in the near future.