Transcatheter aortic valve replacement (TAVR) has several alternative access routes when transfemoral access is unsuitable. This study compared perioperative and mid-term outcomes of transaxillary (TAx) TAVR with those of transapical (TA) and direct aortic (DA) approaches. Among 2,185 patients who underwent TAVR at our three centers between April 2015 and April 2024, 198 non-transfemoral cases were retrospectively analyzed. TAx-TAVR was classified as a non-thoracotomy approach, whereas TA/DA-TAVR were classified as thoracotomy approaches. Perioperative and mid-term outcomes were compared between the two groups. Of the 198 patients, 97 underwent the non-thoracotomy approach and 101 underwent thoracotomy (TA, n = 64; DA, n = 37). Most baseline characteristics were comparable, although dialysis-dependent patients were more common in the non-thoracotomy group. Operative time, transfusion requirement, and hospital stay were significantly greater in the thoracotomy group. Access-related complications included four events in the thoracotomy group (aortic injury or apical rupture) and five events in the non-thoracotomy group (aortic dissection or intimal injury). Postoperative ischemic stroke tended to occur more frequently in the non-thoracotomy group, though not significantly. One-year survival was significantly higher in the non-thoracotomy group, whereas mid-term mortality did not differ between groups. TAx-TAVR was associated with lower perioperative invasiveness and superior one-year survival compared with TA/DA-TAVR. However, the trend toward increased postoperative stroke underscores the importance of careful patient selection and thorough preoperative vascular assessment.

BACKGROUND:The poor prognosis of hemodialysis (HD) patients following transcatheter aortic valve replacement (TAVR) has been established; however, data on the outcomes in the latest generation of devices remain inconsistent. OBJECTIVES:The authors aimed to compare the 1-year clinical outcomes post-TAVR using the latest generation of devices in HD and non-HD patients. METHODS:From the multicenter registry, 760 HD and 3,928 non-HD patients were identified from the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation; UMINID:000020423) registry. To minimize differences in baseline characteristics, 1:1 propensity score matching (PSM) was performed (490 patients each). The primary clinical endpoint was all-cause mortality at 1 year. Secondary endpoints included cardiovascular death, stroke, and heart failure rehospitalization. RESULTS:In the overall cohort, during 208 (41-373) days of follow-up, HD patients had higher 1-year mortality than non-HD patients (105 of 760 [13.8%] vs 189 of 3,928 [4.8%], HR: 2.62; 95% CI: 2.13-3.23; P < 0.001); this difference was attenuated (59 of 490 [12.0%] vs 65 of 490 [13.3%], HR: 1.03; 95% CI: 0.75-1.42; P = 0.858) following well-balanced PSM. There were no significant differences in any secondary endpoints between the 2 groups after PSM; however, HD remained an independent predictor of 1-year mortality in a multivariate analysis of the cohort before PSM. CONCLUSIONS:The poor prognostic value of HD was attenuated after adjusting for baseline risk factors. These findings suggest that the poor outcomes of HD patients result from the burden of multiple comorbidities in addition to the HD risk itself. Considering TAVR as a treatment option for exceptionally high-risk populations will aid in the careful patient selection and realistic prognostic assessments.

Percutaneous left atrial appendage closure (LAAC) is an established treatment option for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) who are unsuitable for long-term oral anticoagulation. However, an anatomically challenging left atrial appendage (LAA) can limit optimal device positioning and complete occlusion with conventional fixed-curve sheaths.Two elderly men with NVAF and high bleeding risk underwent LAAC using Watchman FLX Pro devices (Boston Scientific, Marlborough, MA, USA). Pre-procedural imaging revealed anatomically challenging LAAs. With a standard double-curve sheath, one case showed unacceptable posterior protrusion of a large 40-mm device. In another case, tilting of the device led to incomplete coverage of the posterior lobe, resulting in a residual peri-device leak. After switching to the TruSteer™ Access System (Boston Scientific), a bidirectional steerable sheath, improved coaxial alignment, enabled acceptable device protrusion, complete sealing with no residual leak, and stable device release in both cases. These cases suggest that a steerable sheath can overcome the limitations of fixed-curve sheaths in anatomically challenging LAAs by enabling coaxial alignment and optimized posterior wall apposition during LAAC. Learning objective In wide-neck, shallow, or multilobed left atrial appendages (LAAs), failure to meet PASS criteria with a conventional fixed-curve sheath may reflect non-coaxial deployment and, with very large devices, sheath instability due to kick-back at release, leading to device tilt. A bidirectional steerable sheath provides real-time control of the delivery axis and may prevent kick-back at release, enabling reproducible optimal device positioning in anatomically challenging LAAs where fixed-curve sheaths are inadequate.

BACKGROUND:Female patients with aortic stenosis frequently present with a small aortic annulus (SAA), which may result in unfavorable echocardiographic cardiac function after transcatheter aortic valve replacement. However, evidence comparing the long-term outcomes of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) in this context is limited. OBJECTIVES:This study compares the 7-year clinical outcomes after transcatheter aortic valve replacement using BEV and SEV in female patients. METHODS:Overall, 1,827 female patients treated with BEV and 805 treated with SEV were identified from the Optimized transCathEter vAlvular intervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry. One-to-one propensity score matching (PSM) was performed to adjust for confounding factors, resulting in 744 matched patients per group. The primary clinical endpoints included all-cause mortality, stroke, and heart failure rehospitalization. RESULTS:Overall, 1,303 patients (87.6%) had a SAA. Echocardiographic assessments indicated that BEV had smaller effective orifice area and higher mean pressure gradient than did SEV throughout the follow-up period. In the PSM analysis, BEV was associated with lower all-cause mortality (51.5% vs 57.4%; log-rank, P = 0.021) and stroke at 7 years (10.8% vs 16.7%; Fine-Gray, P = 0.008). Heart failure rehospitalization rates were similar between groups. In multivariable analyses, valve type was not independently associated with long-term outcomes, and subgroup analyses considering annulus size yielded consistent results. CONCLUSIONS:For women predominantly presenting with a SAA, BEV demonstrated decreased echocardiac performance compared with SEV. Although PSM analysis indicated more favorable outcomes with BEV, valve type was not independently associated with long-term prognosis after multivariable adjustment. These findings suggest that both types of transcatheter heart valves may be an acceptable option in this patient population.

Transcatheter aortic valve implantation (TAVI) using SAPIEN 3 Ultra RESILIA (S3UR) offers improved hemodynamic performance than its former generation, SAPIEN 3 (S3). This study compared 1-year clinical outcomes after TAVI using S3UR and S3. Among 2,369 patients from the OCEAN-TAVI registry (UMIN000020423), a 1:1 propensity score-matched analysis identified 775 matched pairs. One-year post-TAVI, S3UR showed significantly lower all-cause mortality (10.3% vs. 13.4%, p = 0.026), stroke (0.9% vs. 3.4%, p = 0.001), and heart failure rehospitalization (1.4% vs. 2.7%, p < 0.001) than S3. These differences were pronounced in patients receiving smaller valves (20–23 mm). S3UR demonstrated a larger effective orifice area, lower mean pressure gradient, and lower incidence of paravalvular leakage than S3 at discharge. At 1 year, S3UR showed significantly reduced paravalvular leakage and lower incidences of mean pressure gradient ≥20 mmHg than S3. We concluded that S3UR demonstrated superior hemodynamic performance to S3, exhibiting better prognosis, particularly in patients with smaller valves.

Background Patients with functional mitral regurgitation (MR) and very severe left ventricular (LV) dysfunction (LV ejection fraction [LVEF] <20%) have been largely excluded from randomized trials of mitral transcatheter edge-to-edge repair (M-TEER), leaving a substantial knowledge gap regarding the role of M-TEER in this high-risk population. Objectives This study aimed to evaluate the safety, feasibility, and 1-year outcomes of M-TEER in patients with functional MR and LVEF <20%. Methods The OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry prospectively enrolled patients undergoing M-TEER. Among patients with functional MR and LVEF ≤40% (n = 1,538), outcomes were compared between those with LVEF <20% (n = 103) and 20%≤ LVEF ≤40% (n = 1,435). The primary endpoint was the composite of all-cause death and heart failure (HF) hospitalization at 1 year. Secondary endpoints included cardiovascular (CV) death and procedural outcomes. Results Acute procedural success was similar between groups (n = 103 [100%, LVEF <20%] vs n = 1,390 [97%, 20%≤ LVEF ≤40%]), with comparable residual MR and postprocedural transmitral pressure gradients. In-hospital mortality did not differ by LVEF category (n = 5 [5%] vs n = 58 [4%]). Both groups showed significant improvement in NYHA functional class at 1 year, although functional status remained worse in patients with LVEF <20%. After adjustment, the primary endpoint did not differ significantly between groups (LVEF <20% vs 20%≤ LVEF ≤40%; HR: 1.24; 95% CI: 0.82-1.88). However, LVEF <20% was independently associated with higher CV mortality (HR: 2.00; 95% CI: 1.08-3.68). Conclusions In patients with ventricular functional MR and LVEF <20%, M-TEER was feasible and associated with meaningful symptomatic improvement without excess risk of death or HF hospitalization, although CV mortality remained higher, likely reflecting advanced myocardial disease.

Background Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) anatomy remains challenging, especially in the presence of heavy calcification. Case Summary A patient with severe aortic stenosis and a heavily calcified type 1 BAV with a calcified raphe underwent transfemoral TAVR with a 29-mm self-expanding Evolut FX + valve. At final release, delayed prosthesis pop-up toward the ascending aorta occurred. Recapture was unexpectedly successful, but redeployment from a deeper position led to frame infolding. The prosthesis was retrieved, and definitive bailout was achieved with a balloon-expandable 29-mm SAPIEN 3 Ultra RESILIA valve and postdilation, resulting in mild residual paravalvular leakage. Discussion Severe calcification in BAV anatomy can complicate TAVR and may be associated with underexpansion, delayed migration, and infolding after resheathing or redeployment. Take-Home Messages Stability checks near final release are essential in calcified BAV anatomy. If infolding is suspected, device-specific instructions should guide prompt definitive management.

Background Data on the prognostic impact of failed surgical bioprosthetic size following valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) remain limited. Objectives This study aimed to assess the impact of failed bioprosthetic size and subsequent prosthesis-patient mismatch (PPM) on midterm outcomes of ViV TAVR. Methods We analyzed patients who underwent ViV TAVR for degenerated surgical bioprostheses in the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention-transcatheter aortic valve implantation) registry. Patients were divided into 2 groups according to the true internal diameter (ID) of bioprostheses: the small bioprosthesis (SB) group (ID ≤20 mm) and the non-small bioprosthesis (NB) group (ID >20 mm). The primary endpoint was a composite of cardiovascular death or heart failure hospitalization at 3 years. Factors associated with severe measured PPM were also examined. Results Among 367 consecutive patients undergoing ViV TAVR (244 patients in the SB group vs 123 patients in the NB group), 30-day mortality was 0.5%. Severe PPM occurred in 16.9% of the entire cohort and was more prevalent in the SB group (21.3% in the SB group vs 8.3% in the NB group; P = 0.001). The SB group had a higher risk of cardiovascular death or heart failure hospitalization at 3 years (19.1% in the SB group vs 9.8% in the NB group; adjusted HR: 3.48; 95% CI: 1.11-10.87). The SB patients with severe PPM had the highest risk of the primary outcome at 3 years (SB with PPM 39.2% vs NB without PPM 11.0%; adjusted HR: 6.65 [95% CI: 1.95-22.71] compared with the NB group without PPM). Factors associated with severe PPM included larger body surface area, balloon-expandable valve implantation, and true ID ≤20 mm. Conclusions ViV TAVR for small surgical bioprostheses was associated with worse clinical outcome, particularly in those with severe PPM. (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation [OCEAN-TAVI]; UMIN000020423)

Since its introduction in 2002, left atrial appendage closure (LAAC) has rapidly expanded as an alternative to anticoagulation in patients with atrial fibrillation at high risk of stroke. Harmonized processes for data collection, analysis, and reporting in LAAC trials are essential to enhance research quality and improve clinical practice. The Left Atrial Appendage Academic Research Consortium (LAARC) initiative is an independent collaboration of academic research organizations, cardiology and neurology experts, clinical trialists, and regulatory authorities from the USA, Europe, and Asia. The consortium engaged clinical experts, regulators-including the US Food and Drug Administration (FDA), European Notified Bodies, and Japan's Pharmaceuticals and Medical Devices Agency (PMDA)-and industry leaders to define standardized study elements and endpoints for LAAC trials. Key considerations included alignment with prior Academic Research Consortium initiatives, procedural and mechanistic insights, and clinical relevance. Consensus definitions were proposed for mortality, stroke, bleeding, and device performance, along with composite endpoints for safety and effectiveness. The proposed LAARC consensus definitions aim to standardize endpoint reporting, improve comparability across studies, and support regulatory and clinical trial applications for this evolving therapy through broad dissemination in the peer-reviewed literature.

Background The prognostic value of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in patients undergoing mitral valve transcatheter edge‐to‐edge repair (M‐TEER) remains unclear. This study evaluated the MAGGIC score to predict outcomes after M‐TEER in patients with functional (FMR) or degenerative mitral regurgitation (DMR) and compared its performance with conventional surgical and M‐TEER–specific risk models. Methods We analyzed 3609 patients (FMR, 71%; DMR, 29%) who underwent M‐TEER in the OCEAN (Optimized Catheter Valvular Intervention)‐Mitral registry. Patients were stratified into MAGGIC score tertiles. The primary outcome was all‐cause death at 1 and 3 years. Secondary outcomes included cardiovascular death. Predictive performance was compared with Society of Thoracic Surgeons score, European System for Cardiac Operative Risk Evaluation II, MitraScore, and COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) score. Results The median age was 81 years, 55.3% were men, and median MAGGIC score was 30. In the FMR cohort, patients in tertile 3 had higher risks of all‐cause death (1 year: adjusted hazard ratio [HRadj], 4.15 [95% CI, 2.34–7.36]; 3 years: HRadj, 1.83 [95% CI, 1.22–2.77]) and cardiovascular death (1 year: HRadj, 2.31 [95% CI, 1.56–3.43]; 3 years: HRadj, 1.61 [95% CI, 1.13–2.31]). In the DMR cohort, tertile 3 was associated with higher all‐cause death (1 year: HRadj, 2.84 [95% CI, 1.18–6.86]; 3 years: HRadj, 2.25 [95% CI, 1.07–4.73]) and cardiovascular death at 3 years (HRadj, 3.49 [95% CI, 1.23–9.84]). The MAGGIC score demonstrated comparable or superior discrimination on the basis of the concordance index. Conclusions The MAGGIC score independently predicted 1‐ and 3‐year all‐cause death after M‐TEER in both FMR and DMR cohorts and cardiovascular death in the FMR cohort and at 3 years in the DMR cohort. It demonstrated comparable or superior predictive performance to conventional surgical and M‐TEER–specific risk models.

Advances in congenital heart surgery have led to a growing population of adults with congenital heart disease (ACHD). Mitral regurgitation (MR) often develops after congenital heart surgery, yet the role and safety of transcatheter edge-to-edge repair (TEER) in this setting remain poorly defined. This descriptive cohort study from the OCEAN-Mitral registry aimed to evaluate the feasibility, procedural characteristics, and short-term outcomes of TEER in adults with surgically repaired congenital heart disease (CHD). Among 3,764 consecutive TEER cases registered between 2018 and 2023, 20 patients (0.5%) had ACHD with prior surgical repair. Baseline characteristics, procedural data, and in-hospital and 30-day outcomes were analyzed using standardized mean differences to account for unequal group sizes. Most ACHD patients (90%) had simple congenital complexity and secondary MR (70%), with preserved left ventricular function and fewer comorbidities than others. All ACHD procedures achieved acute procedural success (100%) with no major intraprocedural complications. Transseptal puncture through surgical atrial septal defect (ASD) patches was feasible and safe under transesophageal echocardiographic guidance. No patients required iatrogenic ASD closure. Hemodynamic parameters improved after TEER, with increased cardiac output and decreased left atrial V-wave pressures. In-hospital mortality and early adverse events were rare. In this descriptive cohort, TEER was technically feasible and safe in adults with surgically repaired CHD, yielding procedural and short-term outcomes comparable to those without repaired ACHD. TEER may represent a viable alternative to repeat surgery in appropriately selected ACHD when performed by experienced multidisciplinary teams.Clinical trials: OCEAN-Mitral registry (UMIN-ID: UMIN000023653).

BACKGROUND:Transcatheter aortic valve implantation (TAVI) is a well-established treatment for patients with severe aortic stenosis. However, long-term data exceeding 10 years remain scarce. OBJECTIVES:This study aimed to evaluate long-term clinical outcomes and transcatheter heart valve durability in patients who underwent TAVI and completed a 10-year follow-up. METHODS:Using data from the multicenter registry in Japan, we analyzed outcomes of 297 patients who received the SAPIEN XT valve (Edwards Lifesciences) from June 2010 to June 2014. All-cause mortality was the primary endpoint. Valve-related outcomes, including bioprosthetic valve failure, were defined according to the Valve Academic Research Consortium 3 criteria. RESULTS:The mean age of the participants was 83.8 ± 6.0 years, and the mean Society of Thoracic Surgeons risk score was 7.5 ± 4.0. Freedom from all-cause mortality at 10 years was 13.2%. Severe structural valve deterioration and bioprosthetic valve failure gradually increased up to 10 years, reaching 3.0% and 10.8%, respectively. Reintervention was performed in 4.5% of patients. Valve-related deaths accounted for 1.3% of all deaths. Most deaths were due to non-valve-related causes. Multivariate analysis revealed that high Society of Thoracic Surgeons score, high clinically frailty scale, renal dysfunction, and low serum albumin levels were independent predictors of mortality. CONCLUSIONS:Few older adult high-risk patients survived beyond 10 years following TAVI. In contrast, transcatheter heart valve demonstrated acceptable durability, and long-term outcomes were primarily determined by baseline comorbidities rather than valve dysfunction. These results support the role of TAVI as a feasible therapeutic approach in this population.

BACKGROUND:The prognostic value of right ventricular-pulmonary artery (RV-PA) coupling in patients with ventricular functional mitral regurgitation (FMR) undergoing mitral transcatheter edge-to-edge repair (M-TEER) is unclear. OBJECTIVES:The authors aimed to compare hospitalization and survival outcomes between patients with preserved and impaired RV-PA coupling. METHODS:We analyzed 1,059 patients with ventricular FMR who underwent M-TEER. RV-PA coupling was assessed after M-TEER using the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP). Impaired RV-PA coupling was defined as TAPSE/SPAP <0.36 mm/mm Hg. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. RESULTS:Overall, 30.7% of patients exhibited impaired RV-PA coupling after M-TEER, with minimal improvement in TAPSE and SPAP. Patients with impaired RV-PA coupling at discharge had significantly lower event-free survival than those with preserved RV-PA (P = 0.004). Multivariate Cox regression analysis confirmed impaired RV-PA coupling as an independent predictor of the primary outcome (HR: 1.360; P = 0.029). The association between postprocedural RV-PA coupling and the primary outcome was more profound in patients with pulmonary hypertension (P = 0.047). Diabetes mellitus, impaired RV-PA coupling, lower left ventricular ejection fraction, smaller left ventricular size, and larger left atrial size before M-TEER were independent predictors of impaired RV-PA coupling. CONCLUSIONS:Impaired RV-PA coupling after M-TEER is independently associated with a higher risk of composite outcomes in patients with ventricular FMR, particularly those with pulmonary hypertension. Therefore, postprocedural assessment of RV-PA coupling may provide valuable prognostic insights and support risk stratification in this population.

Background Patients with extremely small aortic annuli are at increased risk of residual gradients and prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR). Comparative data on contemporary valve platforms in this subset remain limited. Objectives The authors aimed to compare early clinical and hemodynamic outcomes among balloon-expandable valves (BEVs), supra-annular self-expanding valves (SA-SEVs), and intra-annular self-expanding valves (IA-SEVs) in patients with severe aortic stenosis and extremely small annuli. Methods Patients with annular area <314 mm2 from the OCEAN-TAVI registry were analyzed using multinomial propensity score overlap weighting. Primary outcomes were severe PPM, mean transvalvular pressure gradient ≥20 mm Hg, and paravalvular leakage (PVL) ≥mild. Results Among 385 patients, 125, 136, and 124 underwent BEV, SA-SEV, and IA-SEV implantation, respectively. Effective sample sizes after overlap weighting were 92.4, 93.6, and 85.4, with a median follow-up of 358 days. Adjusted probabilities of severe PPM were similarly low (1.6%, 2.0%, and 2.7%; P = 0.85). mean transvalvular pressure gradient ≥20 mm Hg occurred in 4.5%, 8.3%, and 2.3%, respectively (P = 0.19). PVL ≥mild was numerically more frequent with SEV than BEV (15.8%, 27.3%, and 27.0%; P = 0.09), with adjusted odds ratios versus BEV of 1.92 (95% CI: 0.96-3.84) for SA-SEV and 1.83 (95% CI: 0.91-3.70) for IA-SEV. Major complications and 1-year mortality were similar among groups. Conclusions Contemporary TAVR platforms showed broadly similar early outcomes, although PVL ≥mild was numerically more frequent with self-expanding valves.

Background Stroke remains a serious complication after transcatheter aortic valve replacement (TAVR), even with contemporary devices. Objectives To evaluate the incidence, predictors, and prognosis of in-hospital stroke in patients undergoing TAVR with contemporary valve platforms. Methods We analyzed 5,123 patients from the multicenter OCEAN-TAVI registry who underwent TAVR with Sapien 3 Ultra RESILIA, Evolut FX, or Navitor between May 2022 and December 2024. Stroke incidence across valve types was compared using inverse probability of treatment weighting (IPTW). Predictors were assessed using multivariable Firth penalized logistic regression. Results In-hospital stroke occurred in 2.5% of patients. After IPTW adjustment, stroke incidence differed among valve types: 1.7% of patients treated with Sapien 3 Ultra RESILIA, 4.5% with Evolut FX, and 2.4% with Navitor (p = 0.044). Disabling stroke was more frequent with Evolut FX (2.5%) compared with Sapien 3 Ultra RESILIA (0.4%) and Navitor (0.7%; p < 0.001). Self-expanding valve use (adjusted odds ratio [aOR] 2.64, 95% confidence interval [CI] 1.67–4.16 for Evolut FX; aOR 2.37, 95% CI 1.35–4.18 for Navitor; both vs. S3UR), prior stroke (aOR 1.83, 95% CI 1.19–2.73), reduced renal function, and nontransfemoral access (aOR 2.11, 95% CI 1.29–3.45) were independently associated with in-hospital stroke. One-year survival was significantly lower among patients with stroke than among those without stroke (73.0% vs. 90.3%; p < 0.001). Conclusions In-hospital stroke remains an important complication after contemporary TAVR and is associated with worse clinical outcomes. Differences in stroke incidence across valve types were observed, highlighting the need for improved risk assessment.

Patients undergoing hemodialysis (HD) have poor outcomes after transcatheter edge-to-edge repair (TEER). However, the prognostic significance of postprocedural transmitral pressure gradient (TMPG) and residual mitral regurgitation (MR) in this population remains unclear. In the prospective, multicenter Optimized CathEter vAlvular iNtervention (OCEAN)-Mitral registry, we analyzed 3,515 patients with immediate postprocedural TMPG and MR data, including 224 (6.4%) on HD and 3,291 (93.6%) not on HD. The primary outcome was all-cause mortality at 2 years. During a median follow-up of 434 days, 624 deaths (17.8%) occurred. All-cause mortality was significantly higher in HD patients than in non-HD patients (33.0% vs 16.7%, p <0.001). Noncardiovascular death accounted for a greater proportion of deaths in HD patients than in non-HD patients (17.9% vs 6.6%, p <0.001). In non-HD patients, a postprocedural TMPG ≥5 mm Hg was associated with increased mortality (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.18 to 2.03, p = 0.002), whereas this association was not statistically significant in HD patients (adjusted HR 1.68, 95% CI 0.83 to 3.38, p = 0.147). Similarly, residual MR ≥2+ was associated with higher mortality in non-HD patients (adjusted HR 1.26, 95% CI 1.01 to 1.58, p = 0.043), whereas no statistically significant association was demonstrated in HD patients (adjusted HR 1.47, 95% CI 0.70 to 3.08, p = 0.307). In conclusion, elevated postprocedural TMPG and residual MR were associated with higher mortality in non-HD patients, whereas no statistically robust associations were demonstrated in HD patients.