Introduction The adult congenital heart disease (ACHD) population is steadily growing and aging, exposing patients to age-related cardiovascular conditions, particularly degenerative aortic valve disease. While transcatheter aortic valve implantation (TAVI) is a standard treatment in the general population, experience in ACHD remains very limited. Methods Retrospective single-center study including all ACHD patients who underwent TAVI between January 2024 and January 2026. Procedural characteristics, periprocedural outcomes, complications, and events during follow-up were analyzed. The primary endpoint was periprocedural mortality; secondary endpoints included complications, NT-proBNP changes, and aortic bioprosthesis function. Results A total of 8 patients (median age 67.5 years, 56.8–76.3) with moderate or complex CHD were included. Two had genetic syndromes (Williams–Beuren, trisomy 21), and seven (87.5%) had prior heart failure hospitalization. Median NT-proBNP was 2387pg/mL, and median systolic pulmonary artery pressure 56mmHg. Seven patients underwent transfemoral TAVI; one required a carotid approach due to severe diffuse arterial hypoplasia. One patient experienced ventricular fibrillation, which was successfully cardioverted during valve implantation, and another patient developed paroxysmal complete atrioventricular block requiring leadless pacemaker implantation. No periprocedural deaths occurred. At 3-month follow-up, all valves showed excellent hemodynamic performance, with no significant regurgitation or heart failure rehospitalization, and NT-proBNP decreased significantly (P=0.034). Conclusion This series represents, to our knowledge, the largest published experience of TAVI in adult patients with moderate to complex congenital heart disease. TAVI is feasible and safe in carefully selected ACHD patients when performed in a specialized, multidisciplinary setting, and is expected to become an increasingly important therapeutic option as this population continues to age.

Background: Percutaneous closure of patent foramen ovale or atrial septal defect is associated with procedural risks and requires optimal care management. Providing tailored educational support to patients may help to improve their safety and engagement in the care.Aim: To observe the effect of pharmaceutical consultations on the knowledge and skills of patients undergoing percutaneous closure of patent foramen ovale or atrial septal defect.Methods: Multicentre meetings with healthcare professionals from university hospitals, as well as an expert patient, were organized to develop a patient-centred competency framework. Based on this framework, a consultation guide and information sheet were produced to support patients in acquiring key skills for managing their disease. A total of 31 patients were included in the study, 21 of whom attended both the preoperative and 6-month follow-up pharmaceutical consultations to assess changes in knowledge and skills. Patient satisfaction with the consultation and information sheet was evaluated.Results: The competency framework includes 89 skills for patients with patent foramen ovale and 92 for patients with atrial septal defect. This observational study showed an improvement in knowledge and skills between consultations. For example, knowledge regarding cardiac follow-up improved between the preoperative consultation and the 6-month follow-up, increasing from 3 to 9 (P < 0.05).Most patients (90%) preferred to have the consultation before the procedure, as it reassured them and enhanced their engagement with care management. All patients expressed satisfaction with the educational tools provided.Conclusions: Pharmaceutical consultations may support patients to acquire the knowledge and skills necessary for safe and autonomous management of their medical devices after returning home.

Many patients with severe aortic stenosis present with concomitant multivalvular heart disease. The management of this condition remains challenging and requires a multidisciplinary approach that integrates clinical, hemodynamic, and multimodality imaging data to define the most effective and durable treatment strategy. Although randomized evidence to guide treatment decisions in this setting is limited, percutaneous interventions to address additional valvular lesions are being increasingly adopted. This review provides an overview of the pathophysiology of valvular diseases commonly associated with severe aortic stenosis, highlighting their prognostic implications after surgical or transcatheter treatment and their impact on risk stratification and therapeutic management.

Introduction Percutaneous pulmonary valve implantation (PPVI) is an established and increasingly used therapy for patients with dysfunctional right ventricular outflow tract (RVOT). We assessed the safety, efficacy, and early outcomes of redo-PPVI performed for dysfunctional transcatheter pulmonary valves. Methods We conducted a retrospective, multicentre observational study including patients who underwent redo-PPVI. Results Twenty-four centres enrolled a total of 162 patients (mean age 25.2±11.5 years). The index valve was a Melody valve in 102 patients (63.0%), a Sapien valve in 59 (37.7%), and a Harmony valve in 1 (0.6%). The redo valve was a Melody valve in 87 patients (53.7%), a Sapien valve in 70 (43.2%), and a Myval valve in 5 (3.1%). The mean time from index PPVI to redo-PPVI was 7.4±4.0 years. Indications for redo-PPVI were pulmonary regurgitation in 98 patients (60.5%), stenosis in 16 (9.9%), and mixed lesions in 48 (29.6%). Periprocedural complications occurred in 7.4% of patients without relationship with the specific setting of redo-PPVI, such as atrial lead dislocations (n=2) or vascular access complications (n=2). No periprocedural deaths or coronary complications were reported. During follow-up (n=148; median 3.3 years [0.9–6.0]), 6 patients died (3 due to de novo infective endocarditis, 1 due to heart failure) and 29 patients experienced adverse events (2 heart transplantation, 2 cases of heart failure, 9 cases of de novo endocarditis, 1 case of protein-losing enteropathy, 15 cases of sustained tachycardia including 4 ventricular tachycardia, and 11 atrial arrhythmias). Eighteen patients required reintervention: 14 underwent surgical pulmonary valve replacement and 4 underwent balloon dilatation. At last follow-up, none or mild regurgitation was present in 90.7% of patients, and the maximal transvalvular gradient was 26.5±11.9mmHg. Conclusion Redo-PPVI appears to be a relatively safe and effective treatment option for patients with dysfunctional transcatheter pulmonary valves. However, the rate of significant complications highlights the need for close follow-up.

Introduction Sex-related differences in outcomes after transcatheter pulmonary valve implantation (TPVI) remain incompletely understood, particularly regarding infective endocarditis (IE), valve durability, and survival. Methods This study is a sub-analysis of the ENDOCPULM international registry including 1200 patients undergoing TPVI between 2007 and 2021. The cohort comprised 486 females (40.5%) and 714 males (59.5%). Outcomes included IE, pulmonary valve reintervention (PVR), and overall survival. Results Males underwent TPVI at a younger age and exhibited higher post-procedural RVOT gradients. During a median follow-up of 2.3 years (3714 patient-years), 65 patients (5.4%) developed IE. Sex was not associated with IE risk in the overall cohort, and subgroup analyses showed limited and inconsistent signals without robust effect.In contrast, male sex was associated with a higher risk of valve reintervention in specific subgroups (Fig. 1), particularly in patients with conotruncal defects and in those aged>40 years. These findings are consistent with a less favorable hemodynamic profile in males, combining earlier intervention and higher residual gradients.No significant association between sex and overall survival was observed. Conclusion In this large TPVI cohort, sex has no consistent impact on IE risk. However, male sex is associated with increased risk of valve reintervention in selected subgroups, likely driven by timing of intervention and residual hemodynamic burden. No effect on overall survival was observed, although follow-up duration remains insufficient to assess long-term mortality.

Background: Structural heart procedures performed under fluoroscopy and transesophageal echocardiography guidance require the expertise of an interventional echocardiographer in the heart team. Due to the proximity with the radiation source, the physician might be exposed to high radiation doses. This study aims to assess the interventional echocardiographer radioprotection by means of a dedicated cabin and evaluate its ergonomic characteristics. Methods: This is an observational nonrandomized study comparing cumulative radiation exposure between a control arm, consisting of a standard lead glass panel, and the experimental arm using the dedicated radioprotective Echosafe cabin. All structural heart procedures requiring transesophageal echocardiography between July 2021 and April 2022 were included. Cumulative radiation exposure of the interventional echocardiographer was collected by the body part and the satisfaction of the heart team with the cabin was assessed with a questionnaire. Results: A total of 64 procedures were included (24 controls and 40 with the cabin). The irradiation (as estimated by dose area product per procedure) was similar between the two groups (p = 0.94). The use of the cabin resulted in a numerically lower cumulative radiation dose to each body part. The mean overall reduction in radiation dose was estimated to be between 56 and 78% with the cabin. The most frequent negative aspects reported by the cabin users included difficulty moving the transesophageal echocardiography probe and the physical burden associated with initial installation. Conclusions: This preliminary study suggests that radioprotection of the interventional echocardiographer can be increased during structural procedures by using a dedicated cabin. Further studies with larger sample sizes and different design will be needed to confirm the reduction in irradiation of the echocardiographer.

BACKGROUND:Severe calcific aortic stenosis (AS) is the most common valvular heart disease in the elderly and carries a poor prognosis without intervention. The introduction of transcatheter aortic valve implantation (TAVI) in 2002 profoundly reshaped therapeutic strategies. This study aimed to evaluate changes in patient management and outcomes at the Departmental Hospital Center of La Roche‑sur‑Yon over three time periods: 2005 (pre‑TAVI era), 2015 (early TAVI integration), and 2022 (TAVI‑dominant era). METHODS:We conducted a retrospective, single-center observational study including all patients hospitalized for symptomatic severe AS or reduced left ventricular ejection fraction. Clinical characteristics, operative risk scores, management strategies, and one-year outcomes were analyzed. RESULTS:Between 2005 and 2022, the number of patients managed for SAS increased by 158% (65 in 2005, 136 in 2015, 168 in 2022). Mean age (79 years in 2022) and male proportion (60%) remained stable. Therapeutic strategies shifted markedly (p < 0.001): surgery predominated in 2005 (67%), whereas TAVI became the most frequent treatment in 2022 (55%), followed by surgery (21%) and medical therapy (24%). Surgically treated patients were increasingly selected, with a median EuroSCORE II falling from 3,95 % (2005) to 1.1% (2022). One-year all-cause mortality in 2022 was 0% after surgery, 5.9% after TAVI (down from 28.8% in 2015, p = 0.008), and 68% with medical therapy (p < 0.001). Heart failure rehospitalizations were also more frequent in the medical group (33% vs 6% after TAVI and 2% after surgery; p = 0.016). The proportion of patients not presented at the heart team meeting declined significantly (17% in 2022 vs 35% before 2015; p < 0.001). The waiting times nevertheless remained significant (median of 70 days between admission and the MDT meeting, plus 41 days before the procedure). CONCLUSIONS:Integration of TAVI has profoundly transformed AS management in our center, now the dominant strategy with significantly improved one-year prognosis. Medically treated patients still experience poor outcomes, underscoring the need to reduce delays and streamline the care pathway.

BACKGROUND:Management of degenerated aortic bioprostheses through valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) or redo surgical aortic valve replacement (Re-SAVR) shows similar short-term safety and efficacy. However, long-term survival and haemodynamic performance data are limited. AIM:To compare clinical characteristics, haemodynamics and outcomes at 3 years between ViV-TAVR and Re-SAVR techniques. METHODS:This retrospective two-centre study included 266 patients treated for isolated aortic bioprosthesis degeneration (130 Re-SAVR, 136ViV-TAVR) from 2009 to 2018, with up to 3 years of follow-up. RESULTS:The ViV-TAVR group was older (83 vs. 77 years; P=0.005) with higher surgical risk (Logistic EuroSCORE 22% vs. 13%; P=0.005). At 3 years, univariate analysis showed no significant difference in all-cause deaths (22.1% vs. 17.7%; P=0.37). ViV-TAVR was associated with fewer first-month complications, including major bleeding (11.0% vs. 52.3%; P=0.007) and acute renal failure grade 2/3 (5.1% vs. 14.6%; P=0.053). Inverse probability of treatment weighting analysis revealed no difference in all-cause deaths at 1 year (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.36-1.67; P=0.52) or between 1 and 3 years (HR 1.56, 95% CI 0.82-2.99; P=0.17). Composite events were similar at 1 year (HR 0.80, 95% CI 0.44-1.44; P=0.45) and between 1 and 3 years (HR 1.41, 95% CI 0.83-2.38; P=0.21). Mean gradients at 3 years were similar (16.1±11.4 vs. 13.2±5.3mmHg; P=0.17). In patients with small bioprostheses (true internal diameter≤20mm [n=151]), death rates at 3 years were similar (21.1% vs. 20.0%; P=0.86), as was haemodynamic performance (mean gradient 19.2±14.0mmHg for ViV-TAVR vs. 13.7±4.12mmHg for Re-SAVR [P=0.38]). Compared to balloon-expandable, self-expandable valves showed better 1-year mean gradients (16.4±10.5 vs. 13.7±4.12mmHg; P=0.012). CONCLUSIONS:ViV-TAVR and Re-SAVR had similar mortality and haemodynamic outcomes at 3 years, including in patients with small bioprostheses where self-expandable valves yielded the best results.

Background The population of adults with repaired congenital heart disease is increasing, and given their frequent history of repeated surgeries, they are the ones that may benefit the most from less-invasive therapeutic options, in order to truly address their disease with a lifespan-management perspective. Tetralogy of Fallot patients frequently present with significant tricuspid regurgitation which has been associated with adverse clinical events. Case Summary We report hereinafter on a successful transcatheter tricuspid valve replacement (TTVR) in a middle-age Tetralogy of Fallot patient at high surgical risk. Our aim is to emphasize on the technical challenges but also on the major benefits of the procedure, either from a symptomatic or structural remodeling standpoint. Discussion TTVR represents a promising therapy for this underserved subgroup of patients. Take-Home Messages TTVR in Tetralogy of Fallot patients is feasible. Despite the frequent advanced and chronic right ventricular adverse remodeling observed in this population, those patients may derive a great benefit from the procedure. Right ventricular reverse remodeling was associated with major symptomatic and functional improvement.

Background: Few studies have assessed coronary physiology in the setting of coronary artery disease (CAD) with severe aortic stenosis (AS). Fractional flow reserve (FFR) to guide revascularization in such patients is not validated. Aims: We describe changes in coronary physiology in this population before and after transcatheter aortic valve implantation (TAVI). Methods: Patients with stable CAD and severe AS treated with TAVI were prospectively included during 2020-2023. Coronary physiology was assessed before and immediately after TAVI, and at follow-up (median 5.4 months). Results: Twenty-nine patients (mean age 81.3 years) were included. Median (95% confidence interval) FFR decreased numerically, from 0.83 (0.79-0.84) pre-TAVI to 0.81 (0.78-0.83) post-TAVI. During hyperaemia, the transit mean time reduced numerically, from 0.27 (0.19-0.35) to 0.20 (0.18-0.27) seconds, reflecting increased coronary flow. Basal microvascular resistance increased numerically, from 24 (21-35) to 32 (23-45), while resistive reserve ratio increased significantly, from 1.8 (1.5-2.3) to 2.6 (2.2-3.1) (P = 0.002). Consequently, coronary flow reserve (CFR) improved significantly, from 1.5 (1.2-1.7) to 1.9 (1.5-2.4) (P = 0.006). Among 21 patients with follow-up, no significant change in FFR was observed and the significance of the increase in CFR was lost. Only three patients had an index of microvascular resistance > 25, indicating microvascular impairment during hyperaemia. Conclusions: In stable CAD patients treated with TAVI for severe AS, valve replacement provides an immediate improvement in CFR. FFR shows a minimal decrease after valve implantation, supporting its reproducibility to guide revascularization in such patients. Clinical trial registration: . NCT04663334. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

BACKGROUND:The relationships among tricuspid regurgitation (TR) reduction after tricuspid transcatheter edge-to-edge repair (T-TEER), changes in right-sided heart function, and outcomes are poorly explored. OBJECTIVES:This study aims to explore the relationship between functional remodeling and subsequent outcomes and the associations among T-TEER, residual TR, and outcomes. METHODS:Changes in echocardiographic parameters from baseline to 1 year, overall and according to TR reduction were evaluated by a centralized echocardiographic core laboratory in patients included in the Tri.Fr (Evaluation of Tricuspid Valve Percutaneous Repair System in the Treatment of Severe Secondary Tricuspid Disorders) trial. RESULTS:A total of 300 patients (aged 78 ± 5 years; 53.7% women) were enrolled; 152 patients were allocated to the T-TEER + guideline-directed medical therapy (GDMT) group, and 148 were allocated to the GDMT group. Patients in the T-TEER + GDMT group demonstrated a significant decrease in most of parameters of right ventricular (RV) function, whereas patients in the GDMT group exhibited no significant changes in RV metrics at 1 year. The clinical composite score improved progressively with each successive grade of TR reduction. The positive effect of T-TEER on the composite clinical score was observed irrespective of baseline right atrial volume but only in patients with normal RV-pulmonary artery coupling (defined by a tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio ≥0.40). At 1 year, patients with an improved clinical composite score had a lower right atrial volume index compared with patients whose clinical score remained unchanged or worsened (median 112 mL/m2 [Q1-Q3: 78.0-146 mL/m2] vs median 141 mL/m2 [Q1-Q3: 107-173 mL/m2]; P = 0.004). CONCLUSIONS:Although T-TEER can decrease TR severity, its impact on conventional RV function parameters and RV-pulmonary artery coupling remains limited. RV functional recovery has a smaller influence on clinical outcomes at 1 year compared with achieving optimal reduction in TR severity. (Evaluation of Tricuspid Valve Percutaneous Repair System in the Treatment of Severe Secondary Tricuspid Disorders [Tri.Fr]; NCT04646811).

To describe the reliability of quantitative MRI analysis of flows using 4D-PC (Phase Contrast) compared to 2D-PC flow, without contrast agents. The study was conducted at one centre in a retrospective manner from 2021 to 2023. Eligible patients were adults with repaired Tetralogy of Fallot (rToF) whose follow-up MRI protocol included 4D-PC and 2D-PC, without contrast agent. Assessment involved quantitative measurement of aortic and pulmonary flows on both 4D and 2D. Student’s T was used for comparisons of means and Lin’s concordance correlation coefficient agreement (CCC). A 2nd observer was hired. Twenty-six patients were included (50

Background Transcatheter edge-to-edge repair (TEER) provides an alternative option for high risk patients with systemic tricuspid regurgitation (STR). Preliminary data of the French study has shown its feasibility and safety, but mid-term echocardiographic outcome is lacking. Objectives Echocardiographic outcome of TEER in systemic tricuspid regurgitation. Methods TEER French cohort is a multicentre, longitudinal, descriptive, prospective study of patients undergoing TEER for severe STR. 20 patients with severe or greater STR undergoing percutaneous repair with the MitraClip system were enrolled in the study between May 2019 and November 2024. A transthoracic echocardiography was performed at baseline, six months, one year and two years after the procedure. TR was assessed using standard 2-dimensional color Doppler methods and graded TR using the 5-class grading scheme: mild, moderate, severe, massive, and torrential. The number of clips and their localization was analyzed. Results A reduction of at least 1 grade in TR was achieved in all subjects. TR grade remained moderate or less in 83% of patients at 2-years follow-up. TR reduction was sustained at 2-years follow-up for all patients. Among 14 patients, 5 patients had one-clip implantation, and 9 patients had two or more clips implantation. TR grade seemed to be lower in the group of patient with 2 or more clips strategy: TR was mild in 67% of patients in 2 or more clips group and moderate in 100% of patients in 1-clip group. Conclusion TEER of systemic tricuspid regurgitation is found to be safe and effective, with sustained effects at 2 years in patients. Patients with two or more clips implantation seem to have a better outcome in the regurgitation grade, but additional data and a bigger cohort are needed to predict the outcome and define the optimal technical strategy.

AIMS:Aortic valve calcification (AVC) of surgical valve bioprostheses (BPs) has been poorly explored. We aimed to evaluate in vivo and ex vivo BP AVCs and its prognosis value. METHODS AND RESULTS:Between 2011 and 2019, AVC was assessed using in vivo computed tomography (CT) in 361 patients who had undergone surgical valve replacement 6.4 ± 4.3 years earlier. Ex vivo CT scans were performed for 37 explanted BPs. The in vivo CT scans were interpretable for 342 patients (19 patients [5.2%] were excluded). These patients were 77.2 ± 9.1 years old, and 64.3% were male. Mean in vivo AVC was 307 ± 500 Agatston units (AU). The AVC was 562 ± 570 AU for the 183 (53.5%) patients with structural valve degeneration (SVD) and 13 ± 43 AU for those without SVD (P < 0.0001). In vivo and ex vivo AVCs were strongly correlated (r = 0.88, P < 0.0001). An in vivo AVC > 100 AU (n = 147, 43%) had a specificity of 96% for diagnosing Stage 2-3 SVD (area under the curve = 0.92). Patients with AVC > 100 AU had a worse outcome compared with those with AVC ≤ 100 AU (n = 195). In multivariable analysis, AVC was a predictor of overall mortality (hazard ratio [HR] and 95% confidence interval = 1.16 [1.04-1.29]; P = 0.006), cardiovascular mortality (HR = 1.22 [1.04-1.43]; P = 0.013), cardiovascular events (HR = 1.28 [1.16-1.41]; P < 0.0001), and re-intervention (HR = 1.15 [1.06-1.25]; P < 0.0001). After adjustment for Stage 2-3 SVD diagnosis, AVC remained a predictor of overall mortality (HR = 1.20 [1.04-1.39]; P = 0.015) and cardiovascular events (HR = 1.25 [1.09-1.43]; P = 0.001). CONCLUSION:CT scan is a reliable tool to assess BP leaflet calcification. An AVC > 100 AU is tightly associated with SVD and it is a strong predictor of overall mortality and cardiovascular events.

BACKGROUND AND AIMS Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract (RVOT) dysfunction related to congenital heart disease (CHD). Outcomes of TPVI with the SAPIEN 3 valve that are insufficiently documented were investigated in the EUROPULMS3 registry of SAPIEN 3-TPVI. METHODS Patient-related, procedural, and follow-up outcome data were retrospectively assessed in this observational cohort from 35 centres in 15 countries. RESULTS Data for 840 consecutive patients treated in 2014-2021 at a median age of 29.2 (19.0-41.6) years were obtained. The most common diagnosis was conotruncal defect (70.5%), with a native or patched RVOT in 50.7% of all patients. Valve sizes were 20, 23, 26, and 29 mm in 0.4%, 25.5%, 32.1%, and 42.0% of patients, respectively. Valve implantation was successful in 98.5% [95% confidence interval (CI), 97.4%-99.2%] of patients. Median follow-up was 20.3 (7.1-38.4) months. Eight patients experienced infective endocarditis; 11 required pulmonary valve replacement, with a lower incidence for larger valves (P = .009), and four experienced pulmonary valve thrombosis, including one who died and three who recovered with anticoagulation. Cumulative incidences (95%CI) 1, 3, and 6 years after TPVI were as follows: infective endocarditis, 0.5% (0.0%-1.0%), 0.9% (0.2%-1.6%), and 3.8% (0.0%-8.4%); pulmonary valve replacement, 0.4% (0.0%-0.8%), 1.3% (0.2%-2.4%), and 8.0% (1.2%-14.8%); and pulmonary valve thrombosis, 0.4% (0.0%-0.9%), 0.7% (0.0%-1.3%), and 0.7% (0.0%-1.3%), respectively. CONCLUSIONS Outcomes of SAPIEN 3 TPVI were favourable in patients with CHD, half of whom had native or patched RVOTs.