QuestionDoes achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) levels help prevent neoatherosclerosis after drug-eluting stent implantation in patients with ST-segment elevation myocardial infarction (STEMI)?FindingsIn this secondary analysis of the CONNECT randomized clinical trial, neoatherosclerosis was less frequent in patients who achieved guideline-endorsed LDL-C levels and received high-intensity statin therapy. On-treatment LDL-C level emerged as an independent determinant of neoatherosclerosis.MeaningAchieving guideline-recommended LDL-C levels through intensive lipid-lowering therapy may help prevent neoatherosclerosis formation and prevent late stent failure in patients with STEMI. ImportanceNeoatherosclerosis represents a major cause of late stent failure and results in cardiac events after drug-eluting stent (DES) implantation. Achieving secondary preventive low-density lipoprotein cholesterol (LDL-C) target levels can reduce plaque progression in native coronary arteries; however, its association with neoatherosclerosis formation remains unclear.ObjectiveTo determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation.Design, Setting, and ParticipantsThis is a post hoc analysis of the CONNECT randomized clinical trial conducted at 7 sites in Switzerland and Japan that had randomized 239 patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) with biodegradable- or durable-polymer everolimus-eluting stents between June 2017 and June 2020. The prevalence of neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI. Data analysis for this post hoc analysis was conducted from September 2024 to October 2025.InterventionPatients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines.Main Outcomes and MeasuresThe prevalence of neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels. A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis.ResultsAmong 178 patients (mean [SD] age, 63.4 [10.9] years; 27 [15%] female) who underwent OCT at 3 years, 98 patients (55%) achieved the target LDL-C level and 80 patients (45%) did not. The mean (SD) on-treatment LDL-C levels for these groups were 48 (13) and 87 (37) mg/dL, respectively (to convert to millimoles per liter, multiply by 0.0259). The prevalence of neoatherosclerosis was lower in patients who achieved the target LDL-C level as compared with patients who did not (7 patients [7%] vs 15 patients [19%], respectively; odds ratio for those who did not achieve the LDL-C target level, 3.00; 95% CI, 1.19-8.24; P = .02). On-treatment LDL-C level (per 25-mg/dL increase) emerged as an independent determinant of neoatherosclerosis at 3 years in multivariable logistic regression analysis (odds ratio, 1.46; 95% CI, 1.09-2.01; P = .01).Conclusions and RelevanceOn-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI. Neoatherosclerosis was less frequent among patients who achieved the guideline-recommended on-treatment LDL-C level, underscoring the importance of LDL-C lowering in preventing neoatherosclerosis formation.Trial RegistrationClinicalTrials.gov Identifier: NCT03440801 This secondary analysis of the CONNECT randomized clinical trial evaluates whether achieving a guideline-endorsed low-density lipoprotein cholesterol level after drug-eluting stent implantation in patients with ST-segment elevation myocardial infarction (STEMI) is associated with reduced risk of long-term neoatherosclerosis formation.

BACKGROUND:The interplay between atrial fibrillation (AF) and tricuspid regurgitation (TR) has been recognized. However, it is not simple and has not been fully investigated. OBJECTIVES:The aim of this study was to examine the association among AF, TR, and outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER). METHODS:Patients were divided into 4 groups according to the presence of AF and postprocedural significant TR (moderate or greater): no AF and no TR, no AF with significant TR, AF and no TR, and AF with significant TR. The primary outcome was cardiovascular death or heart failure (HF) hospitalization. Right heart structure and function were also evaluated according to AF and TR status. RESULTS:The numbers of patients in each group were 1,184 (no AF and no TR), 229 (no AF with significant TR), 1,423 (AF and no TR), and 830 (AF with significant TR). AF was associated with a higher prevalence of significant TR at baseline and more frequent TR progression and less common improvement during follow-up. Both AF and TR appeared to be independently associated with right-ventricular remodeling and dysfunction, with distinct patterns observed according to MR and TR pathologies. TR grade moderate or greater after M-TEER was associated with a higher adjusted risk for cardiovascular death or HF hospitalization, especially in patients with AF (Pinteraction = 0.02). CONCLUSIONS:Patients with AF, compared with those without AF, experienced greater incidence and progression and less common improvement of TR after M-TEER. In addition, both AF and TR appeared to be independently associated with worse right ventricular status and an increased risk for HF outcomes.

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.

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Short-frame balloon-expandable valves implanted within failed short- or tall-frame transcatheter valves ("short-in-short" and "short-in-tall") pose specific challenges, including coronary risk assessment, valve sizing, anchoring, and preservation of coronary access. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel of experts reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic workflow for redo-TAVR. This document standardizes key anatomic definitions, outlines computed tomography-based strategies for in vivo sizing, and details recommended approaches to predilatation, deployment techniques, and postdilatation. By harmonizing terminology and stepwise planning across imaging, interventional, and surgical teams, this document aims to simplify procedural decision-making and improve safety, coronary preservation, and hemodynamic outcomes in patients undergoing short-in-short and short-in-tall TAV-in-TAV procedures.

BACKGROUND AND AIMS:Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edge-to-edge repair (TEER) for AFMR has not been investigated. METHODS:Patients with AFMR who underwent TEER were selected from the OCEAN-Mitral registry, and medically managed controls were selected from the REVEAL-AFMR registry, using an identical AFMR definition. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. The secondary endpoint was all-cause mortality. RESULTS:A total of 1081 patients (mean age 80.1 ± 8.2 years, 60.5% female) with moderate or severe AFMR were included, of whom 441 underwent TEER and 640 remained on medical treatment. Overlap weighting based on the propensity score yielded well-balanced characteristics (n = 441 vs 640; all standardized mean differences <0.01), where TEER was associated with a lower incidence of the primary (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43-0.99, P = .044) and secondary endpoints (HR 0.58, 95% CI 0.35-0.99, P = .044). In an exploratory subgroup analysis, favourable outcomes might be pronounced in patients with ≤mild residual AFMR after TEER, while event rates in those with ≥ moderate residual AFMR were comparable with the medication group. As sensitivity analyses, inverse probability of treatment weighting (n = 158 vs 173), propensity score matching (n = 104 vs 104), and multivariable Cox regression (n = 441 vs. 640) all confirmed favourable associations of TEER with both endpoints. CONCLUSIONS:In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.

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.

AIMS:The vena contracta width (VCW) in parasternal long axis view (PLAX-VCW) and effective regurgitant orifice area (EROA) may underestimate the mitral regurgitation (MR) severity because of the elliptical-shaped effective orifice in atrial functional MR (AFMR). We aimed to assess the association between the vena contracta width by biplane method (Bi-VCW) and clinical outcomes in patients with AFMR and to compare the discriminative ability of Bi-VCW with those of other quantitative/semiquantitative metrics. METHODS AND RESULTS:This was a substudy of a multicentre registry of moderate or severe AFMR. The Bi-VCW was evaluated as the average of the apical two-chamber and four-chamber views. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, and mitral valve interventions. Among 423 studied patients, the Bi-VCW was higher than PLAX-VCW (8.1 ± 2.4 vs. 4.8 ± 1.9 mm, P < 0.001); the guideline-recommended threshold of Bi-VCW of >8.0 mm stratified 48% as severe MR. The Bi-VCW showed the highest discriminatory performance of the primary outcome (area under the time-dependent receiver operating characteristic curve of 0.76) compared with the PLAX-VCW and EROA and revealed an optimal threshold of 7.9 mm (sensitivity, 76%; specificity, 65%). In the multivariable Cox proportional hazards model, Bi-VCW >8.0 mm was independently associated with a higher risk of the primary outcome (adjusted hazard ratio = 2.97, 95% confidence interval: 2.04-4.32, P < 0.001). CONCLUSION:The Bi-VCW was independently associated with poorer outcomes in patients with AFMR and demonstrated superiority over the guideline-recommended parameters. It could serve as an independent and first surrogate for risk stratification in patients with AFMR.

The extension of transcatheter aortic valve replacement (TAVR) to younger patients with longer life expectancy has driven a shift in focus toward procedural optimization, with the goals of maximal clinical improvement, durable outcomes, maintained coronary access, and avoidance of permanent pacemaker implantation. A TAVR CODE framework including 4 key fluoroscopic parameters-coaxiality, orientation, depth, and expansion-has recently been proposed to standardize the intraprocedural evaluation of optimal transcatheter heart valve (THV) implantation. Systematic implementation of these concepts during TAVR is expected to improve valve performance and durability. This is hypothesized to improve afterload reduction, enhance left ventricular reverse remodeling, and confer increased and longer lasting clinical benefits. To date, procedural strategies to optimize TAVR outcomes have been largely based upon expert opinion, supported predominantly by mechanistic and retrospective studies. Ongoing randomized trials are evaluating the effects of systematic pre- and postdilatation during TAVR, the impact of same-volume double-tap techniques with balloon-expandable valves, and the effectiveness of different commissural alignment techniques. Meanwhile, intravascular ultrasound is under investigation as a tool to evaluate THV expansion to guide postdilatation, while technical consistency may be improved by innovative THV designs that promote symmetrical expansion, better fluoroscopic visualization, and robotic insertion systems using artificial intelligence. In this article, we detail the possible impact of implementing the TAVR CODE framework on THV function, durability, and clinical outcomes, and provide an expert perspective on procedural strategies to achieve optimal index TAVR outcomes, including management frameworks and position statements according to contemporary best practices.

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.

Transcatheter electrosurgery involves the precise application of high-frequency electrical currents to modify or perforate cardiac structures during structural heart interventions. Adoption of these techniques in the Asia-Pacific region has grown significantly alongside the expansion of structural heart programs. Techniques such as Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Coronary Artery Obstruction (BASILICA), Undermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN), Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON), and Balloon Assisted Translocation of the Mitral Anterior Leaflet to Prevent Left Ventricular Outflow Obstruction (BATMAN) have been employed by regional interventionalists to lacerate native or prosthetic heart valves before transcatheter valve implantation, thereby mitigating the risks of coronary or left ventricular outflow tract obstruction. In addition, transcaval access has facilitated transcatheter aortic valve replacement in patients with limited iliofemoral vascular access. This narrative review, authored by the Asia-Pacific Electrosurgery Working Group, explores the evolution of transcatheter electrosurgery, highlighting regional adoption, variations, and innovative contributions. Furthermore, it discusses prevailing challenges and future directions, emphasizing the importance of standardized training and collaborative innovation efforts.

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.

Importance:Neoatherosclerosis represents a major cause of late stent failure and results in cardiac events after drug-eluting stent (DES) implantation. Achieving secondary preventive low-density lipoprotein cholesterol (LDL-C) target levels can reduce plaque progression in native coronary arteries; however, its association with neoatherosclerosis formation remains unclear. Objective:To determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation. Design, Setting, and Participants:This is a post hoc analysis of the CONNECT randomized clinical trial conducted at 7 sites in Switzerland and Japan that had randomized 239 patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) with biodegradable- or durable-polymer everolimus-eluting stents between June 2017 and June 2020. The prevalence of neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI. Data analysis for this post hoc analysis was conducted from September 2024 to October 2025. Intervention:Patients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines. Main Outcomes and Measures:The prevalence of neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels. A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis. Results:Among 178 patients (mean [SD] age, 63.4 [10.9] years; 27 [15%] female) who underwent OCT at 3 years, 98 patients (55%) achieved the target LDL-C level and 80 patients (45%) did not. The mean (SD) on-treatment LDL-C levels for these groups were 48 (13) and 87 (37) mg/dL, respectively (to convert to millimoles per liter, multiply by 0.0259). The prevalence of neoatherosclerosis was lower in patients who achieved the target LDL-C level as compared with patients who did not (7 patients [7%] vs 15 patients [19%], respectively; odds ratio for those who did not achieve the LDL-C target level, 3.00; 95% CI, 1.19-8.24; P = .02). On-treatment LDL-C level (per 25-mg/dL increase) emerged as an independent determinant of neoatherosclerosis at 3 years in multivariable logistic regression analysis (odds ratio, 1.46; 95% CI, 1.09-2.01; P = .01). Conclusions and Relevance:On-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI. Neoatherosclerosis was less frequent among patients who achieved the guideline-recommended on-treatment LDL-C level, underscoring the importance of LDL-C lowering in preventing neoatherosclerosis formation. Trial Registration:ClinicalTrials.gov Identifier: NCT03440801.

Background The association between atrial fibrillation (AF) and prognosis after mitral transcatheter edge-to-edge repair (M-TEER) remains unclear. Objectives The authors examined the association between AF and clinical outcomes after M-TEER according to the etiology of mitral regurgitation (MR). Methods A total of 3,764 patients were classified into degenerative mitral regurgitation (DMR), ventricular functional mitral regurgitation (VFMR), and atrial functional mitral regurgitation (AFMR). We further stratified the patients by the presence of AF. The primary outcome was all-cause mortality within 2 years. Results The prevalence of AF was 57.4% (n = 646 of 1,126) in DMR, 59.7% (n = 1,319 of 2,211) in VFMR, and 83.8% (n = 358 of 427) in AFMR. During 2-year follow-up (the median follow-up: 427 [IQR: 301-821] days), 660 of 3,764 patients (17.5%) died. The association between AF and all-cause mortality had a significant interaction with MR etiology (P for interaction <0.001). AF was associated with a higher risk of all-cause mortality in DMR (adjusted HR: 1.88; 95% CI: 1.17-3.02; P = 0.009), whereas this association was not significant in VFMR and AFMR. Among patients with VFMR, left atrial (LA) volume index modified the association between AF and all-cause mortality. AF was related to a higher risk of all-cause mortality in VFMR patients with lower LA volume index, whereas this association was attenuated in those with higher LA volume index. Conclusions AF was associated with all-cause mortality after M-TEER in patients with DMR, but not in those with VFMR or AFMR. The prognostic effect of AF in patients undergoing M-TEER may be modulated by MR etiology and underlying LA remodeling.

Background Anticoagulants are prescribed less frequently in older patients with atrial fibrillation (AF) because of concerns regarding bleeding risk, despite their high thromboembolism risk. Frailty assessed using the Clinical Frailty Scale (CFS) provides incremental risk stratification for mortality and bleeding after left atrial appendage closure (LAAC); however, its clinical implications remain unclear. Objective To evaluate the impact of frailty, assessed using the CFS, on clinical outcomes and postprocedural antithrombotic management following LAAC. Methods The OCEAN-LAAC registry included 1,409 patients who underwent LAAC. Patients were stratified by CFS into groups 1–3 and 4–8. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included non-procedural major bleeding, ischemic stroke, device-related thrombi, and peri-procedural complications. Results Frailty (CFS 4–8) was present in 32.9% of patients. At 1 year, frail patients had higher mortality rates than nonfrail patients (10.3% vs 3.0%). After multivariable adjustment, frailty was independently associated with mortality (hazard ratio [HR] 3.23, 95% confidence interval [CI], 1.92–5.46). Frailty was also associated with non-procedural major bleeding in the competing risk analysis (subdistribution HR 2.13, 95% CI 1.14–3.96). Despite more frequent de-escalation of antithrombotic therapy in frail patients, rates of ischemic stroke and device-related thrombosis did not differ significantly across frailty groups. Conclusion Frailty assessed using the CFS identifies patients at increased risk of mortality and bleeding after LAAC and may provide incremental risk stratification to guide individualized postprocedural management. Clinical trial registration number OCEAN-LAAC registry (UMIN ID: UMIN000038498)

Background Systemic inflammation is increasingly recognized as an important contributor to cardiovascular outcomes. High‐sensitivity CRP (C‐reactive protein) is an established biomarker, but its prognostic value after mitral transcatheter edge‐to‐edge repair remains unclear. Clinical parameters such as body temperature may also reflect systemic inflammation; however, their prognostic role in this setting is uncertain. We sought to investigate the association between baseline inflammation makers and long‐term outcomes in patients undergoing mitral transcatheter edge‐to‐edge repair. Methods We analyzed 3511 patients from the OCEAN (Optimized Catheter Valvular Intervention)‐Mitral registry with available CRP, categorized by Centers for Disease Control and Prevention/American Heart Association cutoffs: <1.0 mg/L (n=1216), 1.0–3.0 mg/L (n=988), and >3.0 mg/L (n=1307). Body temperature was also assessed as an exploratory inflammatory marker. Results During a median follow‐up of 13 (interquartile range, 10–26) months, 826 deaths and 911 composite event of cardiovascular death or hospitalization for heart failure were observed. In multivariable models, both CRP and body temperature were associated with higher risk of death (CRP: hazard ratio [HR], 1.98 [95% CI, 1.63–2.40]; and body temperature: HR, 1.49 [95% CI, 1.25–1.78]). Patients with both elevated CRP (>3.0 mg/L) and high temperature (≥37.0 °C) had the highest risk. Sequential Cox analyses showed an incremental value of CRP beyond clinical, laboratory, and echocardiographic variables. The prognostic effect was most pronounced in patients without preprocedural inotrope use. Conclusions Elevated CRP is an independent and incremental predictor of death and heart failure outcomes after mitral transcatheter edge‐to‐edge repair, with its prognostic impact amplified by higher body temperature. These findings highlight the importance of incorporating systemic inflammation into risk stratification for structural heart interventions. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN‐ID: UMIN000023653.

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Tall-frame self-expanding valves implanted within failed short- or tall-frame transcatheter valves ("tall-in-short" and "tall-in-tall") present distinct challenges related to anchoring, constrained expansion, valve alignment, and the risk for coronary obstruction or sinus sequestration driven by the resulting neoskirt plane. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic procedural workflow for redo-TAVR in these settings. This consensus document standardizes key definitions, outlines computed tomography-based strategies for in vivo sizing and risk stratification, and details recommended approaches to predilatation, deployment technique, postdilatation, coronary protection and leaflet modification, or hybrid surgical alternative when needed. A structured troubleshooting guide is provided to support safe, reproducible execution and coronary preservation.