Search Results (125)

Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a cornerstone in the management of severe mitral regurgitation, serving as a robust, low-risk alternative to conventional mitral valve surgery. Although thromboembolic risk remains a critical clinical challenge, that varies significantly across the clinical continuum, from pre-procedural substrates to post-procedural management. This review highlights the role of atrial cardiomyopathy in creating a prothrombotic milieu even prior to intervention, while during the procedure, device time emerges as a potentially dominant independent predictor of embolic burden, marking the periprocedural window as the period of peak hazard. Furthermore, this article addresses the notable disparity between the near-universal presence of subclinical ischemic lesions on magnetic resonance imaging and the infrequent incidence of overt neurological deficits. As the post-procedural phase is considered, we discuss the shift from standardized antithrombotic protocols to individualized strategies and the potential role of concomitant left atrial appendage occlusion. Ultimately, integrating these stage-specific clinical and procedural determinants with emerging technologies—like digital twins and artificial intelligence—represents a promising frontier for mitigating embolic risks, optimizing procedural planning and patient safety in the evolving landscape of mitral valve interventions. Full article

Background and Objectives: Overt perioperative stroke remains a feared complication of adult cardiac surgery. Diffusion-weighted magnetic resonance imaging (DWI-MRI) has revealed a more prevalent form of cerebral injury, termed silent stroke or silent brain injury (SBI). Covert ischemic lesions occur without focal neurological deficits but are increasingly associated with postoperative delirium, cognitive decline, and elevated long-term cerebrovascular risk. Despite growing recognition, the true burden, mechanisms, and clinical relevance of SBI remain incompletely integrated into perioperative practice. Materials and Methods: We performed a narrative review of the literature published between January 2000 and December 2025, identified through PubMed/MEDLINE and Scopus. Eligible studies included prospective and retrospective cohorts, randomized trials, systematic reviews, and meta-analyses involving adult patients undergoing coronary artery bypass grafting, valve surgery, or minimally invasive cardiac procedures, with or without cardiopulmonary bypass, and reporting MRI-detected ischemic lesions or validated surrogate markers of cerebral injury. Pediatric studies, transcatheter interventions, case reports, and non-English publications were excluded. Sixty studies met the inclusion criteria. Results: Silent stroke occurred more frequently than clinically apparent stroke, with new DWI-MRI lesions detected in approximately 20–60% of patients following cardiac surgery. Lesions were typically small, multifocal, and embolic in distribution, predominantly affecting cortical and watershed regions. Cardiopulmonary bypass-related factors, including aortic manipulation, cerebral microembolization, hemodilution, hypoperfusion, and impaired oxygen delivery, emerged as key contributors. Several studies demonstrated associations between SBI burden and postoperative delirium, early cognitive dysfunction, and functional decline. Perfusion-based neuroprotective strategies showed mechanistic benefit, although no single intervention conclusively prevented SBI. Conclusions: Silent stroke represents the most frequent form of neurological injury in adult cardiac surgery. Evidence suggests that these covert lesions reflect clinically meaningful cerebral injury, with potential short- and long-term consequences. Recognition of silent stroke as a relevant neurological endpoint supports a shift toward multimodal, perfusion-driven neuroprotective strategies and the routine incorporation of MRI-based outcomes in future cardiac surgical research. Full article

Background and Objectives: Porcelain aorta is an anatomy-driven high-risk phenotype characterized by extensive calcification of the ascending aorta, which complicates surgical aortic valve replacement by increasing embolic and technical hazards during cannulation and cross-clamping. As transcatheter aortic valve implantation (TAVI) expands into younger and low-surgical-risk populations, porcelain aorta creates a distinct clinical dilemma: optimizing short-term procedural safety while ensuring durable long-term outcomes and preserving future treatment options. Materials and Methods: We performed a targeted literature search of MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), with the last search conducted on 31 January 2026. We synthesized contemporary clinical evidence on TAVI in patients with imaging-defined porcelain aorta, focusing on neurological outcomes, procedural strategies to reduce embolic risk, access considerations, valve performance, cerebral embolic protection, and implications for lifetime valve management (including coronary access and feasibility of future valve-in-valve interventions). Results: The evidence base specific to porcelain aorta in the contemporary TAVI era is limited and largely observational. Across published cohorts, TAVI avoids direct ascending aortic cannulation and cross-clamping and is generally associated with favorable early safety, with a recurring directional signal toward lower neurological risk compared with surgical strategies that require manipulation of a severely calcified ascending aorta. Interpretation is constrained by heterogeneity in porcelain-aorta definitions, patient selection, valve platforms and access routes, as well as, variability in neurological endpoint definitions and adjudication. Conclusions: In patients with porcelain aorta, TAVI is frequently favored because it minimizes ascending aortic manipulation and may mitigate neurological and procedural hazards. In younger and low-risk patients, Heart Team decision-making should incorporate lifetime management principles, including access planning, preservation of future coronary access, and procedural strategies to reduce embolic risk (with consideration of cerebral embolic protection when appropriate). Full article

Paravalvular leak (PVL) remains a clinically important complication after surgical or transcatheter valve implantation, presenting predominantly with heart failure (HF) and/or high-shear hemolysis. While redo surgery can be definitive, contemporary candidates frequently carry prohibitive operative risk, positioning transcatheter PVL closure as a key therapeutic alternative. However, available outcome data are largely derived from observational series and registries with heterogeneity in PVL mechanisms, prosthesis types, imaging protocols, and endpoint definitions. Standardized frameworks—such as those proposed by the PVL Academic Research Consortium—support harmonized PVL grading and clinically meaningful composite endpoints that integrate imaging/hemodynamic results with patient-centered outcomes. Across datasets, the most consistent determinant of benefit is residual PVL severity: procedural efficacy is most commonly defined as achieving ≤ mild residual regurgitation without prosthetic leaflet interference, device embolization, or major complications. This review provides a step-by-step, phenotype-driven approach to transcatheter PVL closure, emphasizing multimodality imaging (TEE and cardiac CT, with adjunct CMR and PET when appropriate), access and support planning tailored to valve position, and morphology-matched device selection—often requiring modular multi-device strategies for elongated crescentic channels, particularly in hemolysis-predominant presentations. We also synthesize evidence on complications and bailout management, with a focus on preventable high-severity events (leaflet impingement, embolization, stroke/air, vascular injury, tamponade) and standardized pre-release safety checks. Collectively, contemporary practice supports high implant success in experienced programs, with clinical improvement tightly coupled to procedural endpoint quality and careful Heart Team selection. Full article

Background: Stroke and subclinical cerebral ischemia remain important neurological complications of transcatheter aortic valve replacement (TAVR). The Sentinel cerebral embolic protection (CEP) device is designed to capture embolic debris during TAVR, but its impact on clinical and imaging outcomes remains incompletely characterized. Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing Sentinel CEP versus no protection when TAVR was performed. Outcomes of interest included all stroke, disabling stroke, infarct volume by diffusion-weighted MRI in protected and unprotected areas, all-cause mortality, acute kidney injury, and major vascular complications. Risk ratios (RRs) and median differences with 95% confidence intervals (CIs) were calculated using random-effects models and trial sequential analysis (TSA) assessed evidence robustness. Results: Four RCTs including 10,986 patients were analyzed. Sentinel CEP did not significantly reduce clinical stroke (RR 0.88, 95% CI 0.69–1.12) or disabling stroke (RR 0.68, 95% CI 0.41–1.14). Pooled DW-MRI data showed a significant reduction in new ischemic lesion volume within Sentinel CEP-protected territories (difference in medians −75.7 mm³; 95% CI −130.4 to −21.0). Subgroup analyses in elderly, female, and high-surgical-risk patients revealed no benefit with Sentinel CEP. Additionally, TSA indicated that current data are underpowered for definitive conclusions. Conclusions: The Sentinel CEP device during TAVR did not significantly reduce clinical stroke but was associated with lower MRI-detected ischemic lesion volumes compared with no protection. Further adequately powered RCTs integrating clinical and imaging endpoints are needed to define its role in neuroprotection during TAVR. Full article

Background and Objectives: Transcatheter aortic valve implantation (TAVI) has become the mainstay of treatment for symptomatic aortic stenosis (AS) in patients over 70 years of age. It is also indicated for younger patients with significant comorbidities, for valve-in-valve interventions, and in selected patients with severe aortic insufficiency. We aimed to evaluate procedural and clinical outcomes of transfemoral TAVI performed over the course of 12 years by the same operators using different bioprosthetic valves. Materials and Methods: Between 2012 and 2023, 375 patients underwent TAVI in our clinic, with six types of bioprosthetic valves (Edwards Sapien XT, Medtronic Valves [CoreValve and Evolut R], Portico, Myval, Acurate Neo, and Direct Flow Medical). A transfemoral approach was used in all patients. The procedural and clinical outcomes were defined according to Valve Academic Research Consortium-3 (VARC-3) criteria. Results: The mean age of the patients was 78.4 ± 7.3, and their median STS score was 4.2 (2.9–5.9). Of the 375 patients, 361 had severe AS, 4 had severe aortic insufficiency, 5 were valve-in-valve, and 5 were valve-in-TAVI. Seven patients required a second valve implantation: four due to embolization of the prosthetic valve and three due to deep implantation of the prosthetic valve. Based on the VARC-3 criteria, the rates of technical success and device success were 90.4% and 85.3%, respectively. Major vascular complications were observed in 18 (4.8%) patients. Also, 42 (11.2%) patients required permanent pacemaker implantation. The incidence of moderate or worse paravalvular leak was 2.9%. The peri-procedural, 30-day, 1-year, and 5-year mortality rates were 5.1%, 4.3%, 15.2%, and 45.6%, respectively. STS scores (HR:1.129, 95%CI: 1.068–1.192, p < 0.001) and post-TAVI acute kidney injury (HR:3.993, 95%CI:1.629–9.785, p = 0.002) were detected as independent predictors of mortality in Cox regression analysis. Conclusions: This registry demonstrated the evolution of TAVI procedures at a single center over 12 years. A high level of collaboration between experienced operators and innovations in devices seem to be the key features for achieving high procedural success and low complication rates. Full article

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney disease (ESKD), accounting for approximately 5–10% of patients receiving dialysis worldwide. The large and numerous cysts in the liver and kidneys cause abdominal distention and poor appetite. Previous studies showed that renal arterial embolization (RAE) reduces total kidney volume (TKV), increases appetite, and improves quality of life. This article aims to evaluate the efficacy of RAE in increasing psoas muscle (PM) and paraspinal muscle (PS) mass in patients with polycystic kidney disease. Methods: A retrospective study was conducted from May 2016 to December 2020. Thirty-five patients with PKD and ESKD who received RAE were enrolled. The clinical data, including age, sex, body weight, abdominal circumference, and laboratory results, including albumin, creatinine, estimated glomerular filtration rate, and dialysis vintage, were collected. TKV was calculated with the ellipsoid formula method, and muscle mass was measured with bilateral PM and PS areas at the third lumbar level. The associated clinical, laboratory, and imaging data were compared before and after RAE. Results: There were 19 females and 16 males with a mean age of 59.9 for the final analysis. There were significant changes between baseline and 3-month, 6-month, 12-month after RAE, such as a decrease in TKV (4684 ± 3361 vs. 4079 ± 3456, 3675 ± 3401, 2459 ± 1706 mL, all p < 0.001), an increase in the PM area (12.6 ± 5.8 vs. 13.3 ± 5.7, 14.7 ± 6.9, 14.3 ± 7.1 cm², all p < 0.05), but no difference in body weight, body mass index, albumin, hemoglobin, creatinine, or estimated glomerular filtration rate. The increase in the PM and PS was more obvious in the sarcopenic group than in the non-sarcopenic group in the 12-month follow-up (p = 0.001 and 0.016 vs. p = 0.205 and 0.259). Conclusions: RAE effectively reduces TKV, increases PM and PS mass, and serves as a candidate to reverse muscle loss in patients with PKD. Full article

Patent foramen ovale (PFO) is present in roughly one quarter of adults and is over-represented among younger patients with cryptogenic ischemic stroke. The past decade has produced compelling evidence from randomized trials showing that PFO closure is beneficial than medical therapy in preventing recurrent ischemic stroke in appropriately selected patients. Despite this, anticoagulation continues to be used when closure is not feasible, declined, contraindicated, or considered after recurrent events. The observation that some patients experience “breakthrough” stroke or transient ischemic attack (TIA) despite therapeutic anticoagulation raises a critical question: why does medical therapy fail in PFO-associated stroke, and why does closure appear superior? This narrative review synthesizes the latest evidence on the pathophysiology of PFO-associated stroke, with attention to mechanisms that remain incompletely addressed by anticoagulation. It analyzes randomized trial data comparing antiplatelet therapy, anticoagulation, and transcatheter closure. It examines the role of high-risk PFO anatomical characteristics, the Risk of Paradoxical Embolism (RoPE) score, and the PFO-Associated Stroke Causal Likelihood (PASCAL) classification in understanding medical therapy failure. Additionally, the review explores whether PFO “type” predicts anticoagulation failure and highlights future research directions needed to further optimize therapy. In conclusion, in appropriately selected patients with high-risk PFO features, closure provides greater stroke risk reduction than medical therapy alone, albeit with small absolute risk differences and a procedural risk of atrial fibrillation. Full article

Cesarean scar pregnancy (CSP) carries a high risk of severe hemorrhage and potential loss of fertility. This narrative review summarizes current evidence on uterine artery embolization (UAE) using absorbable gelatin sponge (GS), focusing on GS preparation, procedural approaches, and reported outcomes. PubMed/MEDLINE, Scopus, and Google Scholar were searched from January 2015 to 31 December 2024 for peer-reviewed studies reporting UAE with GS for CSP (GS alone or combined with intra-arterial methotrexate and/or adjunct particles). Fifty studies (N = 3139) were included. Technical success was 3133/3139 (~99.8%) and clinical success was 2975/3139 (~94.8%), with most cohorts reporting high clinical control. Severe complications were infrequently reported (typically ~2–4% in most series). Menstrual function, when assessed, generally recovered within ~1–2 months. Subsequent pregnancy outcomes were inconsistently reported and follow-up durations were heterogeneous, predominantly in retrospective designs. Overall, UAE with GS appears effective for hemostasis in CSP and may reduce escalation to hysterectomy in appropriately selected patients. Standardized reporting of GS preparation and outcomes, as well as prospective multicenter registries/studies, are needed to refine best practices. Full article

Introduction. Patent ductus arteriosus (PDA) is the most common cardiac anomaly in preterm newborns and may aggravate respiratory disease. Invasive closure options after failure of medical treatment include surgical ligation (SL) and transcatheter closure (TCC). Reports on side effects of intravenous contrast media are scarce. Methods. In this retrospective single-center study, we compared 35 preterm infants below 1500 g birth weight undergoing SL with 35 matched infants undergoing TCC. Outcomes were procedural success, complications and postprocedural ventilation. Results. Closure success was high in both groups (97% SL vs. 86% TCC, p = 0.106). One SL patient underwent re-operation after accidental clipping of the left pulmonary artery, and eight patients (24%) had endoscopy-diagnosed vocal cord palsy after SL. Six TCC patients had complications that required further action, including device embolization, device failure and one case of late device migration that resulted in aortic arch obstruction requiring intervention, and 4 TCC patients developed necrotizing enterocolitis (NEC)-like disease within 24 h, requiring surgery in one patient. SL was associated with longer duration of mechanical ventilation (24 h vs. 144 h, p < 0.001), as opposed to TCC, and higher rates of bronchopulmonary dysplasia (86% vs. 53%, p = 0.004). Discussion. Both techniques achieve high success but differ in complication profiles. TCC may reduce respiratory morbidity. NEC-like disease (probably linked to intravenous administration of contrast agents) warrants further investigation. Full article

Transcatheter aortic valve implantation is rapidly emerging as the leading treatment for severe aortic valve stenosis, especially in elderly and high-risk or inoperable patients. Prosthetic embolism is a rare but serious complication of transcatheter aortic valve replacement. Patients who develop prosthetic embolism are at increased risk of mortality and morbidity. These include stroke and aortic dissection associated with manipulation of the prosthesis in the ascending aorta. Treatment of valve embolisms into the aorta may differ depending on the type of valve; however, it traditionally relies on repositioning the valve to an appropriate position. To date, there are no established pharmaceutical guidelines for the management of patients with valve prosthesis embolization. We present a case report of the implantation of a second aortic valve prosthesis after periprocedural embolization of the first transcatheter valve, resulting in residual floating in the ascending aorta and following treatment with oral anticoagulation as well as single antiplatelet therapy due to the increased risk of thrombogenesis. This case report provides an example of the management of a transcatheter valve embolization with residual floating and highlights the need for further studies to address this issue. Full article

Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in elderly and high-risk patients. However, prosthetic valve endocarditis (PVE) remains a rare but devastating complication. Its diagnosis is often delayed due to atypical clinical manifestations and the frequent occurrence of culture-negative endocarditis. Case Presentation: We report the case of a 68-year-old woman with a prior TAVI who presented with sacroiliitis, initially interpreted as a localized musculoskeletal infection. Subsequent evaluation revealed infective endocarditis involving the prosthetic aortic valve and the native mitral valve. Blood cultures remained negative, most likely due to prior antibiotic therapy, which complicated timely diagnosis. During hospitalization, the patient developed acute ST-segment elevation myocardial infarction (STEMI), caused by coronary septic embolization. Discussion: Distinguishing septic emboli from thrombotic occlusion in the setting of STEMI complicating endocarditis is extremely challenging but essential, as therapeutic approaches diverge. While percutaneous coronary intervention is the standard treatment for thrombotic occlusion, it carries major risks of septic embolization, including stent infection, mycotic aneurysm, and uncontrolled sepsis. Conclusions: This case highlights the need for high clinical suspicion of PVE in atypical presentations, the diagnostic challenges of culture-negative endocarditis, and the therapeutic dilemmas posed by acute coronary complications without clear guideline-based solutions. Full article

Background: Intensive Cardiovascular Care Units (ICCUs) are critical in managing high-acuity cardiovascular conditions, yet contemporary data on evolving admission patterns and their association with outcomes are limited. Methods: We conducted a retrospective cohort study of all patients admitted to a tertiary-care ICCU between July 2019 and December 2024. Patients were stratified by admission period: early (2019–2021) and late (2022–2024). Baseline characteristics, index diagnosis, interventions, complications, and mortality outcomes were compared. The primary endpoints were in-hospital and one-year mortality. Results: The study included 6266 patients (median age 69 years, 32% female). Of them, 3125 and 3141 patients were admitted in the early and late periods, respectively. Patients in the later period exhibited a higher burden of co-morbidities, including increased rates of atrial fibrillation, cognitive impairment, and dialysis (p < 0.05 for all). The pattern of index diagnoses shifted, showing an increase in heart failure (5.6% vs. 3.7%, p = 0.001) and malignant arrhythmia admissions (13.9% vs. 9.3%, p < 0.001), alongside a decline in cases of NSTEMI and pulmonary embolism. The use of urgent percutaneous coronary intervention, transcatheter valvular interventions, and microaxial pumps increased, whereas intra-aortic balloon pump usage declined. In-hospital mortality remained consistent between the periods at 2.7%. However, adjusted one-year mortality was significantly reduced in the later period (adjusted HR 0.84, 95% CI 0.71–0.98, p = 0.037). Conclusions: Over five years, ICCU admissions showed increasing complexity and evolving procedural trends. Despite higher acuity, adjusted one-year survival improved, highlighting care advances and the value of continuous data-driven ICCU optimization. Full article

Purpose: Renal angiomyolipomas (AMLs) are benign renal neoplasms that may lead to spontaneous hemorrhage. Transcatheter arterial embolization (TAE) is a nephron-sparing treatment option, yet data on predictors of hemorrhage and re-intervention remain limited. This study evaluates clinical and radiologic outcomes of TAE and identifies predictors of hemorrhage and repeat embolization. Materials and Methods: A retrospective review of 66 patients (69 AMLs) undergoing TAE between 2010 and 2024 was conducted. Clinical, radiological, and procedural variables were analyzed. Tumor size, vascularity, and aneurysmal features were assessed pre- and post-embolization. Logistic regression models identified predictors of hemorrhage and repeat TAE. Results: Pre-treatment tumor diameter was the only significant predictor of hemorrhage (p = 0.011), with a threshold of 6.8 cm yielding 84.6% sensitivity and 71.3% specificity. All hemorrhagic tumors measured ≥4 cm. Post-embolization tumor volume predicted repeat TAE (p = 0.001), with a 248 mL cutoff. TAE significantly reduced tumor diameter (−33.5%) and volume (−60%) (p < 0.001). Radiologic success was achieved in 97% of cases, with a durable success rate of 84%. Clinical success was 94%, and complications occurred in 7.2% of patients, including two major events. Conclusions: TAE is a safe and effective treatment for renal AMLs. Tumor diameter >6.8 cm is a strong predictor of hemorrhage, while larger post-embolization volumes predict the need for re-intervention. These findings challenge the conventional 4 cm treatment threshold and support more individualized management strategies incorporating tumor morphology and response to embolization. Full article

Cardiac computed tomography (CT) has become a cornerstone in the non-invasive evaluation and management of cardiovascular disease, offering clinicians detailed anatomical and functional information that directly influences patient care. This review focuses on three primary clinical applications: coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), and preprocedural planning for structural heart interventions. CAC quantification remains one of the most powerful prognostic tools for cardiovascular risk stratification, with robust evidence supporting its use in asymptomatic and selected symptomatic individuals. CCTA provides a high-resolution assessment of coronary anatomy and plaque characteristics, guiding both preventive and acute care strategies. In structural heart disease, CT is indispensable for accurate device sizing, procedural planning, and complication avoidance in interventions such as transcatheter valve replacement or repair. Beyond these core applications, cardiac CT supports the evaluation of pericardial, myocardial, aortic, and congenital heart disease, and plays a role in pulmonary embolism risk assessment. Technological innovations—including artificial intelligence, dual-energy imaging, and photon-counting CT—are enhancing image quality, reducing radiation exposure, and broadening the modality’s prognostic capabilities. Collectively, these advances are solidifying cardiac CT as an integrated diagnostic and planning tool with a significant impact on clinical decision-making and patient outcomes. Full article