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Real-World Outcomes of Transcatheter Tricuspid Valve Replacement
Does Transcatheter Tricuspid Valve Replacement (TTVR) improve safety and effectiveness at 30 days in real-world patients with severe TR?
Result: Thirty-day outcomes demonstrated acceptable safety, near-complete TR elimination, and significant health status improvements, with lower rates of new CIED implantation and bleeding than in randomized trials.
“Good performance of EVOQUE valve in this STS/ACC TVT Registry of Real-World Outcomes of Transcatheter Tricuspid Valve Replacement with >98% success but 16% new CIED w/o impact on 30 days outcomes. https://t.co/zipqHU6ho5”
These findings show that transcatheter tricuspid valve replacement is translating well from the clinical trial setting into routine practice across the United States. In a large, older and medically complex patient population, we saw very high procedural success, near-complete elimination of tricuspid regurgitation, and rapid improvement in how patients feel and function.
Outcomes of Transcatheter Tricuspid Edge-to-Edge Repair and Transcatheter Valve Replacement for Severe Tricuspid Regurgitation: A Systematic Review and Meta-Analysis
Abstract Background Severe tricuspid regurgitation (TR) is associated with substantial morbidity, mortality, and impaired quality of life. Transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as treatment options, but comparative evidence to guide procedural selection remains limited. Aims To systematically evaluate the safety and clinical outcomes of T-TEER and TTVR in patients with severe TR. Methods and results A systematic review and meta-analysis were performed according to PRISMA guidelines, including studies published through July 2025. Random-effects models were used to pool outcomes at in-hospital, 30-day, and 1-year follow-up. Twenty studies comprising 4,468 patients undergoing T-TEER and 20 studies including 1,017 patients undergoing TTVR were included. T-TEER was associated with very low in-hospital (0.13%) and 30-day (0.46%) mortality, with 1-year mortality of 10.16%. Early mortality was high following TTVR, whereas 1-year mortality was similar between strategies. TTVR achieved more complete and durable elimination of severe TR, while T-TEER resulted in meaningful but less complete TR reduction. Both approaches were associated with substantial improvements in New York Heart Association functional class and quality of life. TTVR was associated with higher rates of permanent pacemaker implantation, thrombotic events, and major bleeding that increased over time, whereas bleeding after T-TEER was predominantly peri-procedural. Changes in right ventricular systolic function were modest and similar between approaches. Conclusion T-TEER and TTVR are associated with improvements in clinical and echocardiographic outcomes in patients with severe tricuspid regurgitation. These findings are descriptive and hypothesis-generating, highlighting the need for prospective studies to clarify optimal patient selection and long-term outcomes.
Incidence of Infective Endocarditis Following Surgical or Transcatheter Mitral Valve Repair or Replacement: A Systematic Review and Meta-Analysis
Does bioprosthetic mitral valve replacement increase the incidence of infective endocarditis compared to mitral valve repair in patients undergoing mitral valve intervention?
Result: Infective endocarditis was significantly more common after surgical MV replacement than surgical MV repair (IRR 2.34, 95% CI 1.06-5.18, p=0.035), but not significantly different between transcatheter MV replacement and repair (IRR 1.56, 95% CI 0.73-3.34, p=0.250).
On the provenance of spontaneous coronary artery dissection
Result: The paper provides a detailed historical consideration of the medical literature from 1800 to trace the provenance and evolving understanding of spontaneous coronary artery dissection.
Yield of Postmortem Genetic Testing in Sudden Arrhythmic Death Syndrome: A Systematic Review and Meta-Analysis
Does postmortem genetic testing identify pathogenic variants in Sudden Arrhythmic Death Syndrome cases?
Result: Postmortem genetic testing identifies pathogenic or likely pathogenic variants in a significant subset of SADS cases.
A case report of distal coronary artery spasm overlapping a calcified nodule: a rare mechanism of acute coronary syndrome
Abstract Background Calcified nodules (CNs) are the least common cause of acute coronary syndrome (ACS) and are distinct from plaque rupture and erosion. Although CNs are increasingly recognized as a unique ACS mechanism, their pathophysiology remains poorly understood. Case summary A 66-year-old man with a long history of alcohol-related chest discomfort was referred for evaluation of worsening exertional symptoms. The initial electrocardiogram was unremarkable, but coronary computed tomography angiography showed a moderately calcified stenosis in the mid–right coronary artery (RCA), and elective coronary angiography was scheduled. However, on admission for the planned procedure, the patient experienced chest discomfort following binge drinking the night before. The electrocardiogram on admission revealed inferior ST-segment elevation. Emergent coronary angiography and intracoronary imaging identified severe mid–RCA stenosis associated with a CN with an overlying thrombus, while distal flow was preserved (Thrombolysis in Myocardial Infarction grade 3). The subsequent acetylcholine provocation test was positive, confirming coronary spastic angina (CSA). These findings raise the possibility that distal embolization from the surface thrombus on the CN contributed to the ACS presentation, potentially facilitated by CSA-associated flow reduction. Discussion This case highlights a potential dual mechanism of ACS, in which distal coronary artery spasm may have promoted thrombus formation on a CN by reducing coronary blood flow. The coexistence of CN and CSA may represent a synergistic pathophysiology linking mechanical plaque vulnerability with flow-mediated thrombus formation.
Targeted Exome Sequencing in Pre-Hospital Sudden Cardiac Arrest Reveals a High Genetic Diagnostic Yield
Background: The role of genetic testing in sudden cardiac arrest (SCA) among young and middle-aged adults remains incompletely understood, particularly in pre-hospital settings and in individuals with established clinical diagnoses such as coronary artery disease. Methods: We performed whole-exome sequencing with targeted analysis in a city-wide cohort of individuals who experienced pre-hospital SCA in Hangzhou, China. Variants were evaluated using a virtual panel of 2151 cardiovascular-related genes. Variant classification followed the American College of Medical Genetics and Genomics guidelines. Results: A total of 69 individuals (mean age 38 ± 14.6 years) were included. Pathogenic or likely pathogenic variants were identified in 13 individuals, corresponding to a diagnostic yield of 18.8%. One individual carried two variants. The identified variants involved genes associated with cardiomyopathies, arrhythmia syndromes, metabolic disorders, and lipid metabolism. Genetic findings were observed both in individuals without a clear clinical diagnosis and in those with apparently established causes of cardiac arrest, including coronary artery disease. When rare variants of uncertain significance with supportive evidence were considered, up to 47.8% of individuals carried potentially relevant variants. Broader gene panels identified more variants than narrower panels limited to established sudden cardiac death genes. Conclusions: Systematic exome sequencing in young and middle-aged individuals with pre-hospital SCA identifies clinically relevant genetic variants in a substantial proportion of cases. Genetic testing may complement conventional clinical investigation and may contribute to molecular autopsy and family-based risk assessment in selected patients.
Infective endocarditis in hypertrophic cardiomyopathy: a real-world matched cohort analysis
Background Patients with hypertrophic cardiomyopathy (HCM) are not currently considered at elevated risk for infective endocarditis (IE) and are excluded from guideline-directed antibiotic prophylaxis, despite structural and haemodynamic features that may predispose to infection. Methods This retrospective cohort study used real-world data from the TriNetX research network, a multicentre electronic health record platform. Adults aged ≥45 years with an ambulatory encounter between 1 January 2015 and 31 December 2019 and a diagnosis of HCM were identified and propensity score matched 1:1 to controls without HCM. A reference group of patients with prior valve intervention was also analysed. The primary outcome was 5-year cumulative incidence of IE, determined by International Classification of Diseases-10 codes. HRs and 95% CIs were calculated using Cox proportional hazards models. Results Among 18 177 matched HCM-control pairs (mean (SD) age, 65.7 (10.4) years; 43.8% female), the 5-year cumulative incidence of IE was 3.25% in the HCM group and 1.31% in controls (HR, 2.62; 95% CI 2.20 to 3.12; p<0.001). In the valve intervention cohort (n=1916), IE incidence was 6.46% versus 1.52% in controls (HR, 4.21; 95% CI 2.62 to 6.75; p<0.001). In an exploratory subgroup of 231 HCM patients treated with mavacamten, no IE cases occurred during the 1-year follow-up period. Conclusions Patients with HCM had more than twice the 5-year risk of IE compared with matched controls and approximately half the risk seen in patients with valve interventions. HCM may represent an intermediate-risk group not currently addressed in prophylaxis guidelines.
Endovascular Therapy for Post-Thrombotic Syndrome — A Randomized Trial
Does endovascular therapy improve post-thrombotic syndrome severity and health-related quality of life in patients with moderate or severe post-thrombotic syndrome and iliac-vein obstruction?
Result: Endovascular therapy led to less severe post-thrombotic syndrome and better health-related quality of life than standard care over a 6-month period, but with a higher risk of bleeding.
“Original Article: Endovascular Therapy for Post-Thrombotic Syndrome — A Randomized Trial (phase 3 C-TRACT trial) https://t.co/XgtK21vpsG Editorial: Stenting for Post-Thrombotic Syndrome — A Step Forward https://t.co/iO6yAK4jvd #SIR26TOR | @SIRspecialists https://t.co/O0PdvA7Wib”
Many patients with PTS suffer in silence because few physicians are aware of this complication or know how to effectively treat it. This study suggests that even severe PTS is, in fact, a treatable condition in many patients.
Device-Detected Atrial Fibrillation: Why Time-Based Thresholds Are No Longer Fit for Purpose
Result: Recent randomised controlled trials show that anticoagulation guided solely by arrhythmia duration confers limited net clinical benefit, with modest reductions in ischaemic stroke offset by increased bleeding.
“#EHRA26 simultaneous publication Kidney disease increases the risk of cardiovascular events in patients with device-detected atrial fibrillation: NOAH-AFNET 6 https://t.co/4dgYLZ4XZn #Europace @EuropaceEiC https://t.co/z2qPBLTznK”
We now have much better estimates of the efficacy and safety of oral anticoagulation in patients with device-detected atrial fibrillation. We clearly need additional methods to identify patients with device-detected atrial fibrillation at high risk of stroke who may benefit from anticoagulation.