A patient with a degenerated surgical xenograft aortic valve and elevated body mass index presented with recurrent pulseless electrical activity arrests, requiring emergency intervention. The clinical team successfully performed an emergency valve-in-valve transcatheter aortic valve implantation (ViV-TAVI), a minimally invasive technique that positions a new valve within the deteriorated xenograft without removing the original surgical valve. This case demonstrates the critical application of ViV-TAVI as a life-saving alternative to conventional open-heart surgery in hemodynamically unstable patients. The procedure proved particularly valuable given the patient's high body mass index, which typically complicates traditional surgical approaches. This emergency intervention highlights the expanding role of transcatheter technologies in managing acute valvular degeneration and emphasizes how ViV-TAVI can provide rapid hemodynamic stabilization in patients unsuitable for redo surgery. The case contributes important clinical evidence regarding the feasibility and effectiveness of emergency transcatheter techniques in treating degenerated bioprosthetic valves across diverse patient populations, potentially reshaping treatment paradigms for similar high-risk presentations.

Percutaneous mitral repair represents an evolving treatment strategy for secondary mitral regurgitation in heart failure with reduced ejection fraction. Beyond established transcatheter edge-to-edge repair (TEER), emerging approaches include next-generation TEER techniques, transcatheter mitral valve replacement (TMVR), transcatheter annuloplasty, and chordal repair. However, most lack randomized evidence for mortality or heart-failure hospitalization benefits and should not be considered equivalent to trial-supported TEER. TMVR may address anatomies unsuitable for TEER, including short or calcified leaflets and severe annular calcification. The SAPIEN M3 system, a fully percutaneous transseptal device comprising a nitinol dock and balloon-expandable valve, was evaluated in the ENCIRCLE trial for symptomatic moderate-to-severe or severe mitral regurgitation in patients unsuitable for surgery or TEER. However, the trial's 72 percent screening-failure rate highlights restrictive anatomic requirements. Tendyne remains the only commercially approved TMVR system, using a transapical approach with apical tether but with restricted use based on annular calcification severity and life expectancy. Long-term structural durability and reintervention outcomes remain uncertain for these emerging technologies.

This prospective study of 54 consecutive patients examines combined transcatheter edge-to-edge repair using MitraClip and TriClip devices for severe mitral and tricuspid regurgitation, conditions that represent a high-risk patient population with advanced right-heart disease and poor outcomes. The research evaluated the prognostic utility of the TRIVALVE score, previously validated for tricuspid interventions alone, in patients requiring dual-valve repair. Thirty-day mortality was 5.5%, with median follow-up of 607 days revealing 1-year and 2-year survival rates of 91.8% and 64.5% respectively. Logistic regression analysis identified both TRIVALVE score and baseline hemoglobin levels as independent predictors of mortality, while the TRIVALVE score independently predicted the composite endpoint of mortality or heart-failure rehospitalization, with pre-procedural atrial fibrillation and right-heart failure emerging as the strongest predictive components. Machine learning models, particularly random forest analysis, demonstrated strong discriminative performance for predicting follow-up mortality. These findings provide important long-term evidence supporting combined TEER as a viable treatment strategy while establishing the TRIVALVE score's prognostic value in this complex dual-valve patient population.

This study published in JACC: Cardiovascular Interventions presents a one-year comparison of two transcatheter edge-to-edge repair (TEER) devices for mitral valve regurgitation: PASCAL and MitraClip. Both devices represent minimally invasive alternatives to surgical repair, addressing moderate to severe mitral regurgitation in patients who may not be surgical candidates. The research, led by Jafer Haschemi MD and colleagues, evaluates the comparative efficacy and safety outcomes of these two prominent mitral valve repair technologies over a twelve-month follow-up period. This comparison is clinically significant as PASCAL represents newer technology with potential procedural advantages, while MitraClip remains the more established option with extensive clinical data. Understanding the relative performance of these devices is crucial for interventional cardiologists and heart teams making treatment decisions. The findings contribute to the growing body of evidence supporting transcatheter mitral valve interventions as viable alternatives in the expanding landscape of structural heart disease treatment, ultimately informing clinical practice regarding device selection and patient outcomes in mitral valve disease management.

Edwards Lifesciences' PASCAL repair system demonstrates safety and efficacy comparable to Abbott's established MitraClip for treating mitral regurgitation, according to findings published in JACC: Cardiovascular Interventions. Researchers from University Hospital Bern and Cleveland Clinic analyzed 30-day outcomes from an early feasibility study of 62 patients across 14 centers and a prior compassionate use cohort of 23 patients. Results showed high procedural success, with 98% of early feasibility patients achieving mitral regurgitation grade ≤2+, and 86% reaching ≤1+. The mortality rate was 1.6% in the feasibility study and 13% in compassionate use, with no strokes recorded in either group. Major bleeding occurred in 6.5% of feasibility cases. PASCAL's wider paddles, independent leaflet grasping capability, and central spacer represent potential advantages over MitraClip. However, experts emphasize that further investigation is needed regarding PASCAL's role relative to MitraClip and how different mitral valve therapies should be integrated into future clinical practice and trials.

Researchers at San Raffaele University Hospital in Milan conducted a comprehensive retrospective analysis examining the very long-term outcomes of transcatheter edge-to-edge repair (TEER) using Abbott's MitraClip device in patients with severe mitral regurgitation. The study followed 150 consecutive patients treated between October 2008 and January 2013 for an extended period, with the cohort predominantly male (78%) and a median age of 73.2 years. Notably, 71.3 percent had secondary mitral regurgitation caused by left ventricular dysfunction, with a median ejection fraction of 26 percent, representing a complex patient population. Initial procedural success was substantial, though 11.3 percent of patients retained residual mitral regurgitation greater than 3+ at discharge. The study achieved impressive follow-up data retention of 96 percent at a median of 4.6 years. These findings remain clinically significant as they address ongoing debates within the medical community regarding the long-term efficacy and patient selection criteria for MitraClip therapy, particularly for high-risk surgical candidates who previously had limited treatment options for managing severe mitral regurgitation.

Cardiac Dimensions announced three major publications establishing comprehensive clinical evidence for the Carillon Mitral Contour System, the only commercially available indirect mitral annuloplasty device. The publications encompass a five-year multi-center CINCH FMR registry (228 patients), the largest single-center experience across both heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), and ten-year survival outcomes. Key findings from the CINCH FMR registry demonstrate sustained mitral regurgitation reduction, with moderate-to-severe cases decreasing from 84% at baseline to 9% at one year and remaining stable through five years. Nearly half of patients remained free from heart failure hospitalizations over the five-year period, with over 97% maintaining therapeutic benefit. The data show consistent benefits across both HFrEF and HFpEF populations in real-world practice, supporting the device's safety and efficacy profile. These results strengthen the clinical foundation as Cardiac Dimensions pursues regulatory submissions in the United States and expands its European commercial presence.

Cleveland Clinic's cardiac specialists provide comprehensive guidance on mitral valve disease in this educational resource. The panel, led by cardiac surgery chair Marc Gillinov and cardiology chair Samir Kapadia, addresses the two primary mitral valve conditions: regurgitation, which involves leakage, and stenosis, characterized by narrowing. These conditions are diagnosed and monitored using echocardiography, an ultrasound imaging technique of the heart. The experts emphasize the critical importance of regular follow-up care even when patients experience no symptoms, as early detection significantly impacts outcomes. Modern treatment approaches range from minimally invasive surgical techniques to catheter-based interventional procedures, enabling patients to return to active lifestyles. The presentation draws from over 200 submitted patient questions, distilling essential information about mitral valve disease management. This resource is part of Cleveland Clinic's "Love Your Heart" educational initiative, sponsored by the Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, designed to promote disease prevention, explain testing and treatment options, and highlight cardiovascular innovations.

Royal Brompton and Harefield hospitals operate one of the world's most experienced transcatheter mitral edge-to-edge repair (M-TEER) programmes, with Dr Robert Smith leading the UK's most proficient team having treated over 1,500 leaky mitral valves. Mitral regurgitation, a common cardiovascular disease where the mitral valve fails to close properly, allows blood to flow backward into the left atrium, forcing the heart to work harder and often resulting in heart failure, fatigue, shortness of breath, and potentially fatal pulmonary congestion. While conventional treatment involves open-heart surgery, this approach carries significant risks and extended recovery times for elderly or frail patients, making it unsuitable when regurgitation stems from weakened heart muscle. M-TEER offers a minimally invasive solution using small clips, such as MitraClip™, attached to the mitral valve, providing improved quality of life for high-risk patients who cannot safely undergo traditional surgical intervention. This advancement represents a critical therapeutic option for the millions worldwide suffering from mitral regurgitation-related heart failure.

Percutaneous left atrial appendage (LAA) closure is an alternative therapeutic strategy for reducing the risk of stroke in patients with atrial fibrillation (AF). Randomized clinical trials have demonstrated that LAA closure is non-inferior to oral anticoagulation (OAC) after long-term follow-up. The Watchman device (Boston Scientific) was approved by the U.S. Food and Drug Administration (FDA) in 2015 to reduce the risk of thromboembolism originating from the LAA in patients with non-valvular AF who are at increased risk of stroke and systemic embolism and have an appropriate rationale for seeking a non-pharmacological alternative to warfarin.

Advancements in diagnostics, devices and technology have helped to develop newer transcatheter techniques to treat heart conditions without surgery in patients who could not be operated on due to their advanced age and multiple other comorbidities and were considered as ‘no option’ patients and because of these conditions were left to suffer and die. This has given new hope to these patients. In this article, we will review some of the transcatheter techniques that have been of great help, especially during the COVID-19 pandemic.

Multiple valve disease presents a complex clinical challenge requiring sophisticated assessment and management strategies. Patients with concurrent valve lesions represent approximately one-fifth of valvular disease cases, with rheumatic and degenerative etiologies predominating. Accurate severity evaluation demands careful integration of individual valve assessments while accounting for critical hemodynamic interactions between lesions. Intervention decisions are guided by comprehensive evaluation of disease consequences, including symptomatology, pulmonary hypertension, and left ventricular dysfunction, balanced against procedural risks. Percutaneous interventions remain nascent in this population but show considerable promise, enabling tailored and staged treatment approaches for this high-risk cohort.

Transcatheter procedures represent a significant advancement in the treatment of heart valve conditions, offering minimally invasive alternatives to traditional surgical interventions. These innovative techniques enable cardiologists to address valvular dysfunction through catheter-based approaches, reducing patient recovery time and associated surgical risks. By utilizing specialized delivery systems and imaging guidance, transcatheter procedures can effectively repair or replace damaged valves with improved outcomes and enhanced patient quality of life. This evolving field continues to expand its clinical applications and technological capabilities.

This systematic review examines predictive machine learning models for valvular heart disease, synthesizing evidence across 195 studies published between 2014 and 2025. The analysis reveals that the majority of studies focused on single-lesion aortic stenosis models using retrospective datasets and internal validation approaches. Notably, only 8.2% of studies developed multimodal models integrating diverse data types, yet these demonstrated superior performance with a 6.3 percentage point advantage over unimodal counterparts. While unimodal models show promise for disease detection and patient stratification, the findings underscore the significant potential of multimodal machine learning approaches in addressing the complex, multifaceted nature of valvular pathologies and advancing cardiovascular care.

Transcatheter edge-to-edge mitral valve repair (M-TEER) has become an established therapeutic option for mitral valve disease. Among the available techniques, M-TEER using the MitraClip (Abbott) system is supported by robust clinical evidence and is now widely adopted as an alternative to surgical treatment. In the management of mitral regurgitation (MR), reducing the severity of regurgitation is undoubtedly a primary therapeutic goal.

Prosthetic heart valves are crucial for treating valvular heart disease and serve as substitutes for native valves. Bioprosthetic heart valves (BHVs) are currently the most common type used in clinical practice. However, despite the long history of use, challenges remain in clinical applications, notably via valve calcification, which significantly affects longevity and quality. The mechanisms through which calcification occurs are complex and not yet completely understood. Therefore, this paper aims to provide a comprehensive review of developments in prosthetic valves, focusing on the calcification processes in bioprosthetic heart valves and the biological, chemical, and mechanical factors involved. In addition, we highlight various anti-calcification strategies currently applied to BHVs and assess whether anti-calcification approaches can prolong valve durability and improve patient prognosis. Finally, we describe the imaging methods presently used to monitor calcification clinically. Advances in nanotechnology and tissue engineering may provide better options for mitigating prosthetic heart valve calcification in the future.

For patients with severe degenerative mitral regurgitation (DMR) at prohibitive or high surgical risk, transcatheter edge-to-edge repair (TEER) has become an effective alternative. The GeminiOne is a novel TEER device featuring a unique groove-cam mechanism.

This mini review examines early bioprosthetic valve failure, a critical complication in cardiac surgery where tissue-based heart valves deteriorate prematurely. The article explores the mechanisms underlying structural valve degeneration, including calcification, pannus formation, and mechanical stress factors that compromise valve integrity. Early failure represents a significant clinical challenge, necessitating reoperation and impacting patient outcomes and quality of life. The review synthesizes current research on risk factors, pathophysiological processes, and prevention strategies for bioprosthetic valve durability. Understanding these mechanisms is essential for improving valve selection, surgical techniques, and long-term management protocols in cardiac care.

This systematic review and meta-analysis evaluates the cusp-overlap technique (COT) against the standard three-cusp technique (ST) for self-expandable transcatheter aortic valve replacement. Analyzing eighteen studies encompassing thousands of patients, researchers compared safety and efficacy outcomes including mortality, conduction disturbances, permanent pacemaker implantation, and cerebrovascular accidents. The findings demonstrate that COT significantly reduces mortality risk compared to ST, suggesting potential clinical advantages. This evidence-based comparison provides valuable insights for cardiac interventionalists selecting optimal fluoroscopic approaches during TAVR procedures, potentially improving patient outcomes and reducing procedure-related complications.

Transcatheter Therapeutic Approaches. Edge-to-Edge Repair (MitraClip / TEER). Transcatheter edge-to-edge repair (TEER) mimics the Alfieri stitch technique.