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Introduction. The elderly population is on the increase and many are affected by aortic stenosis. Several alternatives to conventional aortic valve replacement exist, including the transapical TAVI (TA). However, adverse effects exist. It would therefore be interesting to resect the native aortic valve before implantation of a new valve. The work aims to assess the feasibility of percutaneous resection of the stenotic native aortic valve before implantation of an endovalve by TA in inoperable patients. Methods. To achieve this assessment, first, we have completed a database for TA without resection for comparison with what has already been done and, in the near future, comparison with TA with resection. We included in this monocentric prospective study, 82 patients operated by TA at the Cliniques Universitaires Saint-Luc from 9/4/2008 until 15/1/2016. We closed the database on 31/5/2016. Then we have developed in collaboration with engineers, a resection tool that has been clinically tested. Results. Mean age was 83.45 years (+-6.12; n=82), we counted 59.76% men and 40.24% women. Mean logistic euroSCORE and euroSCORE II were respectively 36.76% (+-18.17; n=56) and 6.29 (+-5.13; n=26). Mean length of hospital stay was 12.93 days (+-4.95; n=82). 10 patients died during hospitalization (12.20%), 14 at 30 days (17.07%), 24 at 1 year (29.27%) and a total of 39 known deaths (47.56%). We noted a survival rate of 50% at 3.20 years (see Kaplan Meier curve). The maximum clinical follow-up was 5 years and 4 months. The mean clinical follow-up was 16.57 months. The maximum survival was 6 years and 10 months. We identified perioperative and early postoperative complications: repoerations (4.88%), cardiac (65.85%), vascular (18.29%), pulmonary (35.37%), infectious (20.73%), gastrointestinal (3.66%) complications, stroke (9.76%), AKF (23.17%). At the ultrasound control, there was no statistically significant difference in the left ventricular ejection function. There was a statistically significant difference in the aortic valve area, the maximum and the mean gradient preoperatively compared to postoperatively until 4 years. Patients with moderate or severe paravalvular leaks died faster. Concomitantly, the resection tool has been tested on 10 patients during open heart operations, with an excellent cutting result. The miniaturization phase to reach the TA resection has just started. Discussion. We confirmed with this study that the TA without resection is feasible but several side effects exits. We look forward to the resection of the native aortic valve by the transapical way to compare our results. Introduction. La population âgée est croissante et nombreux sont ceux touché par une sténose aortique. Plusieurs alternatives au remplacement valvulaire aortique conventionnel existent, notamment le TAVI transapical (TA). Néanmoins, celui-ci n’est pas sans conséquence. Il serait dès lors intéressant de réséquer la valve aortique native avant l’implantation d’une nouvelle valve. Ainsi, le travail effectué a pour but d’évaluer la faisabilité d’une résection percutanée de la valve aortique native sténosée avant implantation d’une endovalve TA chez les malades inopérables. Matériel et méthodes. Pour réaliser cette évulation, nous avons, tout d’abord, complété une base de données pour les TA sans résection pour la comparer à ce qui a déjà été fait, et dans un futur proche, la comparer avec les TA avec résection. Nous avons inclus, dans cette étude prospective monocentrique, 82 patients après par TA aux Cliniques Universitaires Saint-Luc du 9/4/2008 au 15/1/12016. Nous avons clôturé la base de donnes le 31/5/2016. Ensuite, nous avons développé en collaboration avec des ingénieurs, un outil de résection qui a déjà été testé cliniquement. Résultats. La moyenne d’êge était de 83.45 ans (+-6.12 ; n=82) ; nous comptions 59.76 d’hommes et 40.24% de femmes. Les moyennes du logistic euroSCORE et de l’euroSCORE II étaient respectivement 36.76% (+-18.17 ; n=56) et 6.29% (+-5.13 ; n=26). La durée de l’hospitalisation était en moyenne de 12.93 jours (+-4.95 ; n=82). 10 patients sont décédés durant l’hospitalisation (12.20%), 14 dans les 30 jours (17.07%), 24 à 1 an (29.27%) et nous comptions un total de 39 décès (47.56%). Nous notions un taux de survie de 50% 3 0.20 ans (cfr courbe Kaplan Meier). Le suivi clinique maximal était de 5 ans et 4 mois. Le suivi clinique moyen était de 16.57 mois. La survie maximale était de 6 ans et 10 mois. Nous avons relevé les complications périopératoires et postopératoires précoces : réopérations (4.88%), complications cardiaques (65.58%), vasculaire (18.29%), pulmonaires (35.37%), infectieuses (20.73%), gastro-intestinales (3.66%), AVC (9.76%), IRA (23.17%). Lors du suivi échographique, il n’y avait pas de différence statistiquement significative entre la fonction d’éjection ventriculaire gauche en pré- et postopératoire. Il existait une différence statistiquement significative entre les valeurs préopératoires et postopératoires jusqu’à 4 ans pour la surface valvulaire aortique, le gradient maximal et le gradient moyen. Les patients atteints d’une fuite paravalvulaire modérée à sévère décédaient plus rapidement. En parallèle, l’outil de résection a été testé sur 10 patients, durant des opérations à cœur ouvert, avec un excellent résultat de découpe. La phase de miniaturisation pour aboutir à la résection TA vient de démarrer. Discussion. Nous avons confirmé avec cette étude que le TA sans résection est faisable mais qu’il existe certains effets indésirables. Nous attendons avec impatience la résection de valves aortiques natives par voie transapicale pour comparer nos résultats.

Catheter Ablation --- Aortic Valve Stenosis --- Transcatheter Aortic Valve Replacement

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Advances in structural heart disease (SHD) is occurring at a rapid rate, and the Mayo Clinic is at the forefront of developing procedural techniques in this fast-changing field. Handbook of Structural Heart Interventions provides practical, focused coverage of SHD, bringing you up to date with today's evidence-based techniques and approaches for common and uncommon SHD procedures. Ideal for both SHD trainees and established practitioners, attendings, and fellows in interventional cardiology, this easy-to-use handbook is a unique educational and clinical resource in a quickly expanding field. -- Publisher

Heart --- Cardiac Catheterization --- Cardiac Surgical Procedures --- Transcatheter Aortic Valve Replacement --- Heart Diseases --- Heart Defects, Congenital --- Abnormalities. --- Diseases --- Treatment. --- methods. --- surgery. --- Heart defects --- Abnormities and deformities --- methods --- surgery

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This reprint focuses on the transcatheter treatment of the main structural heart diseases covering the latest innovations and hot topics on this subject. All the technological developments witnessed in recent decades have made structural heart disease interventions a growing field and have contributed to offering patients less invasive, more effective, and safe alternative approaches.

Medicine --- Cardiovascular medicine --- cerebral protection device --- transcatheter aortic valve replacement --- stroke --- cerebrovascular events --- bovine aortic arch --- TAVR --- percutaneous access --- vascular complications --- surgical cut-down --- transfemoral approach --- aortic stenosis --- transcatheter aortic valve implantation --- valvular heart disease --- congestion --- plasma volume --- risk stratification --- TAVI --- SAVR --- young --- balloon aortic valvuloplasty --- bridge therapy --- destination therapy --- heart failure --- transradial coronaro-angiography --- single-catheter technique --- coronary artery disease --- futility --- transfemoral --- transcatheter --- aortic valve --- vascular --- complications --- BASILICA --- coronary artery obstruction --- structural heart intervention --- transcatheter mitral valve replacement --- mitral regurgitation --- transoesophageal echocardiography --- cardiac computed tomography --- TAVI degeneration --- SAVR after TAVI --- long-term outcome of TAVI --- tricuspid regurgitation --- atrial functional tricuspid regurgitation --- transcatheter tricuspid valve interventions --- echocardiography --- three-dimensional echocardiography --- multimodality imaging --- sizing --- planning --- MDCT --- 3D echocardiography --- MRI --- n/a

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There has been significant progress in the field of interventional cardiology, from the development of newer devices to newer applications of technology, resulting in improved cardiovascular outcomes. The goal of this Special Issue is to update practicing clinicians and provide a comprehensive collection of original articles, reviews, and editorials. To this end, we invited state-of-the-art reviews, including reviews of new technology and therapeutics, as well as original research in this area to be considered for inclusion in this issue. Examples include the history and evolution of interventional techniques, reviews of specific devices and technologies for coronary artery disease (i.e., stent technology, atherectomy devices, coronary physiology, intracoronary imaging, and robotics), structural heart diseases (i.e., ASD: atrial septal defect; LAAC: left atrial appendage closure; MC: MitraClip; PFO: patent foramen ovale; TAVI: transcatheter aortic valve implantation), advances in the management of challenging coronary anatomy, new biomarkers of cardiovascular disease (noncoding RNAs, etc.), and interventional techniques in the management of heart failure, peripheral arterial diseases, and pulmonary embolism. This Special Issue presents the most recent advances in the field of coronary and structural heart diseases as well as their implications for future patient care.

left atrial appendage --- WATCHMAN occlusive device --- 2D transesophageal echocardiography --- 3D transesophageal echocardiography --- computerized tomography --- atherosclerosis --- cholesterol --- FDG --- inflammation --- PET --- statins --- coronary artery bypass --- on-pump coronary artery bypass --- off-pump coronary artery bypass --- young patients --- severe aortic stenosis --- longitudinal axis strain --- late gadolinium enhancement --- cardiac magnetic resonance imaging --- optical coherence tomography --- percutaneous coronary interventions --- borderline lesions --- nonsignificant lesions --- left main --- bifurcations --- bilateral internal mammary artery --- coronary artery disease --- coronary artery bypass grafting --- da Vinci --- sternotomy --- outcome --- stent thrombosis --- bioresorbable scaffold --- drug eluting stents --- stent bioresorbable --- congenital heart disease --- cardiac surgery --- open heart --- progenitor cells --- regeneration --- stem cells --- subclinical coronary artery disease --- accelerated atherosclerosis --- HIV infection --- carotid intima-media thickness --- coronary calcium scoring --- coronary CT angiography --- magnetic resonance angiography --- fluorodeoxyglucose positron emission tomography --- mechanical circulatory support --- percutaneous coronary intervention --- cardiogenic shock --- acute myocardial infarction --- patient selection --- right heart catheterization --- pulmonary hypertension --- heart failure --- diagnosis --- prognostic evaluation --- clinical implications --- systemic disease --- cardiac computed tomography --- cardiac magnetic resonance --- feature tracking --- tagging --- myocardial deformation --- strain --- radial --- ulnar --- distal radial --- snuffbox --- aortic valvuloplasty --- dual antiplatelet therapy --- antiplatelet --- structural heart disease --- bioresorbable vascular scaffold --- drug-eluting stent --- angioplasty --- acute coronary syndrome --- chronic total occlusion --- target vessel failure --- re-occlusion --- surveillance coronary angiography --- meta-analysis --- ACURATE neo --- SAPIEN 3 --- transcatheter aortic valve replacement --- TAVR --- TAVI --- low risk --- STS --- aortic stenosis --- SAVR

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There has been significant progress in the field of interventional cardiology, from the development of newer devices to newer applications of technology, resulting in improved cardiovascular outcomes. The goal of this Special Issue is to update practicing clinicians and provide a comprehensive collection of original articles, reviews, and editorials. To this end, we invited state-of-the-art reviews, including reviews of new technology and therapeutics, as well as original research in this area to be considered for inclusion in this issue. Examples include the history and evolution of interventional techniques, reviews of specific devices and technologies for coronary artery disease (i.e., stent technology, atherectomy devices, coronary physiology, intracoronary imaging, and robotics), structural heart diseases (i.e., ASD: atrial septal defect; LAAC: left atrial appendage closure; MC: MitraClip; PFO: patent foramen ovale; TAVI: transcatheter aortic valve implantation), advances in the management of challenging coronary anatomy, new biomarkers of cardiovascular disease (noncoding RNAs, etc.), and interventional techniques in the management of heart failure, peripheral arterial diseases, and pulmonary embolism. This Special Issue presents the most recent advances in the field of coronary and structural heart diseases as well as their implications for future patient care.

Medicine --- left atrial appendage --- WATCHMAN occlusive device --- 2D transesophageal echocardiography --- 3D transesophageal echocardiography --- computerized tomography --- atherosclerosis --- cholesterol --- FDG --- inflammation --- PET --- statins --- coronary artery bypass --- on-pump coronary artery bypass --- off-pump coronary artery bypass --- young patients --- severe aortic stenosis --- longitudinal axis strain --- late gadolinium enhancement --- cardiac magnetic resonance imaging --- optical coherence tomography --- percutaneous coronary interventions --- borderline lesions --- nonsignificant lesions --- left main --- bifurcations --- bilateral internal mammary artery --- coronary artery disease --- coronary artery bypass grafting --- da Vinci --- sternotomy --- outcome --- stent thrombosis --- bioresorbable scaffold --- drug eluting stents --- stent bioresorbable --- congenital heart disease --- cardiac surgery --- open heart --- progenitor cells --- regeneration --- stem cells --- subclinical coronary artery disease --- accelerated atherosclerosis --- HIV infection --- carotid intima-media thickness --- coronary calcium scoring --- coronary CT angiography --- magnetic resonance angiography --- fluorodeoxyglucose positron emission tomography --- mechanical circulatory support --- percutaneous coronary intervention --- cardiogenic shock --- acute myocardial infarction --- patient selection --- right heart catheterization --- pulmonary hypertension --- heart failure --- diagnosis --- prognostic evaluation --- clinical implications --- systemic disease --- cardiac computed tomography --- cardiac magnetic resonance --- feature tracking --- tagging --- myocardial deformation --- strain --- radial --- ulnar --- distal radial --- snuffbox --- aortic valvuloplasty --- dual antiplatelet therapy --- antiplatelet --- structural heart disease --- bioresorbable vascular scaffold --- drug-eluting stent --- angioplasty --- acute coronary syndrome --- chronic total occlusion --- target vessel failure --- re-occlusion --- surveillance coronary angiography --- meta-analysis --- ACURATE neo --- SAPIEN 3 --- transcatheter aortic valve replacement --- TAVR --- TAVI --- low risk --- STS --- aortic stenosis --- SAVR