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complication in Balloon-expendable (BE) and Self-expendable (SE) TAVI procedures remain unclear. Methods: 2,769 patients consecutive with a successful procedure and a predischarge transthoracic echocardiography (TTE) were enrolled in 33 centers. Mean follow-up was 302Ϯ164 days. Results: Mean age was 83Ϯ7 years; 49% were female and logistic EuroSCORE was 21.5Ϯ13.8. BE and SE devices was implanted in 67.6% (nϭ1872) and 32.4% (nϭ897), respectively. Approaches were femoral (75.4%) or non femoral: subclavian (5.6%), transapical (17.2%) or transaortic (1.8%). A perivalvular ARՆ2 was observed in 14.9%. Its occurrence was 2 fold higher in SE (19.8%) than in BE-TAVI procedures (12.2%, pϭ0.0001). This remained significant in multivariate analysis (adjusted HRϭ2.01, pϭ0.0001). A perivalvular ARՆ2 was associated with a mortality at 1 year (24.2%) twice higher than in patients without AR (11.9%) (pϭ0.0001). This figure was similar for BE (27.1% vs 12.0%) and SE-TAVI (20.5% vs 11.8%) procedures. By multivariate analysis, a perivalvular ARՆ2 was the strongest predictor of 1 year mortality (ad. ]; pϭ0.0001). This figure was similar for BE (ad. HRϭ2.68) and SE-TAVI (ad. HRϭ2.10) procedures. For BE-TAVI procedures, male gender (ad. HRϭ1.66, pϭ0.001), a device diameter/aortic annulus diameter Ratio Ͻ1.1 (ad. HRϭ1.83, pϭ0.0001) and a femoral approach (ad. HRϭ1.70, pϭ0.006) were the 3 major independent predictors of ARՆ2. For SE-TAVI procedures, male gender (ad. HRϭ1.61, pϭ0.01) and a femoral approach (ad.HRϭ2.1, pϭ0.008) were 2 independent predictors of ARՆ2. Importantly, device diameter/aortic annulus diameter Ratio was not a predictor of AR for SE-TAVI procedures. Conclusions: Post-procedural perivalvular ARՆ2 was observed in 15% of successful TAVI procedures. Its occurrence doubled the 1-year mortality rate and was the strongest and independent predictor of 1-year mortality for both BE and SE-TAVI procedures. Analysis of predictors of AR suggests that device-type and procedural characteristics may impact the occurrence of AR. Background:The presence of mitral regurgitation (MR) is an independent predictor of mortality after conventional aortic valve replacement for aortic stenosis. The predictive value of pre-procedural MR on clinical outcome after TAVI is unknown. Methods: 3,195 consecutive patients were enrolled in 33 centres. MR was graded according to pre-procedural transthoracic echocardiography (TTE) as none/trivial(ϭ0), mild(ϭ1), moderate(ϭ2), moderate-to-severe(ϭ3), or severe(ϭ4). The mean age was 82Ϯ7 years; 49% were female and mean logistic EuroSCORE was 21.9Ϯ14.3. Balloon (BE) and self-expendable (SE) devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were transarterial (transfemoral: 74.6%; subclavian: 5.8%), transapical (17.8%), and transaortic (1.8%). Results: Pre-procedural TTE showed no MR in 32% of cases, a grade 1 MR in 46% of cases, a grade 2 MR in 20% of cases and a grade 3-4 in 2% of cases. Procedural success rate was 96.9%. Actuarial 1 year mortality was 19.5%. By univariate anal...

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The use of antidiabetic drugs represents a major burden on the health care system. The high proportions of patients requiring antihypertensive drugs and lipid lowering drugs further increase drug expenditure. Most of these treatments have been shown to improve clinical outcomes and quality of life, if used appropriately. The impacts of these long-term medications on health care financing require careful evaluation to assess their cost-effectiveness.

Pacemaker (PM) induced tricuspid regurgitation (TR) is a common echocardiographic finding. Although mild or moderate TR is frequently observed, severe TR is rare. We report the exceptional observation of a severe TR due to leaflet malcoaptation occurring late after PM implantation and in the following weeks after an aortic valve replacement. Our hypothesis is that the aortic valve surgery has been responsible for conformational changes between cardiac cavities, tricuspid valve and PM leads resulting in a severe TR.