Objectives We review our experience with 13 periprocedural aortic dissection (AD) cases caused by transcatheter aortic valve replacement (TAVR). Background AD is a potentially lethal complication of TAVR; however, only sporadic case reports have been published to date. Methods Among 1335 consecutive patients who underwent TAVR in 2013–2021, we retrospectively extracted 13 patients (1.0%) with TAVR‐related AD (Stanford type A in 6 [46%], type B in 7 [54%]). AD was defined as a new‐onset dissected layer of the aortic wall and diagnosed by aortography, computed tomography, or transesophageal echocardiography. Results Five of the six type A AD cases (83%) were detected during TAVR versus only one of the seven type B AD cases (14%). Four of the seven type B AD cases (57%) were asymptomatic and incidentally detected on computed tomography. The presumed causes of AD were injury by the delivery sheath (39%), delivery catheter (23%), valve implantation (15%), stent edge (15%), and pre‐dilation balloon (8%). Complicated AD occurred in only one patient (8%). Considering the patient's age and prohibitive surgical risk, all patients were treated conservatively and free of any aortic‐related deaths or interventions during a follow‐up of 1087 days. Conclusions TAVR‐related AD is a rare but life‐threatening condition that may be underdiagnosed. Its optimal therapy remains unclear, and conservative management might be an option for selected patients. Further studies are needed to elucidate the incidence, risk factors, effective screening, optimal therapy, and outcomes of TAVR‐related AD.

In patients with atrial septal defect (ASD), atrial left-to-right shunting causes left atrial (LA) remodeling and dysfunction, leading to atrial fibrillation (AF). In adults with ASD and concomitant AF, LA function should be evaluated after ASD closure plus AF radiofrequency catheter ablation (RFCA).This multicenter retrospective cohort study included patients who underwent transcatheter ASD closure at one of the four leading hospitals. Patients with a history of AF also underwent preceding RFCA. The association between AF history and LA ejection fraction (EF) (indicating LA global function) at 6-12 months following ASD closure was evaluated. To account for differences in baseline characteristics between patients with and without a history of AF, we conducted the following statistical methods: (1) multivariate regression analysis in the prepropensity score (PS)-matched cohort and (2) univariate comparisons in the PS-matched cohort.Overall, this study included 231 patients (30 with AF history, 201 without). Multiple regression analysis showed that AF history was independently associated with impaired LAEF (β = −10.425, P < 0.001, model created prior to propensity matching). A one-to-one PS matching (25 pairs) showed that the LAEF at 6-12 months following ASD closure was significantly impaired in patients with ASD and AF history compared to that in patients without history of AF (median LAEF, 37.5% (interquartile range [IQR] 29.4%-48.5%) versus 52.3 [IQR 50.0%-56.6%]; P < 0.001).LA function was impaired in patients with ASD and a history of AF at 6-12 months after successful transcatheter ASD closure and on maintenance of sinus rhythm by RFCA.

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─ 24 ─ I. Introduction Mitral regurgitation (MR) is caused by anatomical or functional impairment of components of the mitral apparatus necessary for a normal valve function, including the left ventricle (LV), papillary muscle, chordae tendineae, leaflets, and annulus 1) . MR is the most common valve condition in the developed world, with a prevalence of 22% among patients > 65 years old.Its prevalence is projected to increase substantially over the next few decades as the population ages [2][3][4] . MR has been classifi ed as functional in 65% of cases and attributed to LV remodeling or dysfunction, with the remainder attributed to atrial fi brillation/ fl utter, or to idiopathic annular dilation. The severity of functional MR may vary dramatically as a function of LV loading conditions, heart rhythm, conduction system disease, and myocardial ischemia. Functional MR is associated with lower event-free rates (heart failure [HF] or death) than degenerative MR of a similar magnitude. However, whether functional MR is simply a marker of poor outcomes due to LV dysfunction or contributes independently to long-term outcomes in this patient population remains uncertain 5,6) .In the past decade, transcatheter edge-to-edge repair (TEER) using the MitraClip (Abbott Vascular,