To assess the value of computed tomography (CT) for non-invasive detection of pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and to correlate CT measurements and signs with mortality after TAVI. 257 TAVI patients (median 84 years; 134 females) with both right heart catheterisation (RHC) and CT within 3 days were retrospectively analyzed. According to guidelines PH was defined as mean pulmonary artery pressure ≥25 mmHg in RHC. CT-signs for PH assessment were evaluated. Clinical data was recorded before and at 30 days, 1 year and 2 years after TAVI. 161 patients exhibited PH (median 83 years; 90 females). In patients with PH, main pulmonary artery diameter (MPA; p < 0.001) and anterior pericardial recess (PR; p = 0.003) were significantly larger. Furthermore, pleural effusion (p < 0.001) was significantly more common. Sensitivity and specificity for predicting PH were calculated for MPA diameter ≥29 mm (56 and 61%), PR diameter ≥10 mm (37 and 82%), and presence of pleural effusion (42 and 91%). Patients with PH showed significantly higher 2 years mortality after TAVI (30 vs. 17%; p = 0.01) with a Hazard ratio (HR) of 2.5 (95% CI 1.1-5.8; p = 0.027). Pleural effusion was a predictor of higher 2-year-all-cause mortality after TAVI (42 vs. 20%; p = 0.022) with a HR of 2.0 (95% CI 1.0-3.8; p = 0.042). Patients with symptomatic AS and PH at baseline display higher 2 year-all-cause mortality after TAVI. Several CT-signs suggest the presence of PH in TAVI patients with moderate to high specificity, but low sensitivity. Pleural effusion in CT is a predictor of higher 2 year-all-cause mortality.

Objective The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort. Methods One hundred thirty patients underwent TAVR. Frailty assessment using the FORECAST (Frailty predicts death One yeaR after Elective CArdiac Surgery Test) was performed. The European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons (STS) score were assessed as well. Follow-up included assessment of in-hospital and 30-day mortality and morbidity and quality of life using the Short Form-36 questionnaire. Results Mean age was 83.3 years, and 50% were female. Logistic European System for Cardiac Operative Risk Evaluation was 14.9 ± 8.7%, and STS score was 5.1 ± 3.4%. Mean ± standard deviation FORECAST score was 4.8 ± 3.3 points of 15. In-hospital and 30-day mortality were 6.9% and 7.7%, respectively. Thirty-day Short Form-36 assessment showed a decrease in quality of life in five of ten items after the intervention. Receiver operating characteristic curves showed that the FORECAST is a valid tool to predict in-hospital mortality (area under the receiver operating characteristic curve, 0.73). By combining the FORECAST and the STS score, this effect was even higher (area under the receiver operating characteristic curve, 0.77; P = 0.021). Stratifying the patients according to the FORECAST score showed best survival in the lowest frailty group. Conclusions The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine.

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The implantation of a long covered stent such as the Melody valve allows successful sealing following a ViR even in case of partially detached annuloplasty rings. This procedure is a proof of concept that proper sealing can be achieved at the leaflet level without the use of radial force at the annular level.

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