Objectives To investigate the efficacy and safety of larger valve sizing beyond the commercially recommended annular range in transcatheter aortic valve replacement (TAVR) with balloon‐expandable transcatheter heart valve (THVs). Background The clinical implications of larger balloon‐expandable THV implantation with underfilling are poorly evaluated. Methods This retrospective study included 692 consecutive patients who underwent TAVR with SAPIEN3. A total of 271 patients who underwent SAPIEN 3 implantation were analyzed based on three border zones (Zone 1: 300–345 mm2, 23 vs. 20 mm; Zone 2: 400–430 mm2, 26 vs. 23 mm; Zone 3: 500–546 mm2, 29 vs. 26 mm). The primary endpoint was the effective orifice area (EOA) assessed by echocardiography at 1 year, and secondary endpoints were a 30‐day mortality rate, procedural complications during TAVR, and a composite of death from any cause and heart failure requiring rehospitalization at 1 year. Results At 1‐year follow‐up, the EOA in the larger valve groups was greater than that in the recommended valve group in each zone (Zone 1: 1.45 ± 0.03 vs. 1.06 ± 0.06 cm2, p < 0.001; Zone 2: 1.83 ± 0.05 vs. 1.41 ± 0.05 cm2, p < 0.001; Zone 3: 1.93 ± 0.07 vs. 1.69 ± 0.07 cm2, p = 0.02). No significant difference in the secondary endpoint was observed in any of the zones. Conclusions Implantation of the out‐of‐range larger SAPIEN 3 THVs with underfilling was associated with greater EOA at the 1‐year follow‐up and feasible in the selected patients.

A lotus root‐like appearance of the coronary artery diagnosed by optical coherence tomography (OCT) is characterized by old coronary thrombi that form small lumen channels. Herein, serial OCT images of a left anterior descending artery with a lotus root‐like appearance, treated with drug‐coated balloon angioplasty are described.

The number of elderly patients with acute decompensated heart failure (ADHF) is increasing, and it is often difficult to treat. This study aimed to evaluate the efficacy and safety of using tolvaptan early after hospitalization in elderly patients with ADHF and the prognosis one year after hospitalization. This study enrolled 185 patients with ADHF who were admitted for the first time. Tolvaptan was administered within 24 h after admission. These patients were assigned to two groups: over 80 years old (n = 109) and under 80 years old (n = 76). There were no significant differences between the two groups in the occurrence of MACCE within one year (25% vs. 20%, p = 0.59). All-cause mortality was significantly higher in the over-80 group (12% vs. 2%, p = 0.01). There were no significant differences in the incidence of worsening renal failure (11% vs. 7%, p = 0.46) and hypernatremia (5% vs. 9%, p = 1.0), and in the duration of hospitalization (19.2 days vs. 18.8 days, p = 0.8). Tolvaptan might be effective and safe in elderly patients with ADHF, and there was no difference in the incidence of MACCE within one year.

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