Concomitant surgical ablation of AF is a reasonable treatment option for drug refractory AF in patients with HCM undergoing surgical myectomy and/or mitral valve surgery. However, chronic antiarrhythmic drugs are needed to achieve a satisfactory mid-term arrhythmia control.

Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy.

Background: Training in transcatheter cardiovascular skills today represents a significant challenge because of the complexity of the interventions and an extensive use of multiple live imaging technologies. Objectives: We describe the design, the face validation, and content validation of a newly developed physical transseptal puncture (TSP) simulator using additive manufacturing techniques and novel imaging simulation solutions. Methods: The TSP simulator contains a femoral vein catheterization pad, silicon phantoms of the venous system, a replaceable interatrial septum, and cameras to mimic live fluoroscopic and echocardiographic imaging. A validation study was conducted at the University Hospital of Zurich. A total of 14 interventional cardiologists and cardiac surgeons assessed the TSP simulator. Participants performed a TSP on the simulator using standard interventional tools. Face and content validity was demonstrated using a 5-point Likert scale. Results: The TSP simulator is a new training tool for transcatheter cardiovascular interventions. All interventional cardiologists and cardiac surgeons completed the training exercise and scoring. Overall impression was rated (out of 5) 4.04 ± 1.03, haptic feedback scored 4.13 ± 0.82, and the realism of fluoroscopy simulation 4.39 ± 0.79. Usability was rated 4.50 ± 0.63 by the participants, indicating that the simulator could be suitable for training. Conclusion: We demonstrated face and content validity of a new simulator for transcatheter cardiovascular interventions. The TSP simulator's usability, haptic feedback, imaging solutions, and the overall impression of its usage were reported as very realistic. The TSP simulator represents a promising tool for simulation-based training using real interventional toolkits in a mimicked radiological environment. K E Y W O R D S education, simulation training, transseptal puncture

A minimally invasive approach does not have a negative impact on the effectiveness and long-term durability of the EE repair for bileaflet prolapse in Barlow's disease. Long-term outcomes are excellent, and valvular performance remains stable over time with no evidence of mitral stenosis.