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BACKGROUND: MAVERIC (Mitral Valve Repair Clinical Trial) validates the safety and effi cacy of the ARTO system. We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure (HF) with functional mitral regurgitation (FMR) in Asia. METHODS: Two patients, aged 70 and 63, had severe HF with FMR. Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50% with severe mitral regurgitation (MR) in both patients. Optimizing drug treatment could not mitigate their symptoms. Therefore, we used the ARTO system to repair the mitral valve for these patients on March 5 and 6, 2019, respectively. RESULTS: Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients. MR was decreased immediately after the procedures in both patients. The 30-day and 3-month transthoracic echocardiography (TTE) revealed a moderate to severe MR in both patients, and the New York Heart Association (NYHA) scales were also partially improved. CONCLUSION: The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR, and the patient selection appears to be crucial.

BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). This study aims to assess the ascending aortic dilatation rate (mm/ year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography (MDCT) follow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identifi ed using baseline MDCT. Baseline and follow-up MDCT images were analyzed, and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate (mm/year). Furthermore, factors predicting ascending aortic dilatation rate were also investigated. RESULTS:Two hundred and eight patients were included, comprised of 86 BAV and 122 TAV patients. Five, 4, 3, 2, and 1-year MDCT follow-ups were achieved in 7, 9, 30, 46, and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group (43.7±4.4 mm vs. 44.0±4.5 mm; P<0.001) and TAV group (39.1±4.8 mm vs. 39.7±5.1 mm; P<0.001). However, no difference of ascending aortic dilatation rate was found between BAV and TAV group (0.2±0.8 mm/year vs. 0.3±0.8 mm/year, P=0.592). Multivariate linear regression revealed paravalvular leakage (PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group, but not TAV group. No aortic events occurred during follow-ups. CONCLUSION:Ascending aortic size continues to grow after TAVR in BAV patients, but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.

Background The kidney function change after Transcatheter Aortic Valve Replacement (TAVR) in diabetes and/or hypertension patients is currently unknown. Methods A total of 242 severe Aortic Stenosis patients with diabetes mellitus and/or hypertension who underwent TAVR were analyzed. Patients were categorized into 3 groups based on the percent change [(discharge eGFR – baseline eGFR) x 100/baseline eGFR] in eGFR: improved ≥ 10%, no change, and declined ≥ 10%. Results Of these patients, 93 (38.4%) had an improvement in eGFR ≥ 10%, 117 (48.3%) had no changes, and 32 (13.2%) had a decline in eGFR of more than 10%. Patients with unchanged kidney function may be with lower STS scores (5.09 [3.58–8.34] % vs. 7.04 [4.52–9.91] % vs. 7.41 [3.52–10.97] %, p = 0.003), and lower perivascular disease (14.5% vs. 26.9% vs. 40.6%, p = 0.003) when compared with improved and declined kidney function patients, respectively. Patients with improved kidney function had lower eGFR (45.0 [33.9–60.3] mL/min/1.73 m2 vs. 57.4 [43.4–70.7] mL/min/1.73 m2 vs. 56.6 [44.2–76.8] mL/min/1.73 m2, p = 0.000), and lower LVEF (55.1 [40.9–62.0] % vs. 60.4 [53.4–66.1] % vs. 59.9 [52.9–67.8] %, p = 0.002) than the unchanged or declined group, respectively. Moreover, patients with worsening kidney function had higher rate of in-hospital (12.5% vs. 1.7% vs. 0%, p = 0.002) and 30-day (15.6% vs. 1.7% vs. 0%, p = 0.000) mortality. Independent predictors of eGFR changes were STS scores, LVEF, baseline eGFR, and unplanned cardiopulmonary bypass. Conclusions Nearly 40% of diabetic and/or hypertensive patients experience an intermediate improvement after TAVR. Patients with declining renal function suffer more terrible outcomes in mortality.