Percutaneous left atrial appendage (LAA) closure is an alternative therapeutic strategy for reducing the risk of stroke in patients with atrial fibrillation (AF). Randomized clinical trials have demonstrated that LAA closure is non-inferior to oral anticoagulation (OAC) after long-term follow-up. The Watchman device (Boston Scientific) was approved by the U.S. Food and Drug Administration (FDA) in 2015 to reduce the risk of thromboembolism originating from the LAA in patients with non-valvular AF who are at increased risk of stroke and systemic embolism and have an appropriate rationale for seeking a non-pharmacological alternative to warfarin.

Advancements in diagnostics, devices and technology have helped to develop newer transcatheter techniques to treat heart conditions without surgery in patients who could not be operated on due to their advanced age and multiple other comorbidities and were considered as ‘no option’ patients and because of these conditions were left to suffer and die. This has given new hope to these patients. In this article, we will review some of the transcatheter techniques that have been of great help, especially during the COVID-19 pandemic.

Multiple valve disease presents a complex clinical challenge requiring sophisticated assessment and management strategies. Patients with concurrent valve lesions represent approximately one-fifth of valvular disease cases, with rheumatic and degenerative etiologies predominating. Accurate severity evaluation demands careful integration of individual valve assessments while accounting for critical hemodynamic interactions between lesions. Intervention decisions are guided by comprehensive evaluation of disease consequences, including symptomatology, pulmonary hypertension, and left ventricular dysfunction, balanced against procedural risks. Percutaneous interventions remain nascent in this population but show considerable promise, enabling tailored and staged treatment approaches for this high-risk cohort.

Transcatheter procedures represent a significant advancement in the treatment of heart valve conditions, offering minimally invasive alternatives to traditional surgical interventions. These innovative techniques enable cardiologists to address valvular dysfunction through catheter-based approaches, reducing patient recovery time and associated surgical risks. By utilizing specialized delivery systems and imaging guidance, transcatheter procedures can effectively repair or replace damaged valves with improved outcomes and enhanced patient quality of life. This evolving field continues to expand its clinical applications and technological capabilities.

This systematic review examines predictive machine learning models for valvular heart disease, synthesizing evidence across 195 studies published between 2014 and 2025. The analysis reveals that the majority of studies focused on single-lesion aortic stenosis models using retrospective datasets and internal validation approaches. Notably, only 8.2% of studies developed multimodal models integrating diverse data types, yet these demonstrated superior performance with a 6.3 percentage point advantage over unimodal counterparts. While unimodal models show promise for disease detection and patient stratification, the findings underscore the significant potential of multimodal machine learning approaches in addressing the complex, multifaceted nature of valvular pathologies and advancing cardiovascular care.

Transcatheter edge-to-edge mitral valve repair (M-TEER) has become an established therapeutic option for mitral valve disease. Among the available techniques, M-TEER using the MitraClip (Abbott) system is supported by robust clinical evidence and is now widely adopted as an alternative to surgical treatment. In the management of mitral regurgitation (MR), reducing the severity of regurgitation is undoubtedly a primary therapeutic goal.

Prosthetic heart valves are crucial for treating valvular heart disease and serve as substitutes for native valves. Bioprosthetic heart valves (BHVs) are currently the most common type used in clinical practice. However, despite the long history of use, challenges remain in clinical applications, notably via valve calcification, which significantly affects longevity and quality. The mechanisms through which calcification occurs are complex and not yet completely understood. Therefore, this paper aims to provide a comprehensive review of developments in prosthetic valves, focusing on the calcification processes in bioprosthetic heart valves and the biological, chemical, and mechanical factors involved. In addition, we highlight various anti-calcification strategies currently applied to BHVs and assess whether anti-calcification approaches can prolong valve durability and improve patient prognosis. Finally, we describe the imaging methods presently used to monitor calcification clinically. Advances in nanotechnology and tissue engineering may provide better options for mitigating prosthetic heart valve calcification in the future.

For patients with severe degenerative mitral regurgitation (DMR) at prohibitive or high surgical risk, transcatheter edge-to-edge repair (TEER) has become an effective alternative. The GeminiOne is a novel TEER device featuring a unique groove-cam mechanism.

This mini review examines early bioprosthetic valve failure, a critical complication in cardiac surgery where tissue-based heart valves deteriorate prematurely. The article explores the mechanisms underlying structural valve degeneration, including calcification, pannus formation, and mechanical stress factors that compromise valve integrity. Early failure represents a significant clinical challenge, necessitating reoperation and impacting patient outcomes and quality of life. The review synthesizes current research on risk factors, pathophysiological processes, and prevention strategies for bioprosthetic valve durability. Understanding these mechanisms is essential for improving valve selection, surgical techniques, and long-term management protocols in cardiac care.

This systematic review and meta-analysis evaluates the cusp-overlap technique (COT) against the standard three-cusp technique (ST) for self-expandable transcatheter aortic valve replacement. Analyzing eighteen studies encompassing thousands of patients, researchers compared safety and efficacy outcomes including mortality, conduction disturbances, permanent pacemaker implantation, and cerebrovascular accidents. The findings demonstrate that COT significantly reduces mortality risk compared to ST, suggesting potential clinical advantages. This evidence-based comparison provides valuable insights for cardiac interventionalists selecting optimal fluoroscopic approaches during TAVR procedures, potentially improving patient outcomes and reducing procedure-related complications.

Transcatheter Therapeutic Approaches. Edge-to-Edge Repair (MitraClip / TEER). Transcatheter edge-to-edge repair (TEER) mimics the Alfieri stitch technique.

This article examines emergency valve-in-valve transcatheter aortic valve implantation, a minimally invasive intervention for patients requiring urgent aortic valve replacement. The procedure represents an advanced therapeutic approach for managing acute aortic valve dysfunction, particularly in high-risk surgical candidates. By deploying a prosthetic valve within a previously implanted or diseased native valve, clinicians can address life-threatening cardiac conditions while minimizing procedural trauma. The emergency application highlights the technique's versatility and potential to improve patient outcomes in critical situations where traditional surgical intervention may pose excessive risk or prove logistically unfeasible.

This case study documents the successful management of acute thrombosis in an Edwards SAPIEN M3 transcatheter mitral valve replacement (TMVR) caused by oral anticoagulation nonadherence. A 58-year-old patient developed cardiogenic shock with severe mitral stenosis due to prosthetic valve thrombosis and heavy clot burden. Despite initial thrombolytic therapy, hemodynamic deterioration necessitated emergent valve-in-valve intervention, during which a 29-mm Edwards SAPIEN S3 Ultra Resilia valve was successfully implanted within the M3 valve. This rare but serious complication highlights the critical importance of strict anticoagulation adherence in TMVR patients. The case demonstrates that valve-in-valve reintervention represents an effective treatment option for high-risk surgical patients presenting with acute prosthetic valve thrombosis, underscoring the need for vigilant monitoring and early diagnostic consideration in transcatheter mitral valve systems.

Dr. Ehtisham Mahmud from UC San Diego Health discusses how robotic cath lab systems, particularly Corindus/Siemens Healthineers' Corpath GRX, could revolutionize emergency stroke care by enabling remote telemedicine procedures. This technology allows interventionalists to perform thrombectomy procedures from considerable distances, potentially transforming acute stroke treatment in underserved rural areas. Drawing parallels to the evolution of cardiac intervention standards over the past four decades, Mahmud notes that acute stroke care follows a similar trajectory but faces a critical shortage of neuro-interventional specialists. The robotic system could bridge this gap by allowing experienced cardiologists to remotely conduct procedures, though additional training in neuro-vascular techniques would be required. This innovation promises to significantly reduce healthcare disparities and improve access to emergency stroke interventions nationwide.

This research examines age-related variations in mitral valve annulus morphology and their clinical implications. The study investigates how structural changes in the mitral valve annulus occur throughout the lifespan and how these alterations may affect valve function and disease susceptibility. Understanding these age-dependent anatomical variations is essential for accurate diagnosis and management of mitral valve pathology across different patient populations. The findings provide valuable insights into the relationship between aging processes and mitral valve anatomy, which has significant implications for cardiac imaging interpretation, surgical planning, and the development of age-appropriate clinical guidelines for mitral valve disease.

Mitral valve replacement and repair represent a rapidly evolving field in interventional cardiology, building on established experience with transcatheter aortic valve interventions. This comprehensive domain encompasses diverse innovative techniques and devices, with certain mitral repair solutions achieving widespread clinical adoption. Mastery of this complex specialty requires proficiency across multiple disciplines, including advanced imaging modalities such as echocardiography, vascular access strategies, emerging device technologies, pharmacological support, hemorrhage risk assessment, and sophisticated patient selection criteria. EuroIntervention serves as a leading reference journal dedicated to advancing knowledge in coronary, valvular, and structural interventions, providing clinicians with essential insights into the latest research and clinical developments shaping modern interventional practice.

The Mosaic Neo™ mitral bioprosthesis represents a next-generation native porcine valve designed for mitral valve replacement by Medtronic. Its innovative atrialized design reduces stent post protrusion by up to 23% compared to the legacy Mosaic™ valve, while strategically positioned cuff markings optimize leaflet orientation to preserve left ventricular outflow tract clearance. The wider interstrut distance at the anterior annulus minimizes obstruction risk. Long-term clinical evidence demonstrates superior durability compared to bovine pericardial alternatives, with significantly extended intervals before reoperation for structural valve deterioration. The platform incorporates enhanced procedural features including intuitive cuff markings, pre-attached barrel sizers, and a quick-detach handle system designed to streamline implantation and improve surgical workflow efficiency.

Effective management of primary mitral regurgitation demands a comprehensive lifetime strategy integrating both surgical and transcatheter interventions. Contemporary practice emphasizes early intervention timing, repair durability, and strategic planning for potential future reinterventions. A multidisciplinary Heart Team approach is essential to design the initial procedure while preserving therapeutic flexibility across the patient's lifespan. The recently updated 2025 ESC/EACTS Valvular Heart Disease Guidelines provide refined indications for early surgery, improved patient selection criteria for transcatheter edge-to-edge repair, and expanded recommendations for prosthetic valve failure management. This framework enables clinicians to pursue durable surgical repair as the primary goal while maintaining accessible options for subsequent interventions, ensuring optimal long-term outcomes for patients requiring mitral valve intervention.

Transcatheter tricuspid valve interventions have evolved significantly through early clinical experience and iterative refinement. The Cardioband system's early adoption highlighted critical challenges in direct annuloplasty, including technical complexity, imaging limitations, and anchor instability despite sound physiological principles. These lessons revealed that annular dilatation remains the primary driver of secondary tricuspid regurgitation, emphasizing the continued importance of annuloplasty as a therapeutic strategy. Future device development must address engineering constraints and workflow optimization to achieve reproducible, scalable interventions that build upon the foundation established by pioneering experiences.

Integrating human factors into post-market surveillance represents a critical evolution in medical device safety management. While premarket usability studies establish baseline performance, real-world use generates insights that traditional surveillance mechanisms often miss. Both EU MDR and FDA regulations increasingly emphasize continuous demonstration of device usability and safety throughout product lifecycles. By incorporating human factors methodology into post-market surveillance activities, manufacturers can identify user interaction issues, understand root causes of problems, and proactively address safety risks. This integration strengthens regulatory compliance, reduces costly recalls and corrective actions, and ultimately delivers safer, more user-friendly devices that better serve clinical needs in practice.