In patients who underwent transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve, there were no statistically significant differences in permanent pacemaker (PPM) implantation rates at 30 days between patients with and without rapid atrial pacing-induced AV Wenckebach.

Rapid atrial pacing-induced AV Wenckebach may signal potential conduction disturbances but is not an independent predictor of PPM after TAVR.

A large prospective study is warranted to further evaluate whether rapid atrial-pacing-induced AV Wenckebach improves risk stratification regarding the need for PPM after TAVR.

Adverse hemodynamics after transcatheter aortic valve replacement (TAVR) are more common in patients with a small aortic annulus (SAA) and affect clinical outcomes.

In this observational study of 628 patients with a very SAA, 89% of whom were women, severe prothesis patient mismatch (PPM) was associated with an up to fivefold increase in 1-year mortality.

As younger and more active patients are treated with TAVR, it will be important to consider strategies including prosthesis choice as well as surgical root enlargement to avoid severe PPM.

Pre-procedure computer simulation can help to determine the optimal transcatheter heart valve size and implantation depth for patients undergoing transcatheter aortic valve replacement.

Computer simulation may be especially beneficial for patients with challenging anatomy, who are at the highest risk for paravalvular leak and conduction abnormalities.

Computer simulation may also help with planning left atrial appendage occlusion and percutaneous coronary intervention.

Mid term data of TAVR in stenotic bicuspid aortic valves is promising both in term of mortality and valve performance.

Many factors should be considered before we generalize these results to all types of bicuspid native valves, TAVR valves, and patient populations.

A randomized trial to SAVR versus TAVR remains the missing piece before we solve this complex clinical equation.

Transcatheter mitral valve replacement (TMVR) is expanding.

The risk of left ventricular outflow tract obstruction (LVOTO) remains a challenge.

Balloon-assisted leaflet modification is a reasonable approach to mitigate LVOTO, especially with innovative approaches.

The study by Gorla et al. confirms that the incidence of clinically overt stroke is low in contemporary, real-world transcatheter aortic valve replacement (TAVR) practice.

Patients at increased risk for TAVR-related stroke may be identified based on baseline risk factors.

Randomized trials in selected TAVR patients at increased risk for stroke should evaluate patient-tailored preventive measures.

Long term hemodynamic benefit and survival are sustained in patients undergoing stenting of coarctation of the aorta with bare metal and covered Cheatham-Platinum (CP) stents.

Reintervention and complication rates are similar with both bare metal and covered CP stents.

Routine advanced imaging should be performed periodically in the long-term to assess for stent integrity and aortic wall injury, and to guide treatment/reintervention, when necessary.