Transcatheter aortic valve replacement in low-risk young population:A double edge sword?

Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk patients.In 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials.However,these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles.While currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite recovery.Nonetheless,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.Furthermore,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population.Thus,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

Reintervention with Transcatheter and Surgical Aortic Valves: A Systematic Review and Meta-Analysis

Background: Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. Methods: We performed a systematic review and meta-analysis of all published studies with ≥5years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. Results: The meta- analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male). All TAVR procedures were performed with early generations of THV. At a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I2 = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I2 = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I2 = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. Conclusion: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.

Layered K_(0.54)Mn_(0.78)Mg_(0.22)O_(2)as a high-performance cathode material for potassium-ion batteries

Layered Mn-based oxides are one of the promising cathode materials for potassium-ion batteries(KIBs)owing to their high theoretical capacities,abundant material supply,and simple synthesis method.However,the structural deterioration resulting from the Jahn-Teller effect of Mn ions hinders their further development in KIBs.Herein,a novel Mn-based layered oxide,K_(0.54)Mn_(0.78)Mg_(0.22)O_(2),is successfully designed and fabricated as KIBs cathode for the first time.It delivers smooth charging/discharging curves with high specific capacity of 132.4 mAh·g^(‒1)at 20 mA·g^(‒1)and good high-rate cycling stability with a capacity retention of 84%over 100 cycles at 200 mA·g^(‒1).Combining in-situ X-ray diffraction(XRD)and ex-situ X-ray photoelectron spectroscopy(XPS)analysis,the storage of K-ions by K_(0.54)Mn_(0.78)Mg_(0.22)O_(2)is revealed to be a solid-solution processes with reversible slip of the crystal lattice.The studies suggest that the rational doping of inactive Mg2+can effectively suppress the Jahn-Teller effect and provide outstanding structure stability.This work deepens the understanding of the structural evolution of Mn-based layered materials doped with inactive materials during de/potassiation processes.