Highlights of the year in JACC 2010.

Transcatheter aortic valve replacement. Clinical, Doppler, and outcome data were prospectively collected on 639 patients who underwent transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis (AS) in 2 Canadian centers (1). Compared with normal flow patients, 52.3% had low flow (stroke volume index <35 ml/m) and had increased 30-day all-cause mortality (11.4% vs. 5.9%; p < 0.01), 2-year all-cause mortality (35.3% vs. 30.9%), and 2-year cardiovascular mortality (25.7% vs. 16.8%; p 1⁄4 0.01). Reduced flow was an independent predictor of 30-day mortality, cumulative all-cause mortality, and cumulative cardiovascular mortality. The study concluded that stroke volume index should be integrated in the risk stratification process of these patients. The PARTNER (Placement of Aortic Transcatheter Valve) trial of the Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) examined the determinants and outcomes of transcatheter valve embolization (TVE) and/or acute insertion of a second prosthetic transcatheter valve (TV) within the first TV (TV-in-TV) in cohorts A and B (2). Of 2,554 patients, 63 (2.47%) underwent TV-in-TV, and 26 underwent (1.01%) TVE. The TV-in-TV was indicated for aortic regurgitation (AR) in most patients, not only because of malpositioning but also due to leaflet dysfunction, and it was an independent predictor of 1-year cardiovascular