Transcatheter aortic valve replacement (TAVR) has evolved since it was first implemented, and it is now also used to treat low risk patients. One of the questions this has raised is whether patient life expectancy is higher than prosthesis life expectancy. The growing population in need for valve replacement also poses the question of how…
Coronary Physiology after Aortic Valve Intervention
Impact of Aortic Valve Intervention on Coronary Flow Reserve Myocardial flow might be compromised in patients with severe aortic stenosis, which might be driven by CAD and concomitant atherosclerosis or a compromised capillary bed. Capillary circulation might be compromised by increased left ventricular mass (LVM) which in turn might alter coronary flow reserve (CFR). Multiple…
Long-Term Evolution of Hybrid Coronary Revascularization
Currently, myocardial revascularization surgery (MRS) and percutaneous coronary intervention (PCI) are the available strategies for multivessel coronary artery disease. However, an alternative strategy has long been developed, called hybrid coronary revascularization (HCR), where the anterior descending artery is bypassed with a graft from the mammary artery and the rest of the lesions are treated by…
TCT 2022 | Angioplasty vs. Surgery: The BEST Study Long-Term Results
The BEST study was a prospective, randomized study to compare percutaneous coronary intervention (PCI) with everolimus-eluting stents vs. myocardial revascularization surgery (MRS) in patients with multivessel disease. The analysis was interrupted early due to slow patient inclusion. The study included 880 patients, who were randomized 438 to the PCI arm and 442 to the MRS arm.…
Thromboendarterectomy vs. Endovascular Therapy in Common Femoropopliteal Territory. Is Surgery Still the Gold Standard?
For lesions in the common femoral artery, guidelines recommend surgical endarterectomy (TEA) as the gold standard. However, endovascular therapy (EVT) is an alternative option for these lesions. In 2017 the first randomized study comparing TEA vs EVT was carried out, showing that EVT presents clinical benefits, though it does not replace surgical treatment as first…
Coronary Bifurcation Lesions: MRS or PCI? 10-Year Mortality of the SYNTAX Study
Percutaneous treatment of coronary lesions affecting bifurcations has increased in recent decades. Coronary angioplasty (percutaneous coronary intervention, PCI) in these cases is associated with an increased rate of adverse events in patients with multivessel disease and left main coronary artery lesions. The SYNTAX score, which is a predictor of total mortality, is used to evaluate…
TAVR, More Information Supports Its Use
TAVR has been reported beneficial in the treatment of high and intermediate risk patients but, initially, randomized clinical trials have shown vascular complication and pacemaker implantation rates higher than SAVR in low-risk patients. This will most certainly improve as operator experience and device development advance. This is a randomized 1:1 study including 458 patients receiving…
EuroPCR 2022 | TriCLASP, Evolution at 30 Days
Tricuspid regurgitation (TR) is difficult to manage and is a mortality predictor. At present, surgery is recommended, even though its mortality rate is not low. Endovascular intervention of this entity is currently being developed and according to the European guidelines, it has evidence level IIb C in symptomatic inoperable patients. The TriCLASP included 74 patients…
EuroPCR 2022 | Changes in Cardiac Damage after Surgical Aortic Valve Replacement
This study presented at EuroPCR 2022 analyzed the PARTNER study pool and included 1974 patients with a complete echocardiogram. Surgical risk was 17.3% extreme/inoperable, 54.3% intermediate and 28.4% low. 60% received transcatheter aortic valve replacement (TAVR) and the rest surgical aortic valve replacement (SAVR). 6.1% of patients were in stage 0 (no damage), 14.5% were…
Transcatheter Edge-To-Edge Repair Is Favorable for Elderly Patients at High Surgical Risk
Mitral valve prolapse is the most frequent cause of mitral valve regurgitation and is associated to hospitalization for cardiac failure and mortality. At present, the preferred treatment for operable patients is mitral valve surgical repair. Transcatheter edge to edge repair (TEER) has shown great benefit patients at high surgical risk; however, it has not been…