During SOLACI’s coverage of the TCT 2017 Congress in Denver, Colorado, we already mentioned some of the outcomes of this study that has arrived to revolutionize clinical practice, given the differences between its results and those of the classic SHOCK trial, which has marked for almost 20 years the treatment strategy for patients with infarction complicated by cardiogenic shock.
Edwards Lifesciences could have been satisfied after the success of the PARTNER trials and the improvements to its balloon-expandable valve (mainly as regards the delivery system profile and paravalvular leak reduction) in its last model, SAPIEN 3. However, it was not. The company decided to keep going, developing a valve that is radically different from its traditional product. That new valve is CENTERA, a nitinol self-expanding device with a low-profile delivery system (14 Fr) that is motorized, for better implant control!
Several studies show that patients with multivessel lesions who undergo angioplastywith incomplete revascularization experience more events, including higher mortality, than a cohort of patients who have undergone complete revascularization.
Measuring fractional flow reserve (FFR)with a 0.014 pressure wire is the standard to assess the functional significance of epicardial coronary artery stenosis. The use of FFR in the clinical practice lags despite strong supporting evidence. Some of the reasons behind this are technical aspects, like pressure wire handling limitations when assessing certain lesions, or how frustrating it can be to lose position and to have to recalibrate pressures when there is too much drift and we are no longer sure the value we have obtained is the real one.
Even though the presence of paravalvular regurgitation (PVR) has been reduced, thank to greater experience and new devices, it is still frequent and has an impact in survival (especially moderate and severe PVR). Recent research has shown that mild PVR also has a negative impact. However, these data were provided by a handful of studies and a small meta-analysis.
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