The Most Important Articles of 2018 in Structural Heart Diseases

1- ESC 2018 | MITRA FR: Testing MitraClip for Secondary Mitral Regurgitation

In secondary mitral regurgitation, mitral-valve leaflets and chordae are structurally normal and mitral regurgitation results from alterations in left ventricular geometry and function.

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2- TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation

The prognosis of patients with heart failure and mitral regurgitation secondary to ventricular dysfunction and dilation is guarded. Percutaneous mitral valve treatment of these patients may at least improve their symptoms.

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3- NOTION: 5-Year Outcomes of TAVR vs. Surgery in Low-Risk Patients are Promising

At 5 years, there were no differences in all-cause death, stroke, acute myocardial infarction, or all of these combined between low-risk, elderly patients who underwent transcatheter aortic valve replacement (TAVR) or conventional surgery. Taking into account reports from previous years, these results are not at all surprising.

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4- The Perks of Conscious Sedation in TAVR

The main advantage of transcatheter aortic valve replacement (TAVR) has always been its less invasive nature, compared against surgery. Many of the advances in this technique revolve around making it even less invasive, increasing the gap between the two. The kind of anesthesia has been one of these many advances.

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5- TCT 2018 | SOLVE-TAVI: Self-Expandable vs. Balloon-Expandable Valves and General vs. Local Anesthesia in One Study

This prospective, randomized, multicenter study included 447 patients with severe aortic stenosis and intermediate or high surgical risk randomized in a 2×2 factorial design to general vs. conscious sedation with local anesthesia and also to receiving the Sapien 3 valve (balloon-expandable) vs. CoreValve Evolut R (self-expandable).

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6- Five-Year Outcomes for Appendage Closure

The PROTECT AF trial demonstrated that left atrial appendage closure with the Watchman device was equivalent to warfarin for preventing stroke in atrial fibrillation, but it had a high rate of peri-procedural complications. The follow-up randomized trial was PREVAIL, in which the peri-procedural complication rate was lower (although the warfarin cohort experienced an unexpectedly low stroke rate, rendering any interpretation of the efficacy endpoints inconclusive). All of these outcomes were based on relatively few patients followed for a short time.

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7- CoreValve US Pivotal High Risk Trial: at 5 years, similar results

We are well aware of transcatheter aortic valve replacement’s (TAVR) effect in high-risk or inoperable patients at 5 years, even more after the PARTNER 1 trial. Yet, the outcomes of another relevant randomized study remained pending: el CoreValve US Pivotal High-Risk Trial.

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8- Incidence of Cancer in Adult patients with Congenital Heart Disease

Adults with congenital heart disease are exposed to cumulative radiation doses, from multiple catheterization procedures. Seeing as these patients are exposed since early age, the chance of stochastic effect due to radiation exposure are relatively higher than that of the elderly population.

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9- Morbidity and Mortality During Authorization Wait-Times for TAVR

For this Canada-based study, the increased number of patients who required a transcatheter aortic valve replacement (TAVR) may have come hand in hand with an equal increase in healthcare financing, so as to cover procedural costs. In spite of that, the wait-time between the formal request for authorization and the actual procedure was 3 months, and the rates of morbidity and mortality during this period were significant among this high-risk population.

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10- Do the Best Coronary Revascularization Prior TAVR

The presence of coronary artery disease (CAD) in patients with aortic stenosis is high, reaching 50% to70% of cases. This poses a great challenge as to what strategy to use and the things we can do.

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11- EuroPCR 2018 | Meta-Analyzis on Cerebral Protection Devices during TAVR

The risk of stroke is inherent to TAVR and, apart from clinically manifest events, there is abundant evidence of cerebral embolic lesions during TAVR provided by studies using diffusion weighted MRI or transcranial doppler ultrasound. Several devices have been developed to reduce the risk of stroke, though they have been assessed by relatively small trials with controversial outcomes. The aim of this study was to gather all available evidence and carry out a meta-analyzis on the safety and efficacy of embolic protection devices during TAVR.

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