This last year, new data in structural heart disease gave way to changes in practices and new hypotheses, when not simply further justified the already existing evidence.
In this new editorial section, we share the most relevant of last year’s works to keep you up to speed on the main topics in the field.
The Most Relevant of 2021 In Structural Heart Disease
01- New Valvular Heart Disease Guidelines with Key TAVI and Mitral Regurgitation Updates
Valvular heart disease management guidelines were updated last week by the AHA and the ACC. The last complete version had been published in 2014; therefore many of its recommendations have become obsolete before the latest evidence.
Read more HERE
02- Dual Antiplatelet Therapy and TAVR: Obsolete Guidelines
The current guidelines recommend dual antiplatelet therapy (DAPT) 3 to 6 months after transcatheter aortic valve replacement (TAVI). Some recent data finally condensed in the present meta-analysis and recently published in JAHA happen to challenge these guidelines.
Read more HERE
03- Data that Can Change TAVR and SAVR Strategy
In many relatively young patients with severe aortic stenosis, we rule out the idea of a mechanical valve, opting for a surgical aortic valve replacement (SAVR) with a bioprosthesis; we bet once the surgical bioprosthesis deteriorates, we will be able to solve it with transcatheter aortic valve replacement (TAVR) of the failed surgical valve: TAV-in-SAV.
Read more HERE
04- Post TAVR Aspirin vs. Clopidogrel: Conflicting Findings and Guidelines
One month ago we shared a meta-analysis stating aspirin (ASA) as the best antiplatelet following TAVR vs. 3 to 6 dual antiplatelet therapy suggested by guidelines.
Read more HERE
05- European Consensus on Antithrombotic Management in TAVR
All the controlled randomized evidence recently published called for an updated document on antithrombotic management in transcatheter aortic valve replacement (TAVR).
Read more HERE
06- The FDA Approves a Third Device in the TAVR Race
The Portico self-expanding graft has obtained FDA approval and can now compete as one of the three options available in clinical practice for transcatheter aortic valve replacement (TAVR) in the United States. For the time being, its indication will have some restrictions: for example, it can only be used in high-risk patients (unlike CoreValve and Sapien, both FDA-approved for the whole spectrum of patients).
Read more HERE
07- Revascularization Is Needed Before TAVR
Disease prevalence in patients with severe aortic stenosis is highly variable: from 80% in inoperable patients to only 15% according to the most recent research including low-risk patients.
Read more HERE
08- Coronary Access After TAVR: A Potential Problem Ahead
Coronary cannulation after transcatheter aortic valve replacement (TAVR) was unsuccessful in almost 10% of patients. This problem occurred almost exclusively in those who received a self-expanding valve.
Read more HERE
09- The Best Anticoagulant Agent for AF After TAVR
Direct anticoagulant agents were associated with lower long-term mortality in patients with atrial fibrillation (AF) discharged after transcatheter aortic valve replacement (TAVR), compared with classic vitamin K antagonists.
Read more HERE
10- Cusp Overlap for Higher CoreValve Implantation
Implant depth greater than the length of the membranous septum is an independent predictor of permanent pacemaker implantation. Valve implantation 3 to 5 mm below the aortic annulus in a projection coaxial to the device is recommended. The problem is this is rarely in the annular plane of the valve.
Read more HERE
11- ST-Segment Elevation Infarction After TAVR: Problems in Every Aspect
For interventional cardiologists, treating an ST-segment elevation infarction in a patient with transcatheter aortic valve replacement (TAVR) is challenging in many ways. Longer door-to-balloon times and higher rates of primary angioplasty failure than in the general population are translated into very high short- and mid-term mortality.
Read more HERE
The ambitious SOLVE-TAVI (soon to be published in JACC) is aimed at answering to of the most important questions we make when facing a TAVR procedure: What valve do we choose, a self-expanding or a balloon expandable? And once we have chosen our device, do we proceed with general anesthesia or conscious sedation?
Read more HERE
13- TAVR Durability Becomes Irrelevant after TRANSIT Outcomes
The international registry TRANSIT has shown treating degenerated transcatheter aortic valves (TAVs) with a second TAVR is safe and effective. These finding are of crucial importance to the definite adoption of TAVR in the lower risk, younger population.
Read more HERE
Early intervention in asymptomatic valvular heart disease, age recommendations to decide between TAVR and surgery for aortic stenosis, and a push in favor of transcatheter repair in secondary mitral regurgitation are some of the new modifications to the European Society of Cardiology (ESC) Guidelines for the Management of Valvular Heart Disease.
Read more HERE
15- More Keys to Define Moderate Aortic Stenosis
Amidst the current efforts to prove early intervention might have benefits in moderate aortic stenosis (AS), this trial comes along directing us back to basics. In patients with symptomatic aortic stenosis, peaking mortality will clearly justify intervention. But what is the case when there are no symptoms? According to this recent analysis published in JAMA, asymptomatic moderate aortic stenosis does not bring about higher mortality when compared against mild AS.
Read more HERE
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