Courtesy of Dr. Carlos Fava. Severe or moderate mitral regurgitation is associated to worse evolution after TAVR. However, we should not forget the tricuspid valve that, even though not extensively researched, is also associated to a negative impact in its evolution. A meta-analysis of 12 studies with a total 41485 patients was carried out. …
¿Metformin to Treat Abdominal Aortic Aneurysms?
Currently, there are no drugs to treat abdominal aortic aneurysms (AAA) outside those indicated as secondary prevention drugs. What this study shows is that diabetic patients treated with metformin had lower AAA incidence than diabetic patients treated without metformin, and even lower incidence than non- diabetic patients, as if metformin per se were a…
Kidney Insufficiency and the Risk of Developing Aortic Stenosis in the Future
Chronic kidney disease, even in moderate or severe stages before dialysis, is associated with an increased risk of aortic stenosis according to this work recently published in J Am Coll Cardiol. Both share several risk factors, something that complicates the identification of the association between these diseases due to multiple confounding variables. The study…
Modern Valves Reduce the Need for a Pacemaker
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has already demonstrated benefit for different risk groups, but one of the remaining challenges is the reduction of the need for a pacemaker, which is still high for self-expanding valves compared with expandable balloons. The study enrolled 203 patients with severe aortic stenosis who underwent TAVR with…
Subclavian and Axillary Access for TAVR: a Valid Alternative
Courtesy of Dr. Carlos Fava. The femoral approach is preferred when it comes to TAVR, but sometimes it is not viable. This is when other access sites come into play, such as the trans-subclavian/axillary (TS/TAx), the apical, transcaval, transcarotid (TC) or transaortic. At present, few studies have looked into this matter, which is why it…
Mitral Valve Repair with MirtaClip Was Feasible and Safe
Transcatheter mitral valve repair (TMVR) with MitraClip was shown feasible and safe, and therefore a viable option for symptomatic patients with severe mitral valve regurgitation of prohibitive risk. In this regard, the procedure alleviates symptoms, cardiac regurgitation and has a potential benefit on ventricular remodeling. However, many patients presented atrial fibrillation (AF) and mitral valve…
Drug-Eluting Stents vs. Balloons While Paclitaxel Is in the Eye of the Storm
Even after the US Food and Drug Administration (FDA) issued an alert on paclitaxel devices in patients with femoropopliteal artery disease, which caused the interruption of a few ongoing studies, reality indicates that the efficacy of these devices has been proven and that they are still used. The increased mortality observed in the meta-analysis that…
Descending Thoracic Aortic Aneurysms: Is There a New Plan A?
The last available evidence suggests that open surgery should be the preferred treatment for intact descending thoracic aortic aneurysms. However, this study recently published in J Am Coll Cardiol, seems to have steered the wheel. In this study, open surgery was associated to increased early mortality and lower late mortality. Despite this long-term benefit, mean…
E-Cigarettes vs. Nicotine Therapy to Stop Smoking
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy according to this randomized study recently published in the New England Journal of Medicine (NEJM). Both must be accompanied by medical and psychological support for optimal results. While e-cigarettes are commonly used as a smoking cessation strategy, evidence is limited regarding their effectiveness as compared…
Balancing Bleeding Risk vs. Thrombotic Risk to Define Dual Antiplatelet Therapy Duration
Patients who undergo complex angioplasty are at higher ischemic risk, but only benefit from extended dual antiplatelet therapy if there are no factors for high bleeding risk. These data suggest that the bleeding risk must weigh more than the ischemic risk on the determination of dual antiplatelet therapy duration. Complex angioplasty is associated with higher…