500 years have passed since Leonardo da Vinci passed away (1452–1519), which is why we believe this is the perfect time to remember his passionate effort to study the human heart. Not only was Leonardo a gifted artist, but also an innovative engineer and inventor, a pioneer far ahead of his time. His scientific exploration…
What Happens When We Are Blinded by Left Main Disease and Ignore All Other Lesions?
According to this recent Excel analysis, mortality seems to rise when the SYNTAX II score is not taken into account when defining the revascularization strategy. The difference does not reach statistical significance and further studies are required, but the message is clear: the left main coronary artery is not the only thing that matters; other…
Prosthetic Valve Endocarditis and TAVR: though Rare, Devastating
On the bright side, the incidence of prosthetic valve endocarditis (PVE) post TAVR is not higher than post SAVR, according to this study recently presented at EuroPCR 2019, held in Paris. There is plenty of evidence describing PVE incidence, prognosis, risk factors, etc. after surgical valve replacement surgery (SAVR). However, we know little about the…
Antianginal Medication Before and After Rechanneling
Escalation or de-escalation of antianginal medication was less common than treatment continuation without change after a chronic total occlusion rechanneling, with little variation according to the site. Further research is needed to identify patients who would benefit (or not) from these drugs and to develop strategies to adjust treatment during follow-up. This work basically tells…
The FDA Affirms Mortality Signs with Paclitaxel Based Devices
Evidently, we are still uncertain. The information goes both ways, even on our own web page, we have been coming and going just like any other publication around the world. After a 2-day debate, the Circulatory System Devices FDA panel has confirmed the tendency to higher mortality with paclitaxel-based devices and is expected to debate…
Valve-in-Valve with Self-Expanding Prosthesis: What Happens with Gradients at One Year?
Degenerated surgical bioprostheses can be safely treated with CoreValve or CoreValve Evolut using the valve-in-valve procedure. Excellent 1-year clinical and hemodynamic outcomes were achieved in a non-selected regular population, i.e., “real-world” patients. The VIVA (Valve in Valve) registry, conducted at 23 sites, was a prospective study designed to systematically collect data from patients with degenerated…
Aspirin in Primary Prevention: Another “Trendy” Topic in Publications
Aspirin is the standard treatment when it comes to optimal medical treatment in the context of secondary prevention of coronary artery disease, in patients with diagnosed, established atherosclerosis. Even though bleeding risk is rather small in the short period an acute event takes place, it increases substantially over time. However, the evidence clearly supports the…
Pulmonary Hypertension: No Reason for TAVR Contraindication
In most severe aortic stenosis patients with pulmonary hypertension, transcatheter aortic valve replacement (TAVR) reduced pulmonary systolic pressure. There patients presented lower risk and lower all-cause mortality at short, median and long term. This data show that pulmonary hypertension should not be a TAVR contraindication. Pulmonary hypertension is common among TAVR patients. The most frequent…
Low-Risk TAVR Trending in All Papers
Transcatheter aortic valve replacement (TAVR) in low-risk patients with symptomatic severe aortic stenosis appears to be safe at one year. In a follow-up using computerized tomography (TC), hypoattenuated leaflet thickening was observed in a minority of patients, but it did not have a long-term hemodynamic impact. It should be noted that the management strategy for…
Cardiovascular Risk, Dual Antiplatelet Therapy, and Age. What Should We Know?
Non-adherence to dual antiplatelet therapy varies with age and patients older than 75 years old are those who discontinue treatment most frequently. However, this characteristic in elderly patients was not associated with more cardiovascular events. Treatment compliance protected patients younger than 75 years old from events, while there was increased cardiovascular risk among this population…