As experience increases, transcatheter aortic valve replacement (TAVR) has expanded to different populations and anatomies. This study sought to compare technical and clinical outcomes in patients with bicuspid versus tricuspid aortic stenosis from the Bicuspid AS TAVR Multicenter Registry. Outcomes of 561 patients with bicuspid valves and 4546 patients with tricuspid valves were compared. Propensity score matching was used…
Less volume, more mortality: should we be concerned?
Courtesy of Dr. Agustín Vecchia. In general, guidelines recommend a number of procedures a year for operators to maintain a reasonably safe level of proficiency. Even though this number is arbitrary and operators’ aptitude varies considerable, more than one publication has found an inverse correlation between procedure volume and outcomes. This study incorporated 10,496 operators…
CTO in patients with acute myocardial infarction increases long term mortality
Courtesy of Dr. Carlos Fava. It has been proved that in a setting of acute myocardial infarction with multivessel lesions, only the culprit vessel must be treated (if there is no hemodynamic compromise) at first, and other severe lesions are to be treated during a second session. However, proper conduct in cases with presence of chronic…
Incidence, characteristics, and treatment of valve thrombosis after TAVR
Certain studies have carried out a tomographic follow-up of patients who underwent transcatheter aortic valve replacement (TAVR) and described the frequency of leaflet thrombosis; however, in most cases, it is unclear whether this finding requires some sort of intervention. The difference between this work and those previously published is that this study is not focused on imaging, it…
Progress of patients with hypertrophic cardiomyopathy treated with alcohol septal ablation
Courtesy of Dr. José Álvarez. Alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy (OHC) is a procedure introduced in 1995 as an alternative to surgical myectomy. The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines indicate that ASA should be reserved for older patients with comorbidities, thus establishing surgical myectomy…
Success in CTOs caused by restenosis lowers cardiac mortality
Courtesy of Dr. Carlos Fava. Nowadays, chronic total occlusions (CTO) due to in-stent restenosis (ISR) represent 5%-25% of all coronary angioplasties. These lesions pose a new and true challenge, since CTOs are often associated with stent-related problems (fractures, lack of expansion, overlapping, deformation), extreme tortuosity, severe calcification, tandem lesions after CTO, and aorto-ostial lesions, with little…
TAVI without predilation is feasible and safe
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve implantation has already proven to be beneficial for high-risk and inoperable patients. In that sense, it is also an increasingly frequent solid option for lower-risk patients. However, due to the presence of valve calcifications, it may occasionally be necessary to assess the benefits and risks of valve dilation…
The use of IVUS in unprotected left main PCI associated to better outcomes, compared to angiography guided PCI
Courtesy of Dr. Gustavo Leiva. Coronary Artery Bypass Graft (CABG) has traditionally been the procedure of choice in patients with left main coronary artery disease. However, the use of percutaneous techniques in this kind of lesions has been on the rise, partly due to recent research showing similar outcomes with both procedures. Unprotected left main…
The transradial approach reduces the risk of kidney injury in acute patients
It remains unclear whether transradial access, compared with transfemoral access, presents a different risk of post-procedural kidney injury for patients admitted with acute coronary syndrome. Historically, it has been considered (without any evidence) that, given the higher difficulty associated with transradial access, it would require longer fluoroscopy time and higher contrast volume, which would eventually…
Transradial access shows no benefit of bivalirudin
The aim of this study was to compare bivalirudin against heparin in patients with ST elevation acute myocardial infarction undergoing transradial primary PCI. Both bivalirudin and the transradial access are strategies aimed at reducing bleeding complications in patients undergoing acute MI. However, the benefit of their combined use is not year clear. Even though…