Stroke is still a major complication of transcatheter aortic valve replacement (TAVR), with a 30-day mortality of 16.7%. Even in the absence of symptoms, most patients (68-93%) have some type of diffusion imaging defect after TAVR implantation. The Sentinel cerebral protection device (CPD) (Boston Scientific) received FDA approval for the capture of emboligenic material that…
TCT 2022 | CLASP II D TRIAL: Transcatheter Edge-to-Edge Repair for Mitral Regurgitation in Patients at Prohibitive Risk
The CLASP IID study was a prospective randomized study to assess the efficacy and effectiveness of the PASCAL transcatheter valve repair system compared with the MitraClip device for patients with degenerative mitral regurgitation (MR) at prohibitive surgical risk. The study included Patients at prohibitive surgical risk, candidates for both devices, with MR 3+ to 4+,…
TCT 2022 | AMULET IDE: Events at 3 Years Using the AMULET Appendage Closure Device
The aim of this study was to assess the 3-year efficacy for the endpoints of the AMULET Occluder (Abbott) left atrial appendage closure device compared with the Watchman 2.5 device. The evaluated endpoints were analyzed according to a “per protocol” population, assessing a composite of stroke, systemic embolism, or cardiovascular death. The secondary endpoints were…
TCT 2022 | FRANCE-TAVI Registry: Small Annuli
The presence of small annuli, defined in this registry as < 23 mm diameter or indexed diameter <12 mm/m2 by CT, continues to be one of the greatest challenges of both surgical and endovascular aortic valve treatments. The FRANCE-TAVI Registry looked at 1,195 patients presenting small annuli. 895 (74.9%) received balloon expandable valves (BEV) and…
Is the Cause of Mitral Regurgitation Relevant for MitraClip?
Mitral regurgitation (MR) is the most common valvulopathy: it is present in (at least) 7.5% of patients >75 years old. This pathology can be classified as primary or degenerative MR (DMR) and secondary or functional MR (FMR). FMR can be caused by dilatation of the left atrium (most often due to atrial fibrillation), occurring in…
Apixaban and Valve Thrombosis after TAVR
TAVR has been associated with early valve thrombosis, characterized by thrombus formation in the prosthetic valve with or without valve dysfunction. This dysfunction is related to leaflet thickening and reduced motion, reduced effective orifice area, or increased transvalvular gradient. A multidetector CT scan allows the dynamic assessment of valves and ruling out fibrosis vs. thrombosis. …
Should We Treat Stroke Percutaneously in TAVR?
Since its inception, transcatheter aortic valve replacement (TAVR) has improved greatly. However, there still are five big challenges to be solved: paravalvular leak, conduction disturbances, debilitating stroke, impaired kidney function, and major vascular complications and bleeding. Most cases of stroke are periprocedural and ischemic. So far, they have not been well analyzed in terms of…
Can We Discharge TAVR Patients the Same Day?
For over a decade, TAVR has been showing great benefits, but conduction abnormalities such as RBBB and prior A-V block, continue to be one of the biggest challenges, since in different series the need for definite pacemaker implantation (PPM) varies between 17 to 30% in the large, randomized studies of self-expanding valves. Even though we…
TAVR in Bicuspid Patients: Are Outcomes the Same in Men and Women?
Bicuspid aortic valve stenosis (BAV) has not yet been analyzed in large, randomized studies, and TAVR in this scenario has been assessed only by small fairly studies. However, the information available is quite promising. TAVR in women generally presents more complications than in men, but severe bicuspid aortic valve stenosis receiving TAVR has not been…
Balloon expandable vs Self-Expanding Valves: The Best Option for ViV-TAVR in Small Annuli
TAVR has consolidated as an increasingly valid alternative to treat failed surgical aortic valve bioprostheses. One of the major challenges it presents is patients with small annuli treated with a surgical bioprosthesis. There is little data available about this scenario. A few observational studies have shown what appears to be a hemodynamic advantage of…
Surgical Bioprosthesis Deterioration: Is the Valve-in-Valve Technique a Good Option?
The use of surgical bioprostheses has significantly increased, and while they last 15 years or more, in cases where they fail (usually due to stenosis), the decision-making process is challenging. Transcatheter aortic valve replacement (TAVR) is a good alternative for this situation, although information on the subject matter is still scarce. Currently, the only available…