Transcatheter aortic valve replacement (TAVR) has evolved since it was first implemented, and it is now also used to treat low risk patients. One of the questions this has raised is whether patient life expectancy is higher than prosthesis life expectancy. The growing population in need for valve replacement also poses the question of how…
BASILICA: a Complex Strategy, Yet Safe
Coronary artery obstruction (CAO) after TAVR is rare, but it entails extremely high mortality (50% or more), especially after valve-in-valve (V-in-V) or when the coronary ostia are is too close to the valve annulus. This is why the BASILICA technique was developed (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction).…
Evolute Low Risk at 3 Years: Promising Outcomes
Transcatheter aortic valve replacement has shown important benefits but one of its biggest challenges is showing its safety and efficacy at followup in low risk patients. At present we have 2-year data from the Evolute Low Risk, but the we lack information at longer followup. The study looked at 3-year followup of the Evolute Low…
Sex-Related Differences in Clinical Outcomes after Transcatheter Tricuspid Valve Intervention
We are aware of sex related differences when it comes to comorbidities, physiopathology and disease evolution in patients with tricuspid regurgitation (TR). TR is more prevalent among women, whereas among men, coronary artery disease is more prevalent, with worse left ventricular ejection fraction and 10-year survival rate. Transcatheter tricuspid valve intervention (TTVIs) has surged as…
Is There a Way to Reduce the Need for Permanent Pacemaker Implantation in Self-Expanding Valves?
We are well aware of the benefits of TAVR in different scenarios, but the need for permanent pacemaker implantation (PPI) in self-expandable valves is between 15% and 30% according to different randomized and non-randomized studies. This is why the higher implantation strategy or cusp overlap (COT) was developed and, though it has been shown to…
High Implantation of Self-Expanding Valves in the Aortic Position or Cusp Overlapping: Should It Be the New “Gold Standard”?
Transcatheter aortic valve replacement (TAVR) has been proving its benefit in different scenarios for two decades now. However, in the field of self-expanding valves, one challenge has always been its high rate of pacemaker implantation compared with balloon-expandable devices and valvular replacement surgery. For this reason, the high implantation or Cusp Overlapping strategy was developed.…
Clinical Impact of Coronary Artery Disease on Results After TAVR
Coronary artery disease (CAD) coexists with aortic stenosis in about half the patients who suffer the latter. These patients receiving antiplatelet therapy are at a higher risk of periprocedural bleeding—one of the most frequent complications in patients who undergo transcatheter aortic valve replacement (TAVR). One way of limiting the risk for bleeding is choosing the…
Percutaneous Access Closure in TAVR: Are Devices Similar?
One of the challenges that transcatheter aortic valve replacement (TAVR) continues to face is percutaneous access closure with percutaneous closure systems (PCS). However, several systems have been developed, either by plug—such as the MANTA system—or by suture (SU)—such as the ProStar and ProGlide systems. Both of these have been tested in different analyses, but to…
Have Complications Related to Balloon Pulmonary Angioplasty Changed Since its Inception?
Balloon pulmonary angioplasty: Evolution over time and its complications Balloon pulmonary angioplasty (BPA) has grown from its beginnings as an indication for patients with chronic thromboembolic pulmonary hypertension (CTEPH) to being currently a class 1 indication for inoperable patients and/or residual CTEPH. Current evidence on this topic is underpowered, as most reports are based on…
Prosthesis Mismatch in TAVR: It’s Real Impact
Prosthesis-patient mismatch (PPM) was initially proposed by Rahimtoola and reintroduced by Pirabot. PPM is the indexed effective orifice area in relation to body surface area, cutoff value being 0.85 cm2/m2, and <0.70 cm2/m2for obese patients. PPM is considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2 Research studies on surgical prosthesis have…
MitraScore: What Does the Final Result of Edge-to-Edge Treatment of Mitral Regurgitation Provide?
Edge-to-edge treatment has proven to be a safe and effective technique in follow-up, decreasing mortality and hospitalizations for heart failure when a good result is achieved. The MitraScore was developed to assess the outcome at the end of the procedure. In that sense, results <3 represent mild mitral regurgitation, which would be related to lower…