Transcatheter aortic valve replacement (TAVR) by transfemoral access has shown great benefit for different risk groups, but its long-term durability is still uncertain. Available evidence comes from small analysis and a single randomized trial with 280 patients and an 8 year follow-up: the NOTION Trial, where TAVR showed less valvular degeneration than aortic valve replacement (AVR) surgery.…
A Simple Score for Mortality and Cardiac Failure after Edge-to-Edge with MitraClip
Mitral regurgitation (MR) is the most frequent type of valve heart disease, and the COAPT has shown that edge-to-edge with guideline directed medical treatment (GDMT) at maximal tolerated dose (MTD) is superior to medical treatment alone. However, we did not have a score to predict patient evolution when treated with this strategy. Researchers analyzed the…
Prognostic Impact of Acute Kidney Injury Following Tricuspid Transcatheter Edge-to-Edge Repair
Tricuspid failure (TF) mostly affects the elderly and, because of this, is associated with comorbidities that increase surgical risk. Tricuspid edge to edge repair (TEER) has surged as a valid alternative for the mitral valve in high-risk patients and, at present, is increasingly being used for tricuspids. One of the complications following TEER is acute…
Is Right Ventricle-Pulmonary Artery (RV-PA) Coupling Important in Low Risk TAVR?
TAVR has long been an effective strategy to treat aortic stenosis. However, ventricular damage starts further before symptom onset, also affecting the left ventricle, pulmonary vessels, the right ventricle, the tricuspid valve, and the right atrium. It increases arterial afterload and uncouples the right ventricle and the pulmonary artery, defined by transthoracic echocardiogram as the relationship…
TCT 2022 | PROTECTED TAVR
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 | Edge-to-Edge Repair in Patients with Severe Mitral Insufficiency and Cardiogenic Shock: Analysis of the TVT Registry
Approximately 1 in 5 patients admitted for cardiogenic shock (CS) were observed to have moderate to severe mitral insufficiency (MI), which increases the risk of mortality by about 60%. To date, there is limited data on the role of transcatheter edge-to-edge repair therapy in this setting. The aim of this study was to describe the…
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 | 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…